Let's Talk Teeth!

September 9, 2016
Written by  Dr. Donnell Hansen

Can we all agree none of us have had enough dentistry education? There was this wonderful golden period of veterinary students in Minnesota who were fortunate enough to have dentistry and oral surgery as a fixture of their curriculum and a dentist (or two) roaming the hallowed halls but most of you really never had access to a dental education. For technicians, there are many schools starting to step up their dental game but when you consider how much time we spend in general practice spelunking in the mouth, maybe we all should have gone to dental school.

My points:

  1. Forgive yourself when you feel overwhelmed navigating the gingival sulcus or you have friendly in hospital debates about how to tackle tooth resorption.
  2. Continue to be proactive with seeking out opportunities to maximize your potential in veterinary dentistry.

Of course, as many of you know, I am always around proclaiming the joys of doggie dentistry. This year at the VHA Expo, we will be spending some more quality time together reviewing:

  1. A Day in the Life of Veterinary Dentistry: Reviewing select cases of oral pathology, causes, and the associated treatment plan to help gain insight on some commonly and not so common dental maladies.
  2. Let's Talk Teeth: The dental team's guide to oral exam/charting and regional nerve blocks.

Bring your pens for this second discussion as we will pull out our oral exam sheets and literally chart a patient's mouth via photographic journey. The day will be a meandering adventure through a series of patients to view the world of oral pathology and our associated treatment recommendations. 

But just for the fun of it, let’s consider a case now… A common conundrum in my favorite breed, the boxer dog.

Have any of you ever seen a mug like this?

dog

teethWith gums like this?

This is a phenomenon we encounter frequently in Boxer dogs but truthfully, any bully breed is at a higher risk. While we commonly call this gingival hyperplasia (meaning excess gum tissue), it is technically often a generalized fibrous gingival hyperplasia (+/- ossification). Surgical removal via careful gingivectomy and gingivoplasty is recommended. These cases often take several hours to perform a great oral exam, document underlying periodontal disease (and find the missing teeth that are just about guaranteed to be hiding in there), remove the excess gum tissue, and address the remaining dental disease (often as a result of the excess gum tissue). Your secret brain, or an inquiring client, may ask, “Why does it really matter?” Aside from the risk of periodontal disease due to the entrapment of hair, debris, and plaque from the now forming pseudopockets (aka increased periodontal measurements not related to attachment loss but rather, a mountain of gingiva adjacent to the crown of the tooth), these patients suffer quality of life concerns as they are constantly chewing on the excess tissue. The also experience foul breath (which affects how many kisses your family is likely to accept), oral bleeding, and can hide additional dental disease or oral tumors. These dogs are uncomfortable and deserve care to get back to a healthy mouth. 

teeth 2Well, “how do I go about doing that,” you ask? You know, we all have our own favorite method for treating fibrous hyperplasia in the boxer dog. You may catch me using a scalpel, radiosurgery, curettes, and even diamond burs (very carefully) to remove the excess tissue. The important part is to use a reverse bevel incision to recreate a normal gingiva with an appropriate sulcal depth (2-3mm). After a little bit of what feels like arts and crafts, they should look more like this:

If you are paying attention, you might notice how much blood is around. You can almost always manage this with hemostatic agents, but it is important to be diligent about the overall patient when adventuring into a mouth. Be sure there is adequate blood volume and you have no reason to suspect a coagulopathy of any kind prior to care. Further, keep 1-2 days of potential bleeding/oozing in mind in terms of this patient’s family’s expectations as this is not the patient to send home in a beautiful new white leather Cadillac.

In terms of aftercare, anyone who has had gingival surgery KNOWS how these pets have earned great pain control. Typically, I use regional nerve blocks followed by a multimodal post-operative approach (like an opiod/NSAID combo or something similar) for about 5-7 days. We often submit several samples for histopathology if we have any concerns. Be aware, focal fibrous hyperplasia in a boxer can be strikingly similar to a peripheral odontogenic fibroma (formerly called a fibromatous/ossifying epulis).  While in some cases the difference may be academic (as treatment may be similar), it is important to rule out more concerning similar appearing masses like the acanthomatous ameloblastoma (formerly the acanthomatous epulis) or a metastatic neoplasia. A recheck exam 2 weeks following care often reveals healed gingiva and a family who notices what a difference you have made in their pets’ life.

A friendly tip: Don’t forget to be looking for malocclusions (just about every Boxer dog has a traumatic malocclusion) and impacted teeth +/- dentigerous cysts while you are in that cute squishy mouth.

Looking for more? We are always happy to help…. And we will see you at the 2016 VHA Expo on November 3 at the Minneapolis Marriot Northwest!


About the Author:

donnell hansen smDr. Donnell Hansen is a board certified veterinary dentist and oral surgeon from our local BluePearl hospitals working out of both the Eden Prairie and Blaine locations. A Minnesota native, Donnell went to school at Luther College, graduated veterinary college at the U of MN, and spent a year in Stillwater, Oklahoma for her internship before returning home for a residency at the University of Minnesota. In 2009, Dr. Hansen joined forces with some friends to form Moxie Center, which is now known as BluePearl Veterinary Partners. While managing a busy clinical caseload, Dr. Hansen also speaks nationally about the value (both from a patient care standpoint and practice health perspective) of veterinary dentistry and oral surgery. Dr. Hansen has a special interest in maxillofacial surgery but honestly, loves the whole gig. To provide a little balance to life, Donnell enjoys time with her family, including her husband (a fellow veterinarian) and two children, out on Minnesota’s 10,000 lakes or working a jigsaw puzzle during the long Minnesota winters. Like any veterinary family, there are an amalgamation of pets at home but the most beloved include two Labradors (the ancient Cody, and career changed Can Do Canine Scout), and her Pocket Pittie, Crickett.

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