Intraoral Radiographic Interpretation Agreement Between Veterinary Students, Veterinary Dental Residents and Veterinary Dental Specialists.

This study evaluated observer variations in the interpretation of radiographic evidence for periodontal disease, tooth resorption, and endodontic disease in dogs. Forty dental radiographs were evaluated for 12 different parameters (periapical destruction of bone, wider than expected root canal, narrower than expected root canal, apical root resorption, loss of alveolar bone, external surface resorption, external replacement resorption, external inflammatory resorption, external cervical root resorption, internal surface resorption, internal replacement resorption, internal inflammatory resorption). Interpretations by 20 veterinary dentists, 10 veterinary dental residents, and 10 veterinary students were analyzed for consistency within groups and between groups by intraclass correlation coefficients (ICCs [95% CI]). Additionally, the agreement rate between groups compared to histopathological diagnosis, when available, and to a consensus group were evaluated. The results showed fair to good interobserver agreement for all participants when looking at all questions simultaneously (0.578 [0.515-0.635]) and with the consensus group (0.483 [0.451-0.517]). However, questions pertaining to various types of tooth resorption scored the lowest ICCs ranging from 0.005 (-0.311 to 0.321) to 0.189 (-0.105 to 0.402) across individual groups. Students had the lowest agreement compared to the consensus group for all questions (0.383 [0.347-0.421]) with fair to good agreement involving groups of residents (0.501 [0.465-0.538]), recently boarded diplomates (0.541 [0.506-0.578]), and more experienced diplomates (0.545 [0.510-0.582]). While dental radiographs are essential for clinical decision making, this study shows that interpretation of radiographs is highly subjective.

Day one core competencies in veterinary dentistry.

This article describes the core competencies recommended for inclusion in the veterinary curriculum for all veterinary graduates based on the American Association of Veterinary Medical Colleges Competency-Based Veterinary Education document. General practice companion animal veterinarians are frequently presented with patients having dental, oral, or maxillofacial pathology, and veterinary graduates will be relied upon for recommendations for the maintenance of oral health, including the prevention of periodontal disease, identification of endodontic disease, and knowledge of developmental defects. These recommendations should be made for all veterinary patients starting at a young age. These core competencies can apply to many companion species, but mainly are focused on the dog and cat. Because periodontal disease is the most common abnormality observed in dogs and cats, the first key step is taking a few seconds during examination of every patient of any age presented for any reason to examine the oral cavity. Although dental, oral, and maxillofacial pathology is often diagnosed after imaging and evaluation under anesthesia, the first step is observation of dentition and gingivae during the conscious exam to assess periodontal health status. The physical exam of the oral cavity may reveal oral behavior (eg, observation of uncomplicated crown fractures due to chewing on hard objects), which will permit recommendations for enhanced prevention by daily oral hygiene or professional treatment. There are now many involved dental and surgical treatments available, some of which require specialist-level instrumentation and expertise. General practitioners should be able to competently perform the following immediately upon graduation from veterinary school: For patients for whom the owner's reason for the veterinary visit is not dental, oral, or maxillofacial disease, obtain a brief (1 or 2 questions) history of the oral health of the patient. On lifting the lip of every patient, recognize presence or absence of accumulated dental plaque or calculus on the crowns of the teeth, presence or absence of gingival inflammation or ulceration, and presence or absence of other dental, oral, and maxillofacial pathology. On anesthetized patients that have dental, oral, and maxillofacial pathology for which professional treatment is indicated, be able to obtain and interpret appropriately positioned and exposed dental radiographs. When the presence of dental, oral, and maxillofacial pathology is recognized, determine whether each tooth present in the mouth does or does not require professional treatment beyond dental subgingival and supragingival scaling and polishing. List the indications for tooth extraction, know indications for potential oral/dental treatments beyond subgingival and supragingival scaling and polishing or extraction, and determine whether the professional treatment that may be indicated, such as root canal treatment or mass resection of oral tissues, requires referral for specialist-level expertise and instrumentation. Complete a thorough periodontal evaluation and therapy with periodontal probing, including professional subgingival and supragingival ultrasonic scaling with polishing under anesthesia. Demonstrate the ability to extract teeth indicated for extraction, using gentle and appropriate techniques that will risk minimal injury to the jaws and oral soft tissues and reduce postoperative patient pain. Provide appropriate postoperative care, including recognition of when postoperative analgesia and possibly antibiotic administration are indicated.

Brain, Craniofacial, and Dental Lesions of a Free-ranging Gray Wolf (Canis lupus) Implicated in a Human Attack in Minnesota, USA.

We describe significant brain, craniofacial, and dental lesions in a free-ranging wolf (Canis lupus) involved in a human attack. On postmortem examination, the wolf presented asymmetric atrophy and bone remodeling affecting the mandible, incisive, maxilla, lacrimal, palatine, frontal, and ethmoid bones. There was an asymmetrical skeletal malocclusion and dental abnormalities including rotated, malpositioned, partially erupted teeth, and an odontogenic cyst associated with an unerupted canine tooth. Brain changes were bilateral loss and atrophy of extensive cortex regions including olfactory bulb, peduncles, and tract, and the frontal lobe. We highlight the relevance of a thorough postmortem examination of wildlife to elucidate disease-based abnormal behavior as the reason for human-animal conflict.

Suspect Odontogenic Infection Etiology for Canine Lymphoplasmacytic Rhinitis.

The role of odontogenic infection as an etiology for lymphoplasmacytic rhinitis in dogs was evaluated. An association between odontogenic infection and inflammatory rhinitis was identified in 55% of cases evaluated. Odontogenic infection was unlikely or undetermined in 10% and 35% of the cases, respectively. Cases of lymphoplasmacytic rhinitis had roentgen signs associated with endodontic disease, periodontal disease, or retained tooth roots in 60%, 45%, and 25% of the cases, respectively. A collaborative team based approach assessing inflammatory nasal disease is recommended. Based on the history and signalment of the individual patient, diagnostic modalities should be chosen wisely. In some cases, oral examination and intraoral radiographs may be a more direct and cost effective approach for diagnosis and treatment of inflammatory rhinitis.

Evaluation of an Osseous Allograft Membrane for Guided Tissue Regeneration in the Dog.

Clinical application of a demineralized freeze-dried cortical bone membrane allograft (DFBMA) for treatment of intra(infra)bony periodontal pockets in dogs was evaluated. The mean pre-treatment periodontal probing depth equaled 7.2-mm. Post-treatment probing depths in all 11 cases were normal, with a mean periodontal probing gain of 5.4-mm. Guided tissue regeneration using a commercially available veterinary canine DFBMA and canine demineralized freeze-dried bone allograft (DFDBA) resulted in clinically significant periodontal attachment gains. The gain of new periodontal tissue attachment was statistically significant (P < 0.0001). The commercially available veterinary allograft products predictably increased new periodontal attachment without any identified membrane sequelae in these 11 cases.

Acquired myasthenia gravis associated with oral sarcoma in a dog.

Acquired myasthenia gravis is a common neuromuscular disorder resulting from autoantibody directed against the post-synaptic acetylcholine nicotinic receptors in skeletal muscle. Myasthenia gravis has been reported previously as a paraneoplastic syndrome. This case report presents myasthenia gravis secondary to an oral sarcoma in a juvenile Mastiffdog.

Bisphosphonate related osteonecrosis of the jaws: a review.

Bisphosphonate use has increased in veterinary medicine over the last decade. During this time, bisphosphonate related osteonecrosis of the jaws (BRONJ) in human patients has been identified. Only recently was a dog model for BRONJ developed for human oral surgery and medicine. Veterinary patients treated with bisphosphonates may be at an increased risk for BRONJ There has been little, to no, investigation of potential long term side-effects of bisphosphonate use in veterinary patients; potential sequelae are unknown. The history of bisphosphonates, their use, and BRONJ in veterinary patients are discussed.