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Home , Canine tooth, Tooth resorption

Animal Dental Care Tony M. Woodward, DVM, AVDC • Colorado Springs, Colorado • (719) 536-9949 • [email protected]

Feline Resorption (FTR) January 2011

Feline Tooth Resorption (FTR) is a disease of the teeth and periodontium of . Feline We would like to thank you Odontoclastic Resorptive Lesion (FORL) is the term used to describe the lesions present. The for your support and wish terms “cervical line lesions” and “neck lesions” are no longer considered appropriate for this you all the best for 2011. disease. FTR represents the most common dental disease in cats presented to veterinary den- tists in the United States. Various studies show the prevalence rate to be between 20 to 75%. Remember: Only teeth with In reality, about 50% of the feline patients presented to the veterinarian are affected by FORLs. radiographic evidence of Type II TR Although there is archival evidence of FTR being should be treated with the around since the 13th century, there has been a amputation technique. Using this marked increase in prevalence since 1970. To technique in teeth with Type I TR can result in painful retained roots that date, there is no proven etiology, however, as- never resolve. sociation with domestication is apparent and commercial diets containing excessive vitamin D New Class Dates: Our dental training classes in January, February may be a possible cause. It is rare to find FTR in and most of March are completely feral or wild felines. filled. We have a few slots available FTR begins when odontoclasts located Figure 1: Typical location of FTR on the right for the Level I class on March 24th. maxillary . Space is available in Level I and II within the periodontal ligament begin a classes on April 21 and 22. For current pathological resorption of root surface , which then extends into the underlying class availability, please call Trish at . In most cases, the process is eventually exposed to the oral cavity. There are two 719-536-9949. For information on distinct histological types of root surface resorption: Type I (inflammatory) and Type II class content, please go to www. vetdentalclasses.com. (replacement by bone). Type I resorption seems to be initiated by periodontal . FORLs are commonly discovered incidentally on oral examination. Despite the associated Sign up for e-delivery! We discomfort, most effected cats show no obvious clinical signs. Those patients that do demon- are happy to mail you a copy of our monthly educational newsletters, strate signs, may not do so until serious complications have occurred. Anecdotally, cats with but if you would prefer to receive FORLs affecting the teeth seem to be most likely to exhibit behavioral this newsletter in digital form to save changes that are noticed by the owner. Clinical signs may paper, please call us and let us know include decreased appetite, , pawing at the face, your name, clinic and E-mail address. jaw chattering and reluctance to eat hard foods. The man- Reminder: To assist with our case dibular third is the most commonly affected load, Dr. Clarence Sitzman will see tooth and can be considered a “sentinel” for the disease. cases several days a month. He is board-certified in with over When one tooth is effected, there are commonly multiple 30 years experience. When scheduling teeth with problems. appointments, clients are informed Lesions are typically found near the gingival margin as to which doctors are available on a given day. on the buccal surface of the tooth, often filled with calculus or granulation tissue. They cana also be detected Figure 2: FTR near the gingival margin of by palpation with a dental explorer or periodontal probe. the left lower canine tooth. Other common clinical findings are tooth extrusion (super eruption) and alveolar bone expansion () commonly observed over the alveolar juga of the canine teeth. As with any oral disease in animals, examination is not complete until performed under general anesthesia. Full mouth intraoral (dental) Tony M. Woodward, DVM, radiographs are imperative for two reasons: 1) they reveal AVDC, has practiced veterinary far more lesions than oral exam alone, 2) they determine medicine in El Paso County for therapeutic decision making. over 28 years, is past president of FTR may be classified as Type I (inflammatory) Figure 3: Radiograph of the patient the Colorado Veterinary Medical or Type II (replacement) based upon radiographic shown in Figure 2, showing Type II TR. Association and is board certified This case can be treated with crown in . (continued on back) reduction and intentional root retention.

Tony M. Woodward, DVM, AVDC • 5520 N. Nevada Ave., Suite 150 • Colorado Springs, CO 80918 • (719) 536-9949 • email: [email protected] • www.wellpets.com Animal Dental Care Case Study — Feline Tooth Resorption (FTR) assessment of the alveolar bone and root. Type I lesions commonly occur in the cervical and furcational regions of the tooth. Radiographically, Type I teeth show focal loss of tooth structure and adjacent alveolar bone, with the remaining root structure being radiographi- cally distinct from the bone. With Type II lesions the roots and the alveolar bone take on a similar radiographic appearance and cannot be easy distinguished from one another. With some multiple rooted teeth, one root may have Type I resorption, while another has Type II resorption. This combination is termed Type III resorption Teeth with lesions exposed to the oral cavity are usually painful and secondarily in- fected, and complete extraction of tooth material is the treatment of choice. Teeth under- Figure 4: Radiograph of the right , showing Type I TR. The roots of the effected teeth going root resorption in the coronal half of the root will likely progress and should also be are all distinct and should be completely removed. extracted. Attempts to restore TR defects have shown poor long-term success, and laser treatment is controversial. Neither of these treatment options can be recommended at this time. Extractions are performed surgically with full thickness mucogingival flaps to allow for complete removal of tooth material, alveoloplasty, and closure of the extraction site. The use of some type of magnification greatly facilitates the procedure. Pre-op radiographs are essential for appropriate treatment planning. Type I TR requires complete removal of tooth material. Atomization (root pulverization with a high speed bur) of retained root tips should be avoided because of the potential for complications, which can include incomplete extraction, overzealous bone removal, damage to neurovascular structures, pushing root tips into the mandibular canal or nasal passages, and the incomplete resolution of clinical signs in patients with . With early Type II cases, complete extraction is also indicated. In end-stage Type II situations, where there is advanced root replacement resorption, crown amputation with intentional root retention is an acceptable alternative. It should be noted that this technique is commonly overused in veterinary patients, resulting in painful retained roots that may never resolve. The critical factor for selecting the appropriate extraction technique is whether or not the root is radiographically distinct. The radiographic absence of a PDL, without any concurrent evidence of bony replacement of the root structure, is not an indication for the crown amputation technique. Dental radiographs commonly underesti- mate the presence of a periodontal ligament. Teeth with radiographically distinct roots usually have a clinical periodontal ligament and are readily extracted, in their entirety, with correct surgical extraction technique. Regardless of technique used, post-op radiographs are

taken to verify removal of all dental structures.

Case Study—Feline Tooth Resorption (FTR) Resorption Tooth Study—Feline Case

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Tony M. Woodward, DVM, AVDC DVM, Woodward, M. Tony

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