35 Iatrogenic tooth damage
Swelling of the left rostral mandible and a draining fistula at the ventral border of the left rostral mandible.
A rostral mandibular fracture was repaired 5 years earlier, when the dog was a year old, at a specialist centre with orthopaedic expertise. The clinical notes and radiographs had been ‘lost’, so the details of the treatment were not available to us.
A fistula at the ventral border of the left mandible developed 3 years after the mandibular fracture repair. The dog was then referred back to the same specialist centre. Radiographs were taken, which showed a periapical lucency associated with 304 and a diagnosis of ‘apical abscess’ was made. The condition was treated with a long course of antibiotics. The problem resolved but flared up again within 3 months of ceasing antibiotic treatment. The dog was then treated intermittently with antibiotics for just over 2 years before being referred to us. Antibiotic therapy resulted in an improvement, but the fistula remained and started to drain within a few weeks of stopping an antibiotic course.
ORAL EXAMINATION – CONSCIOUS
The dog was extremely well behaved, and allowed careful conscious examination of the head and mouth, which revealed the following:
ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC
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:
Radiographs were taken of the rostral mandible, 304 and 404, and at the sites of the missing 307, 308, 406 and 408.
The following were evident on the radiographs:
Figure 35.2 Radiographs of the rostral mandible.