Lingualy displaced canines

RE: Lingualy displaced canines

Rob Davis — Thu, 30 Jul 2020 10:43:21 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29252/lingualy-displaced-canines/224582#224582"]"Yes, Mrs. Bloggs, we should extract that tooth... what, anything less damaging we could do? Well [wry smile} we could refer you to a veterinary dentist, they might be able to cap it or something, of course you'd have to travel quite a way and it would be awfully expensive..." [/quote]

Ha Ha! Yes I empathise with the frustration at this approach. It is however a step forward from "Yes, Mrs. Bloggs, that tooth is broken, but it doesn't seem to be bothering him so lets just leave it alone"....

RE: Lingualy displaced canines

Evelyn Barbour-Hill — Wed, 29 Jul 2020 16:53:14 GMT

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29252/lingualy-displaced-canines/224576#224576"]I think this is being a little harsh,[/quote]

No, I don't think so.

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29252/lingualy-displaced-canines/224576#224576"]While crown reduction and pulp capping is not a particularly difficult procedure, it does require a certain level of knowledge, training, equipment and materials, [/quote]

It does indeed. Technically demanding, one might say. But relatively straightforward for the competent, and, I emphasise, comparatively not expensive.

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29252/lingualy-displaced-canines/224576#224576"] At least selective extractions would resolve the ongoing attrition and possible discomfort and would surely be preferable to no treatment at all, which may be the only other viable alternative in many cases.[/quote]

I did say, OK as a last resort.

Big trauma (literally) to patient, big trauma (psycho-babble metaphorically) to surgeon, big possibility of breaking tooth and leaving root when done by inexperienced, naive (not being patronising – I mean literally) or over-confident surgeon, and expensive if charged properly.

[quote userid="2235" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29252/lingualy-displaced-canines/224576#224576"] and would surely be preferable to no treatment at all, which may be the only other viable alternative in many cases.[/quote]

Yes, would be preferable to no treatment at all. Not sure how or why it should be viewed as the only viable alternative in this case. And in many general practices extraction seems presented as the obvious first choice for so many things – not only this sort of case, but broken teeth for instance. "Yes, Mrs. Bloggs, we should extract that tooth... what, anything less damaging we could do? Well [wry smile} we could refer you to a veterinary dentist, they might be able to cap it or something, of course you'd have to travel quite a way and it would be awfully expensive..."

RE: Lingualy displaced canines

Norman Johnston — Wed, 29 Jul 2020 16:38:14 GMT

Rob. In my opinion vital pulp capping is at the most technical end of endodontic therapy. There is more to go wrong than conventional endo if done by the unskilled and not reviewed properly.
I agree that extraction is always an option in vet dentistry and sometimes the best one for the welfare of the pet.

RE: Lingualy displaced canines

Rob Davis — Wed, 29 Jul 2020 15:36:06 GMT

[quote userid="2131" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/29252/lingualy-displaced-canines/224546#224546"]Extraction is not an option! Well, of course it is an option, but a very last resort. I apologise for using your question as the opportunity for a rant, but I really deplore the readiness in some areas of general practice to offer extraction as the solution to every problem.[/quote]

I think this is being a little harsh, Evelyn! While crown reduction and pulp capping is not a particularly difficult procedure, it does require a certain level of knowledge, training, equipment and materials, most of which is not currently common among first opinion practices. At least selective extractions would resolve the ongoing attrition and possible discomfort and would surely be preferable to no treatment at all, which may be the only other viable alternative in many cases.

RE: Lingualy displaced canines

Dinu Catilina — Tue, 28 Jul 2020 22:00:05 GMT

Thank you both, I'll have a word with the owner and encourage referral.

RE: Lingualy displaced canines

Norman Johnston — Mon, 27 Jul 2020 16:34:07 GMT

You don’t say how old this dog is but I would see this quite often in rehomed Staffies.
I think it’s four teeth that need attention of some form. From the semi open mouth view it looks as if extraction of either uppers or lowers is not an elegant solution by itself.
Most probably crown reduction of the lower canines with direct pulp capping combined with a sealant on the attrition sites of the upper canines assuming still vital.
A recheck at four months will ensure continued vitality of all canines with a second reseal of the uppers.
This will be the most costly option but functionally the best.

RE: Lingualy displaced canines

Evelyn Barbour-Hill — Mon, 27 Jul 2020 15:47:56 GMT

Extraction is not an option! Well, of course it is an option, but a very last resort. I apologise for using your question as the opportunity for a rant, but I really deplore the readiness in some areas of general practice to offer extraction as the solution to every problem.

OK, got that off my chest.

I would strongly suggest shortening of the lower canine teeth. This will of course mandate pulp capping but in this sort of situation it's a fairly straightforward procedure and not very expensive (certainly cheaper than extraction).

Orthodontic movement is also theoretically possible but I would say not at all appropriate in this case.

But bear in mind that the upper canines will also have to be assessed. With that degree of wear there is a possibility of endodontic disease in these teeth ( and the tip of the crown of 204 has either been broken or worn [I think just worn, from the photo, but can't be sure]). And there's something wrong with 202, maybe 203 as well, looking on the lingual side; I suspect this is from traumatic wear, but I can't be sure from the photo.