Preliminary evaluation of the impact of periodontal treatment on markers of glycaemic control in dogs with diabetes mellitus: A prospective, clinical case series.

BACKGROUND: Periodontal disease (PD) can adversely affect glycaemic control in humans. However, it is unknown if a similar association exists in dogs. METHODS: Ten client-owned dogs with poorly regulated diabetes mellitus (DM) and PD were prospectively enrolled. A complete blood count, serum biochemistry, urinalysis and measurement of C-reactive protein, interleukin-6 (IL-6), tumour necrosis factor-α, haemoglobin A1c (HbA1c) and fructosamine concentrations were performed before periodontal treatment (PT) and monthly thereafter for 3 months. A periodontal disease severity score (PDSS) was determined during PT. The effects of time post-PT and PDSS on markers of inflammation and glycaemic control were determined by generalised estimating equation analysis. RESULTS: HbA1c (mean; 95% confidence interval [CI]) decreased 3 months post-PT (32.1 mmol/mol; 21.1-43.1 mmol/mol vs. 44.3 mmol/mol; 36.4-52.0; p = 0.003). PDSS at enrolment was significantly (p = 0.031) positively associated with HbA1c concentration. Due to a significant (p < 0.001) interaction between PDSS and time post-PT in the analysis of fructosamine, dogs with low (1-3) PDSS and high (7-9) PDSS were analysed separately. Fructosamine (mean; 95% CI) significantly decreased 1 month post-PT (570 µmol/L; 457-684 µmol/L vs. 624 µmol/L; 499-748; p = 0.001) in the high PDSS group but not in the low PDSS group. Fructosamine concentration upon enrolment and PDSS were correlated (r = 0.73, p = 0.017). IL-6 concentration significantly decreased 3 months post-PT (9.9 pg/mL; 8.5-11.3 pg/mL vs. 11.2 pg/mL; 9.7-12.7; p = 0.002). LIMITATIONS: Limitations of the study included the small number of dogs, the lack of a control group and the inability to assess PDSS during follow-ups. CONCLUSIONS: These findings support a potential detrimental interaction between PD and DM. The apparent beneficial effect of PT on markers of glycaemic control was most conspicuous in dogs with more severe PD.

Tooth aspiration in two cats following maxillofacial trauma.

Case series summary: Tooth aspiration is a rare occurrence in human medicine, and even more so in veterinary medicine. This report describes two cats that aspirated a tooth (one canine tooth and one premolar tooth) following maxillofacial trauma. One cat presented with dyspnoea, while the other showed no respiratory clinical signs. In both cases diagnosis was reached by obtaining routine thoracic radiographs, and successful retrieval of the teeth was achieved by bronchoscopy. Both cats recovered uneventfully. Relevance and novel information: To our knowledge, this is the first report in the veterinary literature of tooth aspiration into the tracheobronchial tree following maxillofacial trauma. The scope of this case series is to raise awareness that tooth aspiration can occur following maxillofacial trauma and has the potential for serious complications if not diagnosed and treated promptly. Therefore, an oral examination must be performed in every maxillofacial trauma patient and missing teeth should be accounted for, even when respiratory clinical signs are not detected.

Comparison of three regional anaesthetic techniques for infraorbital or maxillary nerve block in cats: a cadaveric study.

OBJECTIVES: The maxillary nerve courses very close to the globe, rendering cats - with their large eyes - at risk of globe penetration during infraorbital or maxillary nerve blocks. Therefore, the goals of the study were to compare the distribution and potential complications of three infraorbital or maxillary regional injection techniques. METHODS: Twenty-three bilateral maxillae of cat cadavers were used in a randomised blinded trial. Each maxilla was injected with a 0.2 ml 1:1 mixture of lidocaine 2% and a contrast medium by one of three injection techniques: infraorbital foramen (IOF; n = 14); infraorbital canal (IOC; n = 16); or maxillary foramen (MF; transpalpebral approach; n = 16) using a 25 G 1.6 cm needle. CT imaging of each cadaver head was performed before and after injections. A radiologist scored injectate distribution (none [0], mild [1], moderate [2], large [3]) in four locations: rostral, central and caudal IOC, and at the MF, for which the distribution side was also determined. Comparisons were performed with ordinal logistic mixed effects (P <0.05). RESULTS: The median (range) total distribution score of the IOC and MF technique were significantly higher compared with the IOF technique (6.5 [4-12], 4 [2-8] and 0 [0-10], respectively). The total IOC score was also significantly higher compared with the MF technique. Injectate distribution at the MF was significantly more central following IOC injection compared with MF injection, which distributed centrolaterally. None of the techniques resulted in intraocular injection. CONCLUSIONS AND RELEVANCE: The IOC and MF techniques produced a satisfactory spread of the mixture that could result in effective maxillary anaesthesia in cats. Further studies are required to determine the effectiveness and safety of these techniques.

Elastic training for the prevention of mandibular drift following mandibulectomy in dogs: 18 cases (2005-2008).

OBJECTIVE: To describe a noninvasive method for preventing mandibular drift (MD) after mandibulectomy in dogs. STUDY DESIGN: Technique description and case series. ANIMALS: Dogs (n=18) that had mandibulectomy involving resection of a portion of the mandible caudal to the 2nd mandibular premolar tooth. METHODS: One orthodontic button was attached to the lingual aspect of the canine tooth of the intact mandible and 1 to the buccal aspect of the ipsilateral maxillary 4th premolar tooth. An orthodontic elastic rubber chain was attached to the buttons creating tension sufficient for maintaining normal occlusion. The rubber chain was replaced weekly by the clients. Follow-up appointments were scheduled 2, 6, 10 weeks postoperatively and monthly thereafter if indicated. The appliance was removed when dogs had resumed normal occlusion of the canine teeth. RESULTS: All dogs maintained normal occlusion, normal jaw function, had no apparent disfigurement, and resumed preoperative activity levels while wearing the appliance. Eight dogs achieved temporomandibular joint stability and normal occlusion 4.5-6 months postoperatively and 8 did not, resulting in MD. One dog was lost for follow-up and 1 was euthanatized. CONCLUSION: Elastic training using orthodontic buttons and power chain is a viable option for prevention of MD but requires good client compliance. More data and longer follow-up are required to determine the long-term mandibular stabilizing potential of this technique. CLINICAL RELEVANCE: Elastic training is a quick, simple, cost-effective and noninvasive technique, preserving normal occlusion and function in many dogs after mandibulectomy.

The diagnostic yield of conventional radiographs and computed tomography in dogs and cats with maxillofacial trauma.

OBJECTIVE: To compare the diagnostic yield of conventional radiographs and computed tomography (CT) images of the skulls of dogs and cats with maxillofacial trauma (MFT). STUDY DESIGN: Prospective study. ANIMALS: Dogs (n=9) and 15 cats with MFT. METHODS: CT-scans and skull radiographs (4 standard projections) for each animal were evaluated using a semi-quantitative scoring system for the ability to identify 26 predefined, clinically relevant anatomic features (Part 1), and 27 predetermined potential traumatic injuries (Part 2). For Part 1, mean scores for each anatomic feature were recorded for every view and imaging modality. For Part 2, studies were evaluated for the frequency of cases where each predetermined traumatic injury was identified. RESULTS: Part 1: On radiographs it was easy to identify 17 of 26 anatomic features whereas 6 features were very difficult or impossible to identify on any view. All structures were considered easy or very easy to identify on CT. Scores for CT were lower than radiographs for evaluating dental occlusion and the integrity of the mandibular body. Part 2: CT scans demonstrated 1.6 times more maxillofacial injuries for dogs and 2.0 times more for cats than conventional radiographs. The average number of MFT injuries per animal by radiographs and CT-scan was 4.8 and 7.6 in dogs, and 3.8 and 7.7 in cats, respectively. CONCLUSION: CT is superior to conventional skull radiography for identification of anatomic structures and traumatic injuries in dogs and cats. Skull radiography is useful for visualizing the mandibular body and dental occlusion. CLINICAL RELEVANCE: CT allows for accurate assessment, diagnosis and treatment planning of MFT in dogs and cats.