Topical review
Case Based Dental Radiology

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Dental radiology is quickly becoming integral to the standard of care in veterinary dentistry. This is not only because it is critical for proper patient care, but also because client expectations have increased. Furthermore, providing dental radiographs as a routine service can create significant practice income. This article details numerous conditions that are indications for dental radiographs. As you will see, dental radiographs are often critical for proper diagnosis and treatment. These conditions should not be viewed as unusual; they are present within all of our practices. When you choose not to radiograph these teeth, you leave behind painful pathology. Utilizing the knowledge gained from dental radiographs will both improve patient care and increase acceptance of treatment recommendations. Consequently, this leads to increased numbers of dental procedures performed at your practice.

Section snippets

Periodental Disease

Periodontal disease is the number one diagnosed problem in small animal veterinary medicine. By the age of two, 70% of cats and 80% of dogs have some form of periodontal disease.1 Therefore, the vast majority of your dental patients have probing depths that are greater than normal for the species.

Periodontal probing is the critical first step in the evaluation of periodontal disease. However, there are several reasons that dental radiographs should be obtained when evaluating periodontal

Endodontic Disease

Endodontic disease is also very common in veterinary dentistry. One study reported that approximately 10% of all dogs have at least one tooth with direct pulp exposure.4 Unfortunately, animal patients with endodontic disease will typically suffer for a long time before diagnosis and definitive treatment. In fact, the vast majority of endodontic cases go undiagnosed because of the lack of outward signs of disease other than a broken or discolored tooth. This is because cats and dogs rarely show

Feline Tooth Resorption

Dental radiographs are absolutely critical for proper dental care in all feline patients. This is because resorptive lesions, which are very common in cats, require x-rays for diagnostic and therapeutic purposes. Because these lesions typically initiate at or below the gingival margin, clinical evidence does not appear until fairly late in the disease course.7 Consequently, severe root and painful cervical crown resorption can occur undetected (Fig 14). For this reason, many veterinary dentists

Idiopathic Root Resorption in Dogs

Although not nearly as common as resorptive lesions in cats, dogs do develop resorptive lesions. This is more common in older dogs.13 In most cases, it is the mandibular premolar teeth that are involved (Fig 19). In addition to the resorption, these teeth typically have concurrent periodontal disease. The resorption and secondary ankylosis make extraction by traditional means difficult to impossible, thus necessitating a surgical approach. Knowing the condition of the roots before initiating

Persistent Deciduous Teeth

Extraction of persistent deciduous teeth (Fig 20) is a very common procedure performed in veterinary dentistry. However, without dental radiographs this can be a very difficult and frustrating endeavor. A common question posed by general practitioners is, “If I break a deciduous root, do I need to surgically extract the root or will it resorb on its own?” Unfortunately, without the benefit of dental radiographs, this question cannot be answered.

In some cases, the root of the deciduous tooth is

Neoplasia

Aggressive/malignant oral neoplasms almost invariably invade the underlying bone.15 The result of this invasion is either complete bony destruction (Fig 24) or a “moth-eaten” appearance of the affected bone (Fig 25).15 Exposing a dental radiograph and including a dental radiology report on the histopathology request form helps the pathologist with his or her interpretation. It is also important to note that histopathology is not a perfect science and errors can occur. Therefore, if a pathology

Mandibular Fractures

Mandibular fractures are a fairly common occurrence in veterinary dentistry. They are generally traumatic in nature; however, in our aging patients there is an emerging problem known as a pathologic fracture.

Chronic periodontal loss will loosen the tooth support and result in exfoliation. In the majority of teeth, this will occur before severe bone weakening. However, in some situations, significant bone thinning will occur before tooth exfoliation.

Pathologic fractures are most common in small

Missing Teeth

It is exceedingly common for teeth to be absent in the dental arcades of veterinary patients (Fig 31). In some cases, the tooth is truly missing; however, in others, the tooth (or part of it) is present and may be pathologic. Do not assume that the tooth is not present just because it is missing or previously extracted if radiographs have not been taken of the area.

Possible etiologies for missing teeth include:

  • 1)

    Congenitally missing (Fig 32): This is generally considered to be a genetic problem

Extractions

Preoperative and postoperative dental radiographs should be exposed for all extraction procedures. Preextraction x-rays allow the practitioner to determine the amount of disease present, any root abnormalities (supranumery [Fig 37], curved [Fig 38], ankylosis [Fig 39]), as well as the level of remaining bone (see periodontal disease above). Fully 10% of maxillary third premolars in cats have a third root.18 In the case of a mandibular first molar or cuspid extraction, knowing the amount of

Conclusion

Considering that nearly every one of your patients is suffering from oral disease and that dental radiographs are indicated for all oral disease, virtually all patients will benefit from the information provided by dental radiographs. Additionally, dental radiographs are a critical piece of information for the veterinarian when treating oral disease. Therefore, dental x-ray equipment should be used on a daily basis in every general practice.

From a financial standpoint, there is not a piece of

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