Dental pain or FOPS?

RE: Dental pain or FOPS?

Evelyn Barbour-Hill — Sun, 10 Feb 2019 23:58:49 GMT

[quote user="Kate Richardson"]don't have a specific tool for this other than my dental probes- will they suffice? [/quote]

I confess I've always relied on my sharp "shepherd's hook" explorer. Pathfinders are great for locating a narrow canal opening when you've started a preparation, but it never occurred to me to try one to test for an exposure. Do you think I could be missing any?

[quote user="Kate Richardson"]109/209 were not mobile. Clinically I do not tend to see pain associated with mobility of these, nor of the incisors- am I underestimating it?[/quote]

Peter Kertesz held that mobility was not, alone, a good criterion by which to judge a tooth.

In the cat I generally extract a mobile upper 9, if it has any inflammation around it at all (i.e. almost always) because, to put it bluntly, it's so easy. I also used to hypothesise that extracting the 9 altered the flow of saliva and food around the 8 and thus the health of the 8 could be improved, but eventually reached the conclusion that it made no difference.

In contrast, I do believe that even very mobile incisors can perfectly well be left alone as long as there is no visible inflammation around.

RE: Dental pain or FOPS?

Kate Richardson — Sun, 10 Feb 2019 21:27:54 GMT

Thanks Rachel

[quote user="Rachel Perry"] 204 is also fractured at the tip. Please assess this very carefully clinically if you end up anaesthetising it.[/quote]

I assessed when he was anaesthetised for the radiographs and the pulp did not appear to be exposed, but I don't have a specific tool for this other than my dental probes- will they suffice? I must admit I was more focused on the right side as that is the side he paws at.

109/209 were not mobile. Clinically I do not tend to see pain associated with mobility of these, nor of the incisors- am I underestimating it?

[quote user="Rachel Perry"]I think there may be a small area of surface resorption on the medial aspect of the medial root of 408- needs monitoring and re-radiographing maybe in 6 months.[/quote]

I'll take a closer look.

I'm pretty sure we will extract 104, and yes, I pretty much always use nerve blocks now I know I'm doing them correctly after the course with your good self

RE: Dental pain or FOPS?

Rachel Perry — Sun, 10 Feb 2019 13:53:09 GMT

Hi Kate,

I would agree it doesn't sound like a typical FOPS case- these are really distressing for everyone. But it's a Burmese, and who knows if the chronic underlying dental pain can't turn into FOPS as you said.

Main areas of concern from you radiographs: 104 as you've already said, but 204 is also fractured at the tip. Please assess this very carefully clinically if you end up anaesthetising it. An endodontic 'pathfinder' file is a very useful instrument for trying to ascertain if the pulp is exposed or not.

The PDL spaces of 109, 209 look wide- check there's no mobility.

402- resorption as you've spotted, but the other mandibular incisors are showing 50% attachment loss so wouldn't be wrong to extract them too.

I think there may be a small area of surface resorption on the medial aspect of the medial root of 408- needs monitoring and re-radiographing maybe in 6 months.

Regarding treatment for 104- you then have a quandary for extraction over root canal therapy. Extraction will resolve the problem but is more surgically invasive/painful and you may then end up with 404 causing lip catch. Root canal therapy less invasive and perhaps painful, but success rate only up to around 80% and requires GA to re-radiograph in the future. Either way, local anaesthetic nerve blocks recommended!

Hope it goes OK.

RE: Dental pain or FOPS?

Evelyn Barbour-Hill — Thu, 07 Feb 2019 23:21:50 GMT

[quote user="Kate Richardson"](We bought some diamond burs a few months ago and its my new favourite bur Are all dentists as sad as me? )[/quote]

Yes.

[quote user="Kate Richardson"]So am I right about the lucent halo around the root apex? For future ref. [/quote]

I think so.

[quote user="Rob Davis"] Is it my imagination or is there a mass in the region of the missing 01s?[/quote]

Well, I think that's normal soft tissue shadow. But I'm blowed if I can see how one would tell the difference.

I was assuming the 402 had just been partly resorbed as a result of neighbouring inflammation.

RE: Dental pain or FOPS?

Kate Richardson — Thu, 07 Feb 2019 21:32:17 GMT

[quote user="Evelyn Barbour-Hill"]It doesn't sound severe enough to fit the FOPS syndrome, does it? I'm open to correction on that, though.[/quote]

[quote user="Jenny Boyd"]I’m not sure how variably it can present but have seen two cases of FOPS in Burmese cats and it is genuinely distressing to watch them when they have an attack as the pain seems so severe. So possibly this is more due to the dental disease?[/quote]

Agree, I've just had early FOPS on my radar with this cat since I first started seeing him about a year ago and they mentioned casually the intermittent facial pain/irritation, so have been a keeping a close eye on him for progression, assuming some start subtly and progress. My only experiences have also been with severe cases causing severe self trauma; however he has had a couple of recurrent abscesses on his head with no obvious cause and has been assumed cat bites as he does go out, but I'm keeping my options open. The intermittent nature of the 'pain' is hard to interpret- I suppose could be either dental or nerve pain I guess. If it resolves after extraction then we'll know!

[quote user="Evelyn Barbour-Hill"]Yes, obviously 104 needs to be extracted, unless it has endodontic treatment.[/quote]

So am I right about the lucent halo around the root apex? For future ref.

[quote user="Evelyn Barbour-Hill"]And while you're about it, inspect the 307 and 407 sites very carefully. If there's any suspicion of redness, slit the gingiva there and use a small round diamond to bur down the protruding bone/tooth remnant.[/quote]

Completely healed over, no inflammation whatsoever. (We bought some diamond burs a few months ago and its my new favourite bur Are all dentists as sad as me? )

[quote user="Rob Davis"]What's going on with the 402. Is it my imagination or is there a mass in the region of the missing 01s?[/quote]

I'll have another look at radiograph tomorrow (I so about to write 'rad' then remembered Evelyn would be reading ) but there was no inflammation/swelling.

[quote user="Evelyn Barbour-Hill"]Lovely radiographs, by the way.[/quote]

Thank you kindly sir. I can't tell you how much that has made my day.

RE: Dental pain or FOPS?

Rob Davis — Thu, 07 Feb 2019 20:32:03 GMT

What Evelyn said.

What's going on with the 402. Is it my imagination or is there a mass in the region of the missing 01s?

RE: Dental pain or FOPS?

Jenny Harris — Thu, 07 Feb 2019 19:57:27 GMT

I’m not sure how variably it can present but have seen two cases of FOPS in Burmese cats and it is genuinely distressing to watch them when they have an attack as the pain seems so severe. So possibly this is more due to the dental disease? But if it is FOPS then dental treatment could really flare it up so I would go in hard with the multi-modal analgesia and if needed, phenobarb

RE: Dental pain or FOPS?

Evelyn Barbour-Hill — Thu, 07 Feb 2019 19:49:18 GMT

It doesn't sound severe enough to fit the FOPS syndrome, does it? I'm open to correction on that, though.

Yes, obviously 104 needs to be extracted, unless it has endodontic treatment.

And while you're about it, inspect the 307 and 407 sites very carefully. If there's any suspicion of redness, slit the gingiva there and use a small round diamond to bur down the protruding bone/tooth remnant.

Lovely radiographs, by the way.

RE: Dental pain or FOPS?

Kate Richardson — Thu, 07 Feb 2019 18:38:09 GMT

Cat is a 12yo MN Burmese, intermittent signs of left facial pain/irritation, not self traumatising

104 has fractured tip and have been monitoring it for a while as owners reluctant to extract, but I think it needs to come out- wider pulp cavity and some lucency around root apex? I'm not seeing any other obvious lesions on the remainder of the teeth other than 402 and the resorption of 307/407, but I wanted some confirmation. May or may not fix the intermittent pain signs, but want to be able to justify extraction.

Thanks!