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Common Conditions, continued
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Retained Deciduous Teeth
Occlusive Trauma
Periodontal Pockets
Gingival Hyperplasia
Caries
Neoplasia

Retained Deciduous Teeth
Normally deciduous (baby) teeth start being shed and are replaced by permanent teeth at about 4 1/2 months of age. Sometimes, however, the deciduous teeth are not lost as scheduled, This creates a problem because now there is insufficient room for the permanent tooth to erupt. Generally, the permanent does its best to come in which causes crowding and movement of the teeth from their normal positions potentially creating a malocclusion. Whenever two teeth occupy the same position, the deciduous tooth must be extracted. It is recommended that radiographs be taken prior to the extractions to ensure that a healthy permanent tooth is available to occupy the space. Extractions must be done carefully to avoid damaging the permanent tooth bud.
 
deciduous teeth deciduous teeth
   
deciduous teeth Seen especially in the toy and miniature breeds, retained deciduous teeth should be extracted as soon as it is evident that the permanent tooth is trying to occupy the same space. We will also perform “interceptive orthodonture”, if appropriate, to aid in the correction of Class II or Class III malocclusions.
   
deciduous tooth deciduous tooth
Even cats can have retained deciduous teeth.

Occlusive Trauma Also see “malocclusions”
Dogs and cats suffer from many types of malocclusions or abnormalities in their dental architecture which can cause the teeth to hit either one another or the soft tissue in the mouth causing pain, abnormal tooth wear, periodontal disease, and soft tissue injury. We are listing several of the more commonly seen malocclusions here.
 
occlusive trauma occlusive trauma occlusive trauma
Class III Malocclusion (underbite) in damaging the lower incisors and has forced the lower canines outward. More Class III...the upper incisors must be extracted to prevent further and the lower incisors are at risk if traumatic damage has occurred. Severe periodontal disease involving the backsides of the lower incisors from trauma.
     
occlusive tooth occlusive tooth occlusive tooth
Mesioversion (lance canine) of the left upper canine is causing trauma and movement of the left lower canine. Orthodonture is needed. Linguoversion of the right lower canine is damaging the gingiva in front of the right upper canine. Orthodonture can easily correct this malocclusion. This cat’s lower molar has severe gingival recession secondary to the trauma caused by the pointed cusp of the upper premolar. The upper tooth either needs extraction or blunting of the cusp.
Periodontal Pockets    
Pockets result from advanced periodontal disease in which there is loss of gingival attachment and bone which weakens the support of and may cause the eventual loss of the tooth.

periodontal pockets periodontal pockets periodontal pockets
Many times what is seen on the outside does not reflect the true extent of the damage. What appears to be fairly benign periodontal disease is actually end-stage periodontitis. This tooth, on the other hand, has a pocket which could be treated thus potentially saving the tooth.
     
Gingival Hyperplasia (GH)
GH is an enlargement of the gingiva (gum) that is non inflammatory, produced by factors other than local irritation, and is the result of an increase in the number of cells.

It is seen more commonly in Great Danes, Bernese Mountain Dogs, Collies, Dalmatians, and Boxers. Other than its association with certain breeds, it has been linked with the administration of certain drugs such as cyclosporine, phenytoin, and calcium channel blockers.

The problem with GH is that the overgrowth of the gingiva forms pseudo pockets at the gingival margin. These deep pockets trap debris, calculus, and plaque which predisposes the pet to more serious periodontal disease.

Treatment involves trimming the exuberant tissue back to a normal level which eliminates the pseudo-pockets. In our practice, we typically use radiosurgery to recontour the gingiva, a technique which usually results in full healing within a couple of weeks.

great dane gingival hyperplasia gingival hyperplasia
  There is significant enlargement of Otis’ gingiva. Many pseudo-pockets are present. Right lower canine.
Radiosurgery gingivectomy was used to contour the gum back to a normal height. > hyperplasia hyperplasia
    All teeth now have a normal probing depth. There are no pseudopockets.
hyperplasia

hyperplasia

< Extreme gingival hyperplasia can completely cover the teeth.
Caries    
Although rare, caries, or cavities caused by bacterial infections, do occur in dogs. They are treated the same way as with humans...by removing the carious material then cleaning and filling the defect with a replacement material, which is usually a dental composite made of reinforced plastic.
Advanced caries which may have invaded the pulp chamber will require root canal therapy prior to filling. Alternatively, these painful teeth must be extracted. >> caries

 
Neoplasia
An abnormal proliferation of cells. Neoplasms can be benign or malignant. Any unusual mass growing in the mouth must be taken seriously and checked by your veterinarian because there is a high malignancy rate with intraoral tumors. That said, many malignant tumors, if caught early enough, can be successfully treated and the cancer cured. There is an old saying that “any mass in the mouth is cancer unless proven otherwise. It is important to check your pet’s mouth regularly and report any suspicious enlargements to your veterinarian.
 
neoplasia neoplasia  
This a benign gingival tumor secondary to periodontal disease. It is a form of gingival enlargement and was trimmed back in a procedure called gingivectomy. A small gingival tumor also secondary to periodontal disease but is part of a generalized case of gingival hyperplasia. It was removed via gingivectomy.  
     
neoplasia neoplasia  
This gingival mass would previously have been called an epulis. They are now called “fibromas of periodontal ligament origin.” They are related to the periodontal ligament which surrounds the tooth root, therefore the tooth is generally removed along with the tumor. A more invasive but still benign fibroma. It has resulted in the loss of 2 upper incisors and involves the right upper canine.  
     
neoplasia neoplasia  
Acanthomatous ameloblastoma,
a technically benign but locally aggressive tumor related to the fibroma. These tumors must be diagnosed early and removed completely to save the patient.
Same tumor looking at it from the inside.  
     
neoplasia neoplasia neoplasia
This extremely aggressive cancer called osteosarcoma was too advanced for surgery by the time it was diagnosed. The only thing really visible was moderate swelling of the face. Severe destruction of the alveolar bone as well as the tooth roots is characteristic of these types of tumors. The cancer involves the upper 3rd and 4th pre-molars.
     
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