Veterinary dentistry


Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.
In the United States, veterinary dentistry is one of 20 veterinary specialties recognized by the American Veterinary Medical Association. Veterinary dentists offer services in the fields of endodontics, oral and maxillofacial radiology, oral and maxillofacial surgery, oral medicine, orthodontics, pedodontics, periodontics, and prosthodontics. Similar to human dentists, they treat conditions such as jaw fractures, malocclusions, oral cancer, periodontal disease, stomatitis, and other conditions unique to veterinary medicine.
Some animals have specialized dental workers, such as equine dental technicians, who conduct routine work on horses.

Overview

The practice of veterinary dentistry and oral medicine and surgery is performed by veterinarians in accordance with their state veterinary practice acts. Veterinary health-care workers may be allowed to perform certain non-invasive, non-surgical oral and dental procedures under the direct supervision of a licensed veterinarian in accordance with state regulations.
As with other areas of veterinary practice, veterinary dentistry requires a veterinarian-client-patient relationship to protect the health, safety, and welfare of animals.
One of the most important hallmarks of veterinary dentistry is that it addresses periodontal disease, the most common dental condition in dogs and cats. Pets as young as three years old can show early evidence of periodontal disease, which will worsen if effective preventive measures are not taken. Early detection and treatment are critical, because advanced periodontal disease can cause severe problems and pain.
Pain originating from dental problems is very rarely recognized by owners or professionals. Seldom will an animal become anorexic due to a dental problem. The exception to this is in the case of severe soft tissue injury, for example chronic gingivostomatitis. In general, dental pain is a chronic pain, and it is only after treatment that an owner reports how much better their pet is doing. Pain is often mistaken for a pet just getting old. Very few clients examine their pets’ teeth unless they are carrying out daily home care, so actual dental problems often go unnoticed.
It is important to recognize symptoms that may have a link to dental diseases, such as a nasal discharge or external facial swellings. In some cases, dental patients may even present with what appear to be neurological symptoms.
The main signs of oral disease include :
Most pet owners are not aware that their pet has an oral problem, so an examination of the oral cavity should form part of every physical examination given by the veterinarian. The current and both include dental care as part of the assessment during annual veterinary examinations. Oral examination in a conscious animal can only give limited information and a definitive oral examination can only be performed under general anaesthesia. Examinations should occur at least once a year to identify any problems and ensure optimal oral health.
It is important to examine the whole animal, even when the primary complaint is the mouth. Some dental diseases may be the result of a systemic problem and some may result in systemic complications, including kidney, liver, and heart muscle changes. In all cases, dental procedures require a general anaesthetic, so it is important to establish the cardiovascular and respiratory status and the physiological values of the patient to avoid risks or complications. Radiographs may be needed to evaluate the health of the jaw and the tooth roots below the gumline. Most dental disease occurs below the gumline and is not visible.

Oral abnormalities, anomalies, and defects

Abnormal, anomalous, or defective pet teeth are sometimes encountered in veterinary practice.  One or several teeth may be involved and the concern may be for esthetics, function, patient comfort, or a combination of these issues. Causes may be congenital, developmental, or due to lifestyle factors.

Malocclusions

is the imperfect positioning of the teeth when the jaw is closed. In dogs and cats with normal occlusion, the upper incisors rest in front of the lower incisors, the lower canines fit in the diastema between the upper canine and third incisor, the upper first premolars fit behind the lower first premolars, and the upper fourth premolars overlap the lower first molars. Any deviations are known as malocclusions, and they are separated by class.

Class I malocclusion (MAL/1)

Also known as neutrocclusion, MAL/1 occurs when the maxilla and mandible are correctly proportioned, but one or more teeth are misaligned. This type of malocclusion is further classified by type:
Also called distoclusion, brachygnathism, overshot jaw, overbite, and parrot mouth, this occurs when the upper teeth rest in front of the lower equivalents. The maxilla is forward and the mandible is behind. It is more common in animals with dolichocephalic skulls, such as Collies.

Class III malocclusion (MAL/3)

Also called mesioclusion, prognathism, undershot jaw, and underbite, this occurs when the upper teeth rest behind the lower equivalents. The maxilla is behind and the mandible is forward. It is more common in animals with brachycephalic skulls, such as pugs. This type of malocclusion is also often associated with rostral cross bite.

Other malocclusions

Some animals will develop oral lesions, masses, or growths, which may be benign or malignant. These may be caused by tooth or gum infections, tumors, or genetic predisposition. Most pets do not show signs of oral masses until it has grown large enough to make chewing and swallowing difficult. Bad breath, excessive drooling, or bloody oral discharge may also be signs of an oral lesion or mass.

Malignant tumors

Also known as feline cervical neck lesions or feline odontoclastic resorptive lesions, these lesions are most commonly observed in the cat but have been identified in other species as well. The lesion usually starts at the cementoenamel junction and furcation area between the roots of a tooth. They appear as an overgrowth of gingival or pulpal tissue. The lesions erode the dentin within a single tooth. It spreads rapidly once it reaches the pulp of the tooth. The crown of the tooth may appear normal, but the tooth may have little to no root left. This is a very painful condition.
Teeth with resorptive lesions are incurable and cannot be prevented. There is no concrete evidence for the cause, but some studies have suggested they are caused by an excess of vitamin D. Extraction is the only method of treatment.

Developmental conditions

Periodontal disease

The most common and significant oral disease is the inflammation of the deeper supporting structures of the tooth and surrounding tissues of the periodontium; it is also called periodontal disease or periodontitis. It begins with the formation of plaque, specifically subgingival plaque within the gingival sulcus or periodontal pocket. This allows a proliferation of bacteria; the subsequent inflammation and the animal's own immune response starts the progression of periodontal disease. The hallmark feature of periodontitis is attachment loss of the tooth from the alveolar bone. Periodontitis is an irreversible process unless the animal is treated with advanced periodontal surgery techniques.
Periodontal disease is classified by one of four stages:
Periodontal disease eventually culminates in tooth loss; however, significant health problems can precede this.
Local consequences
is the earliest stage of periodontal disease. It is the inflammation of the gingiva and is caused by bacterial plaque. It is reversible and preventable.
Gingivitis appears as a thin red line along the margin of the gums and may be accompanied by swollen gum margins, bad breath, plaque and tartar. The earliest clinical sign of gingivitis is bleeding on probing, chewing, or brushing.

Dental cleaning

In dogs, as in humans, daily tooth brushing is considered the gold standard for at-home prophylaxis and prevention of gingivitis and periodontal disease progression. However, a Swedish study with over 60,000 respondents reported that only 4% of dog owners brushed their dog's teeth daily.
Basic dental cleaning under general anesthesia includes scaling to remove dental plaque, tartar, and calculus deposits, as well as polishing to smooth out microabrasions caused by the dental equipment and normal wear and tear. Endodontic procedures such as tooth extractions and root canals are also performed.

Dental instruments

Dental instruments are tools used to provide dental treatment. They include tools to examine, manipulate, treat, restore, and remove teeth and surrounding oral structures.

Hand instruments