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VetBooks.ir
VetBooks.ir
 Copyright © 2002 by Butterworth–Heinemann
VetBooks.ir

A member of the Reed Elsevier group

All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without the prior written permission of the publisher.
Every effort has been made to ensure that the drug dosage schedules within this
text are accurate and conform to standards accepted at time of publication. How-
ever, as treatment recommendations vary in the light of continuing research and
clinical experience, the reader is advised to verify drug dosage schedules herein
with information found on product information sheets. This is especially true in
cases of new or infrequently used drugs.
Recognizing the importance of preserving what has been written,
Butterworth–Heinemann prints its books on acid-free paper whenever
possible.
Library of Congress Cataloging-in-Publication Data
Mitchell, Paul Q.
Small animal dentistry / Paul Q. Mitchell.
p. cm. — (The Practical veterinarian)
ISBN 0-7506-7321-4 (pbk. : alk. paper)
1. Veterinary dentistry. I. Title. II. Series.

SF867 .M58 2002

636.7'08976—dc21
2001043941
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
The publisher offers special discounts on bulk orders of this book.
For information, please contact:
Manager of Special Sales
Butterworth–Heinemann
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Printed in the United States of America
VetBooks.ir

1
Introduction

This book is meant to be your introduction to the vibrant

and satisfying field of veterinary dentistry. It is both a
quick reference and a tutorial in the basics, to help the
reader gain proficiency in the recognition of common
dental problems and to build confidence in the recom-
mendation of proper treatment options. This book is not
an exhaustive treatment of all of the subdisciplines of
dentistry, but is designed to spur the interested reader
on to more involved texts, such as the following:

Harvey CE, Emily PP. Small Animal Dentistry.

Philadelphia: Mosby, 1993.
Holmstrom SE, ed. Canine dentistry. Vet Clin North
Amer Sm Anim Pract. 1998;28(5):1049–1324.

1
 2 Introduction
VetBooks.ir

Holmstrom SE, Frost P, Eisner ER. Veterinary Dental

Techniques, 2nd ed. Philadelphia: Saunders, 1998.
The Journal of Veterinary Dentistry.
Kertesz P. A Colour Atlas of Veterinary Dentistry and
Oral Surgery. Aylesbury, England: Wolfe, 1993.
Mulligan TW, et al. Atlas of Canine and Feline Dental
Radiography. Trenton, NJ: Veterinary Learning Sys-
tems, 1998.
Verstraete FJ. Self-Assessment Color Review of Veterinary
Dentistry. Ames: Iowa State University Press, 1999.
Wiggs RB, Lobprise HB. Veterinary Dentistry: Principles
and Practice. Philadelphia: Lippincott-Raven, 1997.

Dentistry is a field that has long been overlooked in

the care of veterinary patients. There has been a glaring
lack of emphasis on both the routine preventative oral
care for animals and the advanced tooth-saving proce-
dures that are commonplace in modern human den-
tistry. Although there are differences in tooth size,
shape, and number, the teeth of our domestic pets are
very similar to our own. Our patients are subject to den-
tal problems much like those that plague human
mouths. Because our patients cannot speak and rarely
show obvious signs of oral pain, it is up to the veterinar-
ian, as the advocate for the animal, to aggressively iden-
tify and treat dental disease.
The veterinary dental newcomer must first strive to
understand what is normal for our patients’ mouths by
 Introduction 3
VetBooks.ir

becoming reacquainted with oral anatomy. The anatomy

chapter is designed not only to provide a tutorial on
anatomical normalcy, but also to go further, into the log-
ical progression of the complete oral exam. Because a
veterinarian may only get a few seconds to look into the
mouth of a dog or a cat, it is critical that that time is well
spent actively looking for aberrations of normalcy. Also
included in this chapter is a list of twenty oral disease
processes that are considered to be the minimum accept-
able level of diagnostic proficiency.
Beyond the visual inspection of the teeth and other
oral structures, the student of veterinary dentistry must
also master intraoral radiography. The information
gleaned from these detail films cannot be gained from
any other source. The teeth simply cannot be fully eval-
uated without knowing about the health status of the
roots and their supporting bone. The beginner can use
the technique provided in the radiology chapter to ease
into the world of intraoral radiographs. Such a vital tool
is close at hand to most, if not all, veterinary hospitals.
Above all else the goal of modern comprehen-
sive veterinary dentistry should be the prevention of oral
disease and the preservation of healthy teeth. The
periodontics chapter provides solid prevention and
treatment recommendations as well as providing a
detailed description of the routine dental cleaning. The
endodontics chapter discusses the saving of teeth that
might previously have been extracted and describes the
steps involved with a root canal procedure. It is essential
 4 Introduction
VetBooks.ir

that everyone understand what root canal therapy is and

how it can be so helpful at saving diseased teeth and ren-
dering them painfree.
Tooth extraction is a large part of veterinary den-
tistry and its proper execution requires continual
improvement of technique so that the patient can be
spared as much trauma and pain as possible. The oral
surgery chapter explains the deliberate steps needed to
extract teeth with confidence and success. Great atten-
tion must be paid to how the oral surgeon leaves the
mouth following surgery. The goal of a tooth extraction
is not simply to remove the tooth from the mouth, but
also to carefully respect the soft tissues of the oral cavity
and to close the defect appropriately. To aid the new-
comer to surgical extractions and oral surgery as a
whole, a separate chapter on specialized instruments
provides a look at some of the most useful tools for work
in the oral cavity.
The relationship of the teeth to one another and the
pain that is caused by abnormalities in the bite of a dog
or cat is discussed in the orthodontics chapter. The pain
that malocclusions can cause is emphasized in this chap-
ter. A dental malocclusion can be much more than a cos-
metic problem and one that can have far reaching
consequences if not recognized and addressed. This
chapter also discusses the ethical concern involved with
orthodontic treatment.
Too many veterinary students and graduate veteri-
narians have accepted a sustained level of ignorance for
 Introduction 5
VetBooks.ir

all things dentally related to their patients and it is this

book that seeks to begin the undoing of such ignorance.
A quick reference and glossary are available in the back
of the book to gain fast answers. We know too much to
allow such oral disease to continue unchecked and
untreated. As the reader moves through the following
pages, may they gain a sense of the magnitude of the
pain and suffering pets have endured unnecessarily. And
further may they develop a keen desire to find and right
the dental and oral maladies they shall see every day in
practice.
VetBooks.ir
VetBooks.ir

2
Anatomy and the Oral Exam

Anatomy
Dentistry has its own language, and the newcomer must
learn the terminology. Knowledge of the proper terms
will greatly enhance both your appreciation of dentistry
and your ability to share your findings with others. It is
important to be precise to avoid causing confusion or
spreading misinformation, especially when consulting
with or referring to a specialist.

Directional Terms
The oral cavity has a few directional terms that are very
important to understand so that structures or lesions can

7
 8 Anatomy and the Oral Exam
VetBooks.ir

be properly oriented in the mouth. Because the teeth are

arranged in arches or arcades, the terms rostral and cau-
dal are not used to describe the teeth. Instead, the term
mesial is used to describe a tooth or tooth surface that is
toward the imaginary centerline of the dental arcade.
Likewise, the term distal is used to describe a tooth or
tooth surface that is away from the imaginary centerline
of the dental arcade. The maxillary right canine tooth,
for example, is said to be distal to the maxillary right
third incisor tooth.
Another important set of directional terms relates to
adjacent oral structures, such as the palate, tongue,
cheek, or lip, giving the following terminology:

Palatal: Toward or adjacent to the palate.

Lingual: Toward or adjacent to the tongue.
Buccal: Toward or adjacent to the cheek (primarily
used for premolar and molar teeth and their associ-
ated structures).
Labial: Toward or adjacent to the lip (primarily used
for the incisor and canine teeth and their associated
structures).
Facial: Toward or adjacent to the face (a combina-
tion of buccal and labial to be used for all teeth).

When describing an individual tooth, the terms coro-

nal and apical denote directions toward the crown and
toward the apex of the root, respectively. Other terms,
 Anatomy and the Oral Exam 9
VetBooks.ir

such as occlusal, the chewing or grinding surface of a

tooth, and proximal, the touching surfaces of two adja-
cent teeth, can be used to further define a dental lesion.

Types of Teeth
There are four major types of teeth: incisors, canines,
premolars, and molars. Each tooth type is designed for
specific purposes:

Incisors: For gnawing and grooming.

Canines: For grasping and tearing.
Premolars and molars: For shearing and grinding.

The maxillary fourth premolar teeth and the

mandibular first molar teeth are also known as carnassial,
or “flesh-shearing,” teeth.

Tooth Numbering Systems

Dental notation systems were created to help in the writ-
ten communication of dental problems. These systems
are meant to simplify medical record keeping, and the
two most used in veterinary dentistry are the anatomic
system and the modified triadan system.
The anatomic system uses a letter to designate the
tooth type (lower case for deciduous or primary teeth
and upper case for permanent or adult teeth) as well as
 10 Anatomy and the Oral Exam
VetBooks.ir

an appropriately positioned subscript or superscript to

designate both the tooth’s location and quadrant:

C1: Maxillary right permanent canine tooth.

3
I: Mandibular left permanent third incisor tooth.
2p: Maxillary left primary second premolar tooth.
i2: Mandibular right primary second incisor tooth.

The modified triadan system uses a three-digit code to

identify each tooth in a patient’s mouth. The first digit
designates the quadrant in which the tooth is located
and the last two digits designate the tooth’s location
within that quadrant, always starting with the central inci-
sor and moving distally.
Quadrant designations for the first digit are as
follows:

1: Right maxillary (permanent).

2: Left maxillary (permanent).
3: Left mandibular (permanent).
4: Right mandibular (permanent).

The primary dentition can also be designated with

the following quadrant digits:

5: Right maxillary (primary/deciduous).

6: Left maxillary (primary/deciduous).
 Anatomy and the Oral Exam 11
VetBooks.ir

7: Left mandibular (primary/deciduous).

8: Right mandibular (primary/deciduous).

When the last two digits are added to the quadrant

digit, a unique code is created for each tooth:

104: Right maxillary permanent canine tooth.

201: Left maxillary permanent first incisor tooth.
308: Left mandibular permanent fourth premolar
tooth.
411: Right mandibular permanent third molar
tooth.
502: Right maxillary primary second incisor tooth.
704: Left mandibular primary canine tooth.

Tooth Anatomy
The tooth is externally divided into three main sections
(Figure 2-1):

Crown: The crown is the enamel-covered portion of

a tooth and normally the only part of the tooth to
stick up above the gingival margin. The tip of the
crown is known as the cusp of the tooth.
Root: The root is the portion of a tooth normally
below the gingival margin. A hard, thin layer, called
 VetBooks.ir

12

Gingival sulcus

Free gingiva
Enamel
Dentin
Pulp horn
Cementum Pulp
Pulp chamber
cavity
Periodontal Root canal
Anatomy and the Oral Exam

ligament

Alveolar bone Apical delta

(lamina dura)

Furcation

Figure 2-1 Diagram of pertinent cross-sectional tooth anatomy.

 Anatomy and the Oral Exam 13
VetBooks.ir

cementum, covers it. The tip of the root is known as

the apex. The furcation is the area where the roots
begin to divide in multiple-rooted teeth.
Neck: The junction of the crown and root is the neck
of the tooth, and the normal gingiva attaches here.

Dentin
Dentin is the main bulk of tooth substance beneath
enamel or cementum. Different types of dentin can be
produced:

Primary dentin: This is the dentin that is present at

the time of tooth eruption.
Secondary dentin: This is the dentin normally added
to the inside walls as a tooth matures. It is produced
by healthy odontoblasts and forms in tubules. These
tubules make dentin somewhat porous, looking like
Swiss cheese on cross section when magnified.
Tertiary or reparative dentin: Tertiary dentin is laid
down within a tooth in response to gradual wear or
minor pulpal trauma.

Pulp Cavity
The pulp cavity is the internal hollow portion of a tooth:

Pulp chamber : The pulp chamber is the portion of

pulp cavity within the crown of a tooth.
 14 Anatomy and the Oral Exam
VetBooks.ir

Root canal: The root canal is the portion of pulp cav-

ity within the root of a tooth.
Dental pulp: The pulp is a collection of blood vessels,
nerves, lymphatics, and connective tissue contained
within the pulp cavity.

Apical Delta
The apical delta is the area of the root apex through
which vessels and nerves pass. This is both a portal area
of entrance to and exit from the pulp cavity. Primates
have a single portal known as an apical foramen, but
dogs and cats have many tiny portals.

Periodontium
The periodontium is the collection of hard and soft tis-
sues that supports the roots and allows for the retention
of the teeth within the mouth. There are four major
components of the periodontium:

Gingiva: The gingiva is the soft tissue that protects

the roots of teeth from the oral cavity proper. The
free gingival margin is the edge of the gingiva nor-
mally overlying the base of the crown of a tooth. A
valley is created between the free gingiva and the
tooth, known as the gingival sulcus. The gingival sul-
cus normally is 1–3 mm deep in the dog and 0.5–1
mm deep in the cat. The attached gingiva is the
 Anatomy and the Oral Exam 15
VetBooks.ir

portion firmly adherent to underlying bone, extend-

ing to the mucogingival junction.
Cementum: The cementum is the hard covering of
the tooth root and attaches to the periodontal liga-
ment.
Periodontal ligament: The periodontal ligament is a
network of fibers that attach the cementum of the
tooth root to the alveolar bone. It acts as a shock
absorber for the tooth within the bony socket as an
animal uses its teeth and also resists the tooth from
pulling out of the alveolus.
Alveolus: The alveolus is the bony socket that holds
and supports the tooth root through its connection
to the periodontal ligament.

Occlusion
The normal occlusion of the teeth allows for both full
function of the teeth and oral comfort. The teeth have
important relationships to one another to make proper
occlusion possible:

Incisor relationship: The maxillary incisor teeth

should be positioned slightly labial to the mandibu-
lar incisors and they should overlap in a “scissors”
bite.
Canine relationship: The mandibular canine tooth
should flair labially, so that its cusp can fit in the
 16 Anatomy and the Oral Exam
VetBooks.ir

space or diastema between the maxillary third inci-

sor and the maxillary canine tooth without touching
either tooth (Figure 2-2).
Premolar relationship: Each of the cusps of the maxil-
lary premolar teeth should be directed toward the
diastemae (the spaces between the teeth) of the
opposing mandibular premolar teeth and vice versa,
creating a “pinking shears” effect within the premolar
free space.
Carnassial relationship: The maxillary fourth premo-
lar tooth should occlude buccal to the mandibular
first molar tooth.
Molar relationship: The occlusal surface of the maxil-
lary molars should occlude with the occlusal surface
of the mandibular molars to allow for effective
grinding.

The Complete Oral Exam

Preoperative Exam
The preoperative oral exam can be done in the exam
room in front of the client. It is important to be as thor-
ough as possible so that an accurate treatment plan and
financial estimate can be developed for the client. It is
often helpful and rewarding to involve the client in this
initial oral exam. The term codiagnosis is used to describe
this activity in human dentistry, and it has been shown to
 Anatomy and the Oral Exam 17
VetBooks.ir

Figure 2-2 A model of a dog’s mouth showing the proper

canine occlusal relationship. The mandibular canine tooth should
flair facially and fit between the maxillary third incisor and maxil-
lary canine teeth without touching either.
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