Small Animal Dental, Oral and Maxillofacial Disease A Colour

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Copyright © 2010 Manson Publishing Ltd

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Dedication
3
This book is dedicated to all who have helped me to become someone who could write/edit a book
worth reading.
There are numerous veterinarians who have influenced my life and my career. From my first dental
mentor, Dr. Michael Floyd, I learned not only dentistry, but also how to practice while still enjoying
a balance of fun in life. Special thanks to my true mentor and founding member of the AVDC,
Dr. Thomas Mulligan. Fortunately, you saw promise in me and worked diligently to bring it out,
even if I was reluctant initially. Thank you for taking me under your wing and teaching me to be my
best, through all those late nights at Main Street. However, veterinary medicine is more than
dentistry. I would like to thank Dr. Barry Neichin, my first employer and the best general practitioner
I know, for teaching me the basics of veterinary medicine. Drs. Michael Kelly and Robert Tugend
continued that training and taught me that working in a team is rewarding. Finally, I would like to
thank Dr. Robert Rooks, from whom I gained skills in marketing and client communications.
In addition to the veterinarians who have helped me along the way, I have benefited from working
with a great group of technicians and assistants. First and foremost in this group is Dawn Sabatino,
my right hand (and occasionally my left) for the last decade. So much of my practice would not be
possible without you; thanks for all that you do. I owe many thanks to Robert Furman (soon to be
a veterinarian) who was instrumental in starting my dental practice as well as making my life easier
with his computer and electrical and handy man skills. A note of thanks is also due for my assistants
who went above and beyond in years past: Teresa, Wendy, Tia, and Diane.
Outside of veterinary medicine, I would like to thank and recognize my original inspiration and
uncle, Dr. Greg Steiner DDS, who told me back in the 1980s to do veterinary dentistry! A special
note of gratitude to my old adventure buddy, Lynel Berryhill, whose support and technical help
during my applications to the Dental College and Academy were invaluable. I couldn’t have done
it without you. I also owe a big thank you to Dr. Katie Kangas for her countless hours of editing.
This has greatly improved your (the readers’) experience.
And finally, this book is largely dedicated to my parents Jim and Toni. Without your emotional
and financial support, my years of school, training, and practice would not have been possible. Thank
you for going above and beyond as parents, friends, and business mentors. You’re the best!
Thanks to all of you for the contributions you have made to my life, which in turn have led to
the creation of this book.

Brook
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CONTENTS
4
Foreword . . . . . . . . . . . . . . 6 Step 6: Developing the Complicated crown fracture
Preface . . . . . . . . . . . . . . . . 7 radiograph . . . . . . . . . . . . 69 (open crown fracture) . . 130
Abbrevations . . . . . . . . . . . . 8 Step 7: Techniques for various Caries (cavity,
individual teeth . . . . . . . . 72 tooth decay) . . . . . . . . . 133
Step 8: Interpreting dental Type 1 feline tooth
CHAPTER 1 radiographs . . . . . . . . . . . 79 resorption (TR) . . . . . . . 136
Anatomy and Type 2 feline tooth resorption
Physiology CHAPTER 4 (TR) . . . . . . . . . . . . . . . 138
Canine dental anatomy . . . . . 10 Pathology in the Pediatric Enamel hypoplasia and
hypocalcification . . . . . . 140
Feline dental anatomy . . . . . . 12 Patient
Dental abrasion . . . . . . . . . 142
Rodent and lagomorph Persistent deciduous
dental anatomy . . . . . . . . 13 teeth . . . . . . . . . . . . . . . . 90 Dental attrition . . . . . . . . . . 144
Dental terminology . . . . . . . 14 Fractured deciduous External resorption . . . . . . . 146
Tooth development . . . . . . . 17 teeth . . . . . . . . . . . . . . . . 93 Internal resorption . . . . . . . 148
Enamel, dentin, and pulp . . . 18 Malocclusions (general) . . . . 95 Intrinsic stains (endogenous
Deciduous malocclusions . . . 96 stains) . . . . . . . . . . . . . . 149
Periodontium . . . . . . . . . . . . 20
Class I malocclusions . . . . . . 98 Extrinsic stains (exogenous
Bones of the face and jaws . . . 22 stains) . . . . . . . . . . . . . . 151
Muscles, cheeks, and lips . . . . 26 Mesioversed maxillary
canines (lance effect) . . . 100 Primary endodontic lesion with
Neurovascular structures . . . 28 secondary periodontal
Base narrow canines . . . . . . 102 disease . . . . . . . . . . . . . . 152
Joints of the head . . . . . . . . . 31
Class II malocclusion Primary periodontal lesion with
Hard and soft palates . . . . . . 32 (overshot, mandibular secondary endodontic
Tongue . . . . . . . . . . . . . . . . 34 brachygnathism) . . . . . . 104 involvement . . . . . . . . . 153
Salivary glands . . . . . . . . . . . 36 Class III malocclusion Combined endodontic and
(undershot) . . . . . . . . . . 106 periodontal lesion . . . . . 155
Lymph nodes and tonsils . . . 38
Class IV malocclusion Idiopathic root
(wry bite) . . . . . . . . . . . 108 resorption . . . . . . . . . . . 156
CHAPTER 2 Cleft palate . . . . . . . . . . . . . 110
Oral Examination Cleft lip (harelip) . . . . . . . . 112 CHAPTER 6
Step 1: History . . . . . . . . . . 40 Tight lip . . . . . . . . . . . . . . . 113 Problems with
Step 2: General physical Hypodontia/oligodontia and the Gingiva
examination . . . . . . . . . . 41 anodontia (congenitally
missing teeth) . . . . . . . . 114 Gingivitis . . . . . . . . . . . . . . 160
Step 3: Orofacial
examination . . . . . . . . . . 42 Impacted or embedded Periodontitis . . . . . . . . . . . . 164
Step 4: Conscious (awake) (unerupted) teeth . . . . . 116 Generalized gingival
intraoral examination . . . . 44 Dentigerous cyst enlargement (gingival
(follicular cyst) . . . . . . . . 118 hyperplasia) . . . . . . . . . . 170
Step 5: The anesthetized
orodental examination . . . 54 Odontoma . . . . . . . . . . . . . 119 Trauma . . . . . . . . . . . . . . . 172
Hairy tongue . . . . . . . . . . . 121 Epulids . . . . . . . . . . . . . . . . 173
CHAPTER 3 Enamel hypocalcification Gingivostomatitis (caudal
(hypoplasia) . . . . . . . . . . 122 stomatitis) in cats . . . . . 176
Veterinary Dental
Radiology Feline juvenile (puberty)
Step 1: Patient gingivitis/periodontitis . 124 CHAPTER 7
positioning . . . . . . . . . . . 64 Oral papillomatosis . . . . . . . 126 Pathologies of the Oral
Step 2: Film placement within Mucosa
the patient’s mouth . . . . . 64 CHAPTER 5 Oronasal fistula . . . . . . . . . . 184
Step 3: Positioning the beam Pathologies of the Dental Eosinophilic granuloma
head . . . . . . . . . . . . . . . . 65 Hard Tissues complex . . . . . . . . . . . . 186
Step 4: Setting the Chronic ulcerative paradental
exposure . . . . . . . . . . . . . 67 Uncomplicated crown
fracture (closed crown stomatitis (CUPS)
Step 5: Exposing the fracture) . . . . . . . . . . . . 128 (kissing lesions) . . . . . . . 189
radiograph . . . . . . . . . . . . 68
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CONTENTS
5
Immune-mediated Fractures . . . . . . . . . . . . . . 207 Osteosarcoma . . . . . . . . . . . 235
diseases affecting the Traumatic tooth avulsion and
oral cavity . . . . . . . . . . . 192 luxation . . . . . . . . . . . . . 214
Uremic stomatitis . . . . . . . . 194 CHAPTER 10
Root fractures . . . . . . . . . . . 216 Pathologies of the
Candidiasis (thrush) . . . . . . 195 Osteomyelitis . . . . . . . . . . . 217 Salivary System
Caustic burns of the oral Tumors and cysts . . . . . . . . 218
cavity . . . . . . . . . . . . . . . 197 Sialoceles . . . . . . . . . . . . . . 238
Hyperparathyroidism . . . . . 221 Salivary gland tumors . . . . . 240
Tetanus . . . . . . . . . . . . . . . 222 Sialoliths (salivary stones) . . 241
CHAPTER 8
Botulism . . . . . . . . . . . . . . 224
Problems with Muscles,
Bones, and Joints
Masticatory myositis . . . . . . 200 CHAPTER 9 Appendices ........243
Craniomandibular Malignant Oral Neoplasia
osteopathy . . . . . . . . . . 202 Introduction . . . . . . . . . . . 226
Idiopathic trigeminal References .........249
Malignant melanoma . . . . . 228
neuritis . . . . . . . . . . . . . 204
Fibrosarcoma . . . . . . . . . . . 230
Temporomandibular joint Index .............267
luxation . . . . . . . . . . . . . 205 Squamous cell carcinoma . . 232
Temporomandibular joint Histologically low-grade,
dysplasia . . . . . . . . . . . . 206 biologically high-grade,
fibrosarcoma . . . . . . . . . 234

CONTRIBUTORS

Chapter 1: Anatomy and Physiology Chapter 6: Problems with the Gingiva

John R. Lewis, VMD, FAVD, DAVDC Linda DeBowes DVM, MS, DACVIM, DAVDC
Assistant Professor of Dentistry and Oral Surgery Shoreline Veterinary Dental Clinic, Seattle, USA
Matthew J. Ryan Veterinary Hospital of the
Chapter 7: Pathologies of the Oral Mucosa
University of Pennsylvania, Philadelphia, USA Brook A. Niemiec DVM, DAVDC, FAVD
Alexander M Reiter, Dipl Tzt, Dr med vet, Southern California Veterinary Dental Specialties,
DAVDC, EVDC San Diego, USA
Assistant Professor of Dentistry and Oral Surgery Chapter 8: Problems with Muscles, Bones, and
Matthew J. Ryan Veterinary Hospital of the Joints
University of Pennsylvania, Philadelphia, USA Kendall G. Taney, DVM, DAVDC, FAVD
Chapter 2: Oral Examination Center for Veterinary Dentistry and Oral Surgery,
Lee Jane Huffman, DVM, DAVDC Gaithersburg, MD, USA
Pet Emergency Clinics and Specialty Mark M. Smith, VMD, DACVS, DAVDC
Hospital,Ventura and Thousand Oaks, USA Center for Veterinary Dentistry and Oral Surgery,
This chapter is dedicated with all my love to Gaithersburg, MD, USA
Rebeckah, Nonatime, and my wee ‘Monsieur’.
Chapter 9: Malignant Oral Neoplasia
Chapter 3: Veterinary Dental Radiology Ravinder S. Dhaliwal DVM, MS, DACVIM,
Brook A. Niemiec DVM, DAVDC, FAVD DABVP
vetdentalrad.com Pet Care Veterinary Hospital, Santa Rosa, CA, USA
Chapter 4: Pathology in the Pediatric Patient This chapter is dedicated to my two little angels,
Brook A. Niemiec DVM, DAVDC, FAVD Siona and Nikita,
Southern California Veterinary Dental Specialties, who have given a new perspective to my life.
San Diego, USA Chapter 10: Pathologies of the Salivary System
Chapter 5: Pathologies of the Dental Hard Tissues Brook A. Niemiec DVM, DAVDC, FAVD
Gregg DuPont DVM, DAVDC Southern California Veterinary Dental Specialties,
Shoreline Veterinary Dental Clinic, Seattle, USA San Diego, USA
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FOREWORD
6

Veterinary dentistry has exploded as a discipline within veterinary medicine over the past 20+ years,
primarily due to the tireless efforts of those clinicians in the 1970s and early 1980s who took an often
overlooked area of the patient, and turned it into a focus of major significance. Thanks to these
pioneers in veterinary dentistry, many of us found our calling within veterinary medicine and provide
a valuable service to animals throughout the world. In the early days of veterinary dentistry, those
who had a special interest in dentistry would gather together and discuss conditions and treatments
they had found to be particularly helpful or successful. Out of these meetings rose the organization
of the American Veterinary Dental Society and the Veterinary Dental Forum. The Veterinary Dental
Forum has grown to an annual meeting of nearly 1000 participants, a far cry from the early days of
getting together around a cold beverage to talk about your most challenging/rewarding cases! Also
blossoming out of the efforts of these pioneers has come the Journal of Veterinary Dentistry, a
quarterly publication that is currently recognized internationally as the journal of record for veterinary
dentistry. All these efforts were to help educate veterinarians about veterinary dentistry and to elevate
the practice of veterinary medicine in general.
Though many aspects of veterinary dentistry are continuously evolving, one constant is the clinical
practicality of veterinary dentistry. This is reflected in the organization and thought process
throughout this book. Dr. Niemiec does an excellent job presenting many dental conditions from a
very practical standpoint. Beginning with the initial oral examination, through the diagnostic
procedures, such as dental radiography, Dr. Niemiec provides pragmatic tips along the way. Reading
this text is similar to the way practitioners think through diagnostic challenges within their own
practices. From the early chapters that focus on the normal oral/dental anatomy through the oral
examination and diagnostics for all areas of the mouth, this text is a valuable reference for both the
general practitioner and the seasoned veterinary dentist.
Those of us, like Dr. Niemiec, who have walked in the footsteps of those pioneers of the early
days of veterinary dentistry, can only hope to carry on the tradition of educating others in our quest
to relieve unnecessary patient suffering. This book is an excellent tribute to those practitioners.

With gratitude and thanks,

Michael Peak, DVM, DAVDC

Immediate Past-President, American Veterinary Dental College
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PREFACE
7

This book is designed to be a quick reference for practitioners to identify the common oral
pathologies in the dog and cat. All pathologies are demonstrated by typical photographic and, in
some cases, radiographic examples. Along with the graphic examples is a concise but complete and
current description of the pathology. The description includes etiology, pathogenesis, clinical features,
differential diagnoses, diagnostic tests, and treatment/management. Each topic is then summarized
in easy-to-read key points. This format will make identification and initial therapy of oral diseases
much more efficient.
The first three chapters set a foundation for assessing and diagnosing oral pathology. Chapter one
is a review of oral anatomy and physiology. In the style of the book, this is supported with numerous
full color images. Chapter two presents a stepwise guide on how to perform a proper oral
examination. These techniques will allow practitioners to find the subtle pathologies listed within
the book. Finally, dental radiology is presented. The first part of chapter three discusses proper
techniques for obtaining quality dental radiographs, and the latter part discusses proper diagnosis of
dental radiographs with high-quality digital images.
Following this introduction, the book is presented by anatomic areas, to ease identification of
unknown pathology. These areas include problems with the: teeth; gingiva; oral mucosa; bones,
muscles, and joints; and salivary glands. Individual chapters have been created for pediatric
oral/dental problems and malignant oral neoplasia. These unique topics are presented separately
from the anatomical chapters to decrease time spent scanning the other chapters. Using this efficient
format, if a patient under about 9 months is presented, the practitioner should only have to go
beyond the pediatric chapter on rare occasions. Furthermore, if presented with a novel pathology,
the practitioner may not know the name of the disease process, thereby making an index much less
useful. By directly targeting the chapter which deals with that area of the mouth (for example the
lesion is on the tooth), the practitioner can quickly scan just a few pathologies until he/she finds a
picture that looks like the lesion in question. Then, in just a few minutes, the reader can learn all
about the disease process, including what tests should be run to confirm the diagnosis as well as how
best to manage it. Even experienced practitioners will benefit from the cutting edge information in
this book.
In addition, the succinct and practical style of this volume lends itself to be a client-friendly
education tool. The veterinarian can use this peer-reviewed book to back up their management
recommendations. This is critically important in veterinary dentistry, as most pathologies do not
have obvious clinical signs that owners recognize (fractured teeth for example). The prudent
practitioner will encourage clients to read the brief description of their pet’s particular pathology,
thus improving client compliance with treatment recommendations. Since dental disease is present
in almost all veterinary patients, I would consider having a copy in each exam room. This will aid all
dental related discussions.
This book makes numerous treatment recommendations, but it is not a technical manual. For
those practitioners interested in improving their technical skills, I recommend Veterinary Dental
Techniques, 3rd edn, by Holmstrom SE, Frost P, and Eisner ER (eds), Saunders, 2004. However,
these techniques (including dental radiology) are best learned through hands-on training at wetlabs.
For a list of my wetlabs in San Diego, visit www.sdvdtc.com.
Brook A. Niemiec, DVM, DAVDC, FAVD
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ABBREVIATIONS
8

AI amelogenesis imperfecta MGM/

APD air-polishing device MGL mucogingival margin/line
BPAB black pigmented anaerobic bacteria MM masticatory myositis
CBC complete blood count MRI magnetic resonance imaging
CEJ cementoenamel junction MTA mineral trioxide aggregate
CI calculus index NSAID nonsteroidal anti-inflammatory drug
CK creatine kinase OAF oroantral fistula
COC calcifying odontogenic cyst OSA osteosarcoma
CT computed tomography PDL periodontal ligament
CUPS chronic ulcerative paradental stomatitis PEG percutaneous endoscopic gastrostomy
DI dentinogenesis imperfecta PI plaque index
DR digital radiograph PTH parathyroid hormone
EGC eosinophilic granuloma complex RT-PCR reverse transcriptase polymerase chain
EMG electromyography reaction
FCV feline calicivirus SCC squamous cell carcinoma
FE furcation exposure SE extrinsic staining
FeLV feline leukemia virus SI intrinsic staining
FIV feline immunodeficiency virus SLE systemic lupus erythematosus
FNA fine-needle aspiration SLOB same-lingual/opposite-buccal
FSA fibrosarcoma SRP scaling and root planing
GI gingival index TEN toxic epidermal necrolysis
HIV human immunodeficiency virus TNF tumor necrosis factor
IL-1 interleukin-1 TVT transmissible venereal tumor
IVIG intravenous immunoglobulin VOHC Veterinary Oral Health Care Council
LEO lesions of endodontic origin
 CHAPTER 1
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Anatomy and
Physiology
John R. Lewis and Alexander M. Reiter

• Canine dental anatomy

• Feline dental anatomy
• Rodent and lagomorph dental anatomy
• Dental anatomical terminology
• Tooth development
• Enamel, dentin, and pulp
• Periodontium
• Bones of the face and jaws
• Muscles, cheeks, and lips
• Neurovascular structures
• Joints of the head
• Hard and soft palates
• Tongue
• Salivary glands
• Lymph nodes and tonsils
 10 CHAPTER 1 Anatomy and Physiology
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Canine dental anatomy CLINICAL RELEVANCE

• Knowledge of dental formulas and eruption
Accepted dental formulas for the deciduous and times allows one to recognize abnormalities
permanent dentition in the dog1: such as absent and supernumerary
• Deciduous teeth: (3 upper/3 lower incisors, permanent teeth (Table 1). Identification of
1 upper/1 lower canine, 3 upper/3 lower tooth type is also essential for accurate
premolars) × 2 = 28 teeth. dental charting and record keeping.
• Permanent teeth: (3 upper/3 lower incisors, • The permanent molars and first premolars
1 upper/1 lower canine, 4 upper/4 lower are referred to as nonsuccessional teeth
premolars, 2 upper/3 lower molars) × 2 = because they have no deciduous precursors.
42 teeth. • A deciduous tooth can be distinguished
The modified Triadan system is the most from a permanent tooth by its shape and
common numbering system in veterinary diminutive size relative to permanent teeth.
dentistry2. It provides a method of quick Deciduous premolars often mimic the shape
reference for verbal or written communication. of the adult tooth immediately distal to the
Each quadrant is numbered as follows: deciduous tooth. For example, the
• Right upper quadrant = 100 (500 when deciduous upper fourth premolar has a
referring to deciduous teeth). crown shape similar to the permanent upper
• Left upper quadrant = 200 (600 when first molar.
referring to deciduous teeth).
• Left lower quadrant = 300 (700 when
referring to deciduous teeth).
• Right lower quadrant = 400 (800 when
referring to deciduous teeth).
Each tooth is assigned a number within each
quadrant. Beginning with 01 for the first incisor,
teeth are consecutively numbered from mesial to Table 1 Eruption times of deciduous and
distal. Since the dog has a full complement of permanent teeth in the dog1
permanent premolars, tooth numbering is
consecutive from 01 to 10 on the maxilla and 01 Deciduous teeth Permanent teeth
to 11 on the mandible. Taking the quadrant and Incisors 3–4 weeks 3–5 months
tooth number into consideration, three numbers Canines 3 weeks 4–6 months
are used to identify a specific tooth. For example,
Premolars 4–12 weeks 4–6 months
the permanent left upper canine tooth is referred
Molars No deciduous molars 5–7 months
to as tooth 204. The deciduous left upper
canine is tooth 604 (1A, B).
 Canine dental anatomy 11
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101 201 1A 1B
102 411 M3
202 311
103
1 M2 310
410 1
I3
203 2
1
104
409 M1 309
204 2
C

1 P4 308
105 P1 408
205 2

106 2
206 407 P3 307
P2 2

107 2
207 P2 306
P3 406 2
P1 305
405 1
3
108
C 304
208
P4 404 I2 I1
I3
1
M1
109 209 1
3 403
M2 402 401 303
110 210 3
301 302

Right Left Number Right Left Number

maxilla maxilla of roots mandible mandible of roots

1 Modified Triadan numbering system in the dog. A: Maxilla; B: Mandible. (Three-rooted teeth in
red.)
 12 CHAPTER 1 Anatomy and Physiology
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102 101 201 202

Feline dental anatomy 203
2A
103

Accepted dental formulas for the deciduous and 104

I3 I2 I
1

permanent dentition in the cat1: 1

• Deciduous teeth: (3 upper/3 lower incisors, C
204 1
1 upper/1 lower canine, 3 upper/2 lower 106
premolars) × 2 = 26 teeth. P2
• Permanent teeth: (3 upper/3 lower incisors, 206
107
1 upper/1 lower canine, P3
207
3 upper/2 lower premolars, 1 upper/ 108
1 lower molar) × 2 = 30 teeth.
Several permanent premolars and molars have P4 208
been evolutionarily lost in the domestic cat.
Consequently, use of the Triadan numbering M1 209
system in feline dental charting is slightly more 109
complicated (2A, B). The ‘rule of 04 and 09’
refers to the fact that the canine (tooth 04) and Right maxilla Left maxilla
the first molar (09) are present as reference teeth
(1 root in 27.7% (1 root in 35% (3 roots
to allow counting forward or backward when 2 fully formed roots in 9.2% 2 fully formed roots in 10.3%)
numbering teeth2. For example, the lower first 2 partly fused roots in in 28% 2 partly fused
55.1%) roots in 34.7%)
(05) and second (06) permanent premolars are
absent in the cat, and thus the premolar closest
to the canine tooth may mistakenly be numbered 2B
M1
as the 05 tooth. Knowledge that the lower first 309
2
molar (09 tooth) is the largest cheek tooth of the 409
mandible allows one to count forward and P4 308
2
identify the lower premolar closest to the canine
408
as the 07 tooth (2). Quadrants are numbered as 307
P3 2
described under canine dental anatomy. As an
407
example, the right mandibular third premolar is C 304
tooth 407. The left maxillary second premolar is
tooth 206. I2 1
404 I3 I1
1
CLINICAL RELEVANCE
• The cat’s dentition is different to the dog’s
403 303
in many ways. The total number of teeth is 402 401301 302
greatly decreased, and the crown shapes
reflect the function of a true carnivore. Right Left Number
Eruption times differ (Table 2). mandible mandible of roots
• Since cats do not have occlusal table surfaces
on their molars, they rarely develop true 2 Modified Triadan system in the cat.
carious lesions. A: Maxilla; B: Mandible. (Three-rooted teeth
• Cats are more commonly affected by tooth in red.)
resorption than dogs.
• The groove on the buccal surface of the Table 2 Eruption times of deciduous and
canine teeth of cats has been referred to as a permanent teeth in the cat1
‘bleeding groove’, an adaptation of
Deciduous teeth Permanent teeth
carnivore teeth which is thought to allow
prey to bleed around the tooth while Incisors 2–3 weeks 3–4 months
prehended by the cat. Canines 3–4 weeks 4–5 months
• Variation in the number of roots exists in Premolars 3–6 weeks 4–6 months
maxillary cheek teeth of cats, specifically the Molars No deciduous molars 4–5 months
second and third premolar and first molar3.
 Rodent and lagomorph dental anatomy 13
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Rodent and lagomorph use their incisors in a lateral slicing action. There
dental anatomy are three maxillary and two mandibular
premolar teeth on each side, with three molar
Rodents have a single set of teeth without teeth in all quadrants5,6. The enamel of all
precursors or successors. There is one large, lagomorph teeth is unpigmented. As in true
chisel-shaped incisor tooth in each quadrant (i.e. herbivorous rodents, the rabbit’s incisors and
two upper and two lower incisors). These teeth cheek teeth lack anatomical roots and continue
generally have yellow enamel (except in the to grow throughout life7.
guinea pig) and evolved for dorsoventral slicing
action. Gnawing action wears away tooth CLINICAL RELEVANCE
substance that must be replaced, so incisors • Herbivorous species are often fed
continue to grow throughout the rodent’s life, concentrates in the form of grain or pellets
never developing anatomical roots. Rats, mice, (which are more suited to rats and mice),
and hamsters typically consume high-energy with only limited or no access to hay and
foods (seeds, grain, and tubers) that require little natural vegetation. For many pet rodents
chewing, and thus the cheek teeth are subject to and lagomorphs, the provided food does
little wear4. These rodents have three small molar not match their natural diet. If the diet
teeth in each quadrant, with anatomical roots provides too little tooth wear to compensate
that stop growing once fully erupted5,6. In for the natural growth of the teeth, tooth
contrast, chinchillas and guinea pigs are true elongation may occur.
herbivores, consuming large quantities of low- • Chinchillas and rabbits tend to have severe
energy foods (fibrous mountain vegetation), extension of the cheek tooth apices into
resulting in marked wear to the cheek teeth. adjacent tissues, causing palpable swellings
They have one premolar and three molars in on the ventral border of the mandible and
each quadrant, with large grinding surfaces (3). orbital invasion with epiphora, proptosis of
The chinchilla and guinea pig’s cheek teeth also the eye, and conjunctivitis.
never form anatomical roots, growing • Guinea pigs tend to have severe intraoral
continuously to compensate for constant wear4. tooth overgrowth, leading to formation of
Lagomorphs have two sets of teeth. The sharp enamel points or spikes on the buccal
deciduous teeth are rarely seen since they are and lingual surfaces of upper and lower
generally lost in utero or shortly after birth7. cheek teeth, irritation and ulceration of the
Rabbits have a second, smaller pair of maxillary buccal and lingual mucosa, and ‘trapping’ of
incisor teeth (‘peg’ teeth) palatal to the first the tongue4,7.
incisors. They are true herbivores and primarily

Chinchilla Guinea pig Rabbit

3 Dentition of the chinchilla, guinea pig, and rabbit. A: Lateral view; B: Open-mouth view.
 14 CHAPTER 1 Anatomy and Physiology
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Dental terminology • Apical – referring to a location or direction

Dentistry has its own set of terms to describe toward the tip of the tooth root.
accurately anatomical locations of the head and • Line angle – line where two surfaces of the
surfaces of individual teeth6,8–11. tooth converge (example: mesio-lingual).
• Point angle – point where three line angles
TERMS USED TO DESCRIBE A converge (example: mesio-linguo-
LOCATION OR DIRECTION IN occlusal).
REFERENCE TO THE ENTIRE HEAD
• Rostral – referring to a location toward the TERMS REFERRING TO ANATOMICAL
tip of the nose, analogous to the anatomical STRUCTURES OF THE TOOTH
term ‘cranial’, but specifically used in • Cusp – a pronounced point on the occlusal
describing locations on the head. or most coronal portion of a tooth.
• Caudal – referring to a location towards • Mamelon – one of the three rounded
the tail. protuberances on the cutting edge of a
• Ventral – referring to a location towards newly erupted incisor tooth.
the lower jaw. • Cingulum – rounded surface of the cervical
• Dorsal – referring to a location towards third of the lingual or palatal surface of
the top of the head or muzzle. incisor teeth.
• Embrasure – the open spaces between the
TERMS USED TO DESCRIBE A proximal surfaces of adjacent teeth that
LOCATION OR DIRECTION IN diverge from an area of contact.
REFERENCE TO A TOOTH OR TEETH • Dental bulge – expansion of crown at the
(4A, B) gingival margin designed to deflect food
• Mesial – the interproximal surface of the particles away from the gingival sulcus.
tooth that faces rostrally or towards the • Enamel – highly mineralized inorganic hard
midline of the dental arch. tissue that covers the dentin of the crown,
• Distal – the interproximal surface of the produced by ameloblasts.
tooth that faces caudally or away from the • Dentin – hard tissue covered by enamel
midline of the dental arch. (crown) and cementum (root), produced by
• Vestibular – the surface of the tooth facing odontoblasts.
the lips: ‘buccal’ and ‘labial’ are acceptable • Cementum – hard tissue covering the root
alternatives. surface, similar in composition to bone,
• Facial – specifically refers to the surfaces of produced by cementoblasts.
the rostral teeth visible from the front. • Pulp – soft tissue within the tooth composed
• Lingual – refers to the surfaces of the of odontoblasts, blood and lymph vessels,
mandibular teeth that face the tongue. nerves, and layers of connective tissue.
• Palatal – refers to the surface of maxillary • Pulp cavity – the entire space within the
teeth that face the palate. tooth, containing the pulp.
• Occlusal – refers to the surface of the • Pulp chamber – the part of the pulp cavity
tooth that faces the tooth of the contained within the crown of the tooth.
opposing arcade. • Root canal – the part of the pulp cavity
• Proximal – referring to the mesial and distal contained within the root of the tooth.
surfaces of a tooth that come in close • Attached gingiva – gingival portion attached
contact to an adjacent tooth. to underlying bone and tooth, extending
• Interproximal – referring to the space from mucogingival junction to the
between adjacent teeth. gingival groove.
• Coronal – referring to a location or direction
toward the crown of the tooth.
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4A

Apical

Vestibular or
Labial or Facial Vestibular or Buccal
Palatal
Coronal
Lingual
Dorsal
Ventral Caudal
Lingual
Rostral

Positions & directions

Surfaces

Mesial Distal
4B
Distal

Mesial

Median
plane
Lingual (Mandible)
or Palatal (Maxilla)
Distal
Lingual (Mandible)
or Palatal (Maxilla)

Vestibular or
Labial Mesial Distal Distal

Vestibular or Buccal
Vestibular or Labial

4 Dental anatomical terminology. A: Extraoral view; B: Intraoral view.

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• Free gingiva – free gingival portion, • Heterodont – dentition with teeth of

extending from gingival groove to the different shape and function (e.g. incisors,
gingival margin. canines, premolars, and molars).
• Gingival margin – most coronal extension • Incisors – cutting teeth situated between the
of the gingiva. canine teeth.
• Gingival sulcus (gingival crevice) – • Canines – conical teeth situated between the
physiological space between free gingiva third incisors and premolars, which function
and tooth surface. in protection, hunting, and prehension in
• Subgingival – referring to a structure or carnivores.
area that is apical to the gingival margin. • Premolars – cheek teeth distal to the canine
• Supragingival – referring to a structure or teeth which serve to prehend and tear food
area that is coronal to the gingival margin. in carnivores.
• Molars – cheek teeth distal to the premolars
OTHER TERMS with occlusal surfaces responsible for
• Monophyodont – only one set of teeth will grinding food (except in felines).
erupt and remains functional (e.g. dolphins • Carnassial – referring to the upper fourth
and killer whales). premolar and lower first molar teeth, which
• Polyphyodont – many sets of teeth are serve a shearing function in carnivores.
continually replaced (e.g. sharks and • Elodont – tooth that grows throughout life
crocodiles). (e.g. chinchillas, guinea pigs, and rabbits;
• Diphyodont – having two sets of teeth (e.g. incisors of all other rodents; tusks of
humans and most domesticated mammals). elephants and other animals; caudal teeth of
• Deciduous teeth – the first set of teeth which aardvarks).
are shed and replaced by permanent teeth. • Anelodont – tooth that has a limited period
• Permanent teeth – the second set of teeth in of growth.
diphyodont species. • Hypsodont – tooth with long anatomical
• Successional teeth – permanent teeth which crown at tooth maturity; the tooth is
replace or succeed a deciduous counterpart. continuously erupting as occlusal wear takes
• Nonsuccessional teeth – permanent teeth place (e.g. horses and ruminants).
which do not have a deciduous counterpart. • Brachyodont – tooth with shorter
• Homodont – dentition in which all teeth are anatomical crown than root(s) at tooth
uniform in shape. maturity (e.g. cats and dogs).
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Tooth development surfaces of the molars grind food into

smaller particles in preparation for digestion
Most domesticated animals undergo tooth • Abnormalities or disruptions of the normal
development resulting in two sets of teeth, sequence of tooth development may be an
deciduous (also referred to as primary) and indication of past or ongoing disease.
permanent dentition. Such animals are known • Disruption of ameloblasts during formation
as diphyodonts. The first signs of tooth of enamel matrix protein may result in
development occur at approximately day 25 of enamel hypoplasia and/or enamel
gestation with thickening of embryonic oral hypocalcification. Common causes include
epithelium, known as dental lamina. A series of infection with epitheliotropic viruses such as
invaginations of this epithelium results in the distemper, febrile episodes, metabolic or
formation of the primordial tooth structure nutritional abnormalities, or trauma to a
referred to as enamel organ, more appropriately tooth during the formation of enamel prior
called dental organ12. The dental organ to tooth eruption. Incomplete enamel
progresses through a series of stages of bud, cap, coverage may cause tooth sensitivity,
and bell13,14 (5). The bud stage is the initial increased plaque retention, and
coalescence of the dental lamina in locations development of carious lesions.
corresponding to the future site of deciduous • Caries lesions, though rare in companion
teeth. The cap stage begins when the bud animals, are most commonly seen on the
develops a concavity on its deep surface. At this occlusal surface of the maxillary first molars
stage the dental organ is comprised of three parts due to developmental pits and fissures with
including the outer enamel epithelium, the inner incomplete enamel coverage of the occlusal
enamel epithelium, and the stellate reticulum. surfaces.
The addition of a fourth layer, the stratum • Ectodermal dysplasia is a genetic disease
intermedium, marks the beginning of the bell affecting structures of ectodermal origin
stage. The buds which form the deciduous including skin and teeth. Affected patients
dentition develop extensions called successional often exhibit oligodontia (multiple missing
laminae. These form the permanent dentition teeth), peg teeth (abnormally pointed
after progressing through the bud, cap, and bell crowns), and abnormally shaped or number
stages. Nonsuccessional teeth (permanent teeth of roots.
without deciduous counterparts) develop directly
from the dental lamina. The progressive growth
of the roots results in tooth eruption, occurring
at specific times for each tooth and species.
Development of the teeth of dogs and cats
results in four specific types of teeth, each serving
a distinct purpose. The presence of different Bud 5
types of teeth with different functions is referred Cap
to as heterodont dentition11.

CLINICAL RELEVANCE Bell

• The incisors are designed to cut, prehend,
and groom. Their concave lingual/palatal
surface allows for scooping of food which Successional bud of
facilitates transport into the oral cavity. The adult tooth
canines are used to penetrate and grasp prey
or food and also function as defensive Forming deciduous
weapons in protection. In the carnivore they tooth
represent the teeth with the longest crown
and root. The premolars assist in the ability 5 Development of the tooth.The successional
to hold and carry, in addition to breaking bud of the permanent tooth can be seen
food into smaller pieces. The occlusal forming from the dental lamina.