Sandra Manfra Marretta, DVM, Diplomate, ACVS, AVDC
An accurate interpretation of the history and clinical signs of animals with dental problems combined with a thorough dental examination and dental radiography will result in an accurate diagnosis. Some of the more common historic implications and signs of a dental problem include:
1. changes in eating habits
3. pawing at the mouth
4. abnormal salivation
5. oral hypersensitivity
6. facial swelling
7. draining tracts
8. oral hemorrhage
9. sneezing and nasal discharge
10. abnormal behavior
11. ophthalmic changes
Changes in eating habits in animals with dental problems can range from partial to complete anorexia, preference for soft food rather than hard food, chewing on one side, dropping food from the mouth, and running away from the food dish following attempts to eat.
Halitosis is a common client complaint in animals examined because of dental disease. Some animals with a dental problem will paw vigorously at their mouths. This sign is more frequently seen in cats than dogs although it can be observed in both species. While pawing at their mouths, they may also demonstrate abnormal manipulations of the mouth (i.e., widely opening the mouth, "chattering" of the teeth, and tilting of the mouth to one side. Animals with dental disease may be examined because of hypersalivation or abnormal salivation including thick purulent saliva or blood-tinged saliva.
Oral hypersensitivity is often a sign of a dental problem as is facial swelling. Animals may resent being toughed around the face and may have a significant change in temperament associated with dental pain. Various types of facial swelling may be associated with dental problems. The classical facial swelling in the dog ventral to the eye is usually associated with a periapical abscess of the upper fourth premolar. Facial swelling associated with dental disease is usually sudden in onset; however, chronic, slowly progressive facial swelling does not eliminate the possibility of a dental problem although this is more typical of a neoplastic process. Retrobulbar swelling can be associated with a dental problem, particularly a periapical abscess of the maxillary first molar secondary to periodontal or endodontic disease. Unilateral muzzle swelling may be associated with a periapical abscess of the canine tooth or the second or third premolar. Mandibular swelling is less frequently diagnosed partially because the incidence of periodontal disease is greater in maxillary teeth as compared to mandibular teeth in the dog and because it requires digital palation for diagnosis rather than casual visual observation. Cutaneous and mucosal draining tracts may be associated with dental disease including both draining tracts of endodontic and periodontic origin. A gutta percha point placed in a draining tract will often localize the affected tooth and origin of drainage.
Oral hemorrhage can be related to a dental problem. Hemorrhage may range from a small amount with only blood-tinged saliva to severe with packed cell volumes dropping below 20% in rare instances.
Sneezing and nasal discharge, either mucopurulent or hemorrhagic, is a very common sign of dental disease. These signs are associated with an oronasal fistula which is a communication between the oral and nasal cavity or an oroantral fistula which is a communication between the oral cavity and maxillary sinus. The tooth that most frequently causes oronasal fistulations is the maxillary canine tooth. This tooth frequently has deep palatal periodontal pockets that extend into the nasal cavity. Less frequently nasal discharge and sneezing can be related to severe periodontal disease of the maxillary premolars and molars resulting in oronasal or oroantral fistulas. Incisor teeth may also be infrequently associated with oronasal fistulas. Endodontic disease may also be a cause of sneezing and nasal discharge.
Another historic sign that may be associated with an underlying dental problem is abnormal behavior. Animals with dental pain may hide or whine, refuse to go outside or become aggressive and irritable.
Ophthalmic changes may be associated with dental disease of the maxillary 4th premolar, and the first and second maxillary molars. Some ophthalmic changes that may be associated with periodontal and endodontic disease include orbit, periorbal, and conjunctival changes.
Physical findings associated with dental problems include gingivitis, gingival recession, contact ulcers, dental attrition, dental fractures, odontoclastic resorptive lesions, dental caries, supernumerary teeth, missing teeth, retained deciduous teeth, maloccluded teeth, malformed teeth, and pathologic fractures of the mandible. Careful examination of the oral cavity for these abnormalities can result in an accurate diagnosis and appropriate therapeutic management.
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