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Extractions in cats: indications, techniques and complications (Proceedings)

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Nov 01, 2010

Decision making and techniques to simplify dental extractions in cats have been previous described.1-5 Proper perioperative planning and decision making regarding feline extractions can improve surgical outcome.

Preoperative Considerations in the Feline Dental Patient

It is important to properly assess the feline 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 feline dental patient with adequate perioperative pain management.

Oral Examination in the Awake Feline Patient

It may be difficult to perform a thorough oral examination in the awake feline patient however it is important to attempt to assess the oral cavity in the cat as completely as possible to help determine the general oral health of the patient. It must be remembered that all of the oral and dental lesions will not be readily apparent in the awake feline patient and a thorough oral examination including dental radiographs under anesthesia will be necessary to detect the full extent of the dental lesions. An oral exam is initiated by placing both hands gently around the patient's head and neck and then gently parting the lips with the thumbs to visualize the buccal aspect of the canine teeth and cheek teeth on each side. The incisor and canine teeth may be visualized from the front of the patient using the index fingers and thumbs to retract the lips. The maxilla is then visually assessed for any evidence of asymmetry or swelling. The eyes and nostrils are evaluated for any signs of asymmetry or discharge. The mandibles are then palpated for any evidence of swelling or asymmetry. The mouth is then gently opened by placing the index finger and thumb of the nondominant hand just below the zygomatic arches and tilting the patient's nose dorsally and then carefully placing the tip of the opposite index finger over the lower incisor teeth and gently pushing ventrally to open the mouth to permit visualization of the tongue, palate and pharynx. The thumb of the dominant hand is then placed in the intermandibular space with the index finger still on the lower incisors to displace the tongue dorsally to permit examination of the ventral aspect of the tongue. 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 Feline Patient

Oral examination in the anesthetized feline 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 and resorptive lesions. Abnormalities are noted on the feline dental chart.

Dental Radiography in the Feline Patient Prior to Extraction

Dental radiography is an important tool in the decision making process in feline dental patients. Dental radiography can help determine the most appropriate treatment modality in feline teeth affected with periodontal disease, endodontic disease and feline resorptive lesions.

Radiographic Changes Associated with Feline Periodontal Disease Requiring Extraction

Dental radiographs demonstrating less than 50% of attachment remaining on any mobile tooth indicates that extraction is indicated. In addition if dental radiographs indicate that there is loss of attachment to the apex of a single-rooted tooth or loss of attachment to the apex of any root of a multi-rooted tooth then extraction is indicated.

Radiographic Changes Associated with Feline Endodontic Disease Requiring Extraction or Endodontic Treatment

The presence of endodontic disease or disease of the pulp of a feline tooth requires extraction or endodontic therapy. Radiographic changes associated with endodontic disease include loss of tooth structure to the pulp of the tooth, asymmetrical endodontic canals, periapical lysis or apical lysis.

Radiographic Changes Associated with Feline Odontoclastic Resorptive Lesions Requiring Extraction or Crown Amputation with Intentional Root Retention

Dental radiography is extremely important in the assessment of feline odontoclastic resorptive lesions since the selection of the appropriate treatment is based on proper evaluation of the dental radiographs. Feline teeth with advanced root resorption, without periodontal or endodontal lesions are good candidates for crown amputation with intentional root retention.5 Conversely, a tooth with a feline odontoclastic resorptive lesion that has a well-defined periodontal ligament space, bone loss due to periodontitis, or a periapical lesion evident on radiographs requires standard extraction techniques with complete removal of the roots.5 In individual feline teeth in which one root has an advanced root resorptive lesion and another root has a well-defined periodontal ligament space it is acceptable to perform a crown amputation with intentional root retention on the root that has severe resorption and perform a routine extraction of the root that has a well-defined periodontal ligament space.