Abstract
Anecdotally it seems that many vets in practice dread feline dental procedures. dental education at university level was woefully deficient during our periods of study. Although the situation is changing, students are still leaving university feeling ill-prepared to adequately diagnose and treat dental disease in small animals. 1 Much of what is learnt may be during extramural studies or from senior colleagues once in practice.
Feline tooth roots are long and slender, and may easily break with poor extraction technique or equipment choices. Add to this the frequency with which tooth resorption (previously known as feline odontoclastic resorptive lesions) is encountered in cats and you have a recipe for disaster: multiple broken teeth, vet stress and frustration, potential iatrogenic trauma, delayed healing, and an unhappy client attempting to nurse a chronically painful patient. Contemporary dentistry skills should provide a comfortable patient that heals predictably and quickly alongside an impressed and grateful client. The days of ‘drilling out roots’ should be consigned to the history books – alongside the days when cats didn’t require as much analgesia as dogs or were castrated in a Wellington boot!
This two-part series of clinical reviews arms the practitioner with the contemporary knowledge and skill set required to provide ‘gold standard’ dental care for all feline patients. Furthermore, it serves as a timely reminder to referral practitioners to be cognisant of, and respectful towards, dental disease or dentoalveolar trauma in their feline patients.
In this first issue we begin with oral examination techniques, including the production of a clinically relevant and comprehensive dental chart. A thorough oral examination should always be performed on every feline patient, during every visit to the veterinarian and then documented in a standardised manner.
To further investigate suspected dental or oral pathology, examination under anaesthesia is mandatory. The subgingival structures may only be properly assessed using a periodontal probe, coupled with dental radiography. Given the likelihood of demonstrating clinically relevant information by generating dental radiographs, it is essential that practitioners providing dentistry have access to (and use!) dental radiography. 2 Although the techniques can initially be confusing, they are quickly mastered and full- mouth radiographs may be obtained within minutes. To provide guidance, a detailed, yet practical review on the production and interpretation of feline dental radiographs is included.
Gold standard dental care requires proficiency in intraoral radiography. (a) While clinical examination in this cat shows evidence of dramatic tooth resorption in the right mandibular canine (404), the left mandibular canine (304) is seemingly normal. (b) A dental radiograph, however, reveals that both teeth are severely affected by replacement resorption and require treatment
Extraction techniques are also comprehensively explored in an exquisite and painstakingly produced step-by-step photographic guide. No more blind drilling of roots, and wishful thinking!
The final article in this issue reviews traumatic dentoalveolar and maxillofacial injuries in the cat. The association between the two entities has only recently been described. 3 It is vital that any cat presented with traumatic maxillofacial injuries – for instance having fallen from a height or been involved in a road traffic accident – is also assumed to have one or more dentoalveolar injuries requiring treatment.
The second instalment will be published in January 2015 and will concentrate on frequently encountered clinical presentations. A comprehensive article on malocclusions will be the first of its kind to systematically outline the nature of feline malocclusions typically seen in practice. Periodontal disease and tooth resorption may arguably be the most common diseases encountered in practice, and may lead to unrecognised pain, and local plus systemic sequelae for the patient. Two articles will be devoted to the clinical presentation, diagnosis and treatment options available for these conditions. Tooth resorption is actually what makes dentistry so difficult for practitioners, especially if they do not have radiography readily available. only by utilising radiography may we make an accurate assessment of the type of resorption and from there determine a suitable treatment option. Spending time blindly trying to drill out a root that perhaps has already been resorbed by the body and replaced by bone makes no sense, and can only lead to unnecessary trauma for the patient. Lastly, we will take a close look at an oft-neglected part of feline dentistry, that of the anaesthetic and analgesic protocol. Hypotension, hypothermia and uncontrolled pain become real risks if this protocol is not carefully considered. Regional anaesthesia is also covered, and can help to provide pre-emptive and multimodal analgesia.
We are thrilled to have been part of an intiative merging the disciplines of dentistry, maxillofacial surgery, medicine and anaesthesia to provide, effectively, a feline-specific practical ‘mini-manual’. We’ve purposely set out to combine the experience and expertise of various international leaders in these aforementioned disciplines to produce this multi-faceted resource dedicated to this exciting field. We gratefully acknowledge the immense support and enthusiasm surrounding this project, especially from our international dental, surgical and medical colleagues, as well as those behind the scenes at JFMS. We feel particular gratitude to all authors who have dedicated their time in producing such practical and visually gratifying articles for this educational series.