Evaluation of Dental and Oral Pathologies of 36 Captive Lions (Panthera leo) and Tigers (Panthera tigris).

The documented increase in the occurrence of dental diseases in captive big cats over the past decades has necessitated the need to target dental medical research accordingly. The aim of this study was the systematic evaluation of dental and oral pathologies of lions and tigers which included intraoral dental radiography. Thirty-six animals of both sexes, ranging in age from nine months to 18 years, predominantly in circus husbandry, served as the basis of the present study, and their dental health status was investigated. The preliminary report and history, adspection of the awake animal, and examination under anesthesia provided important information. Eight animals were specifically presented for oral examination because of known dental disease. The remaining 28 animals were anesthetized for other medically necessary procedures, and each animal's oral and dental health status was also evaluated while under anesthesia. In the 28 animals that underwent routine oral cavity examination, pathological changes that had not previously been noticed were found in two-thirds of the animals (19/28). One-quarter of all the animals (9/36) had no abnormal oral cavity findings. Dentoalveolar trauma such as tooth fractures and abrasion (24/36) were diagnosed most frequently. The results highlight the importance of regular oral examinations in big cats. Furthermore, the results suggest that there is a relationship between husbandry conditions and the incidence of dentoalveolar trauma in captive big cats.

Morphometry of the mandibular foramen applied to the local anesthetic block to inferior alveolar nerve in boars (Sus scrofa scrofa Linnaeus, 1758) / Morfometria do forame mandibular aplicada ao bloqueio anestésico local do nervo alveolar inferior de javalis (Sus scrofa scrofa Linnaeus, 1758)

Boars kept on commercial farms use their canine teeth as a mechanism of defense and attack in order to express their natural instincts, which could result in fractures of the teeth and jaws. Thus, utilizing local desensitization of the inferior alveolar nerve is crucial for executing therapeutic procedures in the oral cavities of those animals. Then, the goal is to carry out the morphometry of the mandibular foramen of that species, correlating it with the mandibular structures, while doing so in the safest manner for the animals. For that purpose, six hemimandibles of young-aged Sus scrofa scrofa were used, from which the proposed measurements were taken. On average, the lateral margin of the condylar process stood 142.43 mm away from the root of the lower medial incisive tooth. The longitudinal axis of the body of the mandible measured 22.3 mm at the level of the diastema that exists between the fourth lower premolar tooth and the first lower molar tooth. The mandibular foramen, from the caudal limit of the ventral margin, would be positioned at 26.6 mm from the ventral margin of the angle of the mandible in that level, 34.92 mm away from the medial margin of the condylar process, and 38.63 mm away from the dorsal limit from the caudal margin of the coronoid process. The lack of statistically significant differences, and observing that the osseous accident under scrutiny had been positioned in the ramus of the mandible, indicated that the proposed procedure should be performed from the introduction of the needle in an oblique and rostrodorsal direction for 2.0 cm, and angulated at 60º with the anatomic reference created by the medial demarcation obtained via the support of the thumb on the lateral margin of the ramus of the mandible, ventrally to the zygomatic arch, all while preserving neighboring structures and establishing an unheard-of anesthetic methodology for boars.(AU)

Javalis mantidos em criatórios comerciais utilizam os dentes caninos como mecanismo de defesa e ataque a fim de expressar seus instintos naturais, o que pode resultar em fraturas dentárias e da mandíbula propriamente dita. Desta forma, propiciar a dessensibilização local do nervo alveolar inferior é essencial para a execução de procedimentos terapêuticos na cavidade oral destes animais. Logo, objetivou-se realizar a morfometria do forame mandibular desta espécie a fim de correlacioná-lo com as estruturas mandibulares, inferindo, também, sobre a forma mais segura de realização da referida técnica nos espécimes. Para tanto, foram utilizadas seis hemimandíbulas de Sus scrofa scrofa jovens, a partir das quais foram realizadas as mensurações propostas. Em média, a margem lateral do processo condilar distanciou-se 142,43 mm da raiz do dente incisivo medial inferior; o eixo longitudinal do corpo da mandíbula mediu 22,3 mm ao nível do diastema existente entre o quarto dente pré-molar e o primeiro dente molar inferiores; e o forame mandibular, a partir do extremo caudal de sua margem ventral, posicionou-se a 26,6 mm da margem ventral do ângulo da mandíbula neste nível, 34,92 mm da margem medial do processo condilar, e 38,63 mm do extremo dorsal da margem caudal do processo coronóide. Na falta de diferenças estatisticamente significantes, e observando que o acidente ósseo estudado posicionou-se no ramo da mandíbula, indica que o procedimento proposto deva ser realizado a partir da introdução da agulha em sentido oblíquo rostroventral por 2,0 cm e angulada a 60º com o referencial anatômico criado pela delimitação medial obtida pelo apoio do dedo polegar na margem lateral do ramo da mandíbula, ventralmente ao arco zigomático, preservando as estruturas próximas e definindo-se uma metodologia anestésica inédita para os Javalis.(AU)

Clinical applicability of detomidine and methadone constant rate infusions for surgery in standing horses.

OBJECTIVE: To determine the required rate of a detomidine infusion (loading dose 5 µg kg-1; initial rate 12.5 µg kg-1 hour-1) added to a constant infusion of methadone (0.2 mg kg-1; 0.05 mg kg-1 hour-1) for sedation in standing horses and ponies undergoing elective surgeries with appropriate local anaesthetic techniques. STUDY DESIGN: Prospective, clinical study. ANIMALS: Adult, healthy, client-owned, non-food-producing horses or ponies sedated for elective standing surgeries longer than 45 minutes. METHODS: At baseline (in the stables before administration of sedative agents), at 10 minutes after sedation and every 5 minutes thereafter, ataxia, sedation and surgical condition were evaluated; each scored 0-3. These scores were used to adjust the detomidine administration rate using the Ghent Sedation Algorithm. A 10 cm visual analogue scale (VAS) was used by the main surgeon at the end of the procedure to evaluate the surgical conditions. Heart rate, systolic arterial pressure and respiratory frequency were also recorded at each time point. For statistical analysis, anova for normal, Kruskal-Wallis H-test for non-normal variables, and Mann-Whitney U test for VAS were used. RESULTS: From the 42 horses/ponies included in this study, 28 underwent dental procedures and 14 other types of procedures. Overall, dental procedures required higher mean detomidine rates compared with other types of surgeries (16.9 ± 4.5 versus 9.0 ± 1.9 µg kg-1 hour-1) (p < 0.001). Dental procedures were assigned similar VAS scores, median (range), of 7.8 (5.8-10) with other procedures, 8.7 (2.8-10). Cardiovascular changes were not clinically significant. No signs or behavioural changes of abdominal pain were observed postoperatively. CONCLUSIONS AND CLINICAL RELEVANCE: Satisfactory surgical conditions were achieved using a combination of detomidine and methadone infusions with locoregional anaesthesia, with no adverse effects. Dental procedures required higher detomidine dose rates compared with other surgeries.

Morphometry of the mandibular foramen applied to local anesthesia in hoary fox (Lycalopex vetulus) / Morfometria do forame mandibular aplicada à anestesia local em raposa-do-campo (Lycalopex vetulus)

Great part of the veterinary care in wild carnivores is intended to treat the dental disorders, and oral cavity disorders may generally affect the animal health as a whole. It is factual that knowing the location of the mandibular foramen is vital for local anesthetic block of the inferior alveolar nerve, however, there is still no data on the morphometry of the hoary fox mandibular foramen. The aim was describing morphometry of the mandibular foramen of this species and associating its position with anatomic reference points in the mandible, thus providing support for more effective local anesthetic block of the inferior alveolar nerve in such species. Four adult jaws of Lycalopex vetulus were used. Radiography and biometrics of the hemimandibulas were performed. The rostral third of the jaw body in a lateral view presented three mental foramens, being a rostral, a medium and a caudal. Each hemimandibula presented I3/C1/PM4/M3. The angle of the mandible was marked by the masseteric fossa, the angular incisure, the angular process and the mandibular foramen, and this last one located perpendicularly to the dorsal edge of the angular incisures in medial view. In this view, the crevice to the milohyoid nerve, projected in the caudodorso rostral direction, was also evidenced. The ramus of the mandible was characterized by the presence of the condylar and coronoid processes, and by the dorsal and ventral mandibular incisions. Statistical analyzes did not present significant differences between the antimeres of the studied animals, and the penetration of the needle perpendicularly to the dorsal end of the angular incision on average 8.79mm, overlapped to the medial face of the angle of the mandible could be indicated. Alternatively, the access may also be achieved by inserting the needle in an average of 17.69mm perpendicular to the dorsal end of the angular process, in contact with the medial aspect of the angle of the mandible, and in caudo-rostral projection, also allowing a better anesthetic blockade of the inferior alveolar nerve in L. vetulus. It can also be concluded that the masseteric fossa, the dorsal and ventral mandibular angles, the crevice to the milohyoid nerve, the ramus of the mandible and the mandibular foramen presented differences in their topographic descriptions when compared to the other canids.(AU)

A maior parte dos atendimentos veterinários em carnívoros silvestres destina-se ao tratamento das afecções dentárias, sendo que doenças de cavidade oral podem afetar a saúde do animal como um todo. É factível que o conhecimento da localização do forame mandibular é essencial para o bloqueio anestésico local do nervo alveolar inferior, entretanto, ainda são inexistentes dados sobre a morfometria do forame mandibular de raposa-do-campo. Objetivou-se descrever a morfometria do forame mandibular desta espécie, e correlacionar sua posição com pontos de referência anatômica na mandíbula, oferecendo subsídio para um bloqueio anestésico local mais efetivo do nervo alveolar inferior nesta espécie. Foram utilizadas quatro mandíbulas de cadáveres adultos de Lycalopex vetulus. Realizou-se a radiografia e as biometrias das hemimandíbulas. O terço rostral do corpo da mandíbula em uma vista lateral apresentou três forames mentuais, sendo um rostral, um médio e um caudal. Cada hemimandíbula apresentou I3/C1/PM4/M3. O ângulo da mandíbula foi marcado pela fossa massetérica, pela incisura angular, pelo processo angular e pelo forame mandibular, e este último localizado perpendicularmente ao extremo dorsal da incisura angular em vista medial. Nesta vista, também se evidenciou o sulco para o nervo milohióideo, projetado em sentido caudodorsorostral. O ramo da mandíbula foi caracterizado pela presença dos processos condilar e coronóide, e pelas incisuras mandibulares dorsal e ventral. As análises estatísticas não apresentaram diferenças significantes entre os antímeros dos animais estudados, podendo-se indicar a penetração da agulha perpendicularmente ao extremo dorsal da incisura angular em média 8,79mm, justaposto à face medial do ângulo da mandíbula. Alternativamente, o acesso também poderá ser realizado introduzindo a agulha em média 17,69mm de forma perpendicular ao extremo dorsal do processo angular, em contato com a face medial do ângulo da mandíbula, e em projeção caudorostral, permitindo também um melhor bloqueio anestésico do nervo alveolar inferior na L. vetulus. Também se pode concluir que a fossa massetérica, as incisuras angular, mandibulares dorsal e ventral, o sulco para o nervo milohióideo, o ramo da mandíbula e o forame mandibular apresentaram diferenças em suas descrições topográficas quando comparados aos demais canídeos.(AU)

ANESTHESIA OF AQUARIUM-HOUSED WALRUS ( ODOBENUS ROSMARUS): A CASE SERIES.

Walruses are a challenging species to anesthetize as a result of their large mass, limited access for drug delivery, unique physiology, and small number of reports describing anesthetic procedures. Three aquarium-housed walruses ( Odobenus rosmarus) ranging in age from 3 to 11 yr old (344-1,000 kg) were anesthetized for dental or ophthalmic surgical procedures, with one animal anesthetized twice and one anesthetized three times. Preanesthetic medication was with intramuscular midazolam (0.1-0.2 mg/kg) and meperidine (2-3 mg/kg). A catheter was placed in the extradural intravertebral vein, and anesthesia was induced with propofol to effect. Orotracheal intubation was performed and anesthesia maintained with isoflurane in oxygen using a circle breathing system connected to a ventilator. Intermittent positive pressure ventilation was used in all procedures. For the ophthalmic surgery, the neuromuscular blocking agent, cisatracurium, was given intravenously to provide a central eye and optimal surgical conditions. The neuromuscular block was antagonized with edrophonium. Total anesthesia times ranged from 1.5 to 6 hr. Midazolam and meperidine were antagonized with flumazenil and naltrexone, respectively, in five of six cases. Nonsteroidal anti-inflammatory agents were provided for analgesia. Recoveries were calm and uneventful. The described anesthetic protocols and case management were successful under the conditions encountered.

Regional Nerve Blocks for Equine Dentistry.

Regional nerve blocks are necessary to facilitate equine oral surgery in the standing sedated patient. Step-by-step instruction on how to perform common regional nerve blocks are discussed, including infraorbital, maxillary, middle mental, and inferior alveolar nerve blocks. Regional nerve blocks are critical when performing dental procedures in the standing horse.1 The infraorbital and maxillary nerve blocks provide anesthesia of the infraorbital nerve, which is a branch of the maxillary nerve. Both nerve blocks provide adequate anesthesia for all maxillary dental procedures.1 When the infraorbital nerve block is utilized, care must be taken to advance the needle into the infraorbital foramen in order to appropriately anesthetize the caudal maxillary teeth. Mandibular dental procedures require anesthesia of the inferior alveolar nerve, which is a branch of the mandibular nerve. Local anesthesia at the level of the mental foramen will result in anesthesia of ipsilateral incisors and canines, while anesthesia at the level of the mandibular foramen will anesthetize the entire ipsilateral mandibular dental quadrant. All nerve blocks should have the injection site aseptically prepared prior to the procedure. The 4 most common dental nerve blocks are described step by step.

Unilateral retrobulbar hematoma following maxillary nerve block in a dog.

OBJECTIVE: To describe the clinical findings and management of a case of retrobulbar hematoma formation secondary to performance of a maxillary nerve block in a dog. CASE SUMMARY: An 11-year-old dog was presented for a routine dental procedure including dental extraction to be performed under general anesthesia. After premedication with intramuscular methadone, anesthesia was induced with intravenous alfaxalone until depth of anesthesia was sufficient to allow orotracheal intubation. Anesthesia was maintained with isoflurane delivered in 100% oxygen. A bilateral maxillary nerve block was performed. During administration of the left nerve block, blood was aspirated. Twenty minutes after placement of the left maxillary nerve block, exophthalmos, periorbital swelling, extensive scleral hemorrhage, and ecchymosis with a 2 × 2 cm region of moderate swelling on the palatal mucosa around the injection site were noted. These lesions were the result of retrobulbar hematoma formation following vessel puncture. Treatment included immediate creation of a drainage tract and administration of anti-inflammatories (carprofen 2 mg/kg PO q 12 h for 7 days), broad spectrum antimicrobial therapy (cefovicin 8 mg/kg SC once), and eye drops (viscotears, 2 drops OS q 12 h for 7 days). The periorbital swelling was significantly reduced within 1 hour of drainage and had almost completely resolved 1 week later. NEW OR UNIQUE INFORMATION PROVIDED: This clinical report details the development and successful management of a unilateral retrobulbar hemorrhage following maxillary nerve block. Management of this condition requires prompt recognition and treatment to prevent permanent damage to the eye. The cornerstone of treatment is drainage, which rapidly decreases the increased intraorbital and intraocular pressure. To our knowledge, this is the first documentation of this complication in the English language literature.

Perioperative anaesthetic care of the cat undergoing dental and oral procedures: key considerations.

CLINICAL CHALLENGES: Anaesthesia for dental and oral procedures in cats can be challenging and many factors need to be taken into consideration. Often it is older patients requiring these procedures and, while old age itself is not a contraindication for general anaesthesia, older patients tend to have limited homeostatic reserves and are, therefore, more prone to anaesthesia-induced insults of vital organs. Most sedative and anaesthetic agents have cardiovascular side effects, which may result in detrimental consequences in older patients in which organ reserves are likely reduced. AIMS: The need for good patient assessment and management during the entire perianaesthetic period cannot be overemphasised. This article describes how both anaesthetic protocol and intravenous fluid therapy should be tailored to the individual cat's needs. Application of a multimodal analgesic protocol (the combination of different analgesic agents) and a balanced anaesthetic technique incorporating local nerve blocks is highly recommended and a particular focus of the review. The use of local anaesthetic agents for the latter not only provides optimal pre-emptive analgesia, but also reduces the amount of anaesthetic agents needed to maintain an adequate level of anaesthesia and, therefore, limits their side effects. Other key aspects of perianaesthetic care of the feline dental and oral patient include airway protection, monitoring and maintenance of body temperature, eye protection, and analgesia extending well into the post-anaesthetic period. EVIDENCE BASE: The authors draw on their clinical experience and the referenced literature to provide a practical overview of this critical but often-overlooked aspect of feline dentistry.

Analgesic effects of maxillary and inferior alveolar nerve blocks in cats undergoing dental extractions.

The aim of this study was to evaluate the analgesic effects of maxillary and/or inferior alveolar nerve blocks with lidocaine and bupivacaine in cats undergoing dental extractions. Twenty-nine cats were enrolled. Using an adapted composite pain scale, cats were pain scored before the dental procedure and 30 mins, and 1, 2 and 4 h after isoflurane disconnection. Cats were sedated with buprenorphine (20 µg/kg), medetomidine (10 µg/kg) and acepromazine (20 µg/kg) intramuscularly. Anaesthesia was induced using alfaxalone (1-2 mg/kg) intravenously and maintained with isoflurane in oxygen. Each cat was randomly assigned to receive maxillary and/or inferior alveolar nerve blocks or no nerve blocks prior to dental extractions. Each nerve block was performed using lidocaine (0.25 mg/kg) and bupivacaine (0.25 mg/kg). Heart rate, systolic arterial blood pressure, respiratory rate, end tidal carbon dioxide and isoflurane vaporiser settings were recorded 5 mins before and after the dental extractions, and the difference calculated. Group mean differences (mean ± SD) for heart rate (-9.7 ± 10.6 vs 7.6 ± 9.5 beats/min [nerve block vs control group, respectively], P <0.0001), systolic arterial blood pressure (-10.33 ± 18.44 vs 5.21 ± 15.23 mmHg, P = 0.02) and vaporiser settings (-0.2 ± 0.2 vs 0.1 ± 0.4, P = 0.023) were significantly different between groups. The control group had higher postoperative pain scores (median [interquartile range]) at 2 h (3 [1.75-4.00] vs 1 [0-2], P = 0.008) and 4 h (4 [2-6] vs 2 [1-2], P = 0.006) after the dental extractions. Maxillary and inferior alveolar nerve blocks with lidocaine and bupivacaine administered prior to dental extractions resulted in a reduction in heart rate and blood pressure while allowing for a reduction in isoflurane. Cats receiving nerve blocks had lower postoperative pain scores than the group without nerve blocks.

Area of desensitization following mental nerve block in dogs.

Regional nerve blocks are commonly used to provide analgesia for dental and oral surgical procedures. The purpose of this study was to demarcate the areas of the mandible that would be desensitized by application of the mental nerve block. Seven healthy mixed-breed dogs were anesthetized for an annual dental examination and professional teeth cleaning procedure. Bupivacaine HCl (0.4 ml/ m2) was administered at one middle mental foramen based on previously described techniques for the mental nerve block. A noxious stimulus was applied at 23 predetermined ipsilateral mandibular locations using pressure from a mosquito hemostat on the mucocutaneous junction (MCJ) and a dental curette on the vestibular mucogingival line (MGL) at the incisor canine, and premolar teeth; and, the mesial and distal aspects of the first molar tooth. A thermal stimulus using a refrigerant spray on a cotton ball was applied to the ipsilateral canine, third premolar and fourth premolar teeth; and, the mesial and distal aspects of the first molar tooth. Demonstration of nociception or anesthesia was noted and the responses tabulated. The area of desensitized tissues was smaller than expected and highly variable within the study group. In conclusion, the unilateral mental nerve block does not reliably provide generalized desensitization to tissues of the incisive and rostral regions of the mandible. Although the mental nerve block is recommended, other modes of analgesia should be emphasized for surgical and dental procedures involving these areas.

Establishing a standardized dental record-keeping system for a small investigational colony of rhesus monkeys (Macaca mulatta).

BACKGROUND: Dental hygiene is becoming an increasingly important component of quality health care for laboratory animals, especially non-human primates (NHPs). One key to a successful health care program is an effective and efficient record-keeping system. METHODS: To standardize a dental hygiene program for a small colony of NHPs, we developed a dental recording chart specific for rhesus monkeys. This dental chart was developed using the modified Triadan system. This system numbers teeth across species according to location. RESULTS: An illustrative case report was presented to demonstrate the accurate record keeping and spatial relationship generated from this Old World NHP dental chart design. CONCLUSION: The development and implementation of a standardized dental chart, as part of a dental hygiene program will help minimize variables that may affect research data.

Administering dental nerve blocks.

Dental nerve blocks provide excellent pain management for many oral procedures. They are easy and inexpensive to perform, provide a rapid onset of action, and work in concert with anesthetic and other analgesic modalities. This article explains how to administer various dental nerve blocks and discusses the indications and precautions associated with their use.

Use of a nerve locator to facilitate administration of mandibular nerve blocks in crocodilians.

As part of a clinical workup of dental problems in a large crocodilian collection, mandibular nerve blocks were performed in the animals. A nerve locator was used to facilitate placement of the nerve blocks in American alligators (Alligator mississippiensis), Yacare caiman (Caiman yacare), and a dwarf crocodile (Osteolaemus tetraspis). Provision of analgesia is a frequently underused aspect of patient care in reptiles. Use of a nerve stimulator provides an objective measurement of nerve conduction blockade and may be useful in exotic species in which anatomic landmarks for nerve block placement are not well established.

Oral disorders of exotic ungulates.

There are many species classified as ungulates that possess a large variety of dental formulae and dental adaptations. Despite the diversity found within the ungulate group, the list of dental abnormalities remains short. Regardless of the contributing factors, cases of aveolitis accompanied by osteomyelitis ("lumpy jaw") occur more frequently than some of the other dental problems that are encountered in these species (fractures of tusks/canines, malocclusion, eruption cysts). Commonly, treatment of "lumpy jaw" requires exodontia with additional antibiotic therapy using a drug that is appropriate for the type of infection and the species of animal. Regardless of the dental abnormality, anesthetic, diagnostic, and treatment considerations typically provide the greatest challenge to the clinician in these cases.