Pulp therapy and root canal treatment techniques in immature permanent teeth: an update.

Background According to the Children's Dental Health Survey 2013, around one in ten children in Wales, Northern Ireland and England will have sustained dental trauma to a permanent incisor by the of age 15. Management of an exposed pulp in an immature permanent incisor is often urgent and has an impact on the long-term outcome of the tooth; therefore, it is essential that general dental practitioners feel confident in managing such a scenario to achieve an optimal outcome. This paper discusses the indications, technique, materials and outcomes.Aims This article aims to review the literature, which discusses various treatment modalities and materials for pulpal therapy and root canal treatment in the immature permanent tooth.Method Electronic searches were limited to English language, human studies, published within the past five years and the medical subject heading terms used were: direct pulp capping, apexogenesis, Cvek pulpotomy, full pulpotomy/pulpectomy, partial pulpotomy, apexification, non-vital pulp therapy and mineral trioxide aggregate apexification. Older, seminal articles identified through the references sections have also been included.Conclusion A number of options are available for the management of immature permanent teeth that have suffered an insult such as caries or trauma. This paper reviews the various methods of pulpal treatment, preservation therapy and root canal treatment options depending on the extent of the damage.

Characteristics and outcomes of dog attacks to dogs and cats in Melbourne, Australia: A retrospective study of 459 cases (2018).

Dog-dog and dog-cat attacks can result in severe medical, financial, and emotional injury to pets and owners. The characteristics of dog-dog and dog-cat attack victims, the circumstances surrounding these attacks and the financial burden from veterinary visits is not reported in Australia. Medical records from 459 animals that were presented to the emergency service of four specialty hospitals in Melbourne, Australia in 2018 following a dog attack were assessed via univariate and multivariate methodologies with a retrospective case-control study design. Animals who had been attacked by a dog comprised 2.4% of the overall caseload at these four hospitals. Risk factors identified in dog-dog attack victims for presenting to a veterinary emergency hospital after being attacked were being cross-bred (OR = 1.4, p = 0.014, 95% CI = 1.07-1.84) and neutered (OR = 1.4, p = 0.035, 95% CI = 1.03-2.00). Being aged > 2-7years was protective (OR = 0.70, p = 0.010, CI = 0.48-0.88). Dogs from houses with a lower Socio-economic Indices for Areas score (SIEFA) were more likely to be attacked at home by a known attacker, compared to those from houses with a higher SIEFA score who were more likely to be attacked in public by a dog unknown to them (p = <0.001). Cats who presented following a dog attack had a 46.3% survival to discharge, compared to 91.8% in dogs (p < 0.001). Final cost of treatment for dogs and cats was similar (median AU $380 vs AU $360, respectively). Further research is needed to evaluate the population of dogs and cats attacked by dogs, to inform and direct public education campaigns aimed at reducing their incidence and overall burdens.

Induction of emesis with apomorphine using a novel gingival administration method in dogs.

OBJECTIVE: To describe a novel method of inducing emesis in the dog using gingival administration of apomorphine, compare the efficacy of inducing emesis with gingival apomorphine to conjunctival apomorphine, and describe adverse effects associated with the gingival route. DESIGN: Retrospective study from January 2017 to September 2018. SETTING: Independent all-hours primary and secondary emergency and critical care referral center. ANIMALS: Five hundred fifty-eight client-owned dogs. MEASUREMENTS AND MAIN RESULTS: The medical records of dogs presenting for induction of emesis were searched. Dogs receiving either gingival or conjunctival apomorphine were included in the study. A short online survey was sent to clients whose dogs received gingival apomorphine. Apomorphine was administered conjunctivally in 430 (77.1%) dogs and gingivally in 128 (22.9%) dogs. There was no difference between route of administration and success of emesis (p = 0.29). A total of 14 clients responded to the survey, and diarrhea, lethargy, hyperactivity, and sedation were reported as adverse effects of gingival apomorphine administration. No clients sought veterinary attention for any of the adverse effects reported. CONCLUSIONS: Gingival administration of apomorphine is easy, appears to be safe, and is an effective method of inducing emesis in the dog. Gingival administration of apomorphine may be considered in cases where parenteral administration is not feasible and could replace conjunctival administration in compliant dogs.

A randomized, controlled clinical trial of intravenous lipid emulsion as an adjunctive treatment for permethrin toxicosis in cats.

OBJECTIVE: To assess for any clinical benefit of intravenous lipid emulsion (ILE) for permethrin toxicosis in cats by comparing the progression of clinical signs of cats before and after treatment with ILE to cats treated with a saline control. To accomplish this objective, a clinical staging system for cats with permethrin toxicosis was developed and validated. DESIGN: Prospective, multicenter, randomized, controlled clinical trial. SETTING: University veterinary teaching hospital and 12 private veterinary emergency hospitals. ANIMALS: Thirty-four client-owned cats with permethrin toxicosis. INTERVENTIONS: A clinical staging system was designed based on abnormalities found on physical examination of cats with permethrin toxicosis. The clinical staging system had 6 stages, ranging from Stage A for cats with no abnormalities to Stage F for cats with grand mal seizures. The system was validated for intraviewer and interviewer variability. Cats in the clinical trial were randomized to receive 15 mL/kg of either intravenous 0.9% saline (control) or 20% ILE over 60 minutes. For each cat, a clinical stage was recorded at set time points before and after the randomized treatment was administered. The distribution of clinical stage stratified over time was compared across treatment groups. MEASUREMENTS AND MAIN RESULTS: The clinical staging system showed excellent repeatability (P = 1.0) and reliability (P = 1.0). In the clinical trial, there was a significant difference in the distribution of clinical stages over time (P < 0.001) and from presentation stage to Stage B (P = 0.006), with ILE-treated cats (n = 20) having lower clinical stages earlier than control cats (n = 14). There was no significant difference in signalment, body weight, or supportive treatment between the groups. CONCLUSIONS: The clinical staging system was repeatable and reliable. Clinical stages of permethrin toxicosis in ILE-treated cats improved earlier compared to control cats, suggesting ILE may be a useful adjunctive therapy in the treatment of permethrin toxicosis in cats.