Discoloured canine

RE: Discoloured canine

Bibs — Sat, 21 Nov 2020 19:09:30 GMT

Thank you,

I am just learning to use the dental radiography system but I would take images of this dog. I'd just prefer to refer him as they want to save the tooth if possible. If I couldn't refer him then I imagine I'd struggle to make a decision about this tooth especially if a one off radiograph is not enough to make the call.

RE: Discoloured canine

Evelyn Barbour-Hill — Sat, 21 Nov 2020 15:16:55 GMT

Wot Rob said.

A few extra comments.

[quote userid="11590" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/12693/discoloured-canine/226769#226769"]I know radiographs would be indicated but I am just starting to learn to use the equipment and can imaging I'll probably struggle. [/quote]

If you shy off everything that might be a bit difficult you will never learn to use it! Schedule a day when you can take your time and repeat exposures until you get what you need.

[quote userid="11590" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/12693/discoloured-canine/226769#226769"]They are insured so I'm hoping that the discoloured tooth investigations might be covered and it may be possible to refer.[/quote]

Nearly all insurance policies exclude dental treatment except anything necessitated by accidental damage, which we can say confidently that this is. (Of course it would not be covered if a pre-existing condition when the insurance was taken out). There is one company that excludes anything dental (guess who).

[quote userid="11590" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/12693/discoloured-canine/226769#226769"]Also what are the big arguments for not removing canine teeth in this case apart from the risk of oronasal fistula? [/quote]

It's unnecessary trauma (in proper sense) for the patient. It's trauma (metaphorical) for the less experienced surgeon. And at the end, there's an important tooth missing.

[quote userid="11590" url="~/001/veterinary-clinical/small-animal/f/misc-clinical-discussions/12693/discoloured-canine/226769#226769"]the owners have noticed a "crack" in both upper canines near the gum margin but when they tried to show me I couldn't see it due to tartar and the dog moving around.[/quote]

Not unusual. Observant owners quite often report a crack in "that big back one at the top". It may well be a crack in the calculus, not the tooth. You will see, of course, as soon as you have removed the gross caculus.

Your "scale and polish" should never be just that, as I am sure you know (so please don't take this the wrong way). It's an oral examination and any abnormalities or suspect lesions should be noted and at least have initial investigation. I think you should make it plain that "while he is under" you will radiograph – not offer it as an option.

RE: Discoloured canine

Bibs — Tue, 17 Nov 2020 18:32:26 GMT

Thank you, a very helpful answer.

RE: Discoloured canine

Rob Davis — Tue, 17 Nov 2020 17:07:07 GMT

The above advice is still sound. Radiographs are important, but as Rachel said previously, over 90% of fully discoloured teeth are likely to have necrotic pulp in which case they should be treated. Some with partial discolouration only at the tip can survive the initial pulpitis - I have one or two of these which I have monitored radiographically over a period of time and documented ongoing dentine deposition confirming pulp survival.Single occasion radiography alone will not tell you whether or not the pulp is vital in a significant proportion of cases - opening up the pulp chamber is the only definitive way to tell, and once you've done that you have do perform some form of endodontic treatment either way.

The canine teeth are structurally important and are best preserved if possible. Extraction of periodontally sound canine teeth is considerably more traumatic than root canal treatment. Oro-nasal fistulation should not be a concern in a properly performed extraction with no significant periodontitis. It is most common when there is already ONF from vertical bone loss on the palatal aspect of the upper canines (dachshunds are particularly prone to this). Even if there is ONF at the time of or as a result of the extraction, if a decent flap has been raised and sutured using an appropriate TENSION-FREE technique (excuse the capitals but this is crucial), then it should heal without incidence. Complicated multi-layer techniques are generally not required.

As far as the insurance claim is concerned ensure you make the insurance company aware that this is a traumatic injury as many policies which exclude most dental disease will cover trauma.

RE: Discoloured canine

Bibs — Tue, 17 Nov 2020 12:16:50 GMT

Has anything changed regarding recommendations for discoloured canines since this last post? I know it comes up a lot. I have a husky that is difficult to examine and is coming in for a scale and polish - the owners have noticed a "crack" in both upper canines near the gum margin but when they tried to show me I couldn't see it due to tartar and the dog moving around. I noticed one of the canines was discoloured and said ideally extractions or refer for root canal - now I'm thinking I've been too hasty. I know radiographs would be indicated but I am just starting to learn to use the equipment and can imaging I'll probably struggle. They are insured so I'm hoping that the discoloured tooth investigations might be covered and it may be possible to refer. Also what are the big arguments for not removing canine teeth in this case apart from the risk of oronasal fistula?

Re: Discoloured canine

Pynadath George — Mon, 15 Oct 2012 00:49:57 GMT

[quote user="pjmontgo"]

Thanks for all your advice, will have a chat with the owner, basically told him we should xray initially so will see if he is up for that. Im not sure he will want repeated general anaesthetic and I cant to root canal so maybe referral would be a good idea first up? Will see what he thinks, somehow i think he will not want to do anything...

[/quote] PEriapical X-ray is needed. Not just for peri apical radiolucency but to check for canal sclerosis. This would mean pulp is still vital but sclerosing. If sclerosing then rct is needed depending on the extent. If any peri apical radiolucency then rct is definitely needed.

Re: Discoloured canine

pjmontgo — Wed, 12 Sep 2012 11:24:53 GMT

Re: Discoloured canine

Alan Tevendale — Mon, 10 Sep 2012 23:38:40 GMT

Suits you Michael

Re: Discoloured canine

Michael Woodhouse — Mon, 10 Sep 2012 23:19:30 GMT

Discoloured canine?

Re: Discoloured canine

Rachel Perry — Mon, 10 Sep 2012 21:41:20 GMT

Discolouration is usually due to blunt trauma causing pulpal haemorrhage- the blood seeps into porous dentin. Over time the protein in Hb gets recycled by the body but the iron remains trapped in the dentin. Giving us the usual colour sequence of red/ pink / purple to a more brown/ grey. Certainly if there is periapical pathology on intraoral rads it needs treatment ( root canal preferably or extraction). Herein lies the problem: a paper published in 2001 looked at a number of discoloured teeth in dogs, finding 92% necrotic, but 42% showed NO radiographic evidence of a problem. A necrotic tooth is not painful (if not infected) but it is not a question of if it will get infected but when. Therefore people are able to give immediate feedback to dentists once a tooth becomes painful, unlike our patients. The recommendation from this paper was therefore that there is evidence that all discoloured teeth in dogs should be treated.

Re: Discoloured canine

Mark Holmes — Mon, 10 Sep 2012 20:32:04 GMT

I have heard that these need treating, the thing is I've seen loads and have rarely if ever come across a problem. My brother has one having grass boarded down a flight of stairs. He doesn't report pain and his dentist isn't worried other than cosmetically. Similarly my son has one, dentist not worried and not painful. I wonder if more is made of them than necessary.

Re: Discoloured canine

Evelyn Barbour-Hill — Mon, 10 Sep 2012 20:04:42 GMT

Most definitely you want to Xray it. If there's any periapical pathology at all, that's it, you need root canal therapy. (Not extraction! Oops, we've been here before )

If there's no periapical patholgy at all, well, big names hold that nonetheless there must be pulpitis or pulp necrosis there and you still need root canal therapy.

Re: Discoloured canine

James Laidlaw — Mon, 10 Sep 2012 19:13:39 GMT

Discoloured usually means pulp necrosis, but there can be other courses. I think you need X-rays to asses especially the apex of the root to look for abcess/infection at the deepest part of the root. I think you usually need either root canal or extraction, but sure a dentist will chip in to confirm soon enough. Hard to convince a client who doesn't see the problem, but easier if you can explain the complications and associated pain as there would be with a tooth root abcess.