Presentation brochure
Visual atlas of oral pathologies in dogs Javier Collados Soto
Visual atlas of oral pathologies in dogs
Visual atlas of oral pathologies in dogs Javier Collados Soto
Visual atlas of oral pathologies in dogs
Visual atlas of oral pathologies in dogs
Author: Javier Collados Soto. Format: 22 x 28 cm. Number of pages: 192. Number of images: 500. Binding: hardcover.
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A good mouth care is paramount to prevent health problems in dogs. However, diagnosing and treating some oral conditions may sometimes be really challenging. With almost 500 high-quality images, clear anatomical illustrations, and thorough descriptions, this new volume on veterinary dentistry aims at being a quick visual guide for treating oral problems in dogs.
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Visual atlas of oral pathologies in dogs
Presentation of the book This Atlas constitutes a new and valuable contribution to the literature of Veterinary Dentistry. It is not a text book; rather it uses a wide spectrum of well-organised visual material to clearly explain different oral pathologies in dogs. The Spanish author has selected well-known international collaborators to contribute to a comprehensive range of high-quality visual material comprising around 500 pictures arranged on nearly 200 pages. The chapters and pages are laid out in a clear and interesting format that communicate information effectively and retain the reader’s interest on a voyage of discovery. The overall organisation in terms of aetiology, clinical and diagnostic features together with well-labeled diagrams and illustrations is a format that allows the reader to quickly delve down to whatever level of detail is required. In particular, the juxtaposition of different visual formats provides a multidimensional insight. For example, well-selected clinical photographs and matching radiographs highlight the value of radiography in diagnosis. The Atlas is both a well-conceived idea and a well-executed project. This one book has such a broad coverage of oral pathologies in dogs that it constitutes a uniquely valuable addition to the library of any veterinary surgeon. Cecilia Gorrel
BSc, MA, Vet MB, DDS, MRCVS, Hon FAVD, Dipl EVDC RCVS-recognised Specialist in Veterinary Dentistry
Visual atlas of oral pathologies in dogs
The author Javier Collados Soto Javier Collados Soto graduated in Veterinary Medicine from the Complutense University of Madrid (UCM) in 1994. Specialising exclusively in Veterinary Dentistry and Oral Surgery, he works in numerous veterinary practices and hospitals in Spain, concentrating his services in Madrid. He is responsible for the Dentistry and Oral Surgery service at the Sierra de Madrid Veterinary Hospital. He was a lecturer and subject coordinator in Animal Dentistry at the Faculty of Veterinary Medicine of the Alfonso X el Sabio University of Madrid. Always showing his interest for his specialisation, he has had several stays at the Dentistry and Oral Surgery Service of the University of California (UCDavis) Veterinary Medical Teaching Hospital, USA. He has been member of the European Veterinary Dental Society (EVDS) since 1999 and he is also one of the founder members of the Spanish Society of Veterinary Experimental Dentistry and Maxillofacial Surgery (SEOVE, Sociedad Española de Odontología-Cirugía Maxilofacial Veterinaria y Experimental).
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He has published many articles in this specialty and has participated as a speaker in conferences and national and international courses in the field of Veterinary Dentistry.
Communication services Website Online visualisation of the sample chapter. Presentation brochure in PDF format. Author´s CV. Sample chapter compatible with iPad.
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Visual atlas of oral pathologies in dogs Javier Collados Soto
Table of contents 1. Introduction Dental positional terminology Histological tooth structure in canines and felines Diagram of dog and cat dentition Example of periodontal probing Periodontal disease classification (AVDC, 2007) Classification of plaque and dental calculus index (Logan & Boyce, 1994) Gingival index (Wolf et al., 2005) Stages of mobility (American Veterinary Dental College, 2007) Classification of furcation involvement/exposure (AVDC, 2007) Dental fracture classification (AVDC, 2007) Endo-periodontal lesions Classification of tooth resorption (based on the severity of the resorption) (AVDC, 2007)
2. Oral pathology in dogs Dental physiological and radiological oral cavity in dogs Permanent teeth Deciduous teeth Normal tooth eruption Dog dental radiography models
Occlusion and malocclusion Occlusion Incisal area Area of the first premolars Canine teeth area Area of the last premolars and molars
Malocclusion Dental crowding Dental absence Mandibular distocclusion (class 2 malocclusion) Mandibular mesiocclusion (class 3 malocclusion) Tooth displacement Linguoversion of the mandibular canine teeth Mesioversion of the maxillary canine teeth
Supernumerary teeth
Congenital and development-related
Maxillary-mandibular asymmetry in a dorsoventral direction (“open bite”)
Juvenile cellulitis
Rostral crossbite
Macroglossia
Caudal crossbite
Craniomandibular osteopathy
Persistent teeth
Cheilitis-dermatitis of the lips
Teeth rotation
Cleft palate
Maxillary-mandibular asymmetry in a rostrocaudal direction
Cleft nose
Systemic pathologies and their impact on the oral cavity Secondary hyperparathyroidism Contact dermatitis Leishmaniasis Lymphoma Systemic lupus erythematosus Facial paralysis Bullous pemphigoid Tetanus
Pathologies of the oral cavity Neoplasms Non-neoplastic processes. Gingival hyperplasia Ameloblastoma
Cleft lip
Metabolic and iatrogenic aetiology Calcinosis circumscripta Oronasal fistula Salivary sialocoele or ranula Eosinophilic granuloma
Traumatic aetiology Soft tissue lesions Foreign body Traumatic dermatitis Sublingual granuloma (“cheek-chewing lesion”) Lingual lesions Lesions from occlusion/malocclusion Burns from electric wiring Trauma by external bite
Hard tissue lesions Mandibular fractures Maxillary fractures
Bacterial aetiology
Peripheral ameloblastoma (acanthomatous epulis)
Periodontal disease
Squamous cell carcinoma
Ulcerative stomatitis. Contact ulcers
Peripheral odontogenic fibroma (fibromatousossifying epulis)
Necrotising ulcerative stomatitis
Fibrosarcoma
Oronasal fistula
Haemangiosarcoma
Osteomyelitis in the oral cavity
Mast cell tumour
Fistulous tract of dental aetiology
Viral, mycotic and parasitic aetiology
Melanoma
Demodicosis
Osteosarcoma
Myiasis
Round cell tumour
Papillomatosis
Immunological aetiology Eosinophilic myositis Mucocutaneous pyoderma
References Alphabetical index
Visual atlas of oral pathologies in dogs
C
A
B Malocclusion
Persistent teeth
Persistence of deciduous RmaxP4 (508). A Deciduous RmaxP4 (508). B From right to left: RmaxP3 (107), RmaxP4 (108), RmaxM1 (109). C Vestibular rotation of the distal area of RmaxP4 (108).
B
Key diagnostic/treatment points The persistence of deciduous RmaxP4 frequently causes malocclusions with rotation and displacement of the regional permanent teeth. In this case, there is vestibular rotation in the distal area of RmaxP4 (108), causing pathological interdental space between RmaxP4 (108) and RmaxM1 (109). At this point, interceptive orthodontic treatment should be implemented by extracting deciduous RmaxP4 (508).
D
C A Malocclusion
Persistent teeth
Persistence of mandibular canine teeth and incisors. Use of dental radiology for identification. A From right to left: LmandC (304), LmandI2 (302), LmandI1 (301), RmandI1 (401), RmandI2 (402), deciduous RmandI3 (803), deciduous RmandC (804). Dental
X-ray confirmation. B Crown cusp corresponding with the beginning of eruption of RmandC (404). Dental X-ray confirmation. C Dental X-ray. From right to left: X-ray signs compatible with LmandC (304), LmandI2 (302), LmandI1 (301), RmandI1 (401), RmandI2 (402), RmandC (404),
impacted RmandI3 (403). D Dental X-ray. From right to left: X-ray signs compatible with deciduous RmandI3 (803), deciduous RmandC (804).
Key diagnostic/treatment points Frequently, the definitive oral examination will lead us to an incorrect identification of the teeth, especially during eruption of the permanent teeth and when there is persistence of certain teeth. Dental X-ray is an excellent diagnostic method to identify these teeth. Common errors We may commit significant errors if we do not perform dental X-rays during interceptive orthodontic treatment (extraction of persistent teeth), especially in cases of severe malocclusions, where we may even extract the wrong teeth. 52
Occlusion and malocclusion
B F
A
A
E
A
A
D
C Malocclusion
Persistent teeth
Persistence of four maxillary incisors. A From right to left: deciduous LmaxI2 (602), deciduous LmaxI1 (601), deciduous
RmaxI1 (501) and deciduous RmaxI2 (502). B From right to left: LmaxC (204), LmaxI3 (203), LmaxI2 (202), LmaxI1 (201),
RmaxI1 (101), RmaxI2 (102), RmaxI3 (103), RmaxC (104) and deciduous RmaxC (504). C From right to left: RmandI1 (401), RmandI2 (402), RmandI3 (403) and
RmandC (404). D Palatoversion of LmaxI1 (201) and RmaxI1 (101) due to persistence of de-
ciduous LmaxI2 (602), deciduous LmaxI1 (601), deciduous RmaxI1 (501) and deciduous RmaxI2 (502).
A
Malocclusion
E Suspicions of mandibular mesiocclusion due to malocclusion in the incisal area
and RmandC (404).
F Impacted hair.
Key diagnostic/treatment points The persistence of deciduous teeth may cause existing malocclusions to worsen, such as the suspicions of mandibular mesiocclusion in this case. The persistence of maxillary incisors has caused moderate palatoversion of LmaxI1 (201) and RmaxI1 (101). Initial treatment should start with interceptive orthodontic treatment (extraction of the persistent teeth).
C
B
Persistent teeth
Persistence of RmaxI3 (503). A From right to left: RmaxI1 (101), RmaxI2 (102), RmaxI3 (103), deciduous
RmaxI3 (503) and RmaxC (104). B Persistence of deciduous RmaxI3 (503). C Linguoversion of RmandC (404).
Key diagnostic/treatment points The persistence of deciduous teeth may cause malocclusions, not only with their corresponding permanent teeth, but also with the rest of the teeth of the region. In this clinical case, the persistence of deciduous RmaxI3 (503) hinders the correction of another existing malocclusion such as the linguoversion of RmandC (404). Extraction of the persistent tooth is urgent in these clinical cases. 53
Visual atlas of oral pathologies in dogs
A
B
D A Neoplasms
Peripheral odontogenic fibroma (fibromatous-ossifying epulis)
B
Peripheral odontogenic fibroma (fibromatous-ossifying epulis) in the area of the vestibular gingiva of LmaxP4 (208) (confirmed through histopathology). A From right to left: LmaxM1 (209) and LmaxP4 (208). B Peripheral odontogenic fibroma (ossifying epulis) in the area of the
vestibular gingiva of LmaxP4 (208). Key diagnostic/treatment points The peripheral odontogenic fibroma (fibromatous-ossifying epulis), on this occasion, in spite of its uncommon location, shows characteristic macroscopic signs of the process. However, a histopathological diagnosis is essential to confirm the process, as well as the orientation of the dental radiological assessment.
Neoplasms
Peripheral odontogenic fibroma (fibromatous-ossifying epulis)
C
E
Peripheral odontogenic fibroma (fibromatous-ossifying epulis) in the interdental area (mesial) and palatal area of RmaxI1 (101) and LmaxI1 (201) (confirmed through histopathology). A From right to left: LmaxI2 (202), LmaxI1 (201), RmaxI1 (101) and RmaxI2 (102). B Peripheral odontogenic fibroma (fibromatous-ossifying epulis) in the interdental
and palatal areas of RmaxI1 (101) and LmaxI1 (201). C Distovestibular deviation of RmaxI1 (101) and LmaxI1 (201), due to compression
from the tumour. D Dental abrasion in different teeth, with exposure of tertiary dentin. E Image of the peripheral odontogenic fibroma (fibromatous epulis), rostral view. F Dental X-ray: X-ray signs compatible with absence of invasion in the bone tissue
of the neoplasm in the interdental and palatal regions of RmaxI1 (101) and LmaxI1 (201).
F
G Dental X-ray: X-ray signs compatible with vertical bone loss in the interdental
region of RmaxI1 (101) and LmaxI1 (201); possible causes include dental compression and displacement, and periodontal disease.
Key diagnostic/treatment points The peripheral odontogenic fibroma (fibromatous-ossifying epulis) has no infiltration capacity in local bone tissue although in some cases we have observed, if it is located between teeth and increases in size, it can cause displacement (deviation) of regional teeth. 88
G
Pathologies of the oral cavity
B
A
D
E
H
C
G
Neoplasms
F I
Peripheral odontogenic fibroma (fibromatous-ossifying epulis)
Peripheral odontogenic fibroma (fibromatous-ossifying epulis) in the mesial gingiva of deciduous RmaxI1 (501) and deciduous LmaxI1 (601) in an 80-day-old puppy (confirmed through histopathology). A From right to left: Deciduous RmaxI2 (502), deciduous RmaxI3 (503) and
deciduous RmaxC (504). B Peripheral odontogenic fibroma (ossifying epulis) in the mesial gingiva of
deciduous RmaxI1 (502) and deciduous LmaxI1 (601); rostral view. C Image of peripheral odontogenic fibroma (ossifying epulis) in the mesial
gingiva of deciduous RmaxI1 (502) and deciduous LmaxI1 (601). D Image of peripheral odontogenic fibroma (ossifying epulis) in the mesial
gingiva of deciduous RmaxI1 (502) and deciduous LmaxI1 (601); palatal view.
E Image of tumour ulceration caused by occlusion with the mandibular
deciduous incisors. F Dental X-ray: X-ray signs compatible with peripheral odontogenic fibroma
(ossifying epulis), with formation of osteoid tissue in its interior. G Dental X-ray: (From right to left) X-ray signs compatible with deciduous
RmaxI1 (501), deciduous RmaxI2 (502) and deciduous RmaxI3 (503). H Dental X-ray: (From right to left) X-ray signs compatible with RmaxI1 (101),
RmaxI2 (102) and RmaxI3 (103). I Dental X-ray: artefact.
Key diagnostic/treatment points The peripheral odontogenic fibroma (ossifying epulis), in this case, is observed in a patient under three months of age. This presentation at such young ages is extremely rare, with a benign prognosis if it is adequately treated through surgery. 89
Visual atlas of oral pathologies in dogs
Congenital and development-related
Cleft palate
Cleft palate due to alteration of the secondary palate in a 75-day-old patient. A Alteration of the secondary palate, causing a cleft palate in the area of the
midline of the hard palate. B Alteration of the secondary palate, causing a cleft palate in the area of the
A
midline of the soft palate.
Key diagnostic/treatment points The cleft palate, or congenital palatal fissure, is a process that is considered to be hereditary, in which there is no closure in the bone of the palate or its soft tissues, normally in the midline, causing communication between the oral and nasal cavity. It can occur, therefore, in the regions of the hard or soft palates, or in both such as in this clinical case. The predominant symptoms include a chronic rhinitis due to the entry of foods and liquids in the nasal cavity. Treatment is surgical with a good-to-reserved prognosis.
B
C A B
Congenital and development-related
Cheilitis-dermatitis of the lips
Cheilitis-dermatitis of the lips. A From right to left: RmaxI3 (103) and RmaxC (104). B Area of lip folds with inflammation. C Area moistened by the deposit of saliva and serous liquid due to the inflam-
mation and infection of the region.
108
Key diagnostic/treatment points Lip fold dermatitis is a chronic process in breeds such as Spaniels, Shar Pei, etc. in which, due to the folds in their lips, an accumulation of saliva and food bits is produced causing infection and local inflammation. The initial treatment in mild cases consists of the application of local antiseptics and antibiotic therapy after elimination or trimming of the hair and cleaning of the area. If the symptoms persist, or, in certain moderate and severe cases, surgical treatment is ideal, with a good prognosis.
Pathologies of the oral cavity
Congenital and development-related Cleft nose Cleft nose. A Image of the cleft nose.
A
Key diagnostic/treatment points In those cases where the nasal sulcus reaches the upper lip, we find a cleft nose, typical in breeds such as the Spanish Scenthound. There is no clinical significance.
A
Metabolic and iatrogenic aetiology
Calcinosis circumscripta
Calcinosis circumscripta of the tongue, unknown aetiology (confirmed through histopathology). A Image of the calcinosis circumscripta on the ventral surface of the tongue.
Key diagnostic/treatment points Calcinosis circumscripta is an infrequent benign pathology in the oral cavity that appears like an idiopathic deposit of amorphous calcified material. Traumatic aetiology of different types is considered the most probable cause of the calcium deposit. Histopathological study of the process is always indicated for confirmation. If necessary, surgical resolution by means of excision with narrow margins is curative. 109
Visual atlas of oral pathologies in dogs
Traumatic aetiology Soft tissue lesions Lesions from occlusion/malocclusion Ulcerated lesion in the rostral mucosa of RmaxC (104) and LmaxC (204), due to occlusion of the mandibular canines. A Typical lesion in brachycephalic breeds. B Moderate to severe ulcers due to occlusion of the
mandibular canines. C Lack of alignment of the maxillary incisors.
A
B
C
122
Key diagnostic/treatment points Lesions of soft tissues are relatively frequent, especially this type of lesions in mucosa due to occlusion of canines in brachycephalic breeds. Treatment consists of eliminating the cause by means of orthodontic treatment or by crown reduction of the mandibular canines (partial coronal pulpectomy).
Pathologies of the oral cavity
D
A
C E B
H
F
G I
J C
K Traumatic aetiology
Soft tissue lesions
Burns from electric wiring
Burns from electric wiring causing lesions to soft tissues and focal osteomyelitis in a puppy (confirmed through histopathology). A Lesion on right side of upper lip with loss of soft tissue due to a burn from
biting an electric wiring. B Severe right lateral deviation of the tongue due to loss of tissue on its right
lateral region. C Image of the signs of the burn on deciduous RmaxP3 (507) and deciduous
RmandP4 (808). D Absence of tissue on the right lateral region of the tongue. E Osteomyelitis in the rostral region of deciduous RmandP4 (808).
G Image of the severe tissue defect on the right portion of the upper lip. H Image of the focal osteomyelitis in the radicular region of deciduous
RmaxP3 (507). I Image of the severe tissue defect on the right lateral region of the tongue. J From right to left: RmandI1 (401), RmandI2 (402), RmandI3 (403)
and RmandC (404). K From right to left: (all deciduous) RmandI1 (801), RmandI2 (802), RmandI3
(803) and RmandC (804).
F Moderate tissue defect on the right portion of the lower lip.
Key diagnostic/treatment points Lesions in hard tissues, and especially in soft tissues, are frequent in young animals after biting electric wiring and receiving an electric shock. This shock causes severe lesions in the soft tissues, with destruction and necrosis, as well as subsequent necrosis and osteomyelitis of the bone tissue. If these lesions are severe, they can cause irreversible lesions with mild to severe alteration of the oral cavity’s functioning. 123
Visual atlas of oral pathologies in dogs
C B
A
E
D
F
Traumatic aetiology
Hard tissue lesions
Mandibular fractures
Mandibular fracture in the rostral region of RmandP4 (408). A From right to left: RmandP2 (406), RmandP3 (407), RmandP4 (408)
and RmandM1 (409).
D Macroscopic signs compatible with a mandibular fracture in the rostral
region of RmandP4 (408); rostral view.
B Macroscopic signs of a mandibular fracture due to severe absence of tooth alignment.
E Dental X-ray: X-ray signs compatible with mandibular fracture in the rostral
C Macroscopic signs compatible with a mandibular fracture in the rostral region
F Dental X-ray: artefact.
region of RmandP4 (408).
of RmandP4 (408) with lesioned soft tissues; vestibular view. Key diagnostic/treatment points In all cases in which we detect these mandibular fractures after a traumatic event (bite from another dog), we must perform a complete radiological study to determine the extension and direction of the fracture to determine the most suitable method of surgical resolution. 128
Pathologies of the oral cavity
B
C
D
A Traumatic aetiology
Hard tissue lesions Mandibular fractures
Mandibular fracture in the incisal region and of the mandibular canines. A From right to left: RmandI3 (403), RmandC (404), RmaxC (104). B Suspicions of mandibular fracture due to moderate absence of alignment
of RmandI3 (403) and RmandC (404), as well as lesioned soft tissues. C Malocclusion in the incisal area due to a mandibular fracture. D Macroscopic signs of a mandibular fracture from the mesial area of RmandC
(404), in a distolingual direction, to the distal region of LmandC (304). E Dental X-ray: X-ray signs compatible with a mandibular fracture from
the mesial area of RmandC (404), to the distal region of LmandC (304).
E Key diagnostic/treatment points The definitive oral examination under sedation to confirm the suspicions of a mandibular or maxillary fracture, as well as the radiological examination by means of dental X-ray or a CT scan, are essential for the correct diagnosis of the extension and direction of the fracture; in this clinical case, the lesions first detected are minimal compared to the real mandibular fracture. This clinical case was resolved surgically using a wire reinforced acrylic splint.
129
Visual atlas of oral pathologies in dogs
C
B
A
Bacterial aetiology
Periodontal disease
Oronasal fistula in the area of LmaxC (204). Aetiology: periodontal disease. A Suspicions of stage 4 periodontal disease due to affectation of the palatal area
of LmaxC (204). B Dental calculus. C Confirmation of stage 4 periodontal disease through measurement with a
periodontal probe; periodontal pocket of 13 mm in the palatal area of LmaxC (204).
D
D Detection of an acquired oronasal fistula caused by periodontal disease, after
extraction of LmaxC (204). Key diagnostic/treatment points The detection of oronasal fistulas, caused by advanced stages of periodontal disease, is relatively frequent, especially in small dogs and in the maxillary canine region. The symptoms frequently go unnoticed as they are mild, or symptoms such as mild to moderate chronic rhinitis may appear. In severe cases, drainage of serous, serosanguineous or seropurulent liquid can be detected through the nasal fossa on the affected side. The primary treatment should be based on the correction of the cause (extraction of the affected canine tooth, in this clinical case) and surgical closure of the oronasal fistula. Common errors Not performing an adequate oral examination before starting periodontal treatment. Most of these processes are easily identifiable, and even controllable, in their first stages, if an adequate definitive oral examination is performed using a periodontal probe, and later, implementing adequate regional periodontal treatment. 138
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