Extraction of permanent teeth

29 Extraction of permanent teeth




INITIAL PRESENTATION


Malocclusion – long upper jaw resulting in a relative mandibular brachygnathia.



PATIENT DETAILS


A 7-month-old, female, weimaraner.



CASE HISTORY


The owner was concerned about the ‘long curved nose’ and the obsessive chewing on toys, furniture, etc. Their own veterinarian noted that the lower jaw was too short with respect to the upper jaw, and the dog was referred to us for evaluation and treatment of the malocclusion.



ORAL EXAMINATION – CONSCIOUS


The dog was well behaved and allowed conscious examination, which revealed the following:


1. Skeletal malocclusion
• The upper jaw was extremely long and narrow with respect to the lower jaw, which was of relatively normal length and width for the breed, i.e. relative mandibular brachygnathism.

• The lower canines occluded with the palatal mucosa, distal to the upper canines, causing deep indentations in palate.

• The lower incisors occluded with the palatal mucosa, causing less severe indentations.

2. Generalized gingivitis

3. Uncomplicated crown fracture of 204.

The pulp did not seem exposed to the environment on visual examination. Exploration was not attempted, since touching an exposed pulp would have caused extreme pain and potentially aggressive behaviour.



ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC


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


In summary, examination under general anaesthesia identified the following list:


1. Skeletal malocclusion
• The upper jaw was extremely long and narrow with respect to the lower jaw, which was of a relatively normal length and width for the breed, i.e. relative mandibular brachygnathism.

• The lower canines occluded with the palatal mucosa, distal to the upper canines, causing ulcerated indentations in the palate (Fig. 29.1).

• The lower incisors occluded with the palatal mucosa, causing non-ulcerated indentations (Fig. 29.1). There were also indentations in the palatal mucosa where the lower carnassials occluded.

2. Generalized mild gingivitis (Fig. 29.1)

3. Uncomplicated crown fracture of 204.

image

Figure 29.1 Traumatic lesions in the palatal mucosa. The upper jaw is long and narrow, while the lower jaw is of normal length and width for the breed. Consequently, the teeth are not occluding normally. Note the ulcerated indentations created by the maloccluding lower canines (they occlude with the palatal mucosa medial to the upper canines). Note also the indentations in the palatal mucosa where the lower incisors occlude. There is a generalized gingivitis as evidenced by the red and swollen gingival margins around the circumference of all teeth.


Careful examination with a sharp explorer did not allow communication into the pulp.



FURTHER INVESTIGATIONS


Radiographs were taken of 204 (UCF) and of 104 (contralateral healthy tooth).



RADIOGRAPHIC FINDINGS


The shape and diameter of the pulp system of 104 (contralateral healthy) and 204 (UCF) were the same. Both were immature teeth, as expected in a 7-month-old dog.


There was no evidence of periapical pathology of 204 (UCF).



THEORY REFRESHER


Malocclusion can result from jaw length and/or width discrepancy (skeletal malocclusion), from tooth malpositioning (dental malocclusion), or a combination of both. This case is a skeletal malocclusion and should therefore be considered as inheritable. Malocclusion causing discomfort and pathology always needs treating.


The treatment options available are orthodontics, tooth shortening or extraction. In many instances, tooth shortening or extraction are preferable to orthodontics on ethical grounds.


In human orthodontics, whether malocclusion is hereditary or acquired is not a consideration when planning treatment. This is in contrast to veterinary orthodontics, where aesthetics and ethical concerns are linked, and treatment for the sole purpose of showing dogs or cats cannot be encouraged. The aim of any treatment is primarily to make the animal comfortable; aesthetics are a secondary consideration.


It is essential to determine if the presenting malocclusion is hereditary or not. Orthodontic correction of a malocclusion is contraindicated where the malocclusion is hereditary, unless the animal is also neutered. The rationale for this is to avoid spread of inherited malocclusion within a breed.


Crown fractures are classified as complicated if the fracture line exposes the pulp to the oral environment and as uncomplicated if they do not involve pulpal exposure. Crown fractures are obvious visually. However, at times it can be difficult to determine if the pulp is exposed by the fracture line, and general anaesthesia for examination with a dental explorer and radiography are necessary.


An uncomplicated crown fracture usually requires minimal treatment, e.g. removal of sharp edges with a bur and sealing of the exposed dentine with a suitable liner or restorative material. However, such fractures do require monitoring (clinical examination and radiography) at regular intervals to ensure that the pulp remains vital. If pulp and periapical diseases develop, the tooth requires either extraction or endodontic therapy.




CLINICAL TIPS



• Malocclusion can result from jaw length and/or width discrepancy (skeletal malocclusion), from tooth malpositioning (dental malocclusion), or a combination of both.

Related posts:

  1. The tooth and its periodontium
  2. Multiple tooth and jaw fracture
  3. Natural progression of disease
  4. Iatrogenic tooth damage

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Extraction of permanent teeth

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