Common Conditions


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Common Conditions

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In publishing “Common Conditions” we are attempting to create an awareness of some of the many dental conditions which we see on a regular basis in our practice. It is, by no means, all-inclusive, and the conditions are only briefly discussed. If you see similar changes in your pets’ mouths, we encourage you to have your pet examined by your veterinarian and a more comprehensive diagnosis made.

Fractures
Pulpitis
Tooth Resorption
Stomatitis
Retained Deciduous Teeth

Occlusive Trauma
Periodontal Pockets
Gingival Hyperplasia
Caries
Neoplasia

Tooth Fractures
Crown fractures are either complicated (involve the pulp…nerve and blood vessels) or uncomplicated (no pulp involvement).
A complicated fracture is particularly serious because the intraoral bacteria will infect and cause pulpal death 100% of the time. These teeth need either root canal therapy (endodontics) or extraction. Just “watching” a tooth like this is not an option. Dogs and cats do not usually show evidence of pain. They tend to be extremely stoic and will suffer in silence. We can only go on the human experience of living with a fractured tooth. These teeth hurt. Coupling the pain issue with the certainty of pulpal death and infection means early treatment must be recommended.

$tooth fracture illustration$

$image of fractured tooth$

Images ©American Veterinary Dental College, used with permission.

A near-pulp fracture (uncomplicated crown fracture) which doesn't penetrate into the pulp will also cause pain due to irritation of pulpal nerves which extend into the exposed dentinal tubules. Pulpal infection is also a risk due to the possibility of bacteria migrating through the tubules into the pulp.

$drawing of fractured tooth$

$fractured tooth$ Images ©American Veterinary Dental College, used with permission.

Treatment of uncomplicated fractures generally involves sealing the tubules with a dentin bonding agent.

Exposed dentin which has been etched as part of the bonding process compared with unetched dentin.

Dentin which has been sealed with a bonding agent. Note the tubules which are now plugged.

(Images provided by Dr. Guido Goracci, Associate Professor, Dept. of Restorative Dentistry, University La Sapienza, Rome, Italy)

$fractured tooth$

$fractured tooth$
Even fairly unapparent fractures of small
teeth can cause pain and infection to the pet.

Pulpitis

Pulp is a fleshy material, contained in the pulp chamber and root canals, which provides nutritional support and a nervous supply to the tooth. It is also responsible for forming dentin which is the hard material making up the bulk of the tooth. Because it contains blood vessels, it can be damaged and bleed, even though the bleeding will not be obvious at first. Most pulpal hemorrhage is caused by trauma, usually by the tooth being hit by something. As the blood cells break down they release hemoglobin which wicks out into the porous dentin as well as other chemicals which mediate the inflammation. The hemoglobin stains the dentin a pink or purplish color. Over time the color will evolve into a dull gray. Meanwhile, the pulp continues its degeneration, releasing more chemicals and fluid. Eventually, the fluid leaks out of the root tip into the bone surrounding the tooth where it can cause periodontal disease and possibly eventual loss of the tooth. Dr. Fraser Hale, in a study done in 2001 found that 92% of these teeth require either root canal therapy or extraction. Because pets are amazingly stoic in living with these teeth, one cannot rely on the presence of pain to decide whether or not the tooth is dead. We recommend root canal therapy with all discolored teeth.

Advanced caries which may have invaded the pulp chamber will require root canal therapy prior to filling. Alternatively, these painful teeth must be extracted.

Tooth Resorption (TR)

This is one of the most common dental problems we see in cats and is becoming more common in dogs. Some investigators have shown that upwards of 65% of all cats have TR going on in their mouths. In the past the condition has been referred to by names such as feline odontoclastic resorptive lesions (FORL’s), cat cavities, and neck lesions among others. The teeth are attacked by specialized dental cells called odontoclasts which basically eat holes in the teeth. If the destruction occurs in the roots the root material is replaced by bone. If it occurs on the crown (visible part of the tooth) then the crown is weakened as its structure disappears. If the resorption goes deep into the dentin of the crown, the nerves which supply the tooth are irritated and the animal suffers severe dental pain. Eventually the crown is weakened to the point where it fractures off leaving what is left of the roots including the ex-posed root canals and associated pulp. Many times these teeth develop severe infections which only aggravates an already painful condition for the pet. For those reasons, tooth resorption needs to be recognized and treated early. Unfortunately, teeth undergoing resorption usually need to be extracted. In cases in which the root material is indistinguishable from bone, the crowns may be removed and the gingiva closed over what is left of the roots.


As the crown is destroyed by the resorptive process, the body reacts by forming proliferative gingiva which tries to fill in the defect much like putting a band aid on a wound. These teeth are extremely painful.	These painful teeth have experienced almost total destruction of the crowns.	Early resorption on a smaller mandibular premolar. Gingival hyperplasia is forming.

Radiograph of the tooth above.	Severe destruction of lower molars and premolars. Note how the root structure is disappearing and replaced by bone by bone.	Severe periodontal disease of the molar on the right with resorption having destroyed the crown on the premolar on the right.

Resorption has almost totally destroyed this upper premolar leaving only the exposed root stumps.	The mandibular molar on the right has almost completely disappeared.	Resorbing upper canine. The resorption does not involve the crown therefore no treatment was done. (Radiograph of the tooth above)

End-stage tooth resorption in which the crowns and roots are gone.	The premolar is end-stage and the left lower canine is showing active resorption.	End-stage resorption in the 3rd premolar. The 4th premolar has an unusual middle 3rd root.

Tooth resorption in dogs

Although not nearly as commonly seen as with cats, we see resorbing teeth on a regular basis in dogs and many veterinary dentists think that the incidence is on the upswing. As with cats, if the resorption involves the roots only, and there are no defects on the crown, no treatment is indicated.

Resorption occurring on the right lower first molar of a dog.

Left lower first molar showing almost complete destruction of the crown.

Stomatitus

Stomatitis is characterized by, among other things, an intense inflammatory reaction with profound gingivitis and often gingival proliferation.

CUPS. Chronic ulcerative paradental stomatitis. Seen occasionally in dogs, it is considered to be a reaction to plaque, therefore homecare to prevent plaque accumulation on the teeth is a vital part of the treatment. However, this is often difficult to accomplish and the teeth frequently need to be extracted to eliminate the source of plaque.


Intense gingivitis with mucosal inflammation where the lip contacts the tooth (“kissing lesion”).	Same thing is occurring on the left side.	More generalized gingivitis on the left lower jaw.

Feline Stomatitis. Feline stomatitis comes in 2 forms. The milder form is a generalized intense type of periodontal disease characterized by severe gingivitis, heavy plaque and calculus, and severe bone loss around many teeth. Since this is, again, a plaque related disease, and it can be difficult, if not impossible to eliminate plaque, the teeth are frequently extracted to cure the disease. The most severe form of feline stomatitis is often referred to as LPGS...lymphoplasmacytic gingivostomatitis. LPGS cannot be treated with antibiotics, or corticosteroids….the teeth must be extracted. Some veterinary dentists will start by extracting all the teeth in back of the canines. If that does not resolve the problems, then the canines and incisors must be extracted as well. We recommend full-mouth extractions, including the canines right from the start as that provides the greatest probability of a cure. When doing extractions on these cats, it is imperative that all vestiges of the teeth be removed and therefore, dental radiographs are necessary to insure that no tooth material is left behind.


Advanced LPGS showing severe proliferation almost obliterating the teeth. This is an extremely painful condition for the cat.	Proliferative tissue is covering part of the tongue.	During removal of the teeth, the proliferative tissue is also removed. These cats can be cured with proper treatment.