Surgical Treatment of Facial Abscesses and Jaw Osteomyelitis of Dental Origin Using Extraoral Tooth Extraction in the Domestic Rabbit: A Case Series.

The treatment of facial abscesses of dental origin is difficult as jaw osteomyelitis in rabbits is mainly associated with a thick caseous pus that is particularly difficult to drain. Precise identification of the teeth involved in the infected site with the use of cone beam computed tomography (CBCT) was expected to ensure a favorable surgical treatment plan without a long-term local antibiotic strategy or local marsupialization. The first part of the study compared multi-planar reconstruction (MPR) and 3D reconstruction complemented by a maximum intensity projection filter (MIP). The surgical part of the study included rabbits with documentation of the treatment outcome for a period greater than one month after surgery and having had at least one post-operative CBCT demonstrating the achievement of surgical extraction. MPR is significantly more efficient than MIP techniques for alveolar bone (P < 10-7), spongious bone (P < 10-10) and apical elongation (P < 10-5) parameters. Nineteen of 20 surgical sites gave radiological confirmation of the success of the surgical plan. Eighteen of 20 of the abscess sites were clinically healed within one month. Seven out of 20 of the abscess sites presented evidence of one dental structure regrowth following the CBCT recheck. Two out of these seven cases presented with a concomitant persistent chronic facial fistula. Both cases healed after second-stage surgery to extract the tooth structure. The mean number of teeth extracted was 2.85, and seven of the 20 procedures included one incisor.

Clinical Characterisation of Caudal Traumatic Malocclusions and Treatment Outcomes in Cats (2018-2022).

Caudal malocclusions in cats may result in a variety of traumatic lesions affecting the soft tissues of the ipsilateral mandible such as fovea, gingival cleft, and proliferative lesions. Fifty-one cats diagnosed with a traumatic caudal malocclusion were compared with a control hospital population and evaluated for prevalence with respect to breed and sex. Twenty-two cats that were treated had radiographic, clinical findings, and the outcome of treatment (extraction or odontoplasty) recorded. Maine Coon, Persian, and male neutered cats were overrepresented while Domestic Shorthairs were underrepresented within the study population. Radiographically, 50% of the fovea lesions had an area of decreased bone density in the region of the lesion and none of these had evidence of periodontal disease. All gingival cleft lesions had radiographic changes consistent with periodontal disease. 15.4% of proliferative lesions presented with radiographic changes, with only half of those presenting with both radiographic and clinical evidence of periodontal disease. Eleven cats were treated by odontoplasty and eleven by extraction. One cat treated by odontoplasty developed new lesions caudally, and another had persistence of the initial lesions. Two cats in the extraction group developed new lesions rostral to the extracted teeth. In most instances, odontoplasty or extraction resulted in successful soft tissue lesion resolution. In rare cases, additional treatment was necessary due to either persistence or development of new lesions.

Nerve stimulator-guided mandibular block in an alpaca undergoing dental extraction.

General anesthesia of a 2-year-old castrated male alpaca undergoing mandibular tooth extraction was successfully managed via a mandibular nerve block with bupivacaine, using nerve stimulation to confirm correct needle placement. The local block was effective, with no cardiovascular or respiratory responses to surgical stimulation observed. Key clinical message: Use of a locoregional technique in dentistry confers anesthetic stability, blocks nociceptive responses to surgery, and promotes a smooth recovery and comfortable postoperative period.

Bloc du nerf mandibulaire confirmé en utilisant la stimulation nerveuse chez un alpaga subissant une extraction dentaire. L'anesthésie générale d'un alpaga mâle castré de 2 ans subissant une extraction de dent mandibulaire a été gérée avec succès par un bloc du nerf mandibulaire avec de la bupivacaïne en utilisant la stimulation nerveuse. Aucune réaction contre la stimulation chirurgicale, y compris une augmentation de la fréquence cardiaque et de la pression artérielle, n'a été observée pendant l'opération.Message clinique clé :L'utilisation d'une technique locorégionale en dentisterie confère une stabilité anesthésique, bloque les réactions nociceptives à la chirurgie et favorise un rétablissement en douceur et une période postopératoire confortable.(Traduit par les auteurs).

Intraoral Formation of a Rigid Obturator for the Treatment of Dental Fistulae and Draining Tracts in the Horse.

A retrospective cohort study to describe a novel use of a mechanically retained, rigid obturator (RO) to manage maxillary and mandibular persistent pathologic oral communications (PPOCs). This study included 22 horses with PPOC with at least 6 months of follow-up after treatment with a RO. The RO was made with a flowable, bis-acryl-based composite resin. Medical records were analyzed, including case details, obtained imaging, surgical reports, and follow-up information. There were 10 horses that had follow-up examinations by the authors and 8 horses by the referring veterinarian; in 4 horses, follow-up information was obtained by informal telephone interviews with the owner. Complete resolution of clinical signs was obtained in 21 of 22 (95.5%) horses, with confirmed healing of the PPOC in 15 of 22 (68.2%) horses. Complications were noted in 7 of 22 (31.8%) cases. Complications included: complete loss of RO (2 horses), fracture/defect of the RO (2 horses), displaced/shifted RO (1 horse), and incomplete seal of the PPOC (2 horses). All complications were resolved by repairing or replacing the RO. The RO placement is a successful, noninvasive, easily repeatable treatment for PPOC.

Intra-socket application of medical-grade honey after tooth extraction attenuates inflammation and promotes healing in cats.

OBJECTIVES: Dental diseases are a major problem in cats and often necessitate tooth extraction. Medical-grade honey (MGH) has antimicrobial and wound-healing properties, and therefore the aim of this study was to investigate whether intra-socket application improved healing after tooth extraction. It was postulated that applying MGH would reduce inflammation, improve the viability of the surgical flap and enhance healing following tooth extraction. METHODS: A prospective randomised controlled trial was performed in client-owned cats undergoing bilateral tooth extractions of the same element of the canine or (pre)molar tooth. A split-mouth design was used in which every animal served as its own control. After surgical extraction of the elements, the sockets on one side were filled with an MGH-based ointment (L-Mesitran Soft), whereas the contralateral side received no treatment (control). A mucoperiosteal flap was used on both sides, and simple interrupted monofilament sutures were placed. No antimicrobial drugs were administered. Clinical parameters (inflammation/redness, flap viability and wound healing) were subjectively analysed on days 3 and 7 post-extraction by a veterinarian blinded to the treatment. RESULTS: Twenty-one cats were included. MGH significantly decreased signs of inflammation (P <0.01), improved mucoperiosteal flap viability (P <0.01) and promoted wound healing (P = 0.01), at both time points. MGH was easy to apply and there were no adverse events. CONCLUSIONS AND RELEVANCE: Intra-socket application of MGH after tooth extraction positively affects the surgical wound, as it reduces redness, improves flap viability and enhances wound healing. Applying MGH represents a potent adjuvant therapy to support intra-oral wound healing after tooth extraction.

Clinical effect of buprenorphine or butorphanol, in combination with detomidine and diazepam, on sedation and postoperative pain after cheek tooth extraction in horses.

The objective of this study was to compare effects of butorphanol (BUT) or buprenorphine (BUP), in combination with detomidine and diazepam, on the sedation quality, surgical conditions, and postoperative pain control after cheek tooth extraction in horses, randomly allocated to 2 treatment groups (BUT: n = 20; BUP: n = 20). A bolus of detomidine (15 µg/kg, IV) was followed by either BUP (7.5 µg/kg, IV) or BUT (0.05 mg/kg, IV). After 20 min, diazepam (0.01 mg/kg, IV) was administered and sedation was maintained with a detomidine IV infusion (20 µg/kg/h), with rate adjusted based on scores to 5 variables. All horses received a nerve block (maxillary or mandibular), and gingival infiltration with mepivacaine. Sedation quality was assessed by the surgeon from 1 (excellent) to 10 (surgery not feasible). A pain scoring system (EQUUS-FAP) was used to assess postoperative pain. Serum cortisol concentrations and locomotor activity (pedometers) were measured. Horses in BUP and BUT required a median detomidine infusion rate of 30.2 µg/kg/h (20 to 74.4 µg/kg/h) and 32.2 µg/kg/h (20 to 48.1 µg/kg/h), respectively (P = 0.22). Horses in the BUP group had better sedation quality (P < 0.05) during surgery and higher step counts (P < 0.001) postoperatively. Buprenorphine combined with detomidine provided a more reliable sedation than butorphanol. However, the EQUUS-FAP pain scale became unreliable because of BUP-induced excitement behavior.

Effet clinique de la buprénorphine ou du butorphanol, en association avec la détomidine et le diazépam, sur la sédation et la douleur postopératoire après extraction de dents jugales chez le cheval. L'objectif de cette étude était de comparer les effets du butorphanol (BUT) ou de la buprénorphine (BUP), en association avec la détomidine et le diazépam, sur la qualité de la sédation, les conditions chirurgicales et la gestion de la douleur postopératoire après extraction des dents jugales chez les chevaux, répartis au hasard dans deux groupes de traitement (BUT : n = 20; BUP : n = 20). Un bolus de détomidine (15 µg/kg, IV) a été suivi soit de BUP (7,5 µg/kg, IV) soit de BUT (0,05 mg/kg, IV). Après 20 min, du diazépam (0,01 mg/kg, IV) a été administré et la sédation a été maintenue avec une perfusion IV de détomidine (20 µg/kg/h), avec un taux ajusté en fonction des scores de cinq variables. Tous les chevaux ont reçu un bloc nerveux (maxillaire ou mandibulaire) et une infiltration gingivale avec de la mépivacaïne. La qualité de la sédation a été évaluée par le chirurgien de 1 (excellent) à 10 (chirurgie impossible). Un système de notation de la douleur (EQUUS-FAP) a été utilisé pour évaluer la douleur postopératoire. Les concentrations sériques de cortisol et l'activité locomotrice (podomètres) ont été mesurées.Les chevaux en BUP et BUT ont nécessité un débit médian de perfusion de détomidine de 30,2 µg/kg/h (20 à 74,4 µg/kg/h) et 32,2 µg/kg/h (20 à 48,1 µg/kg/h), respectivement (P = 0,22). Les chevaux du groupe BUP avaient une meilleure qualité de sédation (P < 0,05) pendant la chirurgie et un nombre de pas plus élevé (P < 0,001) après l'opération. La buprénorphine associée à la détomidine a fourni une sédation plus fiable que le butorphanol. Cependant, l'échelle de douleur EQUUS-FAP est devenue peu fiable en raison du comportement d'excitation induit par le BUP.(Traduit par Dr Serge Messier).

Standing Intraoral Extraction of the Right Mandibular Third Molar Tooth in a Cow Utilizing Tooth Sectioning.

A 2-year-old Holstein heifer presented to a university teaching hospital with an apical tooth infection of the right mandibular third molar. A standing oral extraction technique was attempted for tooth removal; however, the molar could not be delivered intact. A tooth sectioning technique was performed, and the affected molar was successfully delivered. Three months postextraction, the heifer had fully recovered, and the extraction site had healed. To the authors' knowledge, this is the first description of a tooth extraction in a cow using a tooth sectioning technique. This case describes an alternative technique for tooth removal in cattle with an apical tooth infection. The clinical, diagnostic, and therapeutic features of this case may be helpful to clinicians when they approach similar cases in the future.

The facultative human oral pathogen Prevotella histicola in equine cheek tooth apical/ periapical infection: a case report.

BACKGROUND: Prevotella histicola is a facultative oral pathogen that under certain conditions causes pathologies such as caries and periodontitis in humans. Prevotella spp. also colonize the oral cavity of horses and can cause disease, but P. histicola has not yet been identified. CASE PRESENTATION: A 12-year-old Tinker mare was referred to the clinic for persistent, malodorous purulent nasal discharge and quidding. Conservative antibiotic (penicillin), antiphlogistic (meloxicam), and mucolytic (dembrexine-hydrochloride) treatment prior to referral was unsuccessful and symptoms worsened. Oral examination, radiography, sino-/ rhinoscopy, and standing computed tomography revealed severe apical/ periapical infection of the upper cheek tooth 209 with accompanying unilateral sinonasal inflammation and conchal necrosis. The tooth exhibited extensive subocclusal mesial infundibular cemental hypoplasia and caries, and an occlusal fissure fracture. After mechanical debridement and thermoplastic resin filling of the spacious subocclusal carious infundibular lesion, the tooth was extracted intraorally. The sinusitis and conchal necrosis were treated transendoscopically. Selective bacteriological swab cultures of affected tooth roots and subsequent matrix-assisted laser desorption ionization-time of flight mass spectrometry showed an infection with the obligate anaerobic, Gram-negative bacterium P. histicola. Surgical intervention and adapted antibiotic therapy led to normal healing without complications. CONCLUSIONS: This study provides the first documented case of dental infection in a horse caused by P. histicola at once indicating necessity of more sufficient microbiological diagnostics and targeted antibiotic treatment in equine dental practice. This finding is also conducive to understand species-specific Prevotella diversity and cross-species distribution.

Bacterial meningitis after dental extraction in a 17-year-old horse.

Dental extractions in horses may result in bacteremia, which can lead to systemic complications. Bacterial meningitis following oral cheek tooth extractions in a 17-year-old Thoroughbred gelding is described in this report. The bacterial meningitis was confirmed by histopathology. The gelding was presented for evaluation of intermittent fever, loose feces, and mild colic signs which started 5 days after cheek tooth extraction. This case illustrates a rare complication associated with oral tooth extraction in a horse and highlights the unusual presenting features of meningitis. Key clinical message: Bacterial meningitis secondary to oral cheek tooth extraction should be considered as differential diagnosis; particularly in cases with the development of pyrexia a few days after the procedure.

Méningite bactérienne après extraction dentaire chez un cheval de 17 ans. Les extractions dentaires chez les chevaux peuvent entraîner une bactériémie, ce qui peut amener des complications systémiques. Un cas de méningite bactérienne à la suite d'extractions buccales de dents jugales chez un hongre pur-sang de 17 ans est décrite dans ce rapport. La méningite bactérienne a été confirmée par histopathologie. Le hongre a été présenté pour évaluation d'une fièvre intermittente, de selles molles et de signes de coliques légers qui ont commencé 5 jours après l'extraction de la dent jugale. Ce cas illustre une complication rare associée à l'extraction dentaire orale chez un cheval et met en évidence des caractéristiques inhabituelles de la méningite.Message clinique clé :La méningite bactérienne secondaire à l'extraction buccale des dents jugales doit être considérée comme un diagnostic différentiel, en particulier dans les cas de développement d'une pyrexie quelques jours après l'intervention.(Traduit par Dr Serge Messier).

Exodontia associated bacteremia in horses characterized by next generation sequencing.

Bacteremia resulting from dental surgery is increasingly recognized as a health risk, especially in older and immunocompromised patients. Dentistry-associated bacteremia can lead to remote infections, as exemplified by valvular endocarditis. Emerging evidence points to a novel role played by oral cavity commensals in the pathogenesis of diabetes, respiratory disease, cardiovascular disease, and adverse pregnancy outcomes. Whether dental extraction, a commonly undertaken procedure in old horses, causes bacteremia has not been reported extensively. In a prospective clinical study using next generation sequencing (based on bacterial 16S rRNA), the circulating blood microbiome was characterized before and at 1 h following extraction of incisor, canine or cheek teeth from 29 adult horses with dental disease. 16S rRNA gene sequencing results from the blood microbiome were compared with those from gingival swab samples obtained prior to extraction at the location of the diseased tooth. Bacteremia associated with translocated gingival commensals was demonstrated in horses undergoing exodontia and was, in some cases, still evident one hour post-operatively.

Meningitis After Tooth Extraction and Sinus Lavage in a Horse.

A five-year-old Thoroughbred mare was evaluated because of chronic, malodorous, unilateral nasal discharge, and suspected maxillary cheek tooth root abscess. Skull radiographs revealed bilateral sinusitis suspected secondary to tooth root abscessation of 109 and 210. Following oral extraction of 109, bilateral conchofrontal sinus trephination and lavage; fever, tachycardia, and cervical stiffness developed. A lumbosacral cerebrospinal fluid tap was performed, and a presumptive diagnosis of bacterial meningitis was made. Targeted therapy consisted of antibiotic treatment with penicillin, enrofloxacin, and metronidazole, as well as antiinflammatory treatment with flunixin meglumine, dexamethasone, and dimethyl sulfoxide. Following the resolution of fever, tachycardia, and cervical stiffness, the second abscessed tooth, 210, was extracted. The mare was discharged receiving enrofloxacin. Twelve months later, the mare continued to do well with no residual signs of meningitis. Bacterial meningitis should be regarded as a life-threatening, although rare, the complication of dental or sinus surgery in horses. Early diagnosis and therapy may result in a successful outcome.

A Retrospective Evaluation of Secondary Wound Healing for Extraction of the Maxillary First Molar in Dogs.

Oral surgery and exodontia can present challenges in veterinary patients, with a particular area of challenge being extraction and closure of the maxillary first molar (M1) in dogs. This retrospective assessment evaluated patients that had the maxillary first molar extracted with placement of a cruciate suture across the alveolus to achieve partial closure and secure the blood clot. Patients that had teeth extracted adjacent to M1 (maxillary fourth premolar [PM4] or second molar [M2]) were excluded from the study. Three groups of patients were assessed: Group A - at the time of extraction of M1, both the maxillary PM4 and M2 were still present in the oral cavity. Group B - at the time of M1extraction only PM4 or M2 was present, but not both. The tissue was completely intact at the location of the missing tooth. Group C - at the time of M1 extraction neither PM4 or M2 were present, but tissue in these locations was intact. In a three-and-a half-year time period (2015-2018), 179 dogs with 213 solitary M1 extractions were performed. Of these 213 extraction sites, 127 sites (60%) had follow up examination within a two-week postoperative period. Of these 127 sites, 126 (99.2%) appeared appropriately healed without complication. The results of this retrospective evaluation demonstrate that primary closure of a maxillary first molar extraction site may not be required for appropriate soft tissue wound healing in canine patients.

Stem cell therapy prior to full-mouth tooth extraction lacks substantial clinical efficacy in cats affected by chronic gingivostomatitis.

OBJECTIVES: The aim of this pilot study was to determine the safety, efficacy and immunomodulatory function of systemically administered adipose-derived mesenchymal stem cells (ASCs) in cats affected by feline chronic gingivostomatitis (FCGS) prior to full-mouth tooth extractions. METHODS: Five client-owned cats affected with FCGS that did not undergo full-mouth tooth extractions for FCGS treatment received two intravenous injections of 20 million fresh, allogeneic or autologous ASCs. An oral examination with photographs, a complete blood count, blood immune cell phenotyping and a biochemical profile were completed at 0 and 6 months after treatment. RESULTS: Four cats completed the study and one cat exited the study 3 months after treatment. While the treatment was determined to be clinically safe, no positive clinical response was observed in three cats and a mild response was noted in two cats. Furthermore, none of the cats exhibited immune modulation, as evidenced by no alteration in circulating CD8+ T cells, normalization of the CD4:CD8 ratio or neutrophil counts. CONCLUSIONS AND RELEVANCE: Unlike the reported efficacy of ASCs in treating cats with non-responsive FCGS after full-mouth tooth extraction, the systemic administration of ASCs prior to full-mouth tooth extraction lacks substantial clinical efficacy and is not recommended at this time.

Equine Oral Extraction Techniques.

This article serves as a template for equine veterinarians to become proficient in basic intraoral premolar and molar extraction techniques of Equidae. Indications, equipment, and methodology are described. Numerous photos and videos are included to achieve a more immersive learning experience than can be accomplished with the written word alone. Clinicians performing these techniques will continue to improve their skillsets to achieve positive outcomes as case specifics become more challenging.

Equine Standing Surgical Extraction Techniques.

Dental repulsion techniques reported in the past decades have a high incidence of complications. Although the practice of surgical extractions in horses is limited because of the training, instrumentation, and experience required to perform these techniques, veterinarians should be aware these procedures are available, general anesthesia is not required, and when performed by skilled veterinary dentists they have low complication rates. Surgical techniques are often used after failure of other extraction techniques to remove retained tooth root and fragments or to debride chronically contaminated orofacial lesions. However, surgical extractions should be considered during initial treatment planning of all complicated cases.

Minimizing Equine Tooth Extraction Complications.

Oral extraction has become the most popular extraction technique owing to its high rate of success with minimal major complication. Repulsion continues to produce unacceptably high iatrogenic complication rates. To avoid tooth repulsion, veterinary dentists have introduced procedures to facilitate difficult intraoral extractions and surgical extraction techniques. Minimizing complications is best achieved preoperatively. A comprehensive preoperative evaluation and treatment plan allows the dentist to predict intraoperative complication and prepare for procedures to produce the best outcome. With proper case selection and adherence to extraction principles, the primary veterinarian and the veterinary dentist can perform equine tooth extractions with minimal complications.

A pilot study to evaluate the serum Alpha-1 acid glycoprotein response in cats suffering from feline chronic gingivostomatitis.

BACKGROUND: Feline chronic gingivostomatitis (FCGS) is a multifactorial immune-mediated disease that can lead to chronic pain, anorexia, and weight loss and has substantial health and welfare effects. Currently, the recommended treatment includes dental extractions to decrease the inflammatory stimulation associated with dental plaque. However, complete remission is observed in less than half of the cases, and the majority need comprehensive medical management. This study aimed to evaluate the serum levels of the acute phase protein alpha-1 acid glycoprotein (AGP) in cats with FCGS and to examine whether dental extractions contribute to a significant decrease in the systemic inflammatory response at two postoperative time points. RESULTS: AGP serum concentrations in the cats with FCGS were significantly higher at all time points than that in the control groups and were significantly correlated with the global caudal stomatitis score at day 0 but not at day 30 or 60. A significant improvement of some clinical scores, such as perceived comfort and global caudal stomatitis, was observed 60 days after the dental extraction. However, the levels of AGP did not significantly change over time. CONCLUSIONS: Cats with FCGS were more likely to have a systemic inflammatory response compared with age- and dental disease-matched controls. Dental extractions, in most cases, did not contribute to a significant decrease of AGP both at 30 and 60 days. Therefore, this study reinforces the need to pursue comprehensive medical management after dental extractions to attenuate the systemic inflammatory response as a result of this disease.