Clinical lesions and signs of discomfort

20 Clinical lesions and signs of discomfort




INITIAL PRESENTATION


Cavities at the buccal aspects of several teeth.



PATIENT DETAILS


A 5-year-old, female, domestic short-haired cat.



CASE HISTORY


The cat had no previous history of oral or dental disease. She had been presented to the referring veterinarian due to signs of oral discomfort, i.e. reduced appetite and selecting soft foods. On conscious clinical examination, the referring veterinarian had identified cavities at the buccal aspects of several teeth and referred the cat to us for evaluation and treatment.



ORAL EXAMINATION – CONSCIOUS


The cat did not allow anything other than a cursory examination of the head and mouth. The findings were as follows:


1. Normal occlusion

2. Generalized mild gingivitis, which was more severe at buccal aspects of upper premolars

3. Obvious cavities at the buccal aspects of 307 and 404

4. Small cavity at the buccal gingival margin of 204.


ORAL EXAMINATION – UNDER GENERAL ANAESTHESIA


A thorough oral examination, including investigating periodontal parameters, was performed and all findings were noted on the dental record.


In summary, examination under general anaesthesia identified the following:


1. Generalized mild gingivitis, which was more severe at buccal aspects of upper premolars.

2. Obvious cavities at the buccal aspects of 307 (Fig. 20.1a) and 404 (Fig. 20.2a).

3. Small cavities at the buccal gingival margin of 204 (Fig. 20.3a) and 107 (Fig. 20.4). The lesion on 107 was only obvious after calculus had been removed.

4. Teeth 106, 206, 207 and 407 were missing. The gingiva at these sites was not inflamed except over 407, which was intensely inflamed.

image

Figure 20.1 Lateral photograph (a) and lateral radiograph (b) of the left lower quadrant.


(a) Note the soft tissue-filled cavity at the buccal aspect of 307.

(b) The radiograph shows that external root resorption has caused destruction and bone replacement of the mesial root. In contrast, the distal root is radiographically unaffected. The resorptive process has spread to involve the crown, resulting in the obvious clinical lesion. Once the disease is clinically apparent, i.e. a cavity is formed, root resorption is extensive. The first clinically detectable sign of resorption is already an end-stage lesion.

image

Figure 20.2 Lateral photograph of the right lower canine (a) and radiograph of the rostral lower jaw (b).


(a) Note the large, soft tissue-filled cavity at the buccal aspect of 404.

(b) Both right and left canine roots are affected by replacement resorption.

image

Figure 20.3 Lateral photograph of the left upper canine (a) and oblique lateral radiograph of the left rostral upper jaw (b).


(a) Note the small, soft tissue-filled cavity at the buccal aspect of 204.

(b) Replacement resorption of 204 is obvious. Note the radiolucent resorption tracks within the dentine of the root. Teeth 206 and 207 were missing on clinical examination. The radiograph shows no evidence of 206, but the resorbing roots of 207 are evident.

image

Figure 20.4 Lateral photograph of 107. Note the small buccal cavity.



FURTHER INVESTIGATIONS


A series of full-mouth radiographs (10 films) was taken.



RADIOGRAPHIC FINDINGS


The following teeth were affected by external root resorption: 304 (Fig. 20.2b), 307 (Fig. 20.1b), 404 (Fig. 20.2b), 104 (Fig. 20.5), 107 and 204 (Fig. 20.3b).


image

Figure 20.5 Oblique lateral radiograph of the right rostral upper jaw. Replacement resorption of 104 is obvious. Note the radiolucent resorption tracks within the dentine of the root. Tooth 106 was missing on clinical examination and the radiograph shows that it is resorbing.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Clinical lesions and signs of discomfort
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