{"id":1304,"date":"2013-05-01T16:14:38","date_gmt":"2013-05-01T16:14:38","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=1304"},"modified":"2022-10-06T13:44:56","modified_gmt":"2022-10-06T13:44:56","slug":"dental-diagnosis-case-of-the-missing-tooth","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/dentistry\/dental-diagnosis-case-of-the-missing-tooth\/","title":{"rendered":"Case of the Missing Tooth"},"content":{"rendered":"

\"pdf_button\"<\/a><\/p>\n

QUESTION<\/span><\/h2>\n

During a routine visit, it is discovered that the patient\u2014a pug\u2014is missing a mandibular first premolar (Figure 1<\/b>); there is no swelling or discharge in the area. Based on the physical examination findings, what are your differential diagnoses and thoughts on further diagnostics and treatment?<\/span><\/p>\n

\"Figure<\/a>

Figure 1<\/p><\/div>\n

ANSWER<\/span><\/h2>\n

It is exceedingly common for teeth to be absent in the dental arcades of veterinary patients. If the tooth is not seen above the gumline, do not assume it is truly absent or previously extracted.<\/span><\/p>\n

Possible etiologies for \u201cmissing\u201d teeth include:<\/span>1<\/sup><\/span><\/p>\n

    \n
  1. <\/b>Congenitally missing:<\/b><\/span>2<\/sup><\/b><\/span>
    \nThis is generally considered to be a genetic problem, but can also occur secondary to significant in utero or neonatal issues. Congenitally missing teeth are common in small, toy, and brachycephalic breeds,<\/span>3<\/sup><\/span> with a predisposition in the Chinese Crested and Mexican hairless breeds.<\/span>1<\/sup><\/span> Teeth most typically affected include premolars, maxillary second and mandibular third molars, and incisors. No specific therapy is necessary.<\/i><\/span><\/li>\n
  2. <\/b>Previously exfoliated or extracted: <\/b><\/span>
    \nWhile rare in juvenile patients, this cause is common in mature to geriatric animals. Exfoliation (ie, the tooth has fallen out \u201con its own\u201d) typically results from periodontal disease, but may also be trauma related. In older animals, extraction is a more likely cause. In these cases, radiographs will usually reveal evidence of a healing alveolus. Again, no specific therapy is necessary.<\/i><\/span><\/li>\n
  3. <\/b>Fracture below the gingival margin: <\/b><\/span>
    \nThis condition is also rare in the juvenile patient, but common in adults. Subgingival tooth fractures may occur as a result of an incomplete extraction attempt, and retained roots are actually far more common than thought.<\/span>4<\/sup><\/span> Dental radiographs can confirm retained roots and potential infectious lesions. Surgical extraction is generally recommended to alleviate pain and endodontic infection.<\/i><\/span><\/li>\n
  4. <\/b>Impacted or embedded: <\/b><\/span>
    \nThese teeth may be malformed or normal, but do not erupt into the dentition because they are blocked by a structure, such as bone or tooth (deciduous or permanent) or, most commonly, by an area of thick and firm gingiva called an operculum<\/i>. This condition is most common in the first and second premolars of brachycephalic breeds.<\/span><\/li>\n<\/ol>\n

    It is critical to note that the first two causes for \u201cmissing\u201d teeth require no therapy, because the teeth are truly absent. However, the remaining two causes can be associated with significant pathology. Therefore, all \u201cmissing\u201d teeth should be radiographed<\/b> to determine whether the cause is true absence versus subgingival pathology.<\/span>5<\/sup><\/span><\/p>\n

    QUESTION<\/span><\/strong><\/h2>\n

    Figure 2<\/b> is a dental radiograph of the area of the absent mandibular first premolar. Based on the physical examination findings and radiograph, what is your diagnosis and treatment plan?<\/span><\/p>\n

    \"Figure<\/a>

    Figure 2<\/p><\/div>\n

    ANSWER<\/span><\/strong><\/h2>\n

    The radiographic image reveals an unerupted mandibular first premolar tooth (white arrow<\/b>). In addition, there is a significant, smooth-edged lytic lesion surrounding the tooth (red arrows<\/b>). Finally, many of the teeth have been displaced (blue arrows<\/b>).<\/p>\n

    \"figure<\/a><\/p>\n

    The primary diagnosis is a <\/span>dentigerous cyst.<\/b><\/span><\/p>\n

    Treatment recommendations include:<\/span><\/p>\n