Integrating animal welfare into disaster management using an 'all-hazards' approach.

Statistics show that disasters have expanded in scope and scale, with impacts on both humans and animals. As animals are valued not only for their economic value, but also for their companionship, people sometimes risk their lives to protect them, and emergency responders are expected to safeguard their welfare during emergencies. This paper discusses experiences from different regions of the world in animal disaster risk reduction and management in terms of legislation, funding streams, planning, capacity development, and communications. It is widely recognised that human, animal and environmental well-being are interconnected; therefore, as this is the case, and as veterinarians are at the forefront in ensuring animal welfare, they should be involved throughout the disaster management cycle. While animals and their welfare should always be considered in national disaster management plans, sub-regional authorities must be empowered to integrate animal welfare principles when responding to emergencies and implementing risk reduction programmes. Capacity development is key for Veterinary Services personnel who work in the fields of disaster management and risk reduction. Training tools and curricula developed by different organisations are available to foster skills such as incident coordination, risk communication, or response planning using tools such as the Livestock Emergency Guidelines and Standards (LEGS). Intergovernmental organisations also play a significant role in setting the standards and frameworks within which professionals operate.

Les données statistiques montrent un accroissement de l'amplitude et de la portée des catastrophes ainsi que l'impact qu'elles peuvent avoir sur les populations humaines et animales. La valeur des animaux n'étant pas seulement économique mais également affective, en cas de catastrophe c'est parfois au péril de leur vie que des personnes tentent de sauver animaux et il est attendu des services de secours d'urgence qu'ils prennent en compte le bien-être animal lors de leurs interventions. Les auteurs examinent l'expérience acquise dans diverses régions du monde en matière de réduction et de gestion des risques de catastrophes affectant les animaux, notamment en termes de législation, de mécanismes de financement, de planification, de renforcement des capacités et de communication. Il est désormais établi que le bien-être humain et animal et la qualité environnementale sont étroitement interconnectés ; par conséquent, il est important que les vétérinaires, qui assurent en première ligne la protection du bien-être animal, soient également associés à toutes les phases du cycle de la gestion des catastrophes. S'il est indispensable que les plans nationaux de gestion des catastrophes prennent en compte les animaux et leur bien-être, les autorités locales devraient également être habilitées à intégrer les principes du bien-être animal lors des interventions d'urgence et de la mise en œuvre des programmes de réduction des risques. Il est crucial de renforcer les capacités des personnels des Services vétérinaires qui travaillent dans les domaines de la gestion des catastrophes et de la réduction des risques. Un certain nombre d'outils et de programmes de formation conçus par différentes organisations sur la base des Normes et directives pour l'aide d'urgence à l'élevage (LEGS) permettent de mettre en place des compétences spécialisées dans la coordination en cas d'incidents, la communication sur les risques et la planification des interventions d'urgence. Les organisations intergouvernementales jouent également un rôle important en établissant les normes et les cadres d'intervention applicables aux professionnels.

Los datos estadísticos demuestran que tanto el alcance como la escala de los desastres van en aumento y repercuten en poblaciones tanto humanas como animales. A veces las personas arriesgan la vida para proteger a sus animales, pues el apego a ellos responde no solo a su valor económico, sino también a consideraciones afectivas. Por este motivo, del personal que interviene en situaciones de emergencia se espera que salvaguarde también el bienestar de los animales. Los autores describen experiencias de distintas regiones del mundo en materia de reducción y gestión del riesgo de desastre ganadero, deteniéndose en aspectos como la legislación, los flujos de financiación, la planificación, la adquisición de medios de acción y las comunicaciones. Poca duda cabe de que el bienestar humano, el animal y el ambiental están conectados entre sí. Si tal es el caso, y dado que los veterinarios son los primeros responsables de velar por el bienestar animal, es obvio que habría que integrarlos en todas las fases del ciclo de gestión de desastres. A la vez que en los planes nacionales de gestión de desastres siempre se debe tener presente la cuestión de los animales y su bienestar, también es preciso que las autoridades de ámbito infrarregional estén capacitadas para integrar los principios del bienestar animal en la respuesta a situaciones de emergencia y en los programas de reducción del riesgo que implanten. La adquisición de capacidad es un elemento clave para el personal de los Servicios Veterinarios que trabaja en la gestión de desastres y la reducción del correspondiente riesgo. Existen herramientas de formación y planes de estudios elaborados por diversas organizaciones que sirven para potenciar competencias como las de coordinación en caso de incidente, comunicación del riesgo o planificación de la respuesta con empleo de las directrices y normas para emergencias ganaderas (Livestock Emergency Guidelines and Standards, LEGS). Las organizaciones intergubernamentales cumplen también una importante función a la hora de establecer las normas y marcos de referencia que encuadran la labor de los profesionales.

Biosecurity in endemic foot and mouth disease settings: a case study of foot and mouth disease vaccination in South-East Asia.

Foot and mouth disease (FMD) is a highly contagious viral infection affecting cloven-hoofed animals including cattle, buffalo, sheep, goats and pigs. The disease is endemic in several parts of Asia, as well as most of Africa and the Middle East. In 1997, the World Organisation for Animal Health (OIE) established the South-East Asia Foot and Mouth Disease Campaign with the aim of increasing livestock sector productivity and economic output through the control and eradication of FMD in South-East Asia. Large-scale vaccination of livestock against FMD has in the past led to the successful eradication (or control) of the disease, for example in the Philippines. However, despite the benefit associated with large-scale vaccination, biosecurity risks can be created by vaccination teams moving between locations. It is therefore recommended that biosecurity measures are used by vaccination teams to prevent inadvertent disease spread. The majority of existing guidelines are focused on high-risk situations such as exotic animal disease outbreaks in developed countries, or agents posing a risk to human health. This paper describes the development of novel biosecurity guidelines for vaccination teams in South-East Asia. To achieve this, available literature was scanned followed by in-country workshops and field-testing of draft materials. Entry and exit procedures are laid out within the context of five core rules that follow the biosecurity principles of situational awareness, segregation, cleaning and disinfection. Guidelines and accompanying fact sheets were translated into local languages and included in a comprehensive vaccination training programme for all vaccination teams undertaking cattle FMD vaccination programmes in the New Zealand OIE FMD control project target countries (Myanmar and Laos). The material developed has wide practical relevance to veterinarians, traditional healers and village or community animal health workers, who all pose a heightened risk of spreading infectious agents.

La fièvre aphteuse est une maladie virale extrêmement contagieuse affectant les artiodactyles (dont les bovins, les buffles, les ovins, les caprins et les porcins). La maladie est présente à l'état endémique dans plusieurs régions d'Asie, dans presque toute l'Afrique et au Moyen-Orient. En 1997, l'Organisation mondiale de la santé animale (OIE) a lancé la Campagne de lutte contre la fièvre aphteuse en Asie du Sud-Est afin d'améliorer la productivité et la rentabilité économique du secteur de l'élevage à travers la lutte contre la fièvre aphteuse voire son éradication de la sous-région. Grâce à la vaccination à grande échelle du bétail, certains pays ont pu éradiquer (ou du moins contrôler) la fièvre aphteuse dans le passé, par exemple les Philippines. Si la vaccination à grande échelle est en soi bénéfique, elle comporte certains risques de biosécurité, liés aux déplacements des équipes de vaccination d'un site à l'autre. Il est donc recommandé que ces équipes appliquent des mesures de biosécurité visant à prévenir toute propagation accidentelle de la maladie. La plupart des lignes directrices existantes sont axées sur les situations présentant un niveau de risque élevé, par exemple la survenue de foyers de maladies animales exotiques dans les pays développés, ou d'agents pathogènes qui constituent un risque pour la santé publique. Dans cet article, les auteurs décrivent la méthodologie suivie pour élaborer des lignes directrices innovantes de biosécurité en Asie du Sud-Est, destinées aux équipes de vaccination. Ces lignes directrices ont été rédigées en passant en revue la littérature sur le sujet lors d'ateliers nationaux et en testant sur le terrain les projets de documents. Les procédures d'entrée et de sortie ont été établies en suivant cinq règles fondamentales fondées sur les grands principes de la biosécurité, à savoir la connaissance de la situation, la ségrégation, le nettoyage et la désinfection. Les lignes directrices et les fiches explicatives qui les accompagnent ont été traduites en langues locales et utilisées dans le cadre d'un programme complet de formation à la vaccination destiné à l'ensemble des équipes de vaccination participant aux programmes de vaccination du cheptel bovin contre la fièvre aphteuse dans les pays couverts par le projet Nouvelle-Zélande­OIE de lutte contre la fièvre aphteuse (Myanmar et Laos). Les matériels proposés présentent une utilité concrète pour les vétérinaires, les guérisseurs traditionnels et les auxiliaires communautaires ou villageois de santé animale, qui sont tous particulièrement exposés au risque de propager involontairement des agents de maladies infectieuses.

La fiebre aftosa es una infección vírica muy contagiosa que afecta a animales biungulados como el ganado vacuno, el búfalo, la oveja, la cabra o el cerdo. La enfermedad es endémica en varias zonas de Asia y en la mayor parte de África y Oriente Medio. En 1997, la Organización Mundial de Sanidad Animal (OIE) instituyó la «Campaña de lucha contra la fiebre aftosa en el Sudeste asiático¼ con el objetivo de que el control y la erradicación de la enfermedad en la región se tradujeran en un aumento de la productividad y la rentabilidad económica del sector ganadero. En ocasiones anteriores la vacunación a gran escala del ganado ya ha resultado eficaz para erradicar (o controlar) la fiebre aftosa, por ejemplo en Filipinas. Sin embargo, pese a los beneficios que depara la vacunación a gran escala, los equipos que la llevan a cabo, al desplazarse de una a otra localidad, también pueden vehicular nuevos riesgos biológicos. Por ello se recomienda que esos equipos apliquen medidas de seguridad biológica destinadas a impedir la propagación accidental de la enfermedad. La mayoría de las directrices existentes al respecto están centradas en situaciones de gran riesgo, como brotes de enfermedades animales exóticas en países desarrollados o presencia de agentes infecciosos que entrañan peligro para la salud pública. Los autores describen la elaboración de nuevas directrices de seguridad biológica dirigidas a los equipos de vacunación que operan en el Sudeste asiático. Para empezar se hizo un repaso de la bibliografía existente, tras lo cual se celebraron talleres nacionales y se ensayaron sobre el terreno las medidas preconizadas en un primer borrador. Como parte de las directrices se instauran procedimientos de entrada y salida encuadrados en cinco reglas básicas que se ajustan a los grandes principios de seguridad biológica: conocimiento de la situación, segregación, limpieza y desinfección. Las directrices y las fichas descriptivas que las acompañan, una vez traducidas a los idiomas locales, fueron incluidas en un programa integral de formación en vacunaciones dirigido a todos los equipos que se disponían a intervenir en programas de vacunación antiaftosa del ganado en Myanmar y Laos, países beneficiarios del proyecto Nueva Zelanda­OIE de lucha contra la fiebre aftosa. El material elaborado reviste gran utilidad práctica para los veterinarios, curanderos tradicionales y trabajadores zoosanitarios de aldeas y comunidades, todos ellos portadores de un riesgo especialmente importante de propagar agentes infecciosos.

Preparing for veterinary emergencies: disaster management and the Incident Command System.

An important question that all veterinary schools should consider is whether veterinary students should be trained to deal with local or regional states of emergency or disasters, such as hurricanes, tornadoes, wildfires, hail and ice storms, wind storms, fires, earthquakes, tsunamis, floods and epidemics. When a large-scale emergency or disaster does strike, the consequences can be dire for the domestic and wild animals of the region and for the humans within the vicinity of seriously and painfully injured animals. The authors argue that emergency preparedness is essential for the veterinary profession to meet its obligations to both animals and humans. The four basic components of disaster management are: mitigation, preparedness, response/emergency relief and recovery.

Pathological studies of cheek teeth apical infections in the horse: 2. Quantitative measurements in normal equine dentine.

Measurements of primary, regular and irregular secondary dentine and pulp dimensions were made on transverse, sub-occlusal and mid-tooth sections, of 40 maxillary and 42 mandibular control equine cheek teeth (CT) of different ages. Maxillary and mandibular CT primary dentine in different age groups had a mean thickness of 922-1,065 microm and 1099-1,179 microm, respectively, on the lateral aspects, and 1,574-2,035 microm and 1155-1,330 microm, respectively, on the medial aspects of pulp horns. Surprisingly, some increase in thickness was found in some mandibular CT primary enamel in the first few years following eruption. Regular secondary dentine thickness increased with age, for example at mid-tooth level in mandibular CT from 124 microm at 3 years dental age to 290 microm at >7 years dental age on the lateral aspect of pulp horns, and from 166 microm to 509 microm on the medial aspects of pulp horns, indicating a deposition rate of 0.5-10 microm/day. This type of dentine was thicker sub-occlusally than in the mid-tooth region. Maxillary dentinal dimensions showed a similar age-related increase in thickness. Maxillary CT dentine was significantly thicker (72% in primary, 43% in regular secondary dentine) on the medial compared to the lateral aspects of pulp horns, but mandibular CT dentine was just 15% and 14% thicker in primary and regular secondary dentine thickness, respectively, on the their medial as compared to their lateral aspects. Dentinal and pulp dimensions varied between individual pulp horns, Triadan tooth position, and dental age, with complex interactions between these variables for some parameters.

Pathological studies of cheek teeth apical infections in the horse: 4. Aetiopathological findings in 41 apically infected mandibular cheek teeth.

Examination of 41 extracted, apically infected mandibular cheek teeth (CT) without obvious causes of infection included radiography, computerised axial tomography and decalcified and undecalcified histology. In CT with recent infections, some pulps remained viable, with proliferative soft and calcified tissue changes confined to the apex. With more advanced CT infections, occlusal pulpar exposure was sometimes present (in 34% of the 41 CT), some infected pulp chambers were filled with necrotic pulp or food, and extensive destructive or proliferative changes were present in the calcified apical tissues. No physical route of infection to the apex was found in 24 CT (59%) that consequently were believed to have anachoretic infections. Fractures involving pulps, including fissure fractures between the clinical crown and infected pulps, were found in eight (20%) CT. Some CT had vertical, full length periodontal destruction between the infected apex and the gingival margin that were believed to be the route of infection in four (19%) CT and dysplastic changes were believed to have caused one (2%) infections.

Pathological studies of cheek teeth apical infections in the horse: 1. Normal endodontic anatomy and dentinal structure of equine cheek teeth.

Morphological examinations were performed on 100 normal equine cheek teeth (CT) of 1-12 years dental age (i.e. time since eruption), using gross examination, dissection microscopy, computerised axial tomography, and decalcified and undecalcified histology. The CT in Triadan 07-10 positions consistently had five pulp horns, but the 06 CT had an additional pulp horn more rostrally. Mandibular and maxillary Triadan 11s had six and seven pulp horns, respectively. Sections of CT taken 2-6mm below the occlusal surface (variation due to normal undulating occlusal surface) showed the presence of pulp in up to 50% of individual maxillary CT pulp horns, and in up to 25% of individual mandibular CT pulp horns. The histological appearances of primary and secondary dentine were described and it is proposed that the type of dentine present most centrally in every pulp chamber examined, currently termed tertiary dentine, should be re-classified as irregular secondary dentine, and that the term tertiary dentine be reserved for the focal areas of dentine laid down following insult to dentine or pulp.

Pathological studies of cheek teeth apical infections in the horse: 3. Quantitative measurements of dentine in apically infected cheek teeth.

Histological measurements of dimensions of primary, regular secondary and irregular secondary dentine, pulp diameter and assessment of the levels of predentine, resting lines and enlarged areas of intertubular dentine were performed in apically infected mandibular and maxillary cheek teeth (CT). These examinations showed significantly reduced regular and irregular secondary dentine thickness in diseased as compared to control CT, with 21/26 infected maxillary CT and 15/18 infected mandibular CT having reduced regular secondary dentine (varying between 27.4% and 89.1% reduced secondary dentine levels compared to age and site matched control CT values). As a result of decreased dentinal deposition, significantly wider pulp horns were present in diseased compared to control CT. No significant differences were found between diseased and control primary dentine thickness in maxillary CT, and minor differences in mandibular CT were not believed to be clinically significant. The significantly reduced presence of predentine and of intertubular dentine and the increased presence of resting lines in diseased compared to control CT confirms that long-term disruption of normal dentine deposition had occurred in many infected CT.

Equine idiopathic cheek teeth fractures. Part 1: Pathological studies on 35 fractured cheek teeth.

REASONS FOR PERFORMING STUDY: There is little published information on the pathology of idiopathic fractures of cheek teeth (CT). OBJECTIVES: To perform pathological examinations on equine CT with idiopathic fractures in order to establish fracture patterns and to gain information on their aetiopathogenesis. HYPOTHESIS: Gross and histological examination of CT with idiopathic fractures, including measurements of dentinal thickness, will provide information on fracture patterns, and on the duration and aetiopathogenesis of these fractures. METHODS: Of 35 CT with idiopathic fractures that were examined to determine their fracture patterns, 20 underwent gross, histological and ultrastructural examinations, including dentinal thickness measurements, with the latter compared to dentinal measurements of dental age and Triadan position matched control CT, to help determine the duration of any pre-existing endodontic disease. RESULTS: The fracture planes involved the pulp chambers in 30 out of 35 CT examined, and ran through coalesced, carious infundibula in the other 5 (maxillary) CT. The maxillary CT, particularly the Triadan 09 position were preferentially affected. The most common fracture plane, which was termed a maxillary buccal slab fracture, occurred through the 2 lateral (1st and 2nd) pulp chambers of maxillary CT and usually involved only the clinical crown. Buccal slab fractures of mandibular CT (through 4th and 5th pulp chambers) and midline sagittal fractures through the infundibula (of maxillary CT) were the next most common fracture patterns. Reduced dentinal thickness (probably indicating prior pathological changes in the fractured CT) was present in 25% of fractured CT. CONCLUSIONS: Most idiopathic equine CT fractures involve the pulp chambers, especially those on the buccal aspect of both upper and lower CT. No predisposition to fracture was found in the majority of affected CT that appeared to have a normal endodontic appearance prior to development of fractures through their pulp chambers. The remaining idiopathic CT fractures were caused by advanced infundibular caries. POTENTIAL RELEVANCE: All CT with idiopathic fractures are all at risk of pulpar or even apical infection.

Public attitudes in New Zealand towards the use of animals for research, testing and teaching purposes.

AIM: To investigate the awareness of and interest in the use of animals for research, testing and teaching (RTT) purposes, the levels of support and attitudes towards this use of animals, and the awareness of and opinions on regulations governing it within the public in New Zealand. METHODS: An independent telephone survey was used to collect information including demographics, awareness and interest in the use of animals for RTT, attitudes towards the use of animals for RTT, and awareness of the regulation of the use of animals in RTT and the degree of confidence held in such regulation. RESULTS: Data were obtained from 750 respondents throughout New Zealand. The rim-weighting efficiency figure was 90%, indicating that the sample collected closely matched the population demographics for New Zealand. Overall, 33% of respondents expressed an interest in the issue generally, 39% were interested in the area of animals used for research and testing purposes, and 21% for teaching purposes. A majority of respondents agreed that the use of animals for teaching (72%) and research and testing (68%) purposes was acceptable as long as there was no unnecessary suffering by the animals. Respondents felt animal research was most justified for research into life-threatening and debilitating diseases, and least justified for safety-testing of cosmetics and household chemicals. Only 8% of respondents knew a fair amount (or more) about the legislation pertaining to the use of animals in RTT. CONCLUSIONS: The majority of New Zealanders were neither interested nor concerned about the use of animals in RTT. The largest proportion of respondents fell into a category of accepting this use of animals with conditions such as where there is no unnecessary suffering by the animals or where the research is for a serious disease. However, the responses also indicated that attitudes towards the use of animals in RTT as a general issue may change when that use is given a specific context. CLINICAL RELEVANCE: The understanding of public opinion with regard to the use of animals in RTT is an important tool for New Zealand Veterinary Association nominees on animal ethics committees (AECs), for these veterinarians, as well as acting as assessors of the welfare of the animals involved, are also independent of the institutions using animals, so that, along with the other 'external' members, they provide a societal perspective to the deliberations of AECs.

Standing oral extraction of cheek teeth in 100 horses (1998--2003).

REASONS FOR PERFORMING STUDY: Extraction of cheek teeth (CT) by the conventional repulsion technique requires general anaesthesia and carries a high rate of post operative complications. Consequently, an alternative method of extraction, i.e. orally in standing horses, was evaluated. HYPOTHESIS: The need for and risks of general anaesthesia could be avoided and post extraction sequelae reduced by performing extractions orally in standing horses. METHODS: One hundred mainly younger horses (median age 8, range 2-18 years) with firmly attached CT that required extraction because of apical infections, displacements, diastemata, idiopathic fractures and the presence of supernumerary CT had the affected teeth (n = 111) extracted orally under standing sedation. Follow-up information was obtained for all cases, a median of 16 months later. RESULTS: Oral extraction was successful in 89 horses and unsuccessful in 11 due to damage to the CT clinical crown (n = 9) during extraction, for behavioural reasons (n = 1) and because the apex of a partly extracted CT fell back into the alveolus following sectioning (n = 1). Predispositions to extraction-related CT fractures were present in 5 of the 9 cases, i.e. advanced dental caries (n = 2) and pre-existing 'idiopathic' fractures (n = 3). The iatrogenically fractured CT were later repulsed under standing sedation (n = 3) and under general anaesthesia (n = 6). Eighty-one of the remaining 89 horses had successful oral CT extraction with no or minimal intra- or post operative complications occurring. Post operative complications in the other 8 cases included post extraction alveolar sequestration (n = 3), alveolar sequestration and localised osteomyelitis (n = 1), localised osteomyelitis (n = 1), incorporation of alveolar packing material into alveolar granulation tissue (n = 1), and nasal discharge due to continued intranasal presence of purulent food material (n = 1) and to ongoing sinusitis (n = 1). The above sequelae were treated successfully in all cases, with general anaesthesia required in just one case. Following oral extraction, significantly (P<0.001) fewer post operative problems developed in 54 horses with apically infected CT in comparison with 71 previous cases that had repulsion of apically infected CT at our clinic. CONCLUSIONS AND POTENTIAL RELEVANCE: Oral extraction of cheek teeth is a successful technique in the majority of younger horses with firmly attached CT and greatly reduces the post operative sequelae, compared with CT repulsion. Additionally, the costs and risks of general anaesthesia are avoided. Further experience and refinement in the described protocol could potentially increase the success of this procedure and also reduce the incidence of post operative sequelae.

A review of equine dental disorders.

Equine dentistry is a very important but until recently rather neglected area of equine practice, with many horses suffering from undiagnosed, painful dental disorders. A thorough clinical examination using a full mouth speculum is a pre-requisite to performing any equine dental procedure. Common incisor disorders include: prolonged retention of deciduous incisors, supernumerary incisors and overjet--the latter usually accompanied by cheek teeth (CT) overgrowths. Overjet can be surgically corrected, but perhaps should not be in breeding animals. In younger horses, traumatically fractured incisors with pulpar exposure may survive by laying down tertiary dentine. Loss or maleruption of incisors can cause uneven occlusal wear that can affect mastication. Idiopathic fractures and apical infection of incisors are rare. The main disorder of canine teeth is the development of calculus of the lower canines, and occasionally, developmental displacements and traumatic fractures. The main indications for extraction of "wolf teeth" (Triadan 05s) are the presence of displaced or enlarged wolf teeth, or their presence in the mandible. Developmental abnormalities of the CT include; rostral positioning of the upper CT rows in relation to the lower CT rows--with resultant development of focal overgrowths on the upper 06s and the lower 11s. Displaced CT develop overgrowths on unopposed aspects of the teeth and also develop periodontal disease in the inevitable abnormal spaces (diastemata) that are present between displaced and normal teeth. Diastemata of the CT due to excessive developmental spacing between the CT or to inadequate compression of the CT rows is a common but under diagnosed problem in many horses and causes very painful periodontal disease and quidding. Supernumerary CT mainly occur at the caudal aspect of the CT rows and periodontal disease commonly occurs around these teeth. Eruption disorders of CT include prolonged retention of remnants of deciduous CT ("caps") and vertical impaction of erupting CT that may lead to large eruption cysts and possibly then to apical infections. Disorders of wear, especially enamel overgrowths ("enamel points"), are the main equine dental disorder and are believed to be largely due to the dietary alterations associated with domestication. If untreated, such disorders will eventually lead to more severe CT disorders such as shearmouth and also to widespread periodontal disease. More focal dental overgrowths will develop opposite any CT not in full opposition to their counterpart, e.g., following maleruption of or loss of a CT. Because of the great length of reserve crown in young (hypsodont) CT, apical infections usually cause infection of the supporting bones and depending on the CT involved, cause facial swellings and fistulae and possibly sinusitis. Diagnosis of apical infection requires radiography, and possibly scintigraphy and other advanced imaging techniques in some early cases. When possible, oral extraction of affected CT is advocated, because it reduces the costs and risks of general anaesthesia and has much less post-extraction sequelae than CT repulsion or buccotomy.