Radiotherapy for the treatment of sinonasal tumors in dogs is generally well tolerated, but the range of long-term adverse effects remains poorly understood. In people receiving radiation for head and neck tumors, existing dental disease is a predisposing factor for radiation-induced oral complications that can lead to worsening periodontal disease long-term. Periodontal disease is widespread amongst the population of senior dogs typically undergoing radiotherapy, and the aim of this retrospective cohort study was to determine if there is evidence of increased alveolar bone loss in these patients. Computed tomography scans from canine patients undergoing definitive intent radiotherapy for sinonasal tumors at a veterinary teaching hospital from 2013 to 2022 were utilized to assess alveolar bone loss in the maxillary and mandibular premolars and molars at multiple follow-up time points. As the radiation dose delivered was concentrated to the maxilla, the mandibular teeth served as a control for the expected degree of alveolar bone loss. Analysis indicated that there is an increase in alveolar bone loss over time, but that there is no difference between the mandible and maxilla. This finding provides evidence that the risk of radiotherapy worsening alveolar bone loss is low in canine patients and is the first study evaluating the relationship between alveolar bone loss and radiation-induced side effects in dogs. Continued long-term follow-up, along with similar investigations for tumors more directly affecting the oral cavity, is essential to appropriately guide patient risk assessment and prophylaxis.

This multicenter study evaluates the efficacy of a regenerative bone adhesive (RBA), a novel mineral-organic biomaterial, in maintaining alveolar ridge dimensions after extraction of large mandibular teeth in dogs. In a controlled, randomized clinical study, 47 patients with 59 tooth extraction sites across 10 practices were treated by veterinary dental specialists. Study extraction sites had the socket filled with RBA to the rim of the alveolar bone, whereas control sites healed with blood clot only. Computed tomography scans were performed at short-term (6-12 wk) and long-term (6-12 mo) follow-up time points. Analysis revealed statistically significant (P < .001) advantages in RBA-treated sites in both short- and long-term restoration and preservation of residual ridge dimensions. In RBA-treated sites, there was a statistically significant preservation of buccal ridge height, with an almost 2 mm advantage at long-term follow-up (to 12 mo). The biomaterial's adhesive properties, mechanical strength, and osteoconductive nature provide crucial support to the postextraction socket, encouraging bony repair instead of ridge height loss, contributing to this favorable outcome. The results demonstrate that RBA can significantly minimize residual ridge resorption compared to standard extraction alone.

Objective: Report normal oral and dental examination findings and evaluate the feasibility of intraoral radiography in four-toed hedgehogs (Atelerix albiventris) under sedation. Methods: Twelve healthy, adult hedgehogs (seven males, five females) were sedated with a combination of alfaxalone (5 mg/kg [2.3 mg/lb]) and midazolam (1 mg/kg [0.45 mg/lb]) SC and an oral examination performed in a research setting. The dental formula, documentation of calculus, missing teeth, fractures, mobility, and microdontia were recorded. Periodontal probing evaluating the sulcus depth for each tooth was performed and a gingivitis score assigned, if applicable. Dental radiography was performed using commercial phosphor dental imaging plates. Intraoral radiographs of maxillary and mandibular quadrants as well as skull radiographs were collected. Results: Sedation was sufficient for performing most of the oral examination, except inspection of the tonsils, soft palate, and pharynx, and permitted intraoral radiography in all hedgehogs. The dental formula for each hedgehog varied, but most animals (7/12, 58%) had I 3/2, C 1/1, P 3/2, M 3/3. Most animals (9/12, 75%) had dental abnormalities, which were most noted in the maxillary quadrants (9/12, 75%). The most noted oral abnormality was calculi, seen in 7/12 (58%) animals. Gingivitis was present in 5/12 (42%) hedgehogs and was most associated with the maxillary incisors. Conclusions and clinical relevance: Subcutaneous alfaxalone-midazolam provides adequate sedation for dental evaluation and intraoral radiography in four-toed hedgehogs. Calculus accumulation, missing teeth, and periodontal disease were common findings in this group of hedgehogs. The high rate of dental abnormalities found in this study underscores the importance of performing regular oral examinations using chemical immobilization in pet hedgehogs. Intraoral radiography can be used as in other pet species to guide clinical decision making.

The purpose of this study was to determine and compare the gape angles (temporomandibular joint range of motion with mouth opening) of conscious and anesthetized domestic felines and to compare gape angles with and without evidence of oral pain. This prospective study evaluated the gape angle of 58 domestic felines. The cats were grouped into painful (n = 33) and nonpainful cohorts (n = 25) and gape angles were compared during conscious and anesthetized conditions. Gape angles were determined based on measurements of the maximal interincisal distance and lengths of the mandible and maxilla followed by calculation of the law of cosines. The mean feline gape angle (standard deviation) was determined to be 45.3° (8.6°) and 50.8° (6.2°) for conscious and anesthetized felines respectively. There was no significant difference between painful and non-painful feline gape angles during conscious (P = .613) or anesthetized (P = .605) evaluations. There was a significant difference between anesthetized and conscious gape angles (P < .001) for both painful and non-painful cohorts. This study determined the standardized, normal feline temporomandibular joint (TMJ) gape angle in both conscious and anesthetized states. This study suggests that the feline gape angle is not a useful indicator of oral pain. By determining the feline gape angle, which was previously unknown, further evaluation of its utility as a non-invasive clinical parameter for evaluation of restrictive TMJ motions as well as its use for serial evaluations may be pursued.

Masticatory myositis (MM) is an inflammatory myopathy reported in dogs and is characterized by inflammation of the masticatory muscles (temporalis, masseter, and pterygoid muscles). Immunosuppressive therapy is the current recommended treatment for MM and may involve glucocorticoids, cyclosporine, azathioprine, mycophenolate mofetil, leflunomide, or a combination of these treatments that are slowly tapered to the lowest effective dose. However, side effects from multimodal medical therapy and complications associated with MM relapses have been reported. The purpose of this case series was to report oclacitinib as a treatment alternative to traditional medical management of MM. The intent of this alternative is to manage side effects from glucocorticoid use. Oclacitinib (1mg/kg per os q12h) was used solely for treatment of MM in three dogs. The dogs were followed up to >6 months after oclacitinib administration. An increase in oral range of motion, as determined by gape angle, was noted in all three dogs. However, a corresponding drop in antibody titers (2M fiber) did not occur. All dogs showed improvement in overall clinical management of MM, side effects from glucocorticoids, and clinical signs related to chronic prednisone use. Larger controlled trials with consistent measurements (interincisal distance, gape angle) and 2M fiber antibody titers are indicated to further assess validation of oclacitinib treatment of MM. The clinical outcome of all dogs was considered successful.

This study evaluated observer variations in the interpretation of radiographic evidence for periodontal disease, tooth resorption, and endodontic disease in dogs. Forty dental radiographs were evaluated for 12 different parameters (periapical destruction of bone, wider than expected root canal, narrower than expected root canal, apical root resorption, loss of alveolar bone, external surface resorption, external replacement resorption, external inflammatory resorption, external cervical root resorption, internal surface resorption, internal replacement resorption, internal inflammatory resorption). Interpretations by 20 veterinary dentists, 10 veterinary dental residents, and 10 veterinary students were analyzed for consistency within groups and between groups by intraclass correlation coefficients (ICCs [95% CI]). Additionally, the agreement rate between groups compared to histopathological diagnosis, when available, and to a consensus group were evaluated. The results showed fair to good interobserver agreement for all participants when looking at all questions simultaneously (0.578 [0.515-0.635]) and with the consensus group (0.483 [0.451-0.517]). However, questions pertaining to various types of tooth resorption scored the lowest ICCs ranging from 0.005 (-0.311 to 0.321) to 0.189 (-0.105 to 0.402) across individual groups. Students had the lowest agreement compared to the consensus group for all questions (0.383 [0.347-0.421]) with fair to good agreement involving groups of residents (0.501 [0.465-0.538]), recently boarded diplomates (0.541 [0.506-0.578]), and more experienced diplomates (0.545 [0.510-0.582]). While dental radiographs are essential for clinical decision making, this study shows that interpretation of radiographs is highly subjective.

OBJECTIVE:To investigate and describe an extraoral approach to perform a maxillary nerve block in guinea pigs. STUDY DESIGN:Prospective, randomized, blinded, descriptive, cadaveric study. ANIMALS:A total of 14 adult guinea pig cadavers. METHODS:Two cadavers were used for anatomic dissection and determination of maxillary nerve block approach. A maxillary nerve block via infraorbital approach was then performed in 12 cadavers. A low volume (0.1 mL) or high volume (0.2 mL) of diluted methylene blue injectate was randomly assigned to the right or left side, with the other volume used for the contralateral side. The maxillary nerve was dissected after each injection by an investigator blinded to injectate volume. The region of dye distribution was identified, and the degree of staining assigned an accuracy score (0-2). Nerve coverage was considered adequate if ≥6 mm of circumferential staining was present. RESULTS:Accuracy evaluation indicated successful dye deposition in 10/12 [2 (0-2), median (range)] injections in the low volume group and 8/12 [2 (1-2)] injections in the high volume group. The majority (79.2%) of injections resulted in adequate nerve staining. There were no statistically significant differences between injectate volumes for accuracy (p = 0.64) or adequacy (p > 0.99) of staining. CONCLUSIONS:The infraorbital approach is a simple and practical method for maxillary nerve blockade in guinea pigs. An injectate volume of 0.1 mL results in adequate maxillary nerve coverage; however, additional studies are needed to assess the efficacy in clinical use.

Our prospective study analyzed clinical, radiographic, and histological characteristics of 102 intrinsically stained teeth. Sixty-nine dogs ranging from one to fifteen years of age were included in this study. Little more than half of the intrinsically stained teeth had no evidence of coronal injury (53.9%, 55/102). We found that most intrinsically stained teeth were histologically nonvital (87.6%, 85/97) and approximately 2/3 of these (57.7%, 56/97) had no histological endodontic or periodontal inflammation at the time of evaluation. Radiographic evidence of endodontic disease was present in 57% (58/102) of the intrinsically stained teeth. Radiographic evidence of periodontal disease was present in 48% (49/102) of intrinsically stained teeth and 28% (29/102) had radiographic evidence of tooth resorption. 18.6% (19/102) of intrinsically stained teeth were radiographically normal. Evidence of pulp necrosis was common in these intrinsically stained teeth, while only occasional teeth (12.4%, 12/97) had histologically confirmed pulpitis. All teeth with radiographic evidence of periapical lucency had pulp necrosis. Based on our histological findings, the majority of intrinsically stained teeth 87.6% are truly nonvital.

Maxillofacial trauma is a common presentation in veterinary medical practice. Accurate assessment, diagnostics, pain management, and finally repair are tenants to treatment. In addition to typical tenants for fracture repair, the restoration of occlusion and return to function (eating, drinking, grooming) are unique to trauma management in these patients. Options for repair include conservative management (tape muzzles), noninvasive repair techniques (interdental wiring and composite splinting), and invasive repair techniques (interfragmentary wiring and plate and screw fixation).

This study reports the gape angle (vertical temporomandibular joint range of motion for mouth opening) in conscious and anesthetized dogs. Mouth opening was reported as an angle in this study. Additionally, conscious and anesthetized measurements were compared to see if the state of anesthesia affected this measurement in asymptomatic patients. This prospective study evaluated 165 anesthetized dogs. Patients were placed in 1 of 2 groups: dental patients or non-dental patients. Only patients who were reported by owners to be asymptomatic for oral pain were included in the study. All dogs that met inclusion criteria had the maxillary length and interincisal distance measured. There was no difference (p = 0.590) between the mean (+/-SD) gape angle of conscious 44.0(o) (+/- 4.1+(o)) and anesthetized patients 43.9(o) (+/- 3.9(o)). No difference was seen in the gape angle between dental (44.2(o)) and non-dental patients (43.2(o)) (p = 0.183), or between conscious (43.8(o)) and anesthetized patients (43.7(o)) (p = 0.610). This study suggests that a consistent gape angle of 44(o) exists in dogs not exhibiting overt signs of oral pain and the gape angle is easy to measure in conscious patients and may be a useful tool during routine physical examination to identify patients with restricted range of motion. Immediate clinical application of this information can be used to monitor progress of treated patients affected by disorders that cause a decreased gape angle.

A dog presented 16 hours after an acute onset of severe generalized lingual swelling from an unknown cause. The dog had recently chewed a deer carcass. Initial physical examination and diagnostic testing did not reveal an underlying cause, and supportive care was provided. After 16 hours of hospitalization strangulating organic foreign material was found at the base of the tongue and removed. Macroglossia and secondary superficial lingual necrosis were successfully managed with supportive care while the patient was hospitalized. Thermographic imaging was used and indicated lingual hypothermia and subsequent normothermia, before and after removal of the linear foreign body respectively. Histopathologic analysis revealed the foreign body consisted of degenerate and autolyzed collagenous connective tissue, likely representing tissues such as tendon, fascia or a large thick-walled blood vessel which was suspected to have been consumed from the deer carcass. Thermographic imaging was employed and demonstrated to be consistent with hypoperfusion (hypothermia) of the affected tissue. Thermographic imaging adds value as an additional diagnostic tool for conditions with compromised blood flow.

Development of gingival enlargement and periodontitis is described in a young dwarf mongoose. Repeated treatments resulted in gingival resection and histologic evaluation however gingival enlargement was ultimately responsive to extraction of associated teeth. In cases such as these, surgical extraction of teeth associated with severe recurrent gingival enlargement should be considered to avoid the stress and risk of repeated immobilizations.

Mandibular fracture repair is complicated by limited availability of bone as well as the presence of the neurovascular bundle and an abundance of tooth roots. Fractures at the location of the mandibular first molar teeth are common and it can be particularly challenging to apply stable fixation. Non-invasive fracture repair techniques utilize intraoral placement of fixation devices typically involving polymerized composites and/or interdental wiring. A novel calcium phosphate-phosphoserine-based mineral-organic adhesive was tested ex vivo to determine its effects on augmenting strength of different non-invasive fracture fixation techniques. This study both tested the use of mineral-organic adhesive for the purpose of stabilizing currently used non-invasive fracture repair constructs (intraoral composite splinting ± interdental wiring) and evaluated adhesive alone or with subperiosteally placed plates on buccal cortical bone surface. Aside from controls, not receiving an osteotomy along the mesial root of the mandibular first molar tooth, six treatment groups were tested to evaluate ultimate strength, stiffness, angular displacement, bending moment, and application time. All forms of fixation were found to be significantly weaker than control (p < 0.001). Only the control (p < 0.001) and mineral-organic adhesive and composite (P = 0.002) groups were found to be significantly stronger than wire and composite. No difference was noted in stiffness between any groups with control or wire and composite. Application times varied from the mineral-organic adhesive group (mean = 206 s) to mineral-organic adhesive and composite (mean = 1,281 s). Twenty-three fixation devices exhibited adhesive failure, 20 demonstrated cohesive failure, and 5 failed by cohesive and adhesive failure. When evaluating the ultimate strength of the fixation device groups, mineral-organic adhesive, and composite was shown to be the strongest construct. The use of resorbable bone adhesive and composite may provide a stronger fixation construct over interdental wire and composite for mandibular fracture repair in dogs.

When performed correctly, noninvasive fracture repair techniques should restore the patient to a functional, comfortable occlusion. Noninvasive repair techniques provide the advantages of reducing the risk of iatrogenic introduction of bacteria into the fracture site and not disrupting the fracture hematoma or periosteum. Noninvasive techniques may create an environment where repair occurs by secondary bone healing. Noninvasive repair techniques include interdental wiring, intraoral composite or acrylic splints, interdental wiring with composite or acrylic splints, muzzle coaptation, maxillomandibular bonding, or use of orthodontic guiding elastics or crown extensions. These noninvasive techniques eliminate the need for surgical exploration of the fracture site but may inadvertently risk dental trauma to tooth structure incorporated in fixation. Careful patient selection determines ideal fracture type and location where noninvasive repair techniques can be considered.

The mandibular first molar (M1) tooth of the dog is commonly involved in dental procedures. Tooth roots and the mandibular canal can vary in location, which has not been described on a large scale. The objective of this study was to describe the three-dimensional anatomic relationship of the mandibular M1 tooth roots and the mandibular canal in dogs. Cone-beam computed tomography (CBCT) was used to evaluate the anatomic relationship between the M1 tooth roots and the mandibular canal. CBCT images were collected from 101 canine cadaver heads from a variety of unknown breeds. All skulls used in this study were mesaticephalic, confirmed by facial index calculations. The position of the apex in relation to the mandibular canal and in relation to the buccal and lingual cortices was recorded and analyzed in relation to mandibular bone height: root length ratio. When evaluating the apex in a buccal-lingual relationship, the tooth roots were found to be located closer to the lingual cortex in 73.3% of M1 roots. Tooth root apical positions were found to be symmetric between the right and left side of the mouth in 93% of mesial roots and 95% of distal roots. Apical positions relative to the mandibular canal within the same tooth were found to be consistent in 52% of teeth. Teeth with roots dorsal to the mandibular canal were associated with the largest mandibular bone height: root length ratio. CBCT provides a more precise overview than dental radiographs of three-dimensional anatomy. The tooth root position can be estimated in a clinical setting based on the ratio of mandibular bone height to tooth root length obtained from intraoral radiographs. Understanding the relative location of important anatomic structures is key to avoiding complications associated with various dental procedures. This study has documented that assessing anatomic structures with 2D imaging alone is flawed, and the large majority of dogs have M1 roots closer to the lingual aspect than the buccal aspect of the mandible.

Mandibular fractures at the level of the first molar tooth (M1) were assessed in 29 dogs. Patients included in this study demonstrated fractures involving the M1 tooth, tooth bud, or alveolus (if tooth was absent). Diagnostic imaging evaluation included intraoral dental radiography and/or computed tomography (CT) with 3D reconstruction. The distal root was involved in 55.2% of cases, mesial root involvement in 34.5% of cases, and the tooth was absent in 10.3% of cases. Fractures were described in the rostral-to-caudal direction. Fractures tended to occur in the caudoventral direction (P = .057). Cases with CT imaging were also evaluated in the buccolingual direction. Fractures were found to occur significantly more frequently in the caudolingual direction (P = .022). When classifying fracture patterns along M1 according to a previously published fracture classification system, it was noted that fractures occurred significantly more frequently in either the mesial (P < .001) or distal (P < .001) roots by coursing along the periodontal ligament space and communicating with the periapical region. Active or nonworsening periodontitis was described as radiographic or tomographic evidence of (>25%) bone loss in the vertical or horizontal direction. Periodontitis was associated with 7 (24.1%) cases. These results help frame the challenges associated with fracture repair at the M1 location. Treatment planning considerations should include limited structural support caudal to fractures involving the distal root, more frequent involvement of the distal root over the mesial root, risk for poor endodontic prognosis, and the predilection for unfavorable fracture patterns to occur.

In veterinary general practice, dental extractions are common procedures that require a specific set of surgical skills. Veterinary medical educators are tasked with preparing students for general practice, equipping them with medical knowledge and surgical skills. Results of this pilot study demonstrate students' preference for circle-based laboratory setup, a perceived high value of immediate feedback when performing laboratory exercises, and a lack of preference for timing of the laboratory relative to the relevant material provided in lecture. The impact of lecture, supplemental information, and laboratory setup on development of these surgical skills are explored.

Pain can be separated into inflammatory pain, where pain is induced by direct stimulation of nociceptors by inflammatory mediators released by damaged tissue and neuropathic pain, where pain is caused by a disease or trauma to a sensory nerve. Due to the complexity of the pain pathway, the management of pain is complex as well. Dental cleanings and oral treatment procedures require access to the oral cavity while maintaining the patient under general anesthesia. Feline oral pain syndrome (FOPS) refers on a disorder affecting cats, resulting in an exaggerated response to a painful or non-painful stimuli resulting in discomfort and mutilation. Local anesthetic agents should be considered as part of the overall analgesic management of the dental patient. Anesthetic delivery is necessity for the safe practice of orodental procedures and aside from maintaining the patient at an anesthetic plane while on inhalant anesthesia, an appropriately inflated endotracheal tube cuff aids in the prevention of aspiration.

Mandibular volume and tooth root volumes were shown to increase at different rates at locations containing the roots of the canine (C) and mesial and distal roots of the first molar (M1). Thirty-six dogs were included in this study. Data were generated using computed tomography at locations of the mandible involving the roots of the C and M1 teeth. Software was used to trace the external surface of the mandible, calculating the volume of the mandible at each location. Similar techniques were used to trace and calculate the volume of the C and M1 roots. Mandible volume, tooth root volume, and root percentage of mandible volume were analyzed and compared using the slopes of the best fit line. At the M1 mesial and distal roots, mandible volume ( P < .001) and root volume ( P < .001) were both noted to increase, with increasing weight at different rates. The rate of change in the root percentage by weight of M1 roots was not different ( P = .214). Each location demonstrated a different increasing rate of change for mandibular volume and increasing root volume. Results show that as patient’s weight increases, the mandible and root volumes increase at different rates. Root percentage by volume at all three locations was noted to decrease by the same rate. Canine and M1 roots are proportionally larger than the supporting mandibular bone in smaller patients. Care should be taken to recommend periodontal disease prevention for owners of small dogs and consideration made when performing extractions or other surgery that may destabilize the mandible.

An apical dye leakage test was utilized to compare 2 endodontic sealer systems commonly used in veterinary endodontic treatment. Rotary instrumentation followed by injection of 2 different sealers (GuttaFlow 2 and AH Plus) and a single master cone obturation technique were compared. Following obturation and restoration, specimens were immersed in India ink for 48 hours. A tooth mineral clearing technique was utilized to render the tooth samples transparent. Subsequently, the apices were evaluated for prevalence and magnitude of apical dye penetration under magnification. Statistical analysis of the results revealed no significant differences in the prevalence or magnitude of apical dye penetration between groups.