Tooth injuring inside of lip

RE: Tooth injuring inside of lip

Evelyn Barbour-Hill — Mon, 09 May 2022 16:20:33 GMT

Excellent.

A lesson to us all to give things time.

RE: Tooth injuring inside of lip

Thomas Johnson — Mon, 09 May 2022 16:09:37 GMT

I saw the cat back today to anaesthetise it and remove 208, but the cat has been showing no signs of oral discomfort for a month, and the sore on the lower gingiva has resolved, there is now a little depression that the crown of the tooth sits in. I have decided to leave well alone.

RE: Tooth injuring inside of lip

Evelyn Barbour-Hill — Tue, 22 Feb 2022 20:00:38 GMT

[quote userid="16672" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/30208/tooth-injuring-inside-of-lip/235964#235964"]Maybe some of the other Dentists/referral practitioners on here have some anecdotes they may be willing to share (or have a reference that I'm not aware of).[/quote]

Martin, everything you say is indisputable and I lkook forward to your paper – which journal will it be, and do we know when?

But in the OP case is there a chance we are over-thinking things? I get the impression from the OP that the traumatic occlusion has developed since, and almost certainly as a result of, the removal of the 307 and 309 crowns. Clearly something has to be done, and in practical terms there is not much choice. Odontoplasty could be successful, if removal of ta small part of the very tip of the main cusp of 208 is sufficient to prevent impingement on the soft tissues. But you can't remove much without getting excessively close to the pulp. To remove more and perform endodontic treatment is theoretically possible, but in my opinion not a practical suggestion. The tiny scale of the tooth makes endodontics difficult and at rather high risk of failure of one kind or another.

Extraction, although I agree it seems a pity to remove a healthy tooth, would solve the immediate problem and instantly restore comfort to the mouth.

Yes, it might result in the development of another traumatic contact, but considering all we have been told about the OP case, in my opinion on the balance of probabilities this is jolly unlikely. In any case, if a further trauma develops it can be dealt with in its turn.

This sort of thing is not uncommon in my experience, tactical extraction solves the problem and complications are rare, unless the traumatic contact has been caused by pre-developing neoplasia or other chronic swelling.

RE: Tooth injuring inside of lip

Martin Hamilton — Tue, 22 Feb 2022 17:21:04 GMT

Anecdotally, and from the cats in our study, none developed lesions on the contralateral side following extraction on one side (that is to say, if extractions were performed on the left side, the formation of new lesions occured only on the left), however that's not to say it can't happen. These cases tend to either go smoothly or become a can of worms, with the latter being less common (<5% of our cases), but still something to be aware of and discuss with the client.

Maybe some of the other Dentists/referral practitioners on here have some anecdotes they may be willing to share (or have a reference that I'm not aware of).

RE: Tooth injuring inside of lip

Thomas Johnson — Tue, 22 Feb 2022 15:40:22 GMT

[quote userid="16672" url="~/001/veterinary-clinical/small-animal/dentistry/f/expert-help/30208/tooth-injuring-inside-of-lip/235960#235960"] Extraction will definitely alleviate the contact you have noted, however in some cats they appear to be able to close the mouth further following extraction, resulting in the development of further contacts. Unfortunately this cannot be easily predicted, but is fortunately uncommon.[/quote]

Thank you for your reply. On the right side of the mouth all of the pre-molars and molars are still present, do you think this makes it less likely that the mouth would close further and create more contact points if 208 is removed?

RE: Tooth injuring inside of lip

Martin Hamilton — Tue, 22 Feb 2022 14:29:51 GMT

Hi Thomas,

Thanks for sharing the case! I am actually in the process of submitting a paper on this very phenomenon! There is very little published in the veterinary literature this far (a paper by Soukup in the Journal of Veterinary Dentistry and Gracis in the Journal of Feline Medicine and Surgery, both 2015).

What you appear to be describing is a traumatic malocclusion, whereby the maxillary fourth premolars are impinging on the soft tissues on the mandible. This can result in a variety of lesions, the most obvious of which are proliferative lesions that resemble pyogenic granulomas, however there are a variety of other lesions such as gingival clefts and foveae of the soft tissues (I'll spare you a long spiel, but the Gracis paper details this and I believe it is open access).

Anyway, long story short, if it is truly impingement of the soft tissues by 208 there are two options - odontoplasty, whereby the cusp of the tooth is reduced slightly and sealed with a sealant, or extraction of the tooth, the latter of which is more invasive. Anecdotally, odontoplasty may be effective but there's always the risk that it is not and extraction is warranted. Extraction will definitely alleviate the contact you have noted, however in some cats they appear to be able to close the mouth further following extraction, resulting in the development of further contacts. Unfortunately this cannot be easily predicted, but is fortunately uncommon.

At the time of addressing the 208 I'd probably take a biopsy of the inflamed tissue and keep a hold of it should extraction or odontoplasty not resolve the lesion which may raise suspicion for a neoplasm.

I don't think it's a bad idea to radiograph the region of the crown amputated 307 and 309's either just to be sure there's nothing else abnormal.