Radiographs essential for reliable identification of tooth resorptive lesions - Veterinary Practice
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Radiographs essential for reliable identification of tooth resorptive lesions

BOB PARTRIDGE a European specialist in veterinary dentistry, spoke on feline dentistry – ‘the little mouth of horrors’ – at VetsNorth 2013 in Manchester

“SEE what happens” – just three little words are all it takes to generate steam from the ears of veterinary dentist Bob Partridge.

The Harrogatebased practitioner told colleagues at the VetsNorth 2013 meeting of his intense irritation at seeing those words appear in the clinical notes for a cat or any other animal that is referred to him for treatment of dental disease.

Such cases must be tackled early, he insisted. “I hate it, there is no point in waiting to see what will happen, we already know: the condition will get worse.

“If we spot early stage disease in the animal’s mouth then it is our duty on clinical and welfare grounds to do something about it because dental disease is often extremely painful.”

Tooth resorption (previously known as “neck lesions” or “FORLs”) is a particularly common condition in cats, occurring in about 30% of cases. But the disease is not always obvious from an inspection of the tooth surface as apparently innocuous lesions on the crown can conceal extensive damage to the root, he warned.

That is why radiographs are essential if tooth resorptive lesions are to be reliably identified. Normally, it is essential to take a series of different exposures to guarantee that every lesion will be clearly visible on x-ray.

A full survey will often involve eight to 10 separate images which would mean that the animal would be under general anaesthetic for at least 30 minutes.

Significant cost

“That has to be charged for and the cost will be significant,” he said. However, he said that his fellow veterinary dentist, Hampshire-based Dr Cecilia Gorrel, has identified an effective screening method which can save time for the practitioner and reduce the costs for their clients.

Dr Gorrel has reported a study showing that the condition of just two teeth (the mandibular premolars classed as 307 and 407 on the standard feline dentistry chart) is a reliable indicator of the cat’s overall tooth resorption status.

“She showed that if those teeth are healthy there is a 90% probability you will not find lesions anywhere else in the cat’s mouth. Also, if there are resorptive lesions in those teeth, then there is an 80% likelihood of other teeth having evidence of disease.

Quick and easy test

“So taking images focused on just those two teeth provides a quick and easy test that gives you the right answers in around 90% of cases.”

There have been efforts to find medical treatments to reverse the resorptive process. Bisphosphonates, a class of drugs used to prevent osteoporotic bone fractures in postmenopausal women, have shown some promise in this indication.

But the problem is one of palatability for an orally administered drug and being able to use these agents in cats will depend on finding a way to make the tablets less bitter, he noted.

In the meantime, the likely treatment for affected teeth will be extraction or crown amputation, Mr Partridge said.

He advised practitioners against using “atomisation” – a technique that was popular a few years ago and is likely to be described in many textbooks still in circulation.

Discredited method

“Don’t use this method, it has now been discredited,” he said. The method involves atomisation of the tooth root with a drill to get rid of the main structure but will create further problems by spinning out fragments of tooth that will become embedded in the surrounding bone.

When teeth are removed from the cat’s jaw, there is an obvious need to remove the blood and debris around the site of the lesion.

Mr Partridge said that in his practice he used a rather unusual tool as surgical swab for such small patients – baby buds.

“You would be surprised how well the plastic tube stands up to being put inside an autoclave to ensure that it is sterile. But make sure you use highquality buds as these are less likely to break down and shed lint than a cheaper product.”

Mr Partridge said he was surprised how commonly practitioners will extract a tooth in small animal patients and leave the socket to heal through natural processes. “You would not leave the wound area uncovered in an orthopaedic patient and you shouldn’t do that for a dental case, particularly when bits of food will get into the wound whenever the animal is ready for its first meal.”

He described the technique he would use to create a flap that will cover the wound site and help speed the healing process. It is essential that the flap used is large enough to cover the site without stretching it. “If there is tension on the suture then it is not a question of whether the wound will break down, but when.”

Another important form of dental disease in feline patients is feline chronic gingivostomatitis syndrome, caused by an abnormal immune response to the presence of plaque on the tooth surface.

Owner encouraged

Again, the main treatment will often be removal of the affected teeth and the owner can then be encouraged to work towards preserving the remaining dentition using analgesia, toothbrushing, protective gels and a low-allergen diet.

A new product, 1-TDC gel, has provided great benefits for some patients and has been shown to reduce the damage caused by periodontal disease in other cases.

Mr Partridge said that removing all teeth caudal to the canines will prevent recurrence of inflammation in the majority of cases and, if required, extracting the canines will achieve benefits for the remainder. But it was vital that extraction procedures were effective in removing all the tooth tissue including the very tip of the root.

“Here is another reason why you need to take routine radiographs: if you are going for clearance then you have to do it right.”

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