Friday, September 16, 2016

Why do you need to do Dental Radiographs?

"Why do you need to do dental xrays on that dog?, asked a veterinary colleague recently.

How do I explain to someone who, by the tone of their voice, sees it like an unnecessary waste of time.  After all, what would radiographs show that you can't see yourself with the naked eye?

"If there is periodontal disease, you don't need dental radiographs to show that.  "  says my veterinary colleague.

"True" I say. " If that was the only reason I would be doing them then you would be completely right."

Periodontal disease is not the only disease that occurs in our pet's mouths. There are so many things that can wrong in there, that it would require multiple volumes to do the topic justice (which is why those textbooks exist).

So, let me see if I can convince my colleague that dental radiographs are necessary, and along the way educate  pet owners that when they are choosing a vet hospital for their pet's next "dental" they should choose one that routinely includes dental radiographs even in the lowest grade dental procedures.

For example, our Grade 1 dental procedure includes two dental radiographs, and in our Grade 2 (and 3 and 4) dental procedures, we always xray the entire mouth.  They are not an optional extra, they are part of our dental packages.


To make sure as  much pathology that is humanly possible to find, is found and treated.

The Wobbly Tooth

Periodontal disease is not the only reason a tooth may wobble.  It may be fractured under the gum, like this one was.  And sitting right next to that was a tooth root from a previously fractured tooth.

If you just removed what you could see (without radiographs), the pet would have nice white teeth, but still be in pain. 

Moth-eaten teeth (aka resorptive lesions)

All vets have seen those typical "neck" lesions on cats, when you touch them with a probe, watching the jaw shudder.  Painful.  But easy to pick up.  

What about those that extend a bit further? You need xrays to find those (which is why our Grade 1 mouths in cats now  always include full mouth xrays the first time we do them). 
Twosome or threesome ? (two roots or three)

It is easy to forget that many pets "Do not read the textbook".  The pictured  tooth that is fractured  is the third upper premolar (of the right), and the textbook says this tooth has two roots.  

The dental charts from all over the world will draw this tooth with two roots only.  

So, without dental radiographs, you would remove the fractured crown, and you would remove two roots.  Most would pat yourself on the back for a job well done.  But,  a tooth root would have been left behind, and be a source of ongoing pain.

Me, as a vet, I would NOT be happy with that at all.  Me as a pet owner, I would be downright angry and disgusted the moment I found out that had happened (the retained root can be a cause of ongoing pain, and sometimes abscessation).

 "Evil" Curve 

 It is not uncommon for us to radiograph a normal looking mouth, and find tooth roots going at 90 degrees at the end.  We warn pet owners about this, as these angled roots make extraction more difficult if they need to be done in the future - more bone needs to be removed, more pain for the pet.

Extraction is not necessarily necessary in all pets - if you keep the teeth healthy through regular oral care, then many pets can keep most, if not all of their teeth well into their senior years. 

 There are some pets that are so genetically flawed, that extractions are going to be necessary, but these should be the exception, not the rule.

 Hide and Go Seek (the unerupted tooth)

This is a radiograph of my own dog, Piper, when she was 7 months old.  The lower first premolar on both sides was not visible.  So why is this important to know?

In any dog with missing teeth, we need to radiograph to make sure that the tooth is truly missing, rather than fractured  or unerupted.

If we, as veterinarians, say that we believe in Animal Welfare, and that we believe in preventative medicine, then what does it say about us, as professionals, if we say "but why do we need to do dental radiographs".

Hallo Halo (aka the tooth root abscess)

 All vets are familiar with the tooth abscess look on the dog - with the painful swelling on the side of the face, or under the eye. The most common tooth that is the culprit is the fourth premolar (second tooth from the left), whereas the problem tooth is the first molar (the first tooth from the left). Radiographs show this up very very clearly.

I once had a case where the dog had wear on all of her teeth, and a swelling along the jaw - it was only with radiographs that we identified the correct tooth causing the abscess (it was her canine), extracted that one only, and problem was solved.

A dead tooth

If you look at the xray closely, you will see that one big canine is different to the other - the pulp (the centre part) is wider in one tooth, which is not normal.  It means that the tooth died a while back.

The teeth are living things within our bodies.  When they die, they cause pain.  Whenever we look at radiographs, we can determine many many things - such as the age, sometimes the breed or breed type, whether there has been previous dental work done.

Dead teeth need either a root canal or extraction. But if I just looked at the tooth visually, I would not have picked it up easily.

So, what do you think?  Was my argument convincing? 

I am Dr Liz, the mad vet from Bellambi.

 Admittedly, I try to be thorough in all aspects of the services that we offer at our veterinary hospital, and dental radiographs are one of the essential core components of our dental services.

At Russell Vale Animal Clinic, we offer free dental checks every day that we are open, all the time. Our dental checks are there to help you continue to keep your pet's teeth healthy, and to recognise all of your hard work in doing so. 
We know when a pet owner has been good (being proactive in their pet's dental health), and not so good (room for improvement).