Day one core competencies in veterinary dentistry.

This article describes the core competencies recommended for inclusion in the veterinary curriculum for all veterinary graduates based on the American Association of Veterinary Medical Colleges Competency-Based Veterinary Education document. General practice companion animal veterinarians are frequently presented with patients having dental, oral, or maxillofacial pathology, and veterinary graduates will be relied upon for recommendations for the maintenance of oral health, including the prevention of periodontal disease, identification of endodontic disease, and knowledge of developmental defects. These recommendations should be made for all veterinary patients starting at a young age. These core competencies can apply to many companion species, but mainly are focused on the dog and cat. Because periodontal disease is the most common abnormality observed in dogs and cats, the first key step is taking a few seconds during examination of every patient of any age presented for any reason to examine the oral cavity. Although dental, oral, and maxillofacial pathology is often diagnosed after imaging and evaluation under anesthesia, the first step is observation of dentition and gingivae during the conscious exam to assess periodontal health status. The physical exam of the oral cavity may reveal oral behavior (eg, observation of uncomplicated crown fractures due to chewing on hard objects), which will permit recommendations for enhanced prevention by daily oral hygiene or professional treatment. There are now many involved dental and surgical treatments available, some of which require specialist-level instrumentation and expertise. General practitioners should be able to competently perform the following immediately upon graduation from veterinary school: For patients for whom the owner's reason for the veterinary visit is not dental, oral, or maxillofacial disease, obtain a brief (1 or 2 questions) history of the oral health of the patient. On lifting the lip of every patient, recognize presence or absence of accumulated dental plaque or calculus on the crowns of the teeth, presence or absence of gingival inflammation or ulceration, and presence or absence of other dental, oral, and maxillofacial pathology. On anesthetized patients that have dental, oral, and maxillofacial pathology for which professional treatment is indicated, be able to obtain and interpret appropriately positioned and exposed dental radiographs. When the presence of dental, oral, and maxillofacial pathology is recognized, determine whether each tooth present in the mouth does or does not require professional treatment beyond dental subgingival and supragingival scaling and polishing. List the indications for tooth extraction, know indications for potential oral/dental treatments beyond subgingival and supragingival scaling and polishing or extraction, and determine whether the professional treatment that may be indicated, such as root canal treatment or mass resection of oral tissues, requires referral for specialist-level expertise and instrumentation. Complete a thorough periodontal evaluation and therapy with periodontal probing, including professional subgingival and supragingival ultrasonic scaling with polishing under anesthesia. Demonstrate the ability to extract teeth indicated for extraction, using gentle and appropriate techniques that will risk minimal injury to the jaws and oral soft tissues and reduce postoperative patient pain. Provide appropriate postoperative care, including recognition of when postoperative analgesia and possibly antibiotic administration are indicated.

Pilot evaluation of a novel test strip for the assessment of dissolved thiol levels, as an indicator of canine gingival health and periodontal status.

This study evaluated a novel test strip designed to assess thiol levels as they relate to gingival/periodontal health in dogs. The simple to use strip (similar in form to a pH test strip) provides a colorimetric signal which estimates the level of thiols dissolved in oral fluid. Among several oral sites tested (left and right lingual vestibules, lower buccal vestibule, and upper buccal gingival margin), fluid from the maxillary gingival margin gave results with the best dynamic range, and its thiol levels correlated well with several oral health parameters (Pearson coefficients between 0.55 and 0.84; P < 0.001), especially those relating directly to the gingiva. The strip, which can be used on animals which are awake, may be useful as a quick, objective assessment of periodontal health, potentially enhancing compliance for thorough examinations, and promoting earlier and better-sustained treatment programs.

Évaluation pilote d'un nouveau bâtonnet diagnostique pour l'évaluation des taux de thiol dissous comme indicateur de la santé gingivale canine et de la situation parodontale. Cette étude a évalué un nouveau bâtonnet diagnostique conçu pour évaluer les taux de thiol tels qu'ils se rapportent à la santé gingivale et parodontale des chiens. Le bâtonnet facile à utiliser (de forme semblable à un bâtonnet diagnostique de pH) fournit un signal colorimétrique qui estime le taux de thiols dissous dans le liquide buccal. Parmi plusieurs sites buccaux testés (vestibules linguaux gauche et droit, vestibule buccal inférieur et bord marginal de la gencive buccale supérieure), le liquide du bord marginal de la gencive maxillaire a donné les résultats avec le meilleur écart dynamique et ses taux de thiol correspondaient bien à plusieurs paramètres de la santé buccale (coefficients de Pearson entre 0,55 et 0,84; P < 0,001), particulièrement ceux se rapportant directement à la gencive. Le bâtonnet, qui peut être utilisé sur les animaux lorsqu'ils sont éveillés, pourra être utile comme évaluation objective rapide de la santé parodontale, ce qui rehaussera potentiellement l'observance pour des examens complets et fera la promotion de programmes de traitement mieux soutenus qui sont administrés plus tôt.(Traduit par Isabelle Vallières).

Effect of TrisEDTA and Chlorhexidine 0.12% on an In Vitro-Defined Biofilm Representing the Subgingival Plaque Biofilm of the Dog.

This study was designed to investigate the effects of chlorhexidine 0.12%, TrisEDTA (tromethamine ethylenediamintetraacetic acid), and a combination of chlorhexidine 0.12% and TrisEDTA on an in vitro plaque biofilm model comprised of three bacterial species commonly found in canine subgingival plaque. Porphyromonas gulae, Actinomyces canis, and Neisseria canis were grown in a biofilm on polished hydroxyapatite coated titanium alloy pucks for 72 h prior to exposure to one of four test solutions: TrisEDTA, chlorhexidine 0.12%, a combination of TrisEDTA and chlorhexidine 0.12%, or sterile deionized water as a control. Following exposure to the test solution, a sample was collected of the biofilm either immediately or following 24 h of additional incubation in a broth medium. Lower numbers of CFU/mL of Porphyromonas gulae resulted when the biofilm was treated with a solution of chlorhexidine 0.12% and TrisEDTA compared to with chlorhexidine 0.12% alone, TrisEDTA alone, or the control and so this solution can be said to be synergistic against Porphyromonas gulae in this controlled in vitro model. Greater reductions in the numbers of CFU/mL of Actinomyces canis and Neisseria canis resulted from treatment with chlorhexidine 0.12% alone than if treated with the combination of TrisEDTA and chlorhexidine 0.12%. When treated biofilm samples were allowed 24 h of additional growth in fresh media, greater variance resulted and this variance highlights the complex dynamics involved in bacterial growth within a biofilm.

Evaluation of composite resin materials for maxillomandibular fixation in cats for treatment of jaw fractures and temporomandibular joint luxations.

OBJECTIVE: To identify a method of composite application for maxillomandibular fixation (MMF) in cats that ensures the material will remain bonded during convalescence but be easy to remove with a low complication rate. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Feline cadavers (n=88). METHODS: MMF was applied using composite to 4 groups of 22 feline cadaver heads each. The protocols were: group CR: acid etch and composite resin; group CR+: acid etch, bonding agent, and composite resin; group FR50: partial surface acid etch and flowable composite resin; group FR100: complete surface acid etch and flowable composite resin. Removal time and complication rate were noted. Load to failure was determined by tensile loading. RESULTS: Load to failure was similar for groups CR and CR+ and for groups FR50 and FR100; however, load to failure for groups FR50 and FR100 was higher than groups CR and CR+ (P<.01). Time for material removal for group FR100 was longer (P<.01) and the complication rate was higher (P<.01) compared with the groups CR, CR+, and FR50, with no significant differences in removal times and complication rate between the latter groups. The most frequent complication during material removal in group FR100 was crown fracture. CONCLUSIONS: Partial coronal surface acid etch before use of flowable composite maintained a strong bond, yet resulted in easy material removal with a low complication rate.

Decision-Making and Management of Immature Permanent Teeth with Crown Fractures in Small Animals-A Review.

Immature permanent teeth with crown fractures present a unique challenge in human and animal patients. Immature permanent teeth have not yet developed completely, often presenting with thin dentin walls, incomplete apical formation, and increased crown-to-root ratios. Loss of pulp function at this stage has devastating long-term implications for these teeth. Ideally, attempts should be made to preserve pulp vitality in immature permanent teeth to allow for continued dental development. The range of treatment options for vital teeth includes odontoplasty with bonding and sealing +/- restoration, indirect pulp capping, and direct pulp capping/vital pulp therapy. These treatments have long been established in human and veterinary medicine, and cases have been reported in dogs and cats. Apexification using calcium hydroxide is a well-established treatment for nonvital immature teeth. The advent of mineral trioxide aggregate and other bioceramic materials for use in vital pulp therapy and apexification has reduced treatment sessions and improved outcomes. Recent developments in the field of regenerative endodontic therapy further expand treatment options and provide the possibility for continued development of a formerly nonvital tooth. Selecting the appropriate treatment based on the severity of tooth fracture and status of pulp vitality can avoid a lifetime of poor structure and function for the affected tooth. This article provides multiple step-by-step protocols for the management of immature permanent teeth with crown fractures in small animals.

Comparison of hand-instrumented, heated gutta-percha and engine-driven, cold gutta-percha endodontic techniques.

An in vitro study compared two gutta-percha obturation techniques of the mandibular first molar in dogs. The mandibular first molars were instrumented and obturated using either K-files and the SuccessFil vertical compaction technique or rotary instruments and the Simplifill/guttapercha master cone technique. Instrumentation and obturation times were recorded for each tooth. Radiographs were used for evaluation of overall appearance of the final fill. A modified apical dye leakage technique was used to evaluate the ability of each method to provide an adequate barrier to apical leakage. The endodontic technique utilizing rotary instruments and Simplifill/gutta-percha master cone required less time and provided a better radiographic appearance to the endodontic fill. In addition, there was no apical dye leakage associated with this technique compared with a 44% leakage incidence in teeth treated with K-file instrumentation and SuccessFil.

Mandibular canine tooth luxation injury in a dog.

A mixed breed dog was presented for lateral luxation of the mandibular left canine tooth following oral trauma. This case report describes the management of this injury including reduction, stabilization using a wire reinforced acrylic splint, and standard endodontic therapy of the mandibular left canine tooth.