Dentistry: Will these roots be ok?

RE: Dentistry: Will these roots be ok?

Evelyn Barbour-Hill — Thu, 10 Oct 2024 18:23:08 GMT

[quote userid="6386" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245639#245639"]I would raise a gingival flap as I would for a complete canine extraction, remove the bone from the lateral aspect of the root and create some gutters around the mesial aspect, then use luxators and elevators to mobilise the root, I might need to remove more bone laterally then 'normal. but once the root becomes mobile I'd be able to grasp it? Am I oversimplifying it? I hadn't really considered that it would be a LOT more difficult- one course I went on in the past taught to remove the crown when extracting canine teeth as a routine, so I wasn't expecting it to be that difficult?[/quote]

Well, you are experienced and expert as far as i know, so I'm sure you'll get on OK. I'm slightly bothered about others here less experienced perhaps thinking "oh well, that can't be too bad, I'll fit it in before lunch, especially as the senior partner can't see what all the fuss is about..."

You do illustrate how traumatic the process is of course.

And, I have never understood the sense of removing bone from the lateral aspect of the mandibular canine tooth, when the root is medial to the axis of the jaw and courses medially. Ultimately, yes, I guess after removing a lot of bone laterally one will get the job done, but why such an illogical method? If bone is to be removed (as of course it will in this case) then to remove it dorsally and medially makes a lot more sense.

Finally – for general consumption this – just remember that the periodontal structures of the mandibular tooth may be considerably stronger than the mandibular symphysis.

RE: Dentistry: Will these roots be ok?

Kate Richardson — Wed, 09 Oct 2024 13:09:49 GMT

[quote userid="2131" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245608#245608"]What techniques would you propose to use here? What will you grasp the tooth with, as there's no crown left to grasp? [/quote]

I would raise a gingival flap as I would for a complete canine extraction, remove the bone from the lateral aspect of the root and create some gutters around the mesial aspect, then use luxators and elevators to mobilise the root, I might need to remove more bone laterally then 'normal. but once the root becomes mobile I'd be able to grasp it? Am I oversimplifying it? I hadn't really considered that it would be a LOT more difficult- one course I went on in the past taught to remove the crown when extracting canine teeth as a routine, so I wasn't expecting it to be that difficult?

RE: Dentistry: Will these roots be ok?

Evelyn Barbour-Hill — Sun, 06 Oct 2024 22:23:41 GMT

[quote userid="6386" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245600#245600"]Ok so what potential complications can occur with endodontic treatment?[/quote]

Well, if it fails, more or less the same as would occur with an untreated tooth. Assuming it's competently done, failure should be very rare in the canine teeth of the cat.

Which I suppose one might say about the complications that can occur with extraction.

[quote userid="6386" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245600#245600"]Also highly unlikely to be a similar price![/quote]

Hmm. OK.

What techniques would you propose to use here? What will you grasp the tooth with, as there's no crown left to grasp? Genuine questions.

[quote userid="14235" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245603#245603"]At least locally to me the cost for root canal is going to be a couple of thousand pound[/quote]

No way. Jeepers.

RE: Dentistry: Will these roots be ok?

Luke Bam — Sat, 05 Oct 2024 22:41:34 GMT

extraction of lower canines in a cat is always one of those tense moments isn’t it. All I would add is do not under sell yourself. Exodontics do not require all of the expensive kit that endodontics do BUT proper technique is skilful work and should be charged appropriately. The only ‘wrong’ thing to do in this case is actively promote leaving the roots in situ because we know cats are so useless at showing oral pain. Root canal therapy in the hands of someone much cleverer than me would make the cat more comfy, and in the long term, so would extraction. At least locally to me the cost for root canal is going to be a couple of thousand pounds which is not affordable for most. It’s just a shame that because we still have this image that surely every vet can extract a tooth, we don’t serm to regard good ‘basic’ dentistry as highly as we should. What ever we do, do it well and charge appropriately

RE: Dentistry: Will these roots be ok?

Kate Richardson — Sat, 05 Oct 2024 10:24:32 GMT

Ok so what potential complications can occur with endodontic treatment? I'm not anti it, I just want to be able to give the owner as much info as possible.

I'm not stressed about the extractions and if the root is gone it's gone, unlikely to have any long term issues?

Also highly unlikely to be a similar price!

RE: Dentistry: Will these roots be ok?

Simon Vogel — Tue, 01 Oct 2024 14:27:16 GMT

Arguably the consequences of a failed rct are more noticeable than a grumbling peri-apical disease, as they are less diffuse, and patients/owners tend to be far more conscious of the potential- just ask amongst friends.

RE: Dentistry: Will these roots be ok?

Evelyn Barbour-Hill — Tue, 01 Oct 2024 14:25:26 GMT

[quote userid="12930" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245569#245569"]

Came from a vet doing root canal treatments. Googling root canal monitoring dog, would suggest this was not a unique approach. If you are not xrayng root canal treatment teeth regularly how do you know they are not a source of the same subtle pain that cannot reliably be detected in the fractured tooth without root canal treatment. I have zero personal knowledge or experi nce of any of this. This Google link says x-ray annually. https://vetmed.illinois.edu/2024/01/24/treating-endodontic-disease-in-veterinary-patients/

I'm pretty sure I read on this forum that one vet made owners sign and commit to such x-ray regular follow up or would refuse root canal and extract only.

[/quote]

Crazy. Not logical.

RE: Dentistry: Will these roots be ok?

Beats — Fri, 27 Sep 2024 14:34:24 GMT

I'm pretty sure I read on this forum that one vet made owners sign and commit to such x-ray regular follow up or would refuse root canal and extract only.

RE: Dentistry: Will these roots be ok?

Evelyn Barbour-Hill — Fri, 27 Sep 2024 11:44:30 GMT

[quote userid="6386" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245558#245558"]Why would endodontic treatment be preferable at this stage?[/quote]

Less traumatic.

Less stressful for the veterinary surgeon (especially regarding the mandibular tooth.)

Similar price.

[quote userid="12930" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245561#245561"](But with the need for 6 monthly sedations for monitoring x-rays for life I was once told [/quote]

Absolutely not. Where did that come from?

I quite see it's partly a matter of personal preference. I just say, please give earnest consideration to endodontic treatment in this case.

If the crowns of the teeth were still present, that would be a different matter, endodontics the treatment of choice, and extraction the very last resort if all else failed.

RE: Dentistry: Will these roots be ok?

Clive Ansell — Fri, 27 Sep 2024 09:00:37 GMT

I don't often , but I referred a smooth collie show dog recently that had damaged and had a discoloured upper right canine.

Mostly though, I work in very economically deprived area and getting folk to even book in for basic dentistry is an uphill struggle. It must still be one of the most neglected areas of anial health, along with pet rabbits.

RE: Dentistry: Will these roots be ok?

janine redman — Fri, 27 Sep 2024 08:23:22 GMT

I think very few of my clients would be willing to consider referral for endodontic treatment.

RE: Dentistry: Will these roots be ok?

David Mills — Thu, 26 Sep 2024 22:58:10 GMT

A case of treating a (undefined and probably indefinable) risk as opposed to pathology...?

RE: Dentistry: Will these roots be ok?

Beats — Thu, 26 Sep 2024 20:52:12 GMT

Less traumatic than tooth extraction? (But with the need for 6 monthly sedations for monitoring x-rays for life I was once told - not sure if that is still or ever was mainstream opinion though

RE: Dentistry: Will these roots be ok?

Kate Richardson — Wed, 25 Sep 2024 14:26:37 GMT

[quote userid="2131" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245554#245554"]Please consider endodontic treatment rather than extraction.[/quote]

Why would endodontic treatment be preferable at this stage?

And just to play devils advocate, if the client refused further treatment, would treating with antibiotics until completely sealed reduce the risks of infection down the line? Or would they not penetrate the dead pulp adequately? Or other toxins would still induce inflammation?

RE: Dentistry: Will these roots be ok?

Evelyn Barbour-Hill — Tue, 24 Sep 2024 23:04:49 GMT

[quote userid="6386" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245525#245525"]Great, thank you. I will advise extraction now rather than waiting. I think I would have definitely advised extraction if I had seen the cat within a week of the trauma, it's just that we're 2 months down the line now. [/quote]

Please consider endodontic treatment rather than extraction.

[quote userid="6386" url="~/f/clinical-questions/31036/dentistry-will-these-roots-be-ok/245525#245525"]Do you have a feeling for what percentage of these go on to have problems if the wait and see approach is taken? [/quote]

A percentage? No. But it's a lot. Probably most if you include those in which the problems are not detected and therefore not treated.

RE: Dentistry: Will these roots be ok?

Kate Richardson — Mon, 23 Sep 2024 10:15:40 GMT

Great, thank you. I will advise extraction now rather than waiting. I think I would have definitely advised extraction if I had seen the cat within a week of the trauma, it's just that we're 2 months down the line now.

Do you have a feeling for what percentage of these go on to have problems if the wait and see approach is taken?

RE: Dentistry: Will these roots be ok?

Evelyn Barbour-Hill — Sun, 22 Sep 2024 21:03:54 GMT

The results of having an exposed pulp – well, one still exposed and one previously exposed – buried deep in the maxilla and mandible, covered over by a lid (partial or whole) of soft tissue. Dead pulp, "toxins" and very probably live bacteria going in and out at the apex. At the most dramatic, an abscess might result. More likely, a grumbling continuous peri-apical inflammation, gradually gradually increasing until eventually there are signs that even a human can see.

At that point you might find that you have no option but to extract – and extracting a broken stump from the lower jaw could be a nightmare.

While that's developing there will be a vague almost indefinable toothache, slowly (very slowly perhaps) getting greater though still not revealing itself to the outsider.

Yes, it may never happen. But why wait until it's obvious?

I too used to consider "wait and see" the best option. But that was years ago.

RE: Dentistry: Will these roots be ok?

Kate Richardson — Sun, 22 Sep 2024 15:07:38 GMT

Or will it be much harder to deal with down the line?
sorry for repeat posts Arlo Guthrieedit doesn’t want to work on an iPhone?

RE: Dentistry: Will these roots be ok?

Kate Richardson — Sun, 22 Sep 2024 15:05:08 GMT

I mean I’m assuming infection and inflammation and associated pain but can that be dealt with IF it happens? Are there more serious consequences that might not be fixable?

RE: Dentistry: Will these roots be ok?

Kate Richardson — Sun, 22 Sep 2024 10:51:26 GMT

Thank you Evelyn- could you elaborate on what the consequences might be?

RE: Dentistry: Will these roots be ok?

Evelyn Barbour-Hill — Sat, 21 Sep 2024 19:35:03 GMT

Well, the mucosa has healed over – and even then, a tiny defect. What remains doesn't really look as if there were any resorptions., as you say. I don't think they will be OK. I wouldn't wait for months. I'd do endodontic treatment (yes, you can on buried stumps), which is quite easy in the canine teeth of the cat, now. Otherwise, unless the cat is very very lucky, there will be consequences which may take a long time to become obvious.