Damaged Teeth

Re: Damaged Teeth

Rob Davis — Thu, 01 Aug 2013 14:12:33 GMT

Er.... No!

Re: Damaged Teeth

Evelyn Barbour-Hill — Thu, 01 Aug 2013 14:10:50 GMT

What we really need is loads of clinical research and quite a lot of systematic histological and electron microscopical research.

It's not going to happen, is it?

Re: Damaged Teeth

Rob Davis — Thu, 01 Aug 2013 09:23:04 GMT

[quote user="Evelyn Barbour-Hill"]As i understand it, the fluoride ions in fluorohydroxyapatite facilitate a constant remineralisation of the constant demineralisation that goes on. Whether that would make the degenerate enamel of hypoplasia more sound and permanent, seems a bit doubtful although I'd be happy to be wrong.[/quote]

I'm sure you're correct. It is mentioned briefly in the BSAVA dentistry manual, and was also mentioned by Cecelia Gorrel on a course I attended recently, though it was very briefly brushed over - I got the impression that it's not something she uses, and I suspect it's benefit if theoretical and without evidence.

[quote user="Evelyn Barbour-Hill"]

Yes you could use unfilled resin or maybe a glass ionomer "fissure sealant" to coat the dentine. I'm just not convinced you are likely to need to. If the tooth erupts this way, with dentine exposed, the instant it erupts there will be slight irritation of the extremely active pulp which will lay down further dentine. Well, it's laying down further dentine anyway, but it will lay down even more.

"Distemper teeth" used to be a not uncommon sight and they appeared to act as healthily as normal teeth.

I guess there are many factors involved. Perhaps a very important factor is the total volume of enamel that is missing? I mean, perhaps the pulp can cope with 10% of enamel missing well coronal, but not with 80% missing? What do you think?

[/quote]

I agree the dentine is likely to be most sensitive in the very young animal with relatively thin dentine with fairly wide tubules. One would expect the sensitivity to reduce as the dentine thickens and the tubules narrow, so I guess if one was intending to seal the tubules, it's best done as early as possible, and even if it doesn't last for long, it hopefully covers the most sensitive period.

I'm sure that there must be an increase in risk of pulpitis with an increase in the area of enamel missing - that would make sense, but I'm not aware of any evidence quantifying this risk.

Re: Damaged Teeth

Evelyn Barbour-Hill — Tue, 30 Jul 2013 22:16:12 GMT

[quote user="Rob Davis"]Topical fluoride is also suppose to decrease dentine sensitivity, though given it's toxic nature if swallowed there are obvious practical difficulties.[/quote]

Good point, if the teeth are sensitive (or rather, excessively sensitive, to be pedantic) . But there are other things which will do the same – see any human "for sensitive teeth" toothpaste.

[quote user="Rob Davis"]Fluoride should increase mineralisation in affected enamel (though if all abnormal enamel has come away then it will be of no benefit)[/quote]

As i understand it, the fluoride ions in fluorohydroxyapatite facilitate a constant remineralisation of the constant demineralisation that goes on. Whether that would make the degenerate enamel of hypoplasia more sound and permanent, seems a bit doubtful although I'd be happy to be wrong.

[quote user="Rob Davis"]How long would you expect the flowable composite to last[/quote]

The new ones should adhere very well if correctly applied (composite is very "technique-sensitive") Probably not on the coronal tip of a canine or other tooth.

"Distemper teeth" used to be a not uncommon sight and they appeared to act as healthily as normal teeth.

Re: Damaged Teeth

Rob Davis — Tue, 30 Jul 2013 19:52:01 GMT

[quote user="Evelyn Barbour-Hill"]What's the fluoride supposed to do, Rob?[/quote]

Fluoride should increase mineralisation in affected enamel (though if all abnormal enamel has come away then it will be of no benefit). Topical fluoride is also suppose to decrease dentine sensitivity, though given it's toxic nature if swallowed there are obvious practical difficulties.

[quote user="Evelyn Barbour-Hill"]Individual teeth might benefit from restoration - a flowable composite would be good for the purpose – but that won't work if the neigbouring enamel is abnormal and flaking off.[/quote]

How long would you expect the flowable composite to last? I would imagine it's going to be fairly vulnerable on a canine tooth with no mechanical retention. Would you consider using a bonding agent only to seal the dentine tubules?

Re: Damaged Teeth

Evelyn Barbour-Hill — Tue, 30 Jul 2013 19:39:46 GMT

[quote user="Rob Davis"]I believe that some people have suggested using fluoride treatments, though I don't think there is much evidence for efficacy.[/quote]

What's the fluoride supposed to do, Rob?

Individual teeth might benefit from restoration - a flowable composite would be good for the purpose – but that won't work if the neigbouring enamel is abnormal and flaking off.

Re: Damaged Teeth

Rob Davis — Tue, 30 Jul 2013 18:33:09 GMT

[quote user="Evelyn Barbour-Hill"]

Enamel hypoplasia.

Possibly to do with nutrition. More likely due to a period of fever at the particular stage in development.

He has some missing teeth too? Unerupted? Broken buried stumps?

Mass extractions are not indicated. In fact no treatment at all may be necessary.

Is the enamel that is present sound, or is it a bit degenerate and still flaking off?

[/quote]

What he said.

Pyrexia before 12 weeks old is likely to be the cause. Be very careful if using an ultrasonic scaler on these teeth - the enamel may fall apart very easilly. I recently saw a case study on a dog with generalised enamel hypoplasia - it did go on to develop periapical lesions beneath almost every tooth. So although I agree that treatment may not be necessary, it is worth monitoring and ideally taking intra-oral radiographs periodically if the owner will allow.

I believe that some people have suggested using fluoride treatments, though I don't think there is much evidence for efficacy.

Re: Damaged Teeth

James Laidlaw — Tue, 30 Jul 2013 14:25:11 GMT

Missing premolars as well by the looks.

Re: Damaged Teeth

Mark Frost — Tue, 30 Jul 2013 13:51:46 GMT

Bingo... missing a few incisors, enamel that is present appears sound - I am quite happy to leave well alone as far as possible.

Many thanks!

Re: Damaged Teeth

Evelyn Barbour-Hill — Tue, 30 Jul 2013 13:37:39 GMT

Enamel hypoplasia.

Possibly to do with nutrition. More likely due to a period of fever at the particular stage in development.

He has some missing teeth too? Unerupted? Broken buried stumps?

Mass extractions are not indicated. In fact no treatment at all may be necessary.

Is the enamel that is present sound, or is it a bit degenerate and still flaking off?

Re: Damaged Teeth

Rob Loxley — Tue, 30 Jul 2013 13:36:02 GMT

[quote user="Mark Frost"]I suspect extraction sooner rather than later would be sensible, they aren't pain at the moment but its only a matter of time[/quote]

With the enamel hypoplasia, if there's just dentine rather than pulp exposure, wouldn't some restorative dentistry with some kind of composite be in order? I guess the subgingival part of the tooth would need assessing first