Are feline super-errupted canines always a sign of apical root lesions?

Re: Are feline super-errupted canines always a sign of apical root lesions?

Miriam Lodewyks — Sat, 13 Sep 2014 13:43:01 GMT

Thank you Pete and Evelyn for your interesting points of view. I did not know that teeth go translucent "naturally" with age, I was under the impression it was a sign of pathology. From your discussion, I guess I'll have to continue making judgement-calls on each individual tooth... until such time as the bosses agree to purchase that dental radiography equipment I've been asking for.

Re: Are feline super-errupted canines always a sign of apical root lesions?

Evelyn Barbour-Hill — Mon, 08 Sep 2014 17:35:09 GMT

[quote user="Peter Southerden"]There isn't a lot published regarding extruded teeth but what there is suggests that extrusion is related to tooth resorption. Limited evidence is perhaps more useful than statements such as "it seems to be a phenomenon related to periodontal disease" and "it's not related to resorptive lesions or any sort of periapical pathology".[/quote]

Mea culpa.

[quote user="Peter Southerden"]The stats relating to in vivo analysis of maxillary canine tooth extrusion is interesting but we know that histological examination will be more accurate in finding evidence of tooth resorption.[/quote]

But come on, Peter, they examined a grand total of nine teeth. Four had been "extruded" and all had histological evidence of resorption. Five had not been "extruded" and one of those had histological etc.. Interesting perhaps, and that's about all.

Which may lead to other interesting questions..... if the degree of resorption is so small as to be only detectable histologically, how can it be taken into account in making therapeutic decisions; and, indeed, is it actually significant to health at all? How many of those molars and premolars which we confidently assert on radiography to have healthy roots maybe would have histological evidence of resorption?

[quote user="Peter Southerden"]There are many factors that will need to be considered regarding the decision whether to extract or not, including radiography, age and health of cat, stage and progression of the disease, presence of periodontitis, evidence of alveolar osteitis, other oral disease, owner preference.[/quote]

Quite so. Which is why I would not advise anyone to "usually extract them".

Re: Are feline super-errupted canines always a sign of apical root lesions?

Peter Southerden — Mon, 08 Sep 2014 17:08:30 GMT

These cases need to be radiographed in order to make a decision whether/how to extract. Hopefully we can agree on that.

There isn't a lot published regarding extruded teeth but what there is suggests that extrusion is related to tooth resorption. Limited evidence is perhaps more useful than statements such as "it seems to be a phenomenon related to periodontal disease" and "it's not related to resorptive lesions or any sort of periapical pathology".

The stats relating to in vivo analysis of maxillary canine tooth extrusion is interesting but we know that histological examination will be more accurate in finding evidence of tooth resorption.

There are many factors that will need to be considered regarding the decision whether to extract or not, including radiography, age and health of cat, stage and progression of the disease, presence of periodontitis, evidence of alveolar osteitis, other oral disease, owner preference.

Re: Are feline super-errupted canines always a sign of apical root lesions?

Evelyn Barbour-Hill — Mon, 08 Sep 2014 14:04:55 GMT

With respect, Peter, that's a slightly misleading statement. ..... on histological examination, " Four of 4 canine teeth with extrusion (100 %) showed histological evidence of resorption, compared to 1 of 5 canine teeth without extrusion (20.0 %)." Admittedly, in simple arithmetic, the figures are 100% and 20% respectively, but quoting them only as percentages gives them a dramatic gloss which is quite unjustified.

Of rather more interest, in vivo ..... " 15 of 24 cats with TR (63.0 %) exhibited extrusion of maxillary canine teeth, compared to 9 of 29 cats without TR (31.0 %)." Now, although the statistical analysis is faultless I'm sure, that's still not a huge sample. Moreover, "TR" in this case stood for even the smallest detectable degree of Tooth Resorption. And even in those without even the smallest detectable resorption, 9 out of 29 exhibited extrusion.

I think that the authors' cautious conclusion, stated in the Summary as: .... "These results suggest that tooth extrusion is linked to or may be caused by similar factors responsible for the development of TR." is all one can draw from this paper.

Which I admit clashes with what I said to the OP about it being "not related to resorptive lesions" but I still see no evidence that resorption is the cause of super-eruption or any reason for summary extraction.

Re: Are feline super-errupted canines always a sign of apical root lesions?

Evelyn Barbour-Hill — Mon, 08 Sep 2014 13:20:00 GMT

[quote user="Peter Southerden"]Abnormal extrusion of canine teeth is often noted in middle aged and geriatric cats.[/quote]

And, indeed, in elderly cats which are not geriatric.

[quote user="Peter Southerden"] A recent study by Lewis (2008) which examined extruded and non extruded teeth showed that all extruded teeth showed histological signs of surface or replacement resorption whereas only 20% of non-extruded teeth showed signs of surface resorption. The results of this study suggest a common aetiology for TR and abnormal tooth extrusion in cats and that extrusion of the maxillary canine teeth may be associated with hypercementosis. This doesn't necessarily mean that these teeth have to be extracted but because of the progressive nature of the pathology I usually do extract them. Taking pre and post operative radiographs is important.[/quote]

Well, I can't argue (yet ) with the findings of the Lewis study, but I commonly find that in "extruded" canine-teeth the remaining attached root is either healthy or healthy enough.

I really cannot see any good reason for extracting the super-erupted (or extruded) tooth unless there is severe, advancing and (in practical terms) uncontrollable periodontitis.

Certainly to find any other reason (such as significant resorption likely to advance to pain or to coronal fracture) to extract the tooth would require radiography, which the original poster does not have access to.

If in doubt, take it out? Absolutely not.

Re: Are feline super-errupted canines always a sign of apical root lesions?

Peter Southerden — Mon, 08 Sep 2014 11:14:18 GMT

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Abnormal extrusion of canine teeth is often noted in middle aged and geriatric cats. A recent study by Lewis (2008) which examined extruded and non extruded teeth showed that all extruded teeth showed histological signs of surface or replacement resorption whereas only 20% of non-extruded teeth showed signs of surface resorption. The results of this study suggest a common aetiology for TR and abnormal tooth extrusion in cats and that extrusion of the maxillary canine teeth may be associated with hypercementosis. This doesn't necessarily mean that these teeth have to be extracted but because of the progressive nature of the pathology I usually do extract them. Taking pre and post operative radiographs is important.

Re: Are feline super-errupted canines always a sign of apical root lesions?

Evelyn Barbour-Hill — Fri, 05 Sep 2014 19:39:04 GMT

[quote user="GrooveJet"]I don't have a dental x-ray machine, so often un-sure whether these sturdy, apparently normal, but super long canines aught to be removed? If there's a lot of bone thickening around the root, or the tooth is going transparent, I usually do...[/quote]

Cripes, no! (Sorry)

"Super-eruption" of cats' canine teeth I don't think has been completely and exhaustively explained, but it seems to be a phenomenon related to periodontal disease if anything. It's not related to resorptive lesions or any sort of periapical pathology.

There's no reason to extract them unless there is advancing, severe and uncontrollable periodontitis going on.

As for going transparent...... cats' teeth do get more and more translucent as their age advances..... don't they?

Re: Are feline super-errupted canines always a sign of apical root lesions?

Rob Davis — Fri, 05 Sep 2014 18:33:30 GMT

Not necessarilly. In my experience they often have associated periodontitis (they are commonly oriental-type cats which tend to be more prone to periodontitis anyway) in which case I will generally extract them, but if they are periodontally sound and have no radiographically visible periapical pathology then I will leave then in situ. I'm sure Evelyn, Rachel or Peter will appear soon with more expert advice.

Re: Are feline super-errupted canines always a sign of apical root lesions?

Hannah Wynne Richards — Fri, 05 Sep 2014 16:42:17 GMT

Ask Evelyn

Wynne