November/December Self Test

A self-test of pathology.

A 9-month-old boxer presented with an inability to chew on the left side of its mouth. Pre-anesthetic testing, including blood chemistry profile, CBC and U/A, were normal.

Under general inhalation anesthesia, the patient’s heart rate and blood pressure accelerated with exploration of tooth #309’s incisal surface. There was no sign of pulp exposure but attrition was noted.

Tooth #409 appeared normal upon intraoral exam and digital oral radiology showed no evident pathology.

What is your diagnosis? What other tests should be run?

Click here for the answer

ANSWER:

During the initial exam, the client mentioned that the boxer mainly chews on its left side. The owner had been giving pig ears and cow hoofs as treats.

The cusp of tooth #309 was worn and the pulp was visible. Even though there was no pulp exposure that does not mean that the pulp in this tooth was healthy.

Reparative dentin is formed in response to wear or trauma to dentin and reparative dentin does not always protect the pulp.  It can be deposited in a pulp that is irreversibly inflamed and its presence does not always lead to a favorable prognosis.

This patient responded well to conventional root-canal therapy. When the canal was debrided, the pulp was necrotic. With root-canal therapy, this patient returned to a quality of life without pain.

This case exemplifies that radiology cannot always confirm endodontic pathology at an early juncture. With time, osteolysis of the bone surrounding the root apices would have occurred. If the client had postponed an exam the patient could have been uncomfortable for weeks.

Since subjective pain is not evident in our animal patients, excellent intraoral work-ups with close attention to signs of pain must be combined with intraoral radiology diagnostics to be successful in achieving a pain free environment for patients.

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