Excessive wear

37 Excessive wear




INITIAL PRESENTATION


Severely worn teeth.



PATIENT DETAILS


A 6-year-old, neutered male, cross-breed.



CASE HISTORY


There was no previous history of oral/dental disease or treatment. The owner was concerned that the teeth appeared to be short and seemed to be getting shorter rapidly. The referring veterinary surgeon was concerned about possible pulpal exposure as a result of the excessive wear and referred the case to us for management.


The dog showed no evidence of discomfort or pain. He was eating well and there had been no change in eating or chewing behaviour. The owner exercised him daily on the beach by throwing tennis balls for him to retrieve. He also had a selection of toys that he chewed in the garden.



ORAL EXAMINATION – CONSCIOUS


The dog had a nice temperament, and allowed conscious examination of the face and of the oral cavity. The findings were as follows:


1. Occlusion was normal.

2. Generalized gingivitis was observed.

3. There was excessive wear of all teeth. The incisors were worn almost to the level of the gingival margin. All teeth had exposed dentine with obvious reparative dentine formation. There was no obvious pulpal exposure of any tooth.


ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC


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


In summary, examination under general anaesthesia identified the following:


1. Mild generalized gingivitis was observed.

2. There was excessive wear of all teeth (Fig. 37.1a, b).

3. There was pulpal exposure of 404. Exploration with a sharp explorer allowed entry into the pulp chamber.

4. There was periodontitis of 109 and 409. Both these teeth had increased probing depths as well as gingival recession.

image

Figure 37.1 Clinical photographs.


(a) Rostrocaudal photograph centring on upper incisors and canines. The incisors were worn to gum level.

(b) Lateral photograph of the right upper and lower canines and premolars. All teeth were affected by severe wear.


FURTHER INVESTIGATIONS


Radiographs were taken of 404 (pulpal exposure), 304 (contralateral without pulpal exposure), 109 (periodontitis) and 409 (periodontitis).



RADIOGRAPHIC FINDINGS


The diameter of the root canal of 404 was wider (pulpal exposure) than in 304 (contralateral, without pulpal exposure), indicating pulp necrosis and cessation of dentine production of 404. In addition, there was periapical bone destruction and external root resorption of 404. Figure 37.2 shows the important radiographic findings associated with 404.


image

Figure 37.2 Oblique rostrocaudal radiograph centring on 404. The excessive wear had resulted in pulpal exposure of 404. Note that the root canal of 404 is wider than the root canal of 304, indicating pulp necrosis and cessation of dentine production of 404 as a consequence of the pulpal exposure. There is also periapical bone destruction and external root resorption of 404.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Excessive wear
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