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Dental Disease: Resorptive Lesions

I write this as a Veterinary Surgeon who qualified almost twenty five years ago as well as a pet owner. It is only in the past five years that I have developed a keen interest in dental disease in domestic pets. Training in dental problems decades ago was admittedly very basic and, in truth, lacking. This is now changing significantly at the training schools. In a similar way, I believe as owners that our attitude to oral disease in our pets has also fundamentally changed. As owners, we are becoming aware that our pets can and do suffer from painful mouth related illnesses, and that these should be diagnosed and treated as quickly and as effectively as possible.

The first step in reaching a diagnosis should be a thorough Vet check. This may be prompted by something we as owners have noticed, such as a sudden increase in bad breath, or a lack of wanting to play with toys. However, I know all too well how our pets often hide signs of mouth pain and appear fine. Often we as Vets pick up that a dental problem exists at a routine consultation such as a vaccination, or perhaps an unrelated problem such as a lump appearing on one of our animals.

I invariably find that if a dental problem is detected and treated as early as possible in the disease process, then a quicker, more favourable outcome can be achieved. Once treatment has been undertaken, owners will tell me how much happier their pets are, even if there appeared to be no obvious problem before the treatment was carried out. Over the past few years this has become increasingly aided by changes in equipment, in particular with the use of Digital Dental Radiography. We at MK Vet Group are extremely fortunate to have this facility at two of our sites, where it is used on a daily basis.

I often find myself quoting statistics to clients, such as two-thirds of animals over three years of age will have some form of dental disease. Yet on reflection I don’t find this particularly helpful. For example, if you have three pets, this does not mean that two of them will have dental disease. What I do find relevant with these statistics is simply to say that that dental disease is extremely common; it is not limited to elderly pets and often is present despite our animals seeming to be fine.

A typical case presented to me recently. An appointment was made for a relatively young cat as the owners had noted a swelling. This swelling was found to not require any treatment; however during the routine examination significant redness of the gums was noted throughout the mouth. It was discussed and agreed to examine this cat’s mouth fully under a general anaesthesia. Only then was it found that this cat suffered from a condition known as Type I/II tooth resorptive lesions affecting several teeth. This is a progressive and typically painful disease. The only effective treatment is extraction, which was carried out without complication.

The radiograph on the right shows three teeth in the lower jaw. The tooth to the left shows a normal healthy tooth. The tooth on the right shows the loss of the majority of the crown of the tooth, with the roots being actively converted to bone tissue similar to the normal jaw bone. The central tooth shows this condition in the early phases with a large, painful lesion seen – the black “hole” visible on the right side of the crown of the tooth. This condition would not have been diagnosed without the use of radiographs.

It is expected that this cat will make an excellent recovery and, rather than having difficulty eating with missing teeth, will now genuinely eat better than before for the simple reason that a painful disease process was recognised and treated promptly.
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Rabbit Dentistry

Rabbit
Dental disease is one of the most common health problems encountered in pet rabbits. Dental problems arise in rabbits due to inappropriate diet and lack of exposure to sunlight. There is likely to be a genetic predisposition in dwarf rabbits as these breeds suffer dental disease more commonly than other rabbits.

Pic: Rabbits with dental disease will often choose to eat soft food instead of grass or hay.



Rabbit
Assessing Dental Disease in Rabbits

Dental disease is initially suspected when a rabbit is displaying appropriate signs. These include reduced appetite, changes in food preferences and increased salivation. An examination can help confirm the suspicion of dental disease. Abnormalities such as facial swellings, overgrown incisors or horizontal ridges on the incisors can be detected at this point.

However, the oral cavity of the rabbit is very narrow and rabbits are unable to open their mouths wide. This makes examination of the cheek teeth very difficult in a conscious rabbit. A full dental examination therefore requires a general anaesthetic. This allows the mouth to be fully opened and the large cheeks to be moved to aside to allow visualisation of the cheek teeth.


Pic: Normal incisors (top) and incisor malocclusion (bottom). (Photos courtesy of Frances Harcourt-Brown www.harcourt-brown.com.uk).



Rabbit
Examination under General Anaesthetic

The cheek teeth are examined for overgrowth, changes in orientation and malocclusion. The mouth is checked for any ulcers or cuts from abnormal teeth.

Spurs on the cheek teeth can be removed at this point using a dental burr. Examination under GA allows the section of the tooth that projects into the oral cavity to be examined. However, unlike cats and dogs, the majority of the crown of the rabbit’s tooth is actually embedded in the bones of the jaw. This section of the tooth also needs to be examined to allow full assessment of dental disease. This requires dental radiographs. These can be taken whilst the rabbit is under anaesthetic and will allow us to assess the full extent of dental disease


Pic: Spurs on the cheek teeth causing trauma to the mouth (photos courtesy of Frances Harcourt-Brown www.harcourt-brown.co.uk).



Rabbit
Dental Radiographs in Rabbits

Left are two radiographs of the skull taken from two different rabbits during dental examination at Milton Keynes Veterinary Group. These radiographs show the long section of the crowns of the teeth embedded in the bones of the skull. This part of the crown is called the ‘reserve crown’ and is not visible during examination of the mouth. Rabbit 1 (top) does not have any evidence of dental disease. Rabbit 2 (bottom), however, has advanced dental disease. Many teeth are missing or have stopped growing. There are associated long term changes in the skull. These radiographs helped us to rule out dental disease in the rabbit 1, and to decide how to manage the dental disease in the rabbit 2.


Pic: Rabbit 1 (top) – normal dentition.
Pic: Rabbit 2 (bottom) – advanced dental disease.


Treatment Options

Rabbits with dental disease will usually require repeat dental procedures under general anaesthetic. During these procedures, the crowns of the affected teeth are shortened to prevent trauma to the mouth and allow the rabbit to eat as normal. Many rabbits will also benefit from dietary modification to increase their calcium and fibre intake. Sometimes, we will recommend procedures such as removal of incisors or cheek teeth. Some cheek teeth can have their growth arrested by ‘pulpectomy.’ These procedures can prevent or reduce the frequency of recurrent dental procedures. These procedures are recommended if appropriate to the particular case.


Other Health Problems associated with Dental Disease

Rabbits with dental disease will often develop other problems as a result of their ongoing dental disease. These include:

  • Infection in the nasolacrimal duct (called Dacrocystitis)
  • Facial dermatitis
  • Facial abscesses
  • Gastric stasis
  • Flystrike




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Fighting Fractured Teeth

Fractured teeth are a common injury in cats and dogs, with the majority involving fractured canines of the upper jaw. Damage is commonly caused by falls, running into objects, clashing teeth and road traffic accidents. In dogs, other objects that can damage teeth include raw hide, bones, sticks/branches, rocks, ice and other hard objects.

The radiograph to the right shows a case of pulpitis in a cat. The pulp cavity is the hollow area inside a tooth filled with sensitive pulp tissue (blood vessels, nerves and connective tissue). This commonly occurs when the tip of the tooth is fractured, allowing bacteria to enter the pulp cavity. Swelling of the pulp tissue prevents blood entering the root canal and the result is ‘death’ of the tooth. On the radiograph we can see widening of the pulp cavity compared to the normal tooth on the right, with evidence of an abscess at the apex of the root. On this occasion the affected tooth was extracted. It is important to note that this problem was found during a routine dental, and the patient did not show any obvious mouth pain at the time, but the owner reported marked improvement in his demeanour and appetite following surgery. Due to high pain threshold and other instinctive behaviours, our patients rarely shows signs of pain and will often hide pain very well.

It is therefore important to never ignore a broken tooth in your pet.
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Does your pet have bad breath?

This could be a sign of dental disease. Dental disease in pets is very common, however it is a disease that can be prevented.

We are focusing on Dental Disease and Prevention during the month of September.

Signs of dental disease can include:
  • Bad Breath
  • Pawing at mouth
  • Difficulty eating
  • Red or inflamed gums
  • Brown discoloured teeth
  • Facial swelling
  • Excessive drooling
  • Mobile teeth
We are offering a FREE DENTAL CHECK* for your cat or dog with one of our Registered Veterinary Nurses who will examine your pet’s teeth and discuss about prevention of dental disease. Appointments are available at our Walnut Tree Hospital, Stoke Road Surgery and Willen Surgery.

Our practice has dental facilities at our Walnut Tree Hospital and Stoke Road Surgery including dental radiography. Dental x-rays allow us to detect hidden disease within the teeth and below the gum line to ensure your pet gets the maximum benefit from their procedure.

* If your pet is found to be ill during the free dental check, treatment costs will be incurred. Dental treatment will be chargeable.
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Meet loveable Jasper….

Milton Keynes Veterinary Group would like to introduce you to Jasper, the beautiful blind dog. Jasper started life as a Guide Dog, but after losing both his eyes to Glaucoma, he was forced to retire at just six years old. Being blind doesn’t stop Jasper from leading a full and happy life with his owner, Janyce, and they have learnt to cope together, building new skills for Jasper and exploring his new world. Read on for Janyce and Jaspers story in her own words

“Jasper worked for my son’s father, David, so I have known him for years. He had to retire, aged 6, when he lost his right eye to glaucoma. I said yes when David asked if I’d like to give Jasper his retirement home, knowing that there was a possibility Jasper could lose the other eye too, which he did, just six months later. He’s been with me since last September. He’s a lovely dog. Very polite, very friendly and good natured with everyone, and so affectionate. I was very worried he’d lose that when he went blind, and that I wouldn’t be able to cope and I’d have to give him back to Guide Dogs, but it has been fine. We have learned together. The people at Guide Dogs were brilliant, making sure Jasper saw a specialist and got the very best treatment, and that what was done was right for him. Jasper was more confident walking on his car harness, so I bought him a Ruffwear Webmaster harness at the start (a strong harness with a handle). I think that has been a really good investment for him. We had a couple of dodgy weeks at the beginning, when he was very reluctant to move around. Guide Dogs are trained not to move when there might be danger and he lost all his confidence. He became very focused on me, leaning up against me as we walked and almost tripping me up. Gradually he became more confident, walking to the end of a lead and stopping leaning on me as we walked, but he was very hesitant and would come back after a few paces. He’s had to learn a lot of new skills and unlearn the guide dog rules. His guide dog training has helped him to be a confident blind dog as he is so obedient and he listens to me when I give commands. But he also gets overconfident sometimes, and he’s very strong and pulls really hard when he recognises his mates (human and canine!). I’ve met a lot of partially sighted and blind dogs in person and through the Blind Dogs Facebook group, who cope brilliantly. Jasper gets a lot of attention when he’s out, he’s very good at making friends. He has a BLIND DOG collar and leash, people often don’t realise he is completely blind as he manages so well. He’ll say hello to a dog, find their human, sniff out the treat pocket and then sit next to it. He knows how to work his disability, usually smiling at the human until they give in and give him one of their treats. Jasper’s a bright boy and picked some things up very quickly. For example, the word “watch” will stop him in his tracks and he’ll turn around and return to me. He knows his way around the house, and when we are out walking he’s usually off the lead, but he doesn’t go very far from me. But I was concerned Jasper wasn’t getting enough exercise. He was healthy but he’d become quite unfit, now he’s getting more exercise with his ball. Just after Jasper went blind, I met another Lab who was blind from cataracts and who was retrieving a ball on a rope, so I knew it was possible. We tried fetch on and off without any kind of enthusiasm from Jasper, although he’d find his squeaky toys and bring them to me at home. I was quite worried about boredom and that everything was focused on food. Then he started going to scent classes a couple of months ago, at the suggestion of Guide Dogs, and he’s really enjoyed it. The other weekend, I thought we’d have another go at retrieving, and it finally clicked with him. He’s moving quickly and confidently and really enjoying it. I’ve not seen him so enthusiastic about something for quite some time, he’s loving it. He even does a version of the excited doggy dance before I throw it again, and he dances in circles when he’s found it. He’s a Lab with a ball, he’s got a job and purpose again. He’s very pleased with himself and a very happy dog.”
See more videos of Jasper on our YouTube page – Milton Keynes Veterinary Group.

Credit to Janyce Quigley

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