Treatment of mandibular osteomyelitis in two red-necked wallabies (Macropus rufogriseus) by means of intensive long-term parenteral drug administration and serial computed tomographic monitoring.

CASE DESCRIPTION 2 female red-necked wallabies (Macropus rufogriseus) were evaluated because of sudden-onset mandibular swelling, ptyalism, and hyporexia. CLINICAL FINDINGS Physical examination revealed a mandibular swelling with a fluctuant center in both wallabies. Hematologic analysis revealed leukocytosis with a mature neutrophilia and monocytosis in one wallaby (case 1) and a slight neutrophilia, hyperglobulinemia, and high serum alanine aminotransferase activity in the other (case 2). Cytologic examination of the swelling revealed a uniform population of gram-negative rods in case 1 and neutrophilic inflammation in case 2. Radiography revealed a soft tissue mandibular swelling with osteolucency around mandibular incisor roots in both wallabies. Computed tomography revealed changes consistent with chronic active mandibular osteomyelitis and reactive bone formation, but also sequestra formation not appreciable via radiography. TREATMENT AND OUTCOME Long-term antimicrobial treatment was initiated with clindamycin (17 to 21 mg/kg [7.7 to 9.5 mg/lb], IV, q 12 h for 40 to 55 days) and high-dose benzathine penicillin G (80,000 U/kg [36,364 U/lb], SC, q 12 h for 150 days). Serial CT was performed to evaluate response to treatment and resolution of disease. A CT scan 18 months after the initial evaluation revealed complete resolution of osteomyelitis and sequestra. CLINICAL RELEVANCE Advanced imaging and long-term treatment and management were integral to the successful outcome for these wallabies, given that the osseous changes visible on CT images were not visible on standard radiographs, guiding therapeutic decision-making. This report provides new therapeutic and diagnostic monitoring information to assist clinicians with similar cases.

Root sepsis associated with insect-dwelling Sebaldella termitidis in a lesser dwarf lemur (Cheirogaleus medius).

Sebaldella termitidis is a rare fastidious microorganism of the Leptotrichiaceae family. A variety of closely related species are associated with severe and even life-threatening disease in humans and animals, such as Streptobacillus moniliformis, the etiological organism of rat-bite fever as well as members of Leptotrichia spp. and Sneathia sanguinegens, which have been reported from cases of septicaemia. In contrast, since its description some 50 years ago, S. ermitidis has so far never been reported as a vertebrate pathogen, nor has it been found aside from its natural termite host. A lesser dwarf lemur was presented with unilateral facial inflammation originating from rotten maxillary teeth and septic root abscess. Surgical intervention and root extraction significantly improved the clinical cause in that a pus-filled cavity underneath the right eye could be drained, sampled and flushed. Bacteria displaying substantial characteristics of S. termitidis were cultured from the sampled pus. Morphological features observed included strictly anaerobic regular Gram-negative rods. Significant shared biochemical properties included negative reactions for cytochrome oxidase, catalase, urease, nitrate reduction and indole production. Furthermore, 16S rRNA gene sequencing revealed 99.9 % sequence homology to the S. termitidis type strain NCTC 11300(T), from which it, nevertheless, differed with respect to rep and rep- and RAPD-PCR profiles. An affiliation of the lemur isolate described in this study with the type strain of S. termitidis as well as a clear discrimination from other members of the Leptotrichiaceae could also be confirmed by matrix-assisted laser desorption/ionization time-of flight mass spectrometry and Fourier transform-infrared spectroscopy. This is the first evidence for clinical disease caused by S. termitidis in a vertebrate species indicating a broader host spectrum of this rarely encountered microorganism.

Computed tomographic features of apical infection of equine maxillary cheek teeth: a retrospective study of 49 horses.

REASONS FOR PERFORMING STUDY: Computed tomographic (CT) studies evaluating the relevance of individual CT features of apical infection in maxillary cheek teeth are lacking. OBJECTIVES: To study the prevalence and relationship of single CT features in horses with and without clinical evidence of apical infection in maxillary cheek teeth. STUDY DESIGN: Retrospective case-control study. METHODS: Multislice CT scans of the head of 49 horses were evaluated retrospectively. Changes of the infundibulum, pulp, root, lamina dura, periodontal space and alveolar bone in maxillary cheek teeth were recorded. RESULTS: Single CT changes were much more prevalent in the 28 horses with clinical signs. However, infundibular changes and a nondetectable lamina dura were also common in the 21 horses without clinical evidence of apical infection. Computed tomographic abnormalities of the pulp, root, periapical bone and periodontal space and the presence of a tooth fracture were significantly related. Infundibular changes were not associated with other CT signs of apical infection. Although nondetectable lamina dura was the most frequent CT change in all teeth in both studied groups, it was most commonly a solitary feature in otherwise normal teeth. Apical infections, defined as ≥3 CT changes, occurred mainly in the 108/208, 109/209 and 110/210 (Triadan numbers) and were found only in horses with clinical evidence of apical infection, except in one horse without clinical signs that had one affected root. CONCLUSIONS: Combined CT changes of the pulp, root, lamina dura, periapical bone and periodontal space and the presence of a tooth fracture appear to be reliable features to diagnose apical infection in maxillary cheek teeth. As a solitary feature, a nondetectable lamina dura should be interpreted cautiously and may even be considered normal due to its minor thickness and/or too low resolution of the imaging modality.

Radiographic appearance of maxillary sinus feed impaction in a horse.

A 15-year-old Belgian gelding presented in respiratory distress, with bilateral mucopurulent nasal discharge, and right-sided epistaxis. The horse had a 5-year history of dental disease and had been recently losing weight. Radiographs indicated tooth root abscessation of the right maxillary third molar tooth and probable maxillary sinus feed impaction. These findings were confirmed at surgery and necropsy. The stippled, granular radiographic appearance described here is highly characteristic of sinus feed impaction.

Orodental diseases and dermatological disorders are highly associated in pet rabbits: a case-control study.

BACKGROUND: Dermatological disorders (DDs) and orodental diseases (ODDs) are a major source of morbidity in pet rabbits. Orodental diseases have anecdotally been associated with cutaneous disorders in rabbits. HYPOTHESIS/OBJECTIVES: The purpose of this study was to evaluate the possible association between DDs and ODDs and to determine whether ODD increases the risk of DD in pet rabbits. METHODS: This study was a retrospective review of 222 medical records of pet rabbits examined over 1 year in 20 private veterinary clinics. Records of rabbits diagnosed with DD were selected. Frequencies of ODDs and other variables were evaluated between rabbits with and without DDs using logistic regression. Rabbits seen during the same time period, but without a diagnosis of DD, were included as control animals. RESULTS: The prevalence of DD was 28.4% (63 of 222), and the prevalence of ODD was 23% (51 of 222). A significant association was present between DD and ODD. Rabbits diagnosed with ODD were 63 times (odds ratio 63.75; 95% confidence interval 23.9-170.2; P < 0.0001) more likely to be diagnosed with DD in comparison to rabbits without ODD. CONCLUSIONS AND CLINICAL IMPORTANCE: The results of this study indicate a strong association between ODD and DD. In particular, rabbits with ODD have a greater risk of developing skin disease later in life. Although coat condition and hair quality can be influenced by many biological and environmental factors, ODDs should be carefully considered as a possible underlying condition in rabbits showing DDs. More prospective studies are needed to evaluate whether this association is due to a behavioural disorder or a metabolic condition.

Computed tomography of the upper cheek teeth in horses with infundibular changes and apical infection.

REASONS FOR PERFORMING STUDY: Infundibular changes are frequently encountered computed tomographic studies of the equine maxillary cheek teeth but the possible importance of this finding is not known. Infundibular caries is a possible cause for pulpitis and apical infection in some horses. OBJECTIVES: To study the relationship between the 2 pathologies and the frequency of changes. METHODS: The maxillary cheek teeth 108-208, 109-209 and 110-210 of 25 horses were evaluated using computed tomography and both the prevalence of infundibular and apical infection changes as the possible link with apical infection evaluated statistically. RESULTS: The prevalence of infundibular changes was high in both normal and diseased teeth. Both apical infection and the occurrence of infundibular changes were more prevalent in 109-209 and 110-210. In spite of this, the 2 processes could not be linked to one another. No differences were noted between the left and right sides. CONCLUSIONS: A direct relationship between the 2 processes was not established statistically and other underlying causes for the high occurrence of both apical infection and infundibular changes in diseased and normal 108-208, 109-209 and 110-210 are considered.

Abscessos dentários periapicais em leitões com síndrome multissistêmica do definhamento / Dental periapical abscesses in piglets affected by postweaning multisystemic wasting syndrome PMWS

Duzentos e oitenta leitões, entre 40 e 70 dias de idade, afetados pela sindrome multissistêmica do definhamento (SMD) foram examinados após eutanásia para pesquisa de lesões dentárias. Pelo menos um abscesso periapical foi observado em 58 leitões (20,7 por cento), dos quais 12 apresentaram abscessos múltiplos. Terceiros incisivos superiores, 3os incisivos inferiores, caninos superiores, caninos inferiores e outros dentes apresentaram respectivamente 22 (31,4 por cento), 16 (22,9 por cento), 4 (5,7 por cento), 23 (32,9 por cento) e 5 (7,1 por cento) abscessos periapicais. A maior prevalência de abscessos observada nos dentes 3os incisivos e caninos inferiores está provavelmente associada com a maior área de corte ou desgaste que sofrem esses dentes. Entre as bactérias isoladas de amostras de 65 abscessos, Streptococcus sp. foi a mais prevalente e esteve presente em 21,48 por cento e 27,7 por cento dos isolados em aerobiose e anaerobiose, respectivamente. Na segunda posição em prevalência estiveram as bactérias corineformes, as quais foram mais freqüentemente isoladas em atmosfera anaeróbica do que aeróbica. Houve preponderância de isolamentos de bactérias Gram-positivas. Não foi possível determinar se as co-infecções bacterianas predispuseram às lesões características de SMD ou foram conseqüentes à imunossupressão causada pela infecção com PCV2.

Swine producers have historically resected needle teeth of newborn pigs to prevent potential injuries to the sow mammary gland and faces of littermates. However, the possible impact of this practice on pig performance has been questioned. As part of a study, 280 PMWS affected piglets, with 40-70 days of age, were examined for the presence of dental lesions immediately after euthanasia. Most pigs were confirmed as PMWS by the detection of typical microscopic lesions and immunohistochemical pattern. At least one periapical abscess was observed in 58 piglets (20.7 percent), of which 12 had multiple abscesses. There were 22 (31.4 percent), 16 (22.9 percent), 4 (5.7 percent), 23 (32.9 percent), and 5 (7.1 percent) abscesses in 3rd upper incisives, 3rd lower incisives, upper canines, lower canines, and other teeth, respectively. The higher prevalence of dental abscesses observed in 3rd incisives and lower canines is probably associated with the wider area of grinding or clipping to which these teeth were subjected. Among bacteria isolated from samples collected from 65 abscesses, Streptococcus sp. was the most prevalent bacteria and was present in 21.48 percent and 27.7 percent of the aerobic and anaerobic isolates, respectively. In the second most frequent group were coryneform microorganisms, which showed higher rate of isolation under anaerobic atmosphere than in aerobic culture. There was preponderance of Gram-positive isolates. It could not be determined whether these bacterial co-infections predisposed pigs to development of PMWS-type lesions or if were subsequent to the PCV2 infection.

Tooth root abscesses in llamas and alpacas: 123 cases (1994-2005).

OBJECTIVE: To determine features, outcome, and complications of surgical treatment of camelid tooth root abscesses. DESIGN: Retrospective case series. ANIMALS: 123 camelids with tooth root abscesses. PROCEDURES: Signalment, history, teeth involved, surgery performed, ancillary diagnostic tests, and short-term complications were recorded from each medical record. An owner questionnaire was used to obtain long-term (> 1 year) follow-up information. RESULTS: The most common surgical treatments included tooth extraction (n = 106) and apicoectomy (13). Owners provided follow-up information on 84 animals. Postoperative complications were reported in 42 of 84 animals. The most common complications included reinfection (n = 15), chronic draining tract (14), and osteomyelitis (14). Significantly more camelids that were in good or obese body condition at the time of surgery were alive at the time of follow-up, compared with those with thin body condition at the time of surgery. Camelids with 2 teeth extracted had significantly more complications than those with 1 tooth extracted. Thirty-four of 47 owners reported that they were completely satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Owners of camelids in poor body condition should be forewarned that such animals are at greater risk for complications following dental surgery. Clinicians should recognize that the number of teeth affected was not associated with a poorer outcome.

Comparação entre sessão única e a utilização do "curativo de demora" no tratamento endodôntico em cães: aspectos histopatológicos e microbiológicos / Comparison of the application of temporary endodontic dressing in teeth of dogs: histopathological and microbiological aspects

No tratamento endodôntico a presença de bactérias é a maior preocupação. A presença de bactérias nos túbulos dentinários, foraminas apicais e no delta apical é considerado como falha de procedimento. Alguns estudos revelam que após o tratamento endodôntico em sessão única, bactérias ainda permanecem em estruturas dentais. O objetivo do presente estudo foi avaliar o tratamento endodôntico em uma ou duas sessões, usando hidróxido de cálcio associado ao paramonoclorofenol canforado (PMCC) como "curativo de demora". Foram utilizados quatro cães, onde dois animais foram submetidos a tratamento em sessão única e os outros em duas sessões. Foram utilizados no estudo 40 dentes: segundo e terceiro pré-molares superiores e segundo, terceiro e quarto pré-molares inferiores divididos em dois grupos. Foi realizada abertura coronária dos dentes, expondo a câmara pulpar por 60 dias. Após este período o grupo tratado em sessão única foi obturado com guta-percha e óxido de zinco e eugenol e o grupo tratado em duas sessões recebeu o PMCC que permaneceu no canal por 30 dias e, após, foi obturado com o mesmo material do outro grupo. Controle clínico e radiográfico foram realizados quinzenalmente e após 60 dias foi retirado um bloco contendo dente e periodonto para análise histopatológica e microbiológica. A análise histopatológica revelou intensa resposta inflamatória em todos os grupos. A análise microbiológica apresentou redução microbiana mais acentuada no grupo tratado em sessão única. Contudo, bactérias ainda foram observadas nos dois grupos evidenciando que nenhum tratamento utilizado foi totalmente eficiente.

During a root canal therapy the microbiota is the major concern. Bacteria present in dentinal tubules, apical foramens and apical delta is related to failure of this procedure. Some studies reveal that during endodontic treatment in one session bacteria still remain in dental structures. The aim of the present study was to evaluate the endodontic treatment in one or two sessions, using calcium hydroxide plus camphorated paramonochlorophenol (CMCP) with temporary endodontic medicaments. Four dogs were used, and two animals were submitted the treatment in one session only and the others in two sessions. Premolar teeth were used in this study: second and third upper premolar teeth and second, third and fourth lower premolar teeth were divided into two groups. Opening of the pulp chamber was performed with burns, and the pulp was exposed for 60 days. After this period the group treated in only session was obtured with gutta-percha and zinc oxide and eugenol, and the group treated in two sessions received the CMCP that remained in the canal per 30 days and was afterwards obtured with the material of the other group. Clinical and radiographical control was performed twice a week, and after 60 days a small block containing the teeth, surrounding periapical tissues and the periodontium was removed for histological and microbiological study. Histological analysis revealed intense inflammatory response in both groups. Microbiological analysis showed a more severe microbial reduction in the group treated in one session. However, bacteria were still observed in the two groups, indicating that none of the treatments presented total efficiency.

Survey on 'lumpy jaw' on deer farms in western Canada: prevalence and distribution, and identification of associated factors.

AIM: To investigate the prevalence and geographical distribution of 'lumpy jaw' (LJ) in a population of white-tailed deer (WTD; Odocoileus virginianus) and mule deer (MD; Odocoileus hemionus) farms from the western Canadian provinces of Saskatchewan and Alberta, and to identify factors associated with its occurrence. METHODS: A cross-sectional study, in which the target population was all farmers of WTD and MD registered in Saskatchewan and Alberta, was conducted between July 2004 and January 2005. A questionnaire was mailed to all farmers requesting information about the presence of LJ and other necrobacillosis- related syndromes (footrot and fawn death syndrome), and various farm characteristics, during 2002, 2003 and 2004. Herd and within-herd incidences of disease were estimated. Global and local spatial analyses were performed to identify possible clusters of occurrence of LJ in the region. Logistic regression analysis was used to identify factors associated with the occurrence of LJ. RESULTS: A total of 139/268 (52%) deer farmers responded to the survey. Over the entire study period, 108/139 (78%) of farmers reported having cases of LJ in their herds, and in any given year the incidence amongst herds was about 40%. The presence of footrot was not associated with the presence of LJ. The proportion of fawns dying suddenly in 2004 was higher on farms affected by LJ than in those considered LJ-free (median of 11.1% and 0%, respectively; p<0.001). Two areas in Saskatchewan were identified as having a higher herd prevalence of LJ (clusters) than all other areas. Density of animals, moving and handling animals, lack of basic hygiene measures, and bottle- feeding of fawns increased the odds of a herd being affected by LJ. CONCLUSIONS AND CLINICAL RELEVANCE: LJ should be considered a common disease in farmed deer in western Canada. The observed relationship between the occurrence of LJ and acute mortality of fawns emphasises the potential of this infection to result in significant economic loss. Intensive management of deer, characterised by high densities and frequent moving and handling of animals, may contribute significantly to the occurrence of LJ. Observed geographical clusters may reflect areas where management of deer was more intensive or the trading of deer more common.

Endosurgical treatment of a retrobulbar abscess in a rabbit.

CASE DESCRIPTION: A 1-year-old sexually intact female Netherland dwarf rabbit was examined because of a 3-week history of signs of lethargy, decreased appetite, left unilateral exophthalmia, a previous draining sinus from a left maxillary facial abscess, and bilateral nasal discharge. CLINICAL FINDINGS: The rabbit weighed 1.0 kg (2.2 lb) and had a body condition score of 1.5/5. Physical examination revealed generalized muscle atrophy, bilateral mucopurulent nasal discharge, and severe left-sided exophthalmia. Diagnostic investigation revealed anemia, neutrophilia, severe dental disease, a superficial corneal ulcer of the left eye, and a retrobulbar abscess. TREATMENT AND OUTCOME: Stomatoscopy-aided dental trimming, tooth removal, and abscess debridement were performed. Antimicrobials were flushed into the tooth abscess cavity, and antimicrobial treatment was initiated on the basis of cytologic findings and results of bacterial culture and susceptibility testing. Two months after the initial surgery, minimal exophthalmia was evident and no further physical, radiographic, or ultrasonographic changes were evident. CLINICAL RELEVANCE: Stomatoscopy is a valuable technique that can facilitate diagnosis, treatment, and serial reevaluation of rabbits with dental disease.

Diagnosis and management of a retrobulbar abscess of periapical origin in a domestic rabbit.

Retrobulbar abscessation is the most common orbital disease of rabbits, and the lesions are notoriously difficult to treat successfully. This article describes the diagnosis, surgical treatment, and long-term management of an extensive abscess located within the right maxilla and retrobulbar space of a domestic rabbit. Preoperative assessment and long-term monitoring were achieved with a combination of radiography, ophthalmic ultrasonography, and CT. Extraoral rigid endoscopy via a fenestration in the maxilla was used to facilitate surgical debridement of the lesion, and extraction of multiple cheek teeth has been fundamental to achieving control. The long-term use of topical and systemic antibiotic preparations and nonsteroidal anti-inflammatory medication is discussed.

[Fractures of the canines require attention]. / Een hoektandfractuur verdient de juiste aandacht.

Hardly any attention was paid to a barely visible fracture of a canine tooth (104) in an 18-month-old dog. When the dog was 6-years old, a fistulous opening was seen on the bridge of the nose. A year later, radiography revealed a periapical process. The investigations performed and treatment given are described, as is the correct way to handle fractures of the canines.

"Lumpy jaw" in exotic hoof stock: a histopathologic interpretation with a treatment proposal.

"Lumpy jaw" of artiodactyls and macropods, although often considered a manifestation of actinomycosis, is actually an osteomyelitis, perhaps commencing with a dental root abscess or trauma to the jaw. Anaerobes may be cultured from the lesions, and vegetable matter may be impacted in them. It is a chronic disease and difficult to treat. Successful treatment may include draining the abscess, cleaning the cavity with saline and antibiotics, flushing with a combination of hydrogen peroxide-sodium hypochlorite and Betadine, and apicoectomy and endodontic filling when active inflammation has subsided.

Periapical curettage: an alternative surgical approach to infected mandibular cheek teeth in horses.

OBJECTIVE: To evaluate an alternative surgical method for treating periapical infection of the mandibular cheek teeth of horses. DESIGN: Retrospective study. ANIMALS: Eleven horses (3-13 years) with periapical mandibular tooth infection. METHODS: Hospital records (1992-2002) of horses that had periapical curettage for the treatment of mandibular cheek tooth root infection were retrieved. Clinical signs, radiographic, and surgical reports were reviewed. Outcome was obtained by telephone questionnaire for 7 horses and by physical examination in 2. RESULTS: Eleven horses (14 infected mandibular molariform teeth) had periapical curettage. Two horses were lost to follow-up. Mean follow-up was 41 months; 2 horses had subsequent tooth repulsion, 7 (78%) horses healed completely although 2 horses still had some local mandibular swelling. CONCLUSION: Periapical curettage, which allows alveolar drainage, appears to be a viable treatment option for periapical infections of equine mandibular cheek teeth. CLINICAL RELEVANCE: Periapical curettage can be performed simply, without expensive imaging or surgical equipment, and thus is useful for both referral and first opinion practice.