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2009, Vol. 4 No. 2, Article 40

 

Studies on Management of Dental Root Abscess and Related Osteomyelitis in Domestic Animals

A. S. Bigham1*, S. N. Dehghani2, Z. Shafiei3 and H. Khosropanah4


1 Assistant professor;

Department of Veterinary Surgery and Radiology, Faculty of Veterinary Medicine, Shahre-kord University, Shahre-kord, Iran.


2Professor; 3Ph.D Scholar;

 Department Of Veterinary Surgery & Radiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.

 
4Associate Professor;

Department Of Periodentology, Shiraz University Of Medical Science, Shiraz, Iran.

 

*Corresponding Author; e-mail address: dr.bigham@gmail.com

 


ABSTRACT

Seven animals of different species suffering from dental problems were referred to the surgical unit of the schools. Six of them had upper or lower jaw osteomyelitis along with dental root abscesses and one had dental fracture. All these animals were managed successfully by extra-oral and intra-oral extraction of the involved teeth.

KEY WORDS

Dental extraction, domestic animals, root abscess, osteomyelitis.

INTRODUCTION

Periodontal disease is the most common infectious disease in humans and animals. 75% to 80% of cats and dogs over 2 years of age exhibit signs of periodontal infection (5). In animals the upper premolar teeth (generally the fourth premolar tooth) whose roots are located near the eye socket are mostly affected. These animals are generally presented with swollen eye and fistula. Treatment includes extraction of the tooth and flushing of the infected site with antibacterial solution. A drain is required in severely infected cases (6). Present study reports successful management of dental root abscess along with lower or upper jaw osteomyelitis, in seven animals of different species.

MATERIALS AND METHODS

The study was conducted on Seven animals of different species having different dental problem ( table 1). Extraction/repulsion of the diseased teeth was performed after radiographic examinations. The premedication in dog ,horse and cat involved tranquilization with acepromazine acetate (0.2 mg/kg, IM) followed by Anaesthesia with ketamine hydrochloride (5-10mg/kg, IV) and diazepam (0.2 mg/kg, IV) and maintained with inhalant anaesthesia (2% Halothane), whereas sheep and cow was sedated with xylazine (0.02 mg/kg, IM) and local dental anaesthesia using 2% lidocaine was achieved prior to extraction of diseased teeth. Affected teeth in cat, dog, sheep and cow were extracted in the following three steps:
(a) Relief to all dental attachments (soft tissue and ligament) up to alveolar cavity,
(b) Dental loosening with continuous lateral and medial movement of tooth,
(c) Dental expulsion with continuous pulling force.
In Arab stallion the affected mandible was shaved and prepared for aseptic surgery. A linear skin incision over the swelling followed by soft tissue dissection after elevation of the masseter muscle from the caudal portion of the mandible provided better access for repulsion of the tooth. After incising and reflecting the periosteum, a rectangular bone window was created using a trephine. The fractured tooth was removed following repulsion technique (8). In Darreshori stallion, a U-shaped skin incision was made and the underlying soft tissues are dissected to expose the cortical bone. After incising and reflecting the periosteum, a rectangular window was created in the bone using a chisel (osteotome). To confirm correct positioning of the dental punch during the act of repulsion, the crown of the diseased tooth was palpated orally to detect vibrations. The tooth had to be removed in several pieces. The necrotic tissues were debrided and purulent exudates irrigated with 10% povidone iodine. The fistulous canal was left open and dressed antiseptically daily for ten days.

RESULTS and discussions

Disappearance of facial wounds and satisfactory alveolar cavity granulation was recorded within 10-20 days post antibiotic treatment (Table 2) in all cases. The horse has normal host defenses that work to maintain the integrity of the tissues that support the tooth. A disruption of the defense mechanisms results in an opportunistic infection (7). In small animal practice tooth extraction is usually performed through the oral approach under general anesthesia (2). In horses the tooth extraction technique is known as repulsion. It requires an osteotomy or trephination to expose the roots of the diseased tooth. Extraction is achieved by driving/repelling the tooth into the mouth with a dental punch (8). After extraction, flushing and gentle debridement of the alveolus removes loose fragments, debris and infected apical tissues (9). This can be done using an intra-oral or extra-oral approach. In all species, the extraction site is generally sutured as this enhances wound healing, prevents contamination from food particles, stops hemorrhage effectively and reduces postoperative pain (3,9). This procedure is contra-indicated, however, in cases of active infection where one should allow drainage of infected debris or discharges (10). Providing extra-oral drainage to infected areas after tooth extraction procedures (approached through cortical bone) in lagomorphs and horses, allows primary closure of the alveolus (1). Postoperative antibiotic administration is indicated in the presence of an active infection; severe periodontal disease or osteomyelitis (4,1,10,11).

REFERENCES

  1. Vlaminck L, Verhaert L, Steenhaut M, Gasthuys F. Tooth extraction techniques in horses, pet animals and man. Post-extraction molariform tooth drift and alveolar grafting in horses 2007;76:262-71.

  2. Taney KG, Smith MM. Surgical extraction of impacted teeth in a dog. J Vet Dent 2006;23:168-77.

  3. Dixon PM, Dacre I. A review of equine dental disorders. The Veterinary Journal 2005;169(2):165-87.

  4. Fitch PF. Surgical extraction of the maxillary canine tooth. Journal of Veterinary Dentistry 2003;20:55-8.

  5. Lobprise HB. Complicated periodontal disease. Clinical Techniques in Small Animal Practice 2000;15(4):197-203.

  6. Sylvester KA, Rutherford NJ. Dental emergencies. North American Veterinary Conference. Orlando, Florida 2005:123-4.

  7. Klugh DO. Equine periodontal disease. In: Proceedings of the 17th Annual Veterinary Dental Forum 2003:206-10.

  8. Turner AS, McIlwraith CW. Repulsion of cheek teeth. In: Turner AS, McIlwraith CW, eds. Techniques in Large Animal Surgery. 2 ed. Philadelphia, USA: Lippincott, Williams and Wilkins 1989:235- 9.

  9. DeBowes LJ. Simple and Surgical Exodontia. Veterinary Clinics of North America: Small Animal Practice 2005;35(4):963-84.

  10. Verstraete FJ. Instrumentation and technique of removal of permanent teeth in the dog. JS Afr Vet Assoc 1983;54(4):231-8.

  11. Smith MM. Exodontics. Vet Clin North Am Small Anim Pract 2005;1998:1297-319. Abdalla O, Fahmy MF, Arnautovic I. Anatomical study of the lacrimal apparatus of the one-humped camel. Acta Anat (Basel) 1970;75(4):638-50.


Table 1: Clinical signs and radiographic observations in different animals


Type of animal

Clinical signs

Radiographic observations

German shepherd bitch, aged 8 yrs,  weighing 30 kg

Wound below medial canther of the eye, purulent malodorous exudates around 4th premolar tooth

Root abscess of  4th  premolar and maxillary osteomyelitis (Fig.1)

Mixed breed dog, aged 3 yrs, weighing 18 kg

Malodorous facial wound indicative of root infection of right maxillary premolar tooth

Infection of 1st, 2nd and 3rd premolar teeth and maxillary osteomyelitis

Holstein cow, aged 5 yrs, weighing 550 kg

Chronic wound below left eye,1st and 2nd premolar loose and carious

Dental root abscess and osteomyelitis

Bakhtiari ram, aged 7 yrs

Chronic wound on the left side of face

Root abscess of 2nd premolar

Arab stallion, aged 6 yrs, weighing 410 kg

Swelling with purulent discharge on left mandible

Root abscess of 2nd premolar

Darreshori stallion, aged 7 yrs, weighing 380 kg

Queding  of feed , 3rd premolar longer than adjacent teeth

Longitudinal fracture from crown to root

Male Persian cat, aged 11 yrs, weighing 4 kgs

Severe right facial swelling ,loosening of right maxillary  premolar teeth

Severe infection of 1st,2bd and 3rd premolars and severeosteomyelitis



Table 2: Post operative antibiotic therapy in different animals.

Type of Animal Therapy

German shepherd bitch and

mixed breed dog

Amoxi-cloxacillin combination 20 mg per kg P.O. tid for 7 days

Flunixin meglumune 2.2mg\kg i/m for 7days

Holstein cow

Penicillin 40000 IU/kg and streptomycin 12mg/kg i/m for 7 days

Bakhtiari ram

Penicillin 40000 IU/kg and streptomycin 12mg/kg i/m for 7 days

Arab stallion and Darreshori stallion

Penicillin 20000 IU/kg and streptomycin 12 mg/kg for 7 days

Male Persian cat

Cephalexin 20 mg/kg P.O for 5 days






 Fig 1:Ventero- dorsal (1) and lateral view (2) radiographs of maxillary osteomyelitis
 and 4th premolar dental root abscess










 


 


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