{"id":1050,"date":"2014-05-01T01:09:14","date_gmt":"2014-05-01T01:09:14","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1050"},"modified":"2022-10-06T13:38:33","modified_gmt":"2022-10-06T13:38:33","slug":"disorders-of-dental-hard-tissues-in-dogs","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/dentistry\/disorders-of-dental-hard-tissues-in-dogs\/","title":{"rendered":"Disorders of Dental Hard Tissues in Dogs"},"content":{"rendered":"<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2016\/06\/T1405C10.pdf\"><img decoding=\"async\" class=\"alignnone size-full wp-image-9886\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2011\/07\/pdf_button.png\" alt=\"pdf_button\" width=\"110\" height=\"27\" \/><\/a><\/p>\n<h2><span class=\"redheader\">ENAMEL HYPOCALCIFICATION\/HYPOPLASIA<\/span><sup>1-4<\/sup><\/h2>\n<p>Enamel is a very thin (&lt; 1 mm) material on the surface of the tooth crown. Ameloblast cells initiate enamel formation, and are only present during this process.<sup>5,6<\/sup> Enamel is created prior to tooth eruption and cannot be naturally repaired after teeth erupt.<\/p>\n<div class=\"orange-box\">\n<h2><span class=\"arial\"><strong>PERTINENT TOOTH ANATOMY<sup><span style=\"font-size: small\">6,12<\/span><\/sup><\/strong><\/span><\/h2>\n<h3><span class=\"arial\"><strong>ENAMEL<\/strong><\/span><\/h3>\n<p>The tooth crown is protected by a thin shell of enamel. Enamel thickness in cats and dogs varies from approximately 0.1 mm to 1 mm.<sup><span style=\"font-size: small\">16<\/span><\/sup><\/p>\n<p><span class=\"arial\"><strong>PULP<\/strong><\/span><\/p>\n<p><span class=\"arial\"><strong>T<\/strong><\/span>ooth pulp is a soft tissue that contains blood vessels, nerves (sensory only), and other types of cells, including odontoblasts, fibroblasts, and fibrocytes. Blood enters the tooth through the apical delta, along with the nerve bundles.<\/p>\n<div id=\"attachment_4754\" style=\"width: 386px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.22.40-AM.png\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-4754\" class=\"wp-image-4754 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.22.40-AM-e1455652461791.png\" alt=\"Screen Shot 2015-06-18 at 11.22.40 AM\" width=\"376\" height=\"288\" \/><\/a><p id=\"caption-attachment-4754\" class=\"wp-caption-text\">Figure. Medical illustration of a maxillary canine in a dog<\/p><\/div>\n<p class=\"arial\"><span class=\"arial\"><strong>DENTIN<\/strong><\/span><\/p>\n<p>Dentin is arranged in tubules\u2014these extend from the pulp to either the area where dentin and enamel meet (dentinoenamel junction) or the root where cementum and enamel meet (cementoenamel junction).<\/p>\n<p>Dentinal tubules are filled with fluid and odontoblastic tendrils, which are cytoplasmic extensions of odontoblasts. These tubules are major pathways for diffusion of material across dentin\u2014a concept known as<em> dentin permeability<\/em>.<sup><span style=\"font-size: small\">1<\/span><\/sup><\/p>\n<h3><span class=\"arial\"><strong>DENTIN\u2013PULP COMPLEX<\/strong><\/span><\/h3>\n<p>Due to the interdependent relationship between pulp and dentin, these two tissues are best considered as one entity: the dentin\u2013pulp complex. Pulp and dentin function as one unit because odontoblasts, which line the pulp cavity wall, project their extensions into dentin. Also, odontoblasts are responsible for formation of dentin. In turn, pulp tissue is dependent on dentin for protection.<\/p>\n<\/div>\n<h3><span class=\"bluboldheader\">Causes &amp; Development<\/span><\/h3>\n<p>Hypoplasia\/hypocalcification results from disruption of normal enamel development.<sup>7,8<\/sup><\/p>\n<ul>\n<li><strong><span class=\"blue\">Enamel hypocalcification<\/span> <\/strong>occurs when normal amounts of enamel are produced, but are hypomineralized, making the enamel softer than normal.<\/li>\n<li><strong><span class=\"blue\">Enamel hypoplasia<\/span> <\/strong>occurs when the enamel produced is hard, but thin and deficient in amount.<\/li>\n<\/ul>\n<p>Enamel hypocalcification can result from trauma to an unerupted tooth, which can affect one or several adjacent teeth, and is the most common acquired cause. While this defect may originate from external trauma, it is often associated with extraction of deciduous teeth.<\/p>\n<p>Enamel hypoplasia may result from a hereditary condition known as<em><span class=\"italic\"> amelogenesis imperfecta<\/span><\/em>,<sup>9<\/sup> which results when a decreased amount of enamel matrix is applied to teeth during development. In these cases, nearly all teeth, and all surfaces, are involved.<\/p>\n<p>A severe systemic infectious (for example, canine distemper virus infection that occurs in puppies before the teeth have erupted) or nutritional condition may also result in improper enamel production.<sup>9<\/sup><\/p>\n<h3><span class=\"bluboldheader\">Clinical Signs &amp; Diagnosis<\/span><\/h3>\n<p>Common signs of enamel hypocalcification\/hypoplasia are listed in <strong><span class=\"bold\">Table 1<\/span><\/strong>. These signs emphasize that prompt therapy is critical to the health of the patient.<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.22.51-AM.png\"><img decoding=\"async\" class=\"alignnone wp-image-4753 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.22.51-AM-e1455652691770.png\" alt=\"Screen Shot 2015-06-18 at 11.22.51 AM\" width=\"473\" height=\"286\" \/><\/a><\/p>\n<p>Prior to therapy, dental radiographs must be exposed to evaluate whether tooth nonvitality or root malformation (<strong><span class=\"bold\">Figure 1<\/span><\/strong>) is present.<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.00-AM-e1455652896476.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4752 size-figure_img\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.00-AM-e1455652896476-496x300.png\" alt=\"\" width=\"496\" height=\"300\" \/><\/a><\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.06-AM-e1455653312418.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4751 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.06-AM-e1455653312418.png\" alt=\"\" width=\"554\" height=\"246\" \/><\/a><\/p>\n<h3>Treatment Options<\/h3>\n<p>Treatment goals include:<\/p>\n<ul>\n<li>Removing sensitivit<\/li>\n<li>Avoiding endodontic infection by occluding the dentinal tubules<\/li>\n<li>Smoothing the tooth to decrease plaque accumulation.<\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.14-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-4750\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.14-AM.png\" alt=\"Screen Shot 2015-06-18 at 11.23.14 AM\" width=\"285\" height=\"876\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.14-AM.png 285w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.14-AM-98x300.png 98w\" sizes=\"(max-width: 285px) 100vw, 285px\" \/><\/a><\/p>\n<p><strong><span class=\"bold\">Composite restoration<\/span> <\/strong>is the most effective way to accomplish these goals (<strong><span class=\"bold\">Figure 3<\/span><\/strong>), and it also improves tooth appearance. However, this therapy only provides a small amount of strength.<\/p>\n<p><strong><span class=\"bold\">Crown therapy<\/span> <\/strong>can be performed if damage is severe and the client is interested in a permanent correction (<strong><span class=\"bold\">Figure 4<\/span><\/strong>).<sup>1<\/sup><\/p>\n<p><strong><span class=\"bold\">Smoothing and bonded sealant application<\/span> <\/strong>can be considered for minor areas of disease or nonstrategic teeth, and in patients whose owners have financial concerns (<strong><span class=\"bold\">Figure 5<\/span><\/strong>). For more information on this procedure, see <a href=\"https:\/\/todaysveterinarypractice.com\/bonded-sealant-application-crown-fractures\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong><span class=\"blue\">Bonded Sealant Application for Crown Fractures<\/span> <\/strong><\/a>(July\/August 2011), available at<strong><span class=\"blue\"> tvpjournal.com<\/span><\/strong>.<\/p>\n<p><strong><span class=\"bold\">Extraction<\/span><\/strong> may be performed, but it is generally not recommended.<\/p>\n<h2><span class=\"redheader\">CARIES<\/span><sup>1,2,9<\/sup><\/h2>\n<p>Caries (in humans, commonly called \u201ccavities\u201d) occur when acid dissolves the hard structures of the teeth. Reports on prevalence vary widely, which may be due to overdiagnosis of discolored surfaces,<sup>18<\/sup> but caries are fairly rare in dogs and almost unheard of in cats. A study that evaluated dogs seen at a veterinary dental referral facility found a prevalence of 5.3%.<sup>19<\/sup><\/p>\n<h3><span class=\"bluboldheader\">Causes &amp; Development<\/span><\/h3>\n<p>Caries lesions begin in areas where food becomes trapped (<strong><span class=\"bold\">Table 2<\/span><\/strong>); bacterial digestion of the food produces acid, which initiates the lesion.<sup>20<\/sup> Therefore, home care can help avoid these lesions.<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.22-AM-e1455653794859.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4741 size-figure_img\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.22-AM-301x300.png\" alt=\"\" width=\"301\" height=\"300\" \/><\/a><\/p>\n<p>Development of caries can ultimately affect the endodontic system.<\/p>\n<ol>\n<li>The initial lesion\u2014a surface decalcification of the enamel\u2014is caused by a drop in pH .<\/li>\n<li>Demineralization follows the direction of the enamel rods.<\/li>\n<li>Eventually, caries breaks through the enamel and invades the dentin. Once this occurs, the lesion expands laterally fairly quickly, as dentin is less mineralized than enamel.<\/li>\n<li>Once dentin is destroyed, the unsupported enamel will collapse, expanding the lesion.<\/li>\n<li>These lesions can progress into the endodontic system, resulting in pain and infection.<\/li>\n<\/ol>\n<h3><span class=\"bluboldheader\">Clinical Signs &amp; Diagnosis<\/span><\/h3>\n<p>Outwardly, caries appear as a discolored tooth defect (<strong><span class=\"bold\">Figure 6<\/span><\/strong>). Discoloration is usually brown to black, but can be white very early in development. Early lesions can mimic wear, and are best diagnosed by tactile feel of the defect with a sharp explorer (<strong><span class=\"bold\">Figure 7<\/span><\/strong>). Healthy tooth structure is solid, whereas caries is soft and sticky. When penetrating the caries, the explorer will experience \u201ctug back.\u201d<\/p>\n<p>Prior to therapy, dental radiographs must be exposed to determine the size of the defect and evaluate tooth vitality. Caries appear as radiolucent areas (<strong><span class=\"bold\">Figure 8<\/span><\/strong>).<\/p>\n<h3><span class=\"bluboldheader\">Treatment Options<\/span><\/h3>\n<p><span class=\"bold\">Evidence of endodontic disease<\/span>:<\/p>\n<ul>\n<li><strong><span class=\"blue\">Root canal therapy<\/span> <\/strong>is required prior to restoration.<\/li>\n<li><strong><span class=\"blue\">Crowns<\/span> <\/strong>are recommended since damage is likely significant\u2014creating teeth susceptible to fractures.<\/li>\n<li><strong><span class=\"blue\">Extraction<\/span> <\/strong>can also be considered.<\/li>\n<\/ul>\n<p><span class=\"bold\">Early to moderately advanced caries<\/span>:<\/p>\n<ul>\n<li><strong><span class=\"blue\">Removal of all diseased tooth structures<\/span> <\/strong>is required prior to restoration.<\/li>\n<li><strong><span class=\"blue\">Composite resin<\/span> restoration<\/strong> is generally the best choice (<strong><span class=\"bold\">Figure 9<\/span><\/strong>).<\/li>\n<li><strong><span class=\"blue\">Amalgam<\/span><\/strong>, however, is also a valid option.<\/li>\n<\/ul>\n<p>Lesions at or below the gingival margin:<\/p>\n<ul>\n<li><span class=\"bold\"><strong><span class=\"blue\">Glass ionomer restoration<\/span> <\/strong>is most likely the best treatment.<sup><span style=\"font-size: small\">21<\/span><\/sup><\/span><\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.27-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4742 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.27-AM-e1455654109853.png\" alt=\"Screen Shot 2015-06-18 at 11.23.27 AM\" width=\"214\" height=\"664\" \/><\/a><\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.33-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4743 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.33-AM-e1455654154543.png\" alt=\"Screen Shot 2015-06-18 at 11.23.33 AM\" width=\"208\" height=\"407\" \/><\/a><\/p>\n<h2><span class=\"redheader\">DISCOLORED (INTRINSICALLY STAINED) TEETH<\/span><\/h2>\n<p><em><span class=\"italic\">Intrinsically stained teeth<\/span> <\/em>are discolored teeth in which the abnormal color stems from inside the tooth, specifically the dentin\u2013pulp complex.<\/p>\n<h3><span class=\"bluboldheader\">Causes &amp; Development<\/span><sup>1,2<\/sup><\/h3>\n<p>In dogs, intrinsic staining most often results from blunt trauma of sufficient force to cause pulp hemorrhage, but not enough to fracture the tooth. However, in other dogs, there may be no history of trauma and discoloration occurred for other reasons. For example, another possible, but unlikely cause, is tetracycline use in very young patients; most, if not all teeth, become discolored (yellow\/brown).<\/p>\n<p>Intrinsic staining results when extravasated blood is forced into the dentinal tubules and then degenerates:<\/p>\n<ol>\n<li>A tooth stained by degenerating blood products following pulp hemorrhage appears pink immediately after the injury, eventually becoming darker brown or gray (<strong><span class=\"bold\">Figure 10<\/span><\/strong>).<\/li>\n<li>Although dental pulp can heal after injury, the vast majority of discolored teeth are nonvital.<\/li>\n<li>Once the tooth becomes nonvital, it often becomes infected via the blood supply, in a process known as <em><span class=\"italic\">anachoresis<\/span><\/em>.<\/li>\n<li>Once the tooth becomes infected, it acts as a bacterial fortress, allowing bacteria to create periapical infection, which may spread to the entire body.<\/li>\n<li>Intrinsically stained teeth can also cause clinical abscessation.<\/li>\n<\/ol>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.40-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4744 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.40-AM-e1455654326688.png\" alt=\"Screen Shot 2015-06-18 at 11.23.40 AM\" width=\"214\" height=\"707\" \/><\/a><\/p>\n<p>The only exceptions to the above process are:<\/p>\n<ul>\n<li><strong><span class=\"blue\">Young patients<\/span>:<\/strong> The large endodontic system and good blood supply of these patients allow them to recover from the inflammatory pulpitis, and the tooth returns to normal color in a few weeks. If this does not occur, the tooth should be considered nonvital.<\/li>\n<li><strong><span class=\"blue\">Patients with only discolored cusps<\/span> <\/strong>(rest of the tooth unaffected) (<strong><span class=\"bold\">Figure 11<\/span><\/strong>): These teeth should be radiographed and transilluminated; if both results are normal, the tooth should be monitored.<\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.49-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4745 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.49-AM-e1455654548997.png\" alt=\"Screen Shot 2015-06-18 at 11.23.49 AM\" width=\"215\" height=\"928\" \/><\/a><\/p>\n<h3><span class=\"bluboldheader\">Clinical Signs &amp; Diagnosis<\/span><\/h3>\n<p>Clinical observation is generally diagnostic.<\/p>\n<p><strong><span class=\"bold\">Transillumination<\/span> <\/strong>should be performed if there is any question whether the tooth is discolored (<strong><span class=\"bold\">Figure 1<\/span>2<\/strong>). <strong><em>Note:<\/em><\/strong> As pulp cavity diameter decreases with age, transillumination becomes less reliable and eventually impossible.<\/p>\n<p><strong><span class=\"bold\">Dental radiographs<\/span> <\/strong>should also be exposed to determine the condition of the roots.<\/p>\n<ul>\n<li><strong><span class=\"blue\">Nonvitality<\/span> <\/strong>is indicated by change in width of the endodontic space or periapical lucency (<strong><span class=\"bold\">Figure 13<\/span><\/strong>).<\/li>\n<li><strong><span class=\"blue\">Pulp necrosis<\/span> <\/strong>is indicated by a larger root canal diameter than the contralateral tooth.<\/li>\n<li><strong><span class=\"blue\">Generalized pulpitis<\/span> <\/strong>is indicated by a smaller diameter root canal space than the contralateral tooth.<\/li>\n<li><strong><span class=\"blue\">Periapical lucency<\/span> <\/strong>is evidence of endodontic infection, causing bony resorption.<\/li>\n<\/ul>\n<p>Normal radiographs do <em><strong>not<\/strong> <\/em>indicate that the tooth is alive and not infected, but some will argue that lack of radiographic changes indicates the tooth has responded to the insult and is vital. However, radiographs are not very specific for diagnosing infected teeth<sup>22<\/sup> because:<\/p>\n<ul>\n<li>30% to 50% of the bone must be lost before it is appreciated radiographically<sup>23<\/sup><\/li>\n<li>The endodontic system changes very gradually in older pets.<sup>5<\/sup><\/li>\n<\/ul>\n<p>A 2001 study by Hale demonstrated that only 40% of intrinsically stained teeth had radiographic signs of endodontic disease.<sup>24<\/sup> However, when physically examined, 92.7% were nonvital and infected. In our experience (over 1000 cases), <em><strong>all<\/strong> <\/em>discolored teeth have been nonvital and infected.<\/p>\n<h3><span class=\"bluboldheader\">Treatment Options<\/span><sup>1,2<\/sup><\/h3>\n<p>Discolored teeth (with the exceptions noted earlier) are generally irreversibly inflamed or necrotic. Once the endodontic system becomes nonvital and\/or infected, the tooth must be removed. There are 2 main options for removal.<\/p>\n<p><strong><span class=\"bold\">Root canal<\/span> therapy<\/strong> is the treatment of choice for larger teeth, such as canines and carnassial teeth (<strong><span class=\"bold\">Figure 14<\/span><\/strong>).<\/p>\n<p><strong><span class=\"bold\">Extraction<\/span> <\/strong>is a viable alternative for small teeth, such as incisors and premolars; however, root canal therapy is also indicated if the client wishes to save the tooth.<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.57-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4746 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.23.57-AM-e1455654731276.png\" alt=\"Screen Shot 2015-06-18 at 11.23.57 AM\" width=\"210\" height=\"244\" \/><\/a><\/p>\n<h2><span class=\"redheader\">ABRASION\/ATTRITION<\/span><sup>1<\/sup><\/h2>\n<p>These lesions are similar to uncomplicated crown fractures; however, they result from long-term wearing of the tooth as opposed to a 1-time traumatic event.<\/p>\n<p>Both of these lesions are created by chronic contact with a hard object.<\/p>\n<ul>\n<li><strong><span class=\"blue\">Abrasion<\/span> <\/strong>is caused by a tooth wearing against something foreign.<\/li>\n<li><strong><span class=\"blue\">Attrition<\/span> <\/strong>is caused by tooth-on-tooth contact.<\/li>\n<\/ul>\n<p><strong><span class=\"bold\">Attrition<\/span> <\/strong>is caused by a malocclusion in which the opposing teeth are in contact, which may be due to:<\/p>\n<ul>\n<li><strong><span class=\"blue\">A <em>level<\/em> bite<\/span><\/strong>\u2014a mild class III malocclusion (undershot) and most common cause (<strong><span class=\"bold\">Figure 15<\/span><\/strong>)<sup>25<\/sup><\/li>\n<li><strong><span class=\"blue\">Maxillary third incisors<\/span> <\/strong>creating attrition on the mandibular canines (<strong><span class=\"bold\">Figure 16<\/span><\/strong>)<\/li>\n<li><strong><span class=\"blue\">Improper reduction<\/span> <\/strong>of a maxillofacial fracture.<\/li>\n<\/ul>\n<p><strong><span class=\"bold\">Abrasion<\/span> <\/strong>can be caused by many different objects but, in general, is due to very aggressive chewing, which is more common in large breed dogs.<\/p>\n<ul>\n<li><strong><span class=\"blue\">Chronic chewing on toys<\/span><\/strong>, such as tennis balls, wears down the canines and premolars (<strong><span class=\"bold\">Figure 17<\/span><\/strong>).<\/li>\n<li><strong><span class=\"blue\">Chronic chewing on the skin<\/span> <\/strong>due to allergic dermatologic disease typically wears down the canines and incisors, often to the gum line (<strong><span class=\"bold\">Figure 18<\/span><\/strong>).<\/li>\n<li><strong><span class=\"blue\">Chewing on a chain link fence<\/span> <\/strong>damages the distal aspect of the canines (<strong><span class=\"bold\">Figure 19<\/span><\/strong>).<\/li>\n<\/ul>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.03-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4747 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.03-AM-e1455654891489.png\" alt=\"Screen Shot 2015-06-18 at 11.24.03 AM\" width=\"216\" height=\"679\" \/><\/a><\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.09-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4748 size-full\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.09-AM-e1455654931970.png\" alt=\"Screen Shot 2015-06-18 at 11.24.09 AM\" width=\"215\" height=\"696\" \/><\/a><\/p>\n<h3><span class=\"bluboldheader\">Treatment Options<\/span><\/h3>\n<p>All teeth with attrition or abrasion should be radiographed to ensure tooth vitality. If there are signs of endodontic disease (clinical or radiographic), required treatment is root canal therapy or extraction.<\/p>\n<p><strong><span class=\"bold\">Treatment of dental attrition<\/span> <\/strong>is generally not necessary\u2014unless there is evidence of endodontic disease (clinical or radiographic)\u2014because slowly exposed dentin generally becomes sclerotic and subsequently impervious to pain and bacterial invasion.<\/p>\n<p><a href=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.17-AM.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-4749\" src=\"https:\/\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.17-AM.png\" alt=\"Screen Shot 2015-06-18 at 11.24.17 AM\" width=\"219\" height=\"781\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.17-AM.png 219w, https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/wp-content\/uploads\/sites\/4\/2014\/05\/Screen-Shot-2015-06-18-at-11.24.17-AM-84x300.png 84w\" sizes=\"(max-width: 219px) 100vw, 219px\" \/><\/a><\/p>\n<ul>\n<li><strong><span class=\"blue\">Slight odontoplasty<\/span> <\/strong>with a fine diamond or white stone bur should be performed to alleviate any contact, followed by application of a bonded sealant.<\/li>\n<li><strong><span class=\"blue\">Extraction or odontoplasty with restorative or endodontic treatment<\/span> <\/strong>should be performed before restoration of deep defects, such as those on the mandibular canines caused by maxillary third incisors, because the malocclusion has reached equilibrium\u2014any restorative creates new contact and discomfort.<\/li>\n<\/ul>\n<p><strong><span class=\"bold\">Treatment of dental abrasion<\/span><\/strong>, such as restorative therapy, is not generally indicated because slow progression of abrasion typically results in sclerotic dentin.<\/p>\n<p><strong><span class=\"blue\">Behavior modification<\/span> <\/strong>is the most important form of therapy, and may include:<\/p>\n<ul>\n<li>Supervising play time<\/li>\n<li>Changing toys to less abrasive ones<\/li>\n<li>Modifying the cage<\/li>\n<li>Treating allergic dermatitis.<\/li>\n<\/ul>\n<p><strong><span class=\"blue\">Cast metal crowns<\/span> <\/strong>can help \u201cbuild up\u201d canine teeth if behavior modification is not possible and the client wishes to protect the tooth and provide more tooth surface (<strong><span class=\"bold\">Figure 20<\/span><\/strong>).<\/p>\n<p>Full-coverage cast metal crowns are strongly recommended to strengthen teeth in dogs that have significant damage on the distal aspect due to fence chewing, as they are in great danger of fracturing if not protected (<strong><span class=\"bold\">Figure 21<\/span><\/strong>).<sup>1<\/sup> I have had excellent long-term success with this technique in military and police dogs. However, some veterinarians favor a three-quarter crown to decrease the amount of tooth structure removed.<sup>26<\/sup><\/p>\n<h2><span class=\"redheader\">IN SUMMARY<\/span><\/h2>\n<p>Any time dentin is exposed, tooth sensitivity and inflammation results. In addition, teeth with direct pulp exposure are initially exceedingly painful, and then invariably become infected. These teeth can and should be restored.<\/p>\n<p>Common options for restoration include bonded sealants, composite restoration, and crowns. Most of these techniques are easy to learn, taught at certain training centers, and inexpensive to initiate in practice. When the pulp is involved (including discoloration), treatment is directed at removing the infected root canal system, which can be accomplished by root canal therapy or extraction.<\/p>\n<p>Client education is the key to gaining acceptance of treatment recommendations. The article <a href=\"https:\/\/todaysveterinarypractice.com\/dental-services-good-medicine-for-patients-practices\/\" target=\"_blank\" rel=\"noopener noreferrer\"><strong><span class=\"blue\">Dental Services: Good Medicine for Patients &amp; Practices<\/span> <\/strong><\/a>(September\/October 2011), available at <strong><span class=\"blue\">tvpjournal.com<\/span><\/strong>, discusses the client education process with regard to dentistry.<\/p>\n<h3 class=\"references\"><span class=\"bold\">FIGURE CREDITS<\/span><\/h3>\n<p class=\"references\"><span class=\"bold\">Figure 1<\/span>: Reprinted with permission from<em> <span class=\"italic\">Small Animal Dental, Oral, and Maxillofacial Disease\u2014A Colour Handbook<\/span><\/em>. Niemiec BA (ed). London: Manson, 2010.<br \/>\n<span class=\"bold\">Figures 2 to 7, 20, and 22<\/span>: Reprinted with permission from <span class=\"italic\"><em>Restorative Dentistry for the General<\/em> Practitioner<\/span>. Niemiec BA. Tustin, CA: Practical Veterinary Publishing, 2013.<br \/>\n<span class=\"bold\">Figures 12 and 13<\/span>: Courtesy Dr. Jerzy Gawor.<br \/>\n<span class=\"bold\">Figures 14 and 15<\/span>: Reprinted with permission from <em><span class=\"italic\">Veterinary Dental Applications in Emergency Medicine &amp; Critical or Compromised Patients<\/span><\/em>. Niemiec BA (ed). Tustin, CA: Practical Veterinary Publishing, 2012.<br \/>\n<span class=\"bold\">Figures 16 to 18<\/span>: Provided by Rob Yelland and reprinted with permission from <em><span class=\"italic\">Veterinary Orthodontics<\/span><\/em>. Niemiec BA (ed). Tustin, CA: Practical Veterinary Publishing, 2012.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>ENAMEL HYPOCALCIFICATION\/HYPOPLASIA1-4 Enamel is a very thin (&lt; 1 mm) material on the surface of the tooth crown.<\/p>\n","protected":false},"author":187,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":2794,"footnotes":""},"categories":[366],"tags":[13],"class_list":["post-1050","post","type-post","status-publish","format-standard","hentry","category-may-june-2014","tag-peer-reviewed","clinical_topics-dentistry"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Disorders of Dental Hard Tissues in Dogs | Today&#039;s Veterinary Practice<\/title>\n<meta name=\"robots\" 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