dentistry 35

Veterinary Dentistry Overview

• Veterinary dentistry has been recognized as a specialty for over 30 years.

• Traditionally, few veterinarians and technicians had formal training in dentistry and oral surgery due to a lack of educational opportunities.

• Recently, dental training opportunities have greatly increased over the past five years.

• Dental disease is prevalent, affecting over 80% of adult cats and dogs, yet treatment rates in practices remain low compared to the number of affected animals, often due to a lack of owner awareness, perceived cost, or underestimation of pain.

• Untreated dental disease can lead to chronic pain, local infections, and systemic health issues affecting organs like the heart, kidneys, and liver.

• Understanding the importance of oral health is essential for veterinary teams to effectively communicate with pet owners.

Role of Veterinary Technicians in Dentistry

• Technicians can significantly contribute to dental practices by:

  1. Educating clients about professional dental cleaning and its link to systemic health, emphasizing preventive care.

  2. Performing professional dental cleanings including periodontal debridement (supragingival and subgingival scaling) and polishing.

  3. Gathering diagnostic data via dental charting (e.g., periodontal probing depths, gingival recession, mobility) and radiography.

  4. Assisting intraoperatively in dental and oral surgeries by monitoring anesthesia, passing instruments, and maintaining a sterile field.

  5. Conducting discharge appointments that include client education on post-procedural care and home care products.

• Most practices handle professional dental cleaning and exodontics, while veterinary dentists manage advanced procedures like endodontics and orthodontics.

• Technicians have a critical role in early disease identification during routine dental care.

• A summary foundation in oral anatomy and pathology is crucial for technicians involved in recognizing and treating diseases.

• Special focus is given to periodontal disease; this chapter will detail its pathophysiology, treatment, and prevention.

Periodontal Disease

• Procedures typically performed include scaling and polishing, often mistakenly referred to as prophylaxis or prophy, are now more accurately termed as professional dental cleaning or comprehensive oral assessment and treatment (COHAT).

• Key competencies include:

  • Assessment of periodontal health using a periodontal probe to measure sulcus depth and identify gingival recession, conducting supragingival (above the gumline) and subgingival (below the gumline) scaling to remove plaque and calculus, polishing teeth to smooth surfaces and prevent new plaque adhesion, providing home care guidance, and advising on diet and dental products.

  • Periodontal disease progresses through stages (e.g., mild gingivitis, moderate periodontitis with some attachment loss, severe periodontitis with significant bone loss and tooth mobility).

• Dental radiology is vital as diseases can go undetected without examining teeth below the gingival margin, and techniques for taking and interpreting radiographs are discussed.

• Other dental subspecialties covered include:

  • Endodontics (tooth pulp management)

  • Exodontics (tooth extractions)

  • Orthodontics

  • Restorative dentistry

Dental Morphology

• Morphology: The form and structure of organisms; in dentistry, it pertains to the class and structural features of teeth.

• Teeth Classification:

  • Brachydont: Short crown with well-developed roots that cease to grow after eruption; found in humans, carnivores (dogs and cats), and pigs. These teeth have an enamel-covered crown and cementum-covered root.

  • Hypsodont: Tall crown with root structures that allow lifelong growth or extended eruption; prevalent in horses, rodents, and rabbits.

  • Radicular (roots grow but close over time, e.g., horse cheek teeth)

  • Aradicular (continues developing without true root structure, growing continuously, e.g., rodent incisors)

Types and Function of Teeth in Dogs and Cats

• Dogs and cats have four types of teeth:

  • Incisors: Small, single-rooted teeth at the front of the mouth, used for gnawing, grooming, and picking up small objects. Most rostral teeth.

  • Canines: Long, pointed, single-rooted teeth, designed for gripping, tearing, and holding prey. Placed distal to incisors.

  • Premolars: Located between canines and molars, they have multiple cusps and roots, primarily used for shearing and grinding food, particularly in conjunction with molars.

  • Molars: Larger, multi-rooted grinding teeth at the back of the mouth, crucial for crushing and pulverizing food.

• Diphyodonts: Mammals that have two sets of teeth during their lifetime (deciduous or "baby" teeth and permanent teeth).

• Dental Formulas:

  • Dog: 28 deciduous teeth, 42 permanent (C: $1/1$; I: $3/3$; P: $4/4$; M: $2/3$)

  • Cat: 26 deciduous teeth, 30 permanent (C: $1/1$; I: $3/3$; P: $3/2$; M: $1/1$)

Eruption Schedule

• Deciduous Teeth Eruption in Dogs and Cats (in Weeks):

  • Incisors: 4-6 (dogs), 3-4 (cats); Permanent Incisors: 12-16 (dogs), 11-16 (cats)

  • Canines: 3-5 (dogs), 3-4 (cats); Permanent Canines: 12-16 (dogs), 12-20 (cats)

  • Premolars: 5-6 (dogs), 5-6 (cats); Permanent Premolars: 16-20 (dogs), 16-20 (cats)

  • Molars: None for puppies (deciduous molars are absent), first permanent molars erupt at 16-20 (dogs) and 20-24 (cats).

Anatomy and Terminology

• Common structures and terms vital for dental technicians:

  • Mesial: Towards the midline or the front of the dental arc.

  • Distal: Away from the midline or towards the back of the dental arc.

  • Modified Triadan System: A standardized numeric system for dental identification, commonly used in veterinary medicine. Each tooth is assigned a three-digit number where the first digit indicates the quadrant (e.g., maxillary right quadrant is 100 series, left maxillary is 200 series, mandibular left is 300 series, mandibular right is 400 series) and the subsequent two digits identify the specific tooth within that quadrant (e.g., 101 for the maxillary right first incisor, 108 for the maxillary right fourth premolar).

  • Comprehensive identification aids utilize a visual system and standardized terminology; understand variations in root structures through preoperative radiography.

Diagnosis and Treatment Planning

• Important steps start with conducting a thorough oral examination and gathering patient history before any dental procedures.

• Symptoms of dental disease include pawing at the mouth, decreased appetite, difficulty chewing, drooling, and uncharacteristic behavior (e.g., anorexia, aggression near the mouth) due to pain.

• A complete examination includes both extraoral (assessing the face, jaw, eyes, ears, neck, palpable lymph nodes, and salivary glands for symmetry, swelling, or discharge) and intraoral assessments of soft tissues (gingiva, tongue, palate, pharynx for inflammation, masses, or lesions), periodontium, and teeth.

• Documentation through dental charting is critical, and all abnormalities should be addressed when developing a comprehensive care and treatment plan.

Dental Radiography

• Radiographic procedures are essential to diagnose conditions missed during visual examinations (e.g., abscesses, unerupted teeth, root fractures, bone loss, retained root fragments, and other periapical lesions).

• Include safety measures during exposure such as proper positioning, use of lead shielding for personnel, and equipment checks, following all safety protocols to minimize radiation risks.

Ethics and Regulations

• The level of care a veterinary technician can provide varies state-by-state; knowledge of local laws and veterinary practice acts is essential. Technicians should only perform tasks for which they are adequately trained and legally permitted.

• AVDC and AVDT guidelines recommend advanced training for technicians; however, surgical tasks like extractions or suturing in oral surgery should be strictly performed by veterinarians.

Advanced Procedures

• Endodontics: This involves the care of the tooth pulp, often necessary after tooth fractures that expose the pulp (leading to infection and pain) or deep carious lesions. Procedures include vital pulp therapy (to preserve the vitality of the pulp in young teeth) or root canal treatment (to remove infected pulp and fill the pulp chamber).

• Restorative Dentistry: Procedures aim to retain tooth structure and function, using materials like composites or crowns to repair defects, restore integrity, and improve aesthetic. This can address enamel defects, minor fractures, or dental caries.

• Orthodontics: Various malocclusions (e.g., overbites, underbites, wry bite, base narrow canines) can be