Decision making and extraction techniques in dogs (Proceedings)
Decision making and techniques to simplify dental extractions in dogs have been described.1-5 Proper perioperative planning and decision making regarding canine extractions can improve surgical outcome.
Preoperative Considerations in the Canine Dental Patient
It is important to properly assess the canine patient prior to the performance of extractions. This includes complete general physical and oral examinations and appropriate preoperative blood work. Once the patient has been properly assessed it is important to select an appropriate anesthetic protocol that will provide the canine dental patient with adequate perioperative pain management.Oral Examination in the Awake Canine Patient
Oral examination in the awake canine patient is similar to the oral examination in the awake feline patient. Abnormalities detected are discussed with the owner with the stipulation that additional abnormalities may be detected in the anesthetized patient.
Oral Examination in the Anesthetized Canine Patient
Oral examination in the anesthetized canine patient begins with a thorough oral examination including evaluation for missing or supernumerary teeth, malformed teeth, proper occlusion, periodontal probing and exploration of the teeth with a dental explorer to detect pulpal exposure, worn teeth and dental caries. Abnormalities are noted on the canine dental chart.
Dental Radiography in the Canine Patient Prior to Extraction
Dental radiography is an important tool in the decision making process in canine dental patients. Dental radiography can help determine the most appropriate treatment modality in canine teeth affected with periodontal disease, endodontic disease, dental caries and other lesions.
A dental radiograph taken prior to performing a difficult extraction will provide the veterinarian with important information regarding the tooth. Radiographic evaluation of the tooth will determine if other treatment options may be possible so that the owner can be offered alternatives to extraction. In cases of severe periodontal or endodontic disease extraction may be the best treatment option for the patient. Dental radiographs prior to extraction will also reveal structural abnormalities that might be present in the tooth or surrounding bone. These structural abnormalities include: severe periradicular bone loss secondary to periodontal or endodontic disease, supernumerary roots, abnormal root angulation including convergent roots and excessive curvature of the apical portion of the root, ankylosis and hypercementosis. Knowledge of these structural abnormalities prior to initiation of the extraction will provide important information regarding the most appropriate technique for the extraction and will help reduce the incidence of complications.
Proper Equipment and Instrumentation for Canine Extractions
A high-speed handpiece with fiberoptics is extremely helpful when performing surgical extractions in dogs. The fiberoptic handpiece provides a light source directly on the surgical site. Burs utilized frequently include a variety of round burs for the removal of buccal bone and tapered fissure burs for sectioning multi-rooted teeth. Essential hand instrumentation for performing canine extractions have been previously described.1-5 Hand instrumentation specifically designed for canine extractions is available through numerous veterinary supply companies. Instruments for canine extractions may be packaged together in a canine extraction pack and steam sterilized prior to each use. Instrumentation in canine extraction packs include: scalpel handle upon which a #15 blade can be placed prior to surgery, a periosteal elevator, a soft tissue retractor, a variety of dental elevators and luxators, extraction forceps, needle holders, Adson tissue forceps, suture scissors and an iris scissors for cutting soft tissue. A small root forceps is also helpful for reaching down into an alveolus and obtaining a firm grasp on a loose root tip. It is imperative to routinely sharpen dental extraction instrumentation to insure optimal functionality.
Anatomic Features of Canine Teeth
The dental formula in the adult dog is: 2 (I 3/3, C1/1, P4/4, M2/3) = 42. The incisors and canine teeth all have one root. The 1st premolars and the lower 3rd molars have one root. The upper 2nd and 3rd premolars and the lower 2nd,3rd 4th premolars and 1st and 2nd premolars have two roots and the upper 4th premolar and 1st and 2nd molars have 3 roots. Knowledge of the location of the furcation of the teeth will permit accurate sectioning of teeth during surgical extractions.