Retained canines

Re: Retained canines

Rob Loxley — Sun, 24 Feb 2013 22:12:25 GMT

[quote user="Jo Jones"]

This surely should be an open and shut insurance case, with no quibbles.

But it's insured with E&L. What do you think my chances are?!

[/quote]

Zero. Open and shut: they do not cover teeth.

Re: Retained canines

Jo Cobbett — Sun, 24 Feb 2013 20:30:15 GMT

I had an 11 year old terrier come in last week with a broken canine. The owner found the tooth on the floor, looked in the dog's mouth, and hey presto... It was snapped off below the gumline, with the pulp exposed, and very tender, so was extracted (I'm sure Evelyn will tell me we could have done something more sophisticated with it). The rest of the teeth were in fantastic condition, no gingivitis/periodontal disease, barely a spot of plaque. This surely should be an open and shut insurance case, with no quibbles.

But it's insured with E&L. What do you think my chances are?!

Re: Retained canines

James Laidlaw — Sat, 23 Feb 2013 09:53:54 GMT

It's so ridiculous, isn't it! The two do go hand in hand, don't they.

Re: Retained canines

Rob Davis — Sat, 23 Feb 2013 09:17:19 GMT

Obviously most companies don't pay for dentistry full stop, however those that do (?only petplan) in my experience seem happy to pay for claims related to periodontitis as long as the animal has been checked regularly and that the dental treatment has been performed when advised. I have yet to have a claim refused because the owners don't brush their dog's teeth. It is slightly naughty calling gingivitis periodontal disease, but insurance claims consultants don't generally understand the difference between periodontal disease and periodontitis. They won't pay for scaling and polishing where there is gingivitis only (and I think that is fair enough), but where it has progressed to periodontitis and extractions (or periodontal surgery) are required then they generally seem happy to pay.

Re: Retained canines

James Laidlaw — Fri, 22 Feb 2013 18:59:11 GMT

I always found periodontal disease is a rule out for claiming, as it's preventable with good dental care?

Re: Retained canines

Rob Davis — Fri, 22 Feb 2013 15:10:06 GMT

Perhaps careful wording of future claims may help. There is often gingivitis associated with the persistent deciduous tooth, so including the term periodontal disease may help! However I don't really like having to play word games so that a poorly trained claims consultant can tick the correct boxes...

Re: Retained canines

James Laidlaw — Fri, 22 Feb 2013 14:49:59 GMT

[quote user="Rob Davis"]

[quote user="James Laidlaw"]

Had a claim rejected on the basis that - if they weren't causing a problem, then we don't pay out for this. I assume that once two teeth are present (deciduous and permanent) that that IS a problem... Will email to clarify today so I know what their position is for the future.

[/quote]

I have had this situation too. I tried to explain to the insurance company why waiting until they caused a problem was not appropriate, but did not manage to pursuade them to settle the claim. I hope you have more luck.

[/quote]

No.

Exactly the same response unfortunately. Shame.

Re: Retained canines

Rebekah Robinson — Fri, 22 Feb 2013 14:02:04 GMT

Will try this, works in rabbits!

Re: Retained canines

Rebekah Robinson — Fri, 22 Feb 2013 14:01:32 GMT

Evelyn,

Thank you for the brilliant description. If ever you have time to take some photos to help me visualise where you area making your gingival incisions, please would you mind posting them or emailing them on. I guess I'm probably most cagey about the rostral side of the deciduous tooth as the adult tooth is right there!

Cheers,

Rebekah

Re: Retained canines

Rob Davis — Fri, 04 Jan 2013 18:07:00 GMT

[quote user="James Laidlaw"]

[/quote]

Re: Retained canines

Rajat — Fri, 04 Jan 2013 11:16:36 GMT

Hi Rebekkah

I've broken them too before and still break the odd one! Patience really is the key.

I found being gentle never pulling not using an elevator- only sharp luxators helps.

What I do find very useful is taking a long needle and using it as a tool to cut the periodontal ligament. You can (within reason) really go to town on the ligament with these as it is unlikely to traumatise the permanent tooth, and this is especially useful when like me you are stuck in a branch without access to your sharper luxators and have to take out 4 k9s in a baby poodle!

Evelyn your descriptions of the anatomy etc are awesome thank you!

Re: Retained canines

Evelyn Barbour-Hill — Thu, 03 Jan 2013 16:27:35 GMT

[quote user="Rebekah Robinson"]I recently broke a deciduous canine using the old technique of using an elevator to remove it. First time it's happened but now I have the heebie jeebies about doing them. Funny thing how one experience can change your mindset. Problem was, I do flaps for removing other teeth with success but when it came to removing the deciduous canine, I wasn't sure where to incise so as to not damage the adult canine. [/quote]

We had a thread about this long ago but I can't put my finger on it right now.

Visualise the anatomy of the tooth. The crown is curved but the root is long and straight. It looks a bit like a highwayman's pistol. You can generally palpate it through the gum if you are sensitive..The root goes almost horizontally rostro-caudal, only slightly dorsally. There's only a thin shell of soft bone over it on the buccal side.

Incise parallel to the root and just on the ventral (for an upper canine) side. Make your incision meet the gingival margin of the crown. This will usually give you an adequate flap when you raise it with a small periosteal elevator (- if you really want more exposure, make a little bit of an incision from the other side of the crown, going dorso-rostrally; now you've got a really big triangular flap). Remember the periosteum is supposed to come up with your flap, but it will anyway.

Now work a suitable small thin instrument - luxator ideal, thin elevator would do - down the buccal side of the tooth (constantly visualising anatomy) keeping the instrument practically parallel to the tooth and flick off flakes of bone until most of the root is exposed. Now put your luxator gently down the deep side of the root, parallel to the tooth; it won't go near the permanent tooth and it will wedge the deciduous tooth out side ways with practically no force at all.

Tidy up any odd bits of bone if need be, and suture (simple interrupted) with 6/0 Vicryl or 6/0 Monocryl. 5/0 will do if that's all you've got. It won't take many sutures.

Re: Retained canines

Michael Woodhouse — Thu, 03 Jan 2013 16:12:41 GMT

[quote user="Rebekah Robinson"]Iain if you (or anyone else in this thread) has a video clip or series of photos and tips on removing them, would love to hear about it![/quote]

Really fine elevator and I think it was EBH who said twist - it's a revelation. Never pull.

Re: Retained canines

James Laidlaw — Thu, 03 Jan 2013 15:08:25 GMT

Have had that happen before too, not for a while, but I really think x-rays help you plan and prepare, and if the proverbial hits the fan, you can always take another and see what's left!

Re: Retained canines

Rebekah Robinson — Thu, 03 Jan 2013 14:49:44 GMT

I recently broke a deciduous canine using the old technique of using an elevator to remove it. First time it's happened but now I have the heebie jeebies about doing them. Funny thing how one experience can change your mindset. Problem was, I do flaps for removing other teeth with success but when it came to removing the deciduous canine, I wasn't sure where to incise so as to not damage the adult canine.

Iain if you (or anyone else in this thread) has a video clip or series of photos and tips on removing them, would love to hear about it!

Re: Retained canines

Anthony Todd — Wed, 02 Jan 2013 14:11:19 GMT

[quote user="James Laidlaw"]

[/quote]

I, and probably all of us, will be interested in the reply. I doubt if any vet will agree with the insurance company's view.

Re: Retained canines

James Laidlaw — Wed, 02 Jan 2013 09:24:50 GMT

Re: Retained canines

Evelyn Barbour-Hill — Thu, 24 May 2012 01:28:34 GMT

Remove them as soon as you see there are two teeth in the same position (unless they are a bit mobile in which case get the owners to keep picking at them and they will come out naturally).

Use a flap if you are an occasional dentist, or learn the art of ectracting them "closed" with Fahrenkrug "elevators".

There's considerable debate as to whether:

a)a retained deciduous tooth causes the permanent tooth to malalign; or

b) the permanent tooth is malaligned so the deciduous does not resorb because of the lack of pressure; or

c) the two are coincidence, a dog that's genetically inclined to malalignment of teeth being also genetically inclined to non-resorption of deciduous teeth.

It's a bit of a sterile debate though.

Re: Retained canines

Iain McAllister — Wed, 23 May 2012 17:13:56 GMT

As soon as you clinically define them as retained - waiting to see if they fall out over the next few months is a big mistake because even if they are shed it can lead to a malocclusion developing -

Remove via a flap to avoid damaging the structure of the permanent canine - takes about 10-15 mins per tooth

cheers

Re: Retained canines

Dagmar Steele — Wed, 23 May 2012 16:54:09 GMT

I remove them rather sooner than later, about six or seven months. Having said that I have seen dogs lose them at nine months, but very rarely. As the problem lies in the not dissolving roots I would not expect chewing toys to be of any help. Just yesterday I removed two retained canines from a one year old Yorkshire-Terrier and both roots were completely intact, as long as you would expect them in permanent teeth. As they waited so long the permanent canines were in the wrong place and covered in tartar already. Will be interesting to see if they move into place now the other ones have gone but I doubt it.