Feline resorption lesions

RE: Feline resorption lesions

Nicola Cole — Fri, 04 Dec 2015 20:24:20 GMT

Many thanks for the replies. The reason for my question is because I had a couple of years off doing anything dentalwork-wise (had child then back to work part time and hardly seeing any dental work) and have noticed a definite difference in my ability to remove those very well seated teeth with resorption in non-geriatric cats-whether it be that I am more concerned these days about doing things as atraumatically as possible (always was concerned so don't think it's that) or out of practice and had a dip in my technique as hardly having to deal with teeth at moment or whether I've just had a run of ankylosed ones I'm not sure!

Dental CPD or going to see practice with a specialist is next on my agenda!

RE: Feline resorption lesions

Tom Ward — Mon, 30 Nov 2015 18:27:38 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Tom Ward"]

[quote user="Evelyn Barbour-Hill"]

Don't necessarily do anything.

[/quote]

That tends to be my approach a lot of the time. Is that because it is a balance of risk (painful tooth vs risk of jaw f#) or because they don't need attention? If these lesions are painful, shouldn't we do something? Could a crown amputation be suitable if there is no visible periodontal ligament space even if the root appears intact?

[/quote]

Take a common situation:

The lower canines look fine on external inspection; the gum is not inflamed; the gum level is normal, or a little low, or the teeth are mildly super-erupted; no probe; no mobility; no symptoms. On the Xray survey, you find some resorption, often quite extensive, in the roots:

in that common situation I don't do anything other than record it and tell the owner, and of course "monitor" it (i.e. remember to look carefully at these teeth whenever I look at the teeth, which would of course be whenever I see the cat).

Why would they need attention? Why would they be painful?

It's not a matter of balance of risk. If there's a painful tooth, it needs attention – if there's a risk of jaw fracture you must just be very careful.

I'm aware of a school of thought that every tooth with resorption should be extracted. In my opinion this is completely irrational.

Now then, if you do need to extract a lower canine in that situation – perhaps because the resorptive lesion is peeking out at the gum line – proceed carefully in your normal skilled extraction way. So you won't fracture the tooth through a normal part: that horrid sharp crack that we all dread. Possibly, the tooth may come out "intact" (inverted commas there, because obviously it won't be intact if some has vanished through resorption). Very probably, it will break at a natural point where a high proportion (50%?) of dentine has been resorbed and replaced. That will be a squidgier sort of breaking sound. That's OK, just tidy up the broken surface a little bit (make sure there are no spikes sticking up), tidy up the edges of the alveolus (no spiky bits, no loose bits, no possibly non-viable bits, and maybe reduce the edges a bit so that the flap goes across comfortably), flush like mad, and suture the gingiva and periosteum across. Don't fret if you can't completely close the hole.

[quote user="Tom Ward"] Could a crown amputation be suitable if there is no visible periodontal ligament space even if the root appears intact?[/quote]

Assuming that you did actually need to remove that tooth, yes it could.

[/quote]Many thanks Evelyn - makes me feel better about approaching these teeth!

RE: Feline resorption lesions

Evelyn Barbour-Hill — Sun, 29 Nov 2015 16:12:00 GMT

[quote user="Anthony Todd"]Does anyone ever tap the suspect tooth with the finger end of a pair of artery forceps, easy with canines?[/quote]

Yes, of course. If pain reaction tooth probably painful. If no reaction, it means nothing.

[quote user="Anthony Todd"]Dentists sometimes place an ethyl chloride swab on a suspect tooth. You sure know if the tooth is alive.....[/quote]

Yes, or an ice stick does the same. But we aren't debating here how to tell if a pulp is vital or not.

RE: Feline resorption lesions

Anthony Todd — Sun, 29 Nov 2015 11:51:26 GMT

[quote user="Liz white"]Evelyn, what criteria do you use in deciding if which of these teeth are painful? [/quote]

Does anyone ever tap the suspect tooth with the finger end of a pair of artery forceps, easy with canines?

Seemed to work for dinovets.

Dentists sometimes place an ethyl chloride swab on a suspect tooth. You sure know if the tooth is alive.....

RE: Feline resorption lesions

Liz w — Sat, 28 Nov 2015 21:22:16 GMT

Thanks, that makes sense.

RE: Feline resorption lesions

Evelyn Barbour-Hill — Sat, 28 Nov 2015 18:12:17 GMT

[quote user="Liz white"]Evelyn, what criteria do you use in deciding if which of these teeth are painful? [/quote]

You mean the mandibular canines?

Why should they be painful?

The pain associated with resorptive lesions is the pain of pulp exposure or near-exposure.

When the resorption is above gum line, or exposed in some other way, or close to being exposed, the tooth is going to be painful.

The same applies to all teeth. But of course, if it's something like a lower 7, you might as well extract it as soon as you know it's resorbing – that doesn't apply to a lower 4.

RE: Feline resorption lesions

Liz w — Sat, 28 Nov 2015 16:25:33 GMT

Evelyn, what criteria do you use in deciding if which of these teeth are painful?

RE: Feline resorption lesions

Bob Russell — Sat, 28 Nov 2015 10:25:17 GMT

Two advantages human dentists have are a patient that can tell you it hurts and easy radiography every six months or so.

We don't have that advantage so must do the best we can to work out the likelihood of a tooth being painful!

RE: Feline resorption lesions

Catriona MacIntyre — Fri, 27 Nov 2015 22:02:58 GMT

[quote user="Evelyn Barbour-Hill"]I'm aware of a school of thought that every tooth with resorption should be extracted. In my opinion this is completely irrational.[/quote]

Evelyn..... you've gained a massive fan. I feel much happier now!

RE: Feline resorption lesions

Evelyn Barbour-Hill — Fri, 27 Nov 2015 21:34:50 GMT

[quote user="Tom Ward"]

[quote user="Evelyn Barbour-Hill"]

Don't necessarily do anything.

[/quote]

Take a common situation:

Why would they need attention? Why would they be painful?

It's not a matter of balance of risk. If there's a painful tooth, it needs attention – if there's a risk of jaw fracture you must just be very careful.

I'm aware of a school of thought that every tooth with resorption should be extracted. In my opinion this is completely irrational.

[quote user="Tom Ward"] Could a crown amputation be suitable if there is no visible periodontal ligament space even if the root appears intact?[/quote]

Assuming that you did actually need to remove that tooth, yes it could.

RE: Feline resorption lesions

Virginia Campbell — Fri, 27 Nov 2015 21:06:06 GMT

It's my impression that often all the roots of the affected teeth will do the same thing in the individual. So if I have tried a couple of teeth and the roots seem to be ankylosed, I only make a token trial effort on the rest before reaching for the drill. If I've got roots out intact, I spend much more time trying the rest. The senior partners have said dental radiography is in our near future though so hopefully won't have to rely on this approach for much longer.

RE: Feline resorption lesions

Martin Atkinson — Fri, 27 Nov 2015 19:05:24 GMT

[quote user="Tom Ward"]Could a crown amputation be suitable if there is no visible periodontal ligament space even if the root appears intact?[/quote]Pretty much what I said and I'm quite surprised no one has red-starred me yet!

RE: Feline resorption lesions

Tom Ward — Fri, 27 Nov 2015 18:47:16 GMT

[quote user="Evelyn Barbour-Hill"]

Don't necessarily do anything.

[/quote]

RE: Feline resorption lesions

Evelyn Barbour-Hill — Fri, 27 Nov 2015 18:44:23 GMT

[quote user="Tom Ward"]Still doesn't help with working out what to do with those elderly cats with bilateral lower canine resorptive lesions though - they still make my blood run cold.[/quote]

Don't necessarily do anything.

RE: Feline resorption lesions

Tom Ward — Fri, 27 Nov 2015 18:42:28 GMT

+1 not being without dental radiography - it really is a godsend and in our practice, after about 18 months it now gets used multiple times on a daily basis (probably >50% of 'dentals').

Still doesn't help with working out what to do with those elderly cats with bilateral lower canine resorptive lesions though - they still make my blood run cold.

RE: Feline resorption lesions

Nicola Lawlor — Fri, 27 Nov 2015 14:36:17 GMT

I wouldn't be without dental xray anymore - it seriously saves time and stress for many of these cases. It also regularly highlights teeth that look fine on the surface but have issues below the gumline - I had a dog today with a perfectly good looking tooth but on xray one root was missing a great chunk below the gumline. I split the tooth prior to removal and the crown on that side fell off without me even touching it, thankfully the rest of the root was easily located and removed.

Don't give yourself a time on dental extractions. Patience is a big thing and technique too. I would really advise spending time doing practical dental CPD as it makes a huge difference both for you and your patients. It helps you understand what you should be explaining to clients and if you do that properly clients usually do not mind paying appropriate fees for the dental work.

RE: Feline resorption lesions

Bob Russell — Fri, 27 Nov 2015 09:55:43 GMT

Radiography can save a lot of time. You can see where attempting to remove a root is not going to be possible. It can determine those that you really should be able to get out!

Just started to use a high speed handpiece with built in LED - wonderful!!

Better to charge a few quid for an X-ray and save time and money trying to remove the unremovable!

RE: Feline resorption lesions

Martin Atkinson — Fri, 27 Nov 2015 09:43:42 GMT

[quote user="Nicola M"]how long would you expect it to take to extract a feline tooth with a neck lesion,[/quote]Evelyn's response is of course the correct one but we don't all have the benefit of the equipment, time and experience that he has and not all clients are prepared to pay for the time if costed properly.

So my take on this is that: it takes as long as I reasonably believe that I will be causing more harm by continuing than stopping which on average is 5 minutes per root. As Evelyn suggests a large number of these have ankylosed anyway and you're not going to get them out without taking half the mandible with them so they end up being crown amputations. If the fracture root fragment is well below the edge of the alveolar bone, doesn't look infected or necrotic then it is probably fine to leave it in situe. This approach has served me well for 40 years and although I know the cat can't tell me if its still in pain it's response to the procedure to all intents and purposes suggest that it is sound one.

I know that this will result in a flurry of brickbats from the veterinary dentists amongst us!

RE: Feline resorption lesions

Evelyn Barbour-Hill — Thu, 26 Nov 2015 23:41:08 GMT

Well, various answers

1. I've no idea, I've never timed myself.

2. There's no sense in judging by time. Judge by the feel of it. I am perfectly serious. This is why extraction is a manual skill which has to be learned.

3. If you know it's resorptive, because there's a "neck lesion", then you know it may be ankylosed.

4. Don't put yourself into the absence of radiography?

Does that help?