Inadequate oral hygiene can lead to a plethora of health issues including, but not limited to, gingival recession, lesions, worn teeth, plaque (Figure 1) and tartar build up, gingivitis and stomatitis, pulp exposure and root abscesses. All of these can be very painful and are usually only addressed when an owner notices that their pet has stopped eating. The main cause of health issues comes from plaque deposits, with some animals, mainly cats, having reactions to the plaque build-up known as chronic stomatitis.
Deciduous teeth in the cat and dog begin to erupt within the first few weeks after birth, and their permanent teeth erupt to completion by around 4–7 months depending on breed. Persistent deciduous teeth cause lots of problems to permanent tooth eruption — there is not enough room in the mouth to hold both deciduous and permanent teeth. Displacement of adult teeth becomes apparent and can cause painful malocclusions where the tip of the tooth starts to penetrate the soft tissues/palate. This was discussed later in the workshop when discussing how to assess teeth in consultations, and the terminology used to gain client trust and compliance surrounding persistent deciduous teeth.
When writing clinical notes or charting it is important to remember to include the deciduous tooth number that is still present. The numbers carry on from the four permanent quadrants meaning that the upper right arcade starts from 501, the upper left arcade starts from 601, the lower left arcade starts from 701 and the lower right arcade starts from 801. This is a universal way of numbering teeth, so no matter who views a dental chart any deciduous dentition present will be known by the viewer.
Common dental problems include:
- Crown fracture (enamel fracture/enameldentin fracture/enamel-dentin-pulp fracture) — these usually occurs when the animal bites down on something hard (bones/antlers), and is normally seen in teeth towards the back of the mouth. Enamel fractures are superficial as the enamel on the crown is thin, no treatment of these is usually indicated. Enamel-dentin fractures remove the full thickness of the enamel exposing the dentin. Dentin is sensitive and the patient could show sensitivity, i.e. chewing on one side or not wanting to play. Odontoblasts in the pulp respond and produce a tertiary layer of dentin to the affected area and sensitivity should subside; however, because the thin layer may allow bacteria into the region and can cause pulpitis, extraction is usually indicated. Enamel-dentin-pulp fractures expose the pulp to bacteria, causing infection, pulpitis and abscessation. These teeth either need root canal treatment or extraction. Your patient will be painful! The same goes for deciduous teeth too, they need removal quickly.
- Worn teeth — the enamel has worn away to expose dentin, it is usually a slow process and odontoblasts get to work building the dentin back up. The wear of these teeth is usually smooth and passing an explorer over the areas reveals no irregularity, however much more rapid abrasion/attrition will lead to pulp exposure and should be treated in the same way as a fractured crown. You will see a lot of abrasion on animals that are pruritic because of their constant chewing.
- Discoloured teeth — usually means there has been some trauma to the pulp or pulp canal that has caused bleeding. This trauma can be direct to the tooth or as a result of damage to the blood supply to the tooth affected.
- Caries/cavities — this is true tooth decay and can be seen in the form of lesions as a result of enamel and dentin loss. Cavities often extend to the pulp and cause pulp necrosis and these teeth should either be removed or the patients should have root canal treatment.
- Tooth resorption — indicated by lesions found on the crown surface above the gingival margin and often have a pink discolouration. Resorption can present from the root canal, known as internal resorption, or from the outside surface of the root known as external resorption. Primarily in cats, but some dogs are affected too.
- Enamel hypoplasia — teeth erupt with either thin or absent enamel.
- Enamel hypo mineralisation — teeth have a chalky soft enamel that is easily removed or worn away.
- Cleft lips and palates — the formation of the structures did not fuse while the fetus was developing. Cleft lips are obvious from birth, however cleft palates are more difficult to diagnose.
- Oral masses and swellings — usually seen as inflammation, neoplasia, gingival enlargement, abscesses, or cysts. Further investigation is always indicated at this point to evaluate the seriousness of the mass or swelling. While the patient is anaesthetised it is imperative to look all around the mouth, even before intubation, and under the tongue.
- Inflammatory masses/granulomas — the growth of soft tissue or bone in the oral cavity. This can be a result of breed disposition (e.g. boxers with gingival enlargement) or from a chronic mechanical injury. In some cases, epulis are encountered, which is a mass on the gingiva, and must be investigated.