HALE VETERINARY CLINIC
DENTAL AND ORAL SURGERY FOR PETS

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You will need Adobe Acrobat Reader to open these files. You can download a free version by clicking here.

Old Newsletters are not news. But some of the old articles are still valuable. This page contains links to pdf versions of some of the more timeless information from back issues of The CUSP.

Each article has the date of original publication in the footer.

Articles are sorted into broad categories as follows:
General Anatomy and Physiology
Periodontal Disease and Home Care
Endodontic (Pulp) Disease
Developmental Problems
Traumatic Injuries
Other Oral Pathology
Feline Issues
Intra-Oral Dental Radiology 
Equipment
Miscellaneous Topics

Some articles appear in multiple sections as appropriate.

There is a collection of one-page client information sheets on several of the subjects on the Forms & Handouts page as well.

CUSP Videos can be found here.

 

GENERAL ANATOMY AND PHYSIOLOGY

The Tooth

Discusses the basic anatomy of  and the tissues that comprise the tooth.

The Anatomy and Physiology of the Periodontium

Understanding, preventing and treating periodontal disease depends in understanding the structure and behaviour of the periodontal tissues.

Endodontic Anatomy & Physiology

A brief introduction to the world inside the tooth - the world of dental pulp.

Juvenile Veterinary Dentistry

Puppies and kittens are subject to a number of dental and oral concerns. Early recognition and treatment of these conditions can often prevent more serious problems and the pet grows.
Focus on the Mandibular Symphysis In dogs and cats, the right and left mandibles are connected to each other by a cartilage plate in the centre of the chin. Damage to this plate requires careful assessment to determine the appropriate mode of treatment.

PERIODONTAL DISEASE

The Anatomy and Physiology of the Periodontium

Understanding, preventing and treating periodontal disease depends in understanding the structure and behaviour of the periodontal tissues.
Why Is Periodontal Disease Still So Common? Periodontal disease remains rampant in the pet population. How can this still be so in this age of dental enlightenment?
Periodontal Disease is Hidden Periodontal disease is not only the most common health problem in cats and dogs, it is also largely hidden from view below the gum line. The only way to accurately assess and treat periodontal disease is by anesthetizing the patient to allow for a thorough and detailed examination with probing, charting and intra-oral dental radiography.
You cannot prevent disease that is already established. Another case-based illustration of how important it is to start a multi-faceted approach to periodontal disease BEFORE there are signs of trouble. Also, you cannot treat periodontal  disease with measures that are intended to prevent it.
COHAT Defined COHAT stands for Comprehensive Oral Health Assessment and Treatment. This paper outlines the 23 steps involved in the procedure. 
Pericoronitis A discussion on the periodontal consequences of having a tooth partially un-erupted or under-erupted.
Non-Professional Dental Scaling Many owners, fearful of anesthesia, wonder if it is possible to perform beneficial dental treatments without anesthesia. The answer is a resounding NO.

Periodontal Disease in Diabetic Patients

Periodontal disease can be difficult to manage at the best of times. Diabetic patients pose extra challenges.

Home Care Concepts and Products

Dental Home Care can be a very important part of maintaining good oral health. As with everything, the benefits are only realized if it is done properly. This collection of articles will help you get off on the right foot.
Reasonable expectations for dental home care There are several good strategies and products to aid in daily home plaque control to help keep a healthy mouth healthy. However, NONE of these products/strategies will treat established disease and none are 100% effective all on their own. It is important to have reasonable expectations for what these products/strategies can acheive.
VOHC SEAL The Veterinary Oral Health Council confers their seal of acceptance to products that have shown valid research to back their claims of being helpful in controlling plaque and/or tartar. Learn more about the VOHC from this paper or by visiting www.vohc.org
CUPS Chronic Ulcerative Paradental Stomatitis is a frustrating and painful condition that requires aggressive management. Unfortunately, potions, lotions, rinses and pills will fail to give relief. Aggressive mechanical plaque-control on a daily basis or whole-mouth extraction was required to give these animals a mouth free from pain and infection.
healthymouth(tm) There are many products on the market that claim to aid in the prevention or even treatment of dental disease. Most are worse than useless. This product, which has the VOHC seal of acceptance for plaque control is of value

Doxirobe(tm)

Doxirobe(tm) is an absorbable antibiotic gel useful as an aid in the treatment of periodontal disease. As with all products, getting the best result depends on using the product properly.
Sanos(tm) This is a product that became available in Canada in January of 2013. Applied in hospital in the anesthetize patient immediately after a COHAT, it is considered a "Veterinary Dental Sealant" that is reputed to reduced plaque and calculus accumulation at and below the gum line. 
OraStrip(tm) OraStrip(tm) QuickCheck Canine is an in-office diagnostic test designed to detect early stages of periodontal disease so intervention can be undertaken before there is serious damage.
Probing Depth Measuring probing depth is an essential part of every detailed dental examination. But how do you do it and what is "normal"? This paper attempts to shed some light.
Cleaning House Old animals with a long history of periodontal disease are often best served by having all their teeth removed to avoid the need for future anesthetics and to avoid chronic infection.

ENDODONTIC (PULP) DISEASE

Endodontic Anatomy & Physiology

A brief introduction to the world inside the tooth - the world of dental pulp.

Vital Pulpotomy Vs. Total Pulpectomy

This article looks at the issues to consider when deciding how to manage a fractured tooth. Read the Endodontic Anatomy & Physiology article first.
Endodontic Diagnosis Deciding if a tooth has endodontic disease (disease of the pulp) is sometimes very simple and other times quite difficult. This paper looks at some of the criteria for determining if a tooth needs endodontic treatment (or extraction) or not.
The Chevron Sign A common radiographic finding in larger dogs which is easily confused with signs of endodontic disease yet is just a variation on normal.
Uncomplicated Crown Fractures Crown fractures are designated as 'complicated', meaning the pulp is obviously exposed and 'uncomplicated', meaning there is no gross pulp exposure. As this paper indicates, assessing and coming up with a treatment plan for uncomplicated crown fractures is often more complicated that for complicated crown fractures. Confused? Then read on.
What is Root Canal Treatment? Teeth with endodontic (pulp) disease need root canal therapy or extraction. But what is root canal therapy and how is it done?

DEVELOPMENTAL PROBLEMS

Juvenile Veterinary Dentistry

Puppies and kittens are subject to a number of dental and oral concerns. Early recognition and treatment of these conditions can often prevent more serious problems and the pet grows.
Stop Brachycephalism, Now! This paper may win me many enemies, but after 30 years in practice, I can stay silent no longer. Brachycephalic breeds suffer their entire lives because of serious craniofacial deformities that are imposed upon them in the name of esthetics and cosmetics. As advocates for animal welfare, I believe veterinarians must start informing the public about this very real animal health issue in the hope of changing attitudes and breed-choice habits.
More on Brachycephalism These eleven, richly illustrated pages outline many of the oral problems seen so commonly in brachycephalic animals. It is seeing the suffering resulting from these issues that inspired me to speak out on this subject. In reading this paper you will learn about the problems, how to recognize them and what can (in most cases) be done to mitigate the suffering.

Pro-Active Dental Care

This paper reports on the difference in oral health between two littermates living in the  same home, one of whom had pro-active dental care at seven months of age and the other who did not. The results are compelling.

Lance Canines

Shelties are very prone to a developmental problem with the placement of the maxillary canine teeth.

"Missing" Teeth

According to the textbooks, dogs should have 42 adult teeth and cats should have 30. Sometimes they are missing one or more teeth and sometimes there are teeth hiding. Hidden teeth need to be found and removed or serious problems can arise.
Dentigerous Cysts When an adult tooth fails to erupt, it will often lead to the development of a large, destructive dentigerous cyst. This should never be allowed to happen.
Focus On: Micro Dogs Small dogs are subject to a wide variety of dental and oral abnormalities in need of identification and treatment.
Focus on: Soft Tissue Impactions Sometimes teeth have trouble erupting because the overlying gingiva is very tough and fibrous. Early intervention is the key.
Crown Reduction When a malocclusion results in the lower canines traumatizing the palate, often, a crown reduction procedure is indicated to alleviate the problem.
Ball Therapy A simple technique for the management of mild linguoversion (base narrow) mandibular canine teeth.

Ethics & Orthodontics

Every animal is entitled to a comfortable bite, but they do not need a perfect bite. Performing cosmetic orthodontic work on pets raises a number of ethical issues.

TRAUMATIC INJURIES

Avulsion and Luxation Teeth traumatically torn from their sockets constitute a serious, time-sensitive dental emergency. What should you do and what should you not do when this injury occurs?
Focus on Mandibular Fractures Fractures of the mandible in dogs and cats provide some interesting challenges. This article outlines my opinion on what to do and what to avoid when treating these serious injuries.
Mandibular Fracture in a Puppy This paper outlines management of a traumatic mandibular fracture in an 8-week-old puppy using a series of nylon muzzles.
Radiographic Interpretation:
Case 1
A case study of the management of a mandibular fracture complicated by mis-interpretation of the pre-operative radiographs.

Vital Pulpotomy Vs. Total Pulpectomy

This article looks at the issues to consider when deciding how to manage a fractured tooth. Read the Endodontic Anatomy & Physiology article first.
Focus on the Mandibular Symphysis In dogs and cats, the right and left mandibles are connected to each other by a cartilage plate in the centre of the chin. Damage to this plate requires careful assessment to determine the appropriate mode of treatment.

OTHER ORAL PATHOLOGY

Dental Caries Tooth decay (caries, cavities) does happen in dogs. This article briefly describes the causes, diagnosis and treatment of cavities in dogs.
Focus On Boxers Boxers are great dogs, but they have messed-up mouths. Here are just some of the highlights.
Focus on: Dental Resorptive Lesions in Dogs Most of us are aware of the dental resorptive lesions in cats. Well, as nasty as those are to deal with, they are nothing compared to what can happen in dogs. (way more teeth to deal with).
 Gingival Hyperplasia A discussion of the causes, significance and treatments of gingival enlargements.
Gum Chewer Syndrome Also known as traumatic buccal or sublingual granulomas, this condition arises when animals chew on the lining of their cheek or excess tissue under the tongue. Once bitten, the tissue becomes inflamed and enlarged, making it hard for the animal to avoid chewing on it more, causing more inflammation and pain.
Enamel Hypoplasia If the cells responsible for the production of dental enamel are prevented from doing their job properly, enamel hypoplasia is the result.

FELINE ISSUES

Tooth Resorption in Cats Tooth resorption in cats continues to be a painful, frustrating, mysterious, controversial and very common problem in cats. This paper outlines my current thoughts on the subject as of August, 2012.
Feline Chronic GingivoStomatitis A very painful, frustrating and mysterious feline disease that requires early and aggressive surgical management.
Chemotherapy for SCC? Ginigval squamous cell carcinoma is a common and terrible disease in cats. Off-label use of a drug from Pfizer is showing some promise.
A Feline Malocclusion A short piece on one particular and relatively common malocclusion seen cats.
Lip Entrapment When cats lose their upper canine they are inclined to bite their upper lip with their lower canine.
Feline Gum Chewer Syndrome Malocclusion and/or the loss of the lower molar in a cat can lead to a recurrent and painful ulceroproliferative lesion on the lower jaw. Treatment involves removing the offending upper teeth.

INTRA-ORAL DENTAL RADIOLOGY

Thoughts on Radiology Intra-oral dental radiology will become the standard of care. Get in front of the curve by incorporating this essential diagnostic tool into your dental practice now.
Why should you do whole-mouth radiographs? If you are equipped and trained to obtain and interpret intra-oral dental radiographs, that is super. But are you doing whole-mouth studies on all of your dental patients? If not, it is time you started.
Analog vs Direct Digital vs Indirect Digital While the need for intra-oral dental radiography cannot be disputed, which technology to embrace is a hotly contested topic. Here are my thoughts and observations.
The Chevron Sign A common radiographic finding in larger dogs which is easily confused with signs of endodontic disease yet is just a variation on normal.
Radiographic Interpretation:
Case 1
Getting diagnostic intra-oral radiographs is certainly important but is only half the battle. Accurate interpretation of the images is equally important. This case illustrates this point.
Normal Canine Dental Radiographs This is simply a set of normal intra-oral dental radiographs of a 30 kg, 4 year old cattle dog cross.
Normal Feline Dental Radiographs This is simply a set of normal intra-oral dental radiographs of a 4 kg, 1.5 year old cat.

EQUIPMENT

Dental Waterline Disinfection The water lines in dental equipment can be a cesspool of bacteria. This unsolicited article describes a very simple system for keeping dental water lines clean.
Shopping List A brief run down on the essential equipment list for your dental department.
Sharpening I All dental instruments need to be inspected and sharpened after EVERY procedure prior to being autoclaved. This video from Hu-Friedy outlines how to sharpen dental scalers and curettes.
Sharpening II All dental instruments need to be inspected and sharpened after EVERY procedure prior to being autoclaved. This video (done by me) outlines how to sharpen dental and periosteal elevators.
Digital Camera A good digital camera is essential for so many things in practice. This paper introduces you to the one I am using currently.

MISCELLANEOUS TOPICS

Whole Mouth Extraction for Everyone This is a bit out there and is mainly meant to make a point, but there is actually some logic to it. Have a look.
Anesthesia-Free Dentistry I have discussed the perils of anesthesia free dentistry before, but it is a problem that seems reluctant to go away, so here is a call to arms.
AAHA Dental Care Guidelines Composed by a number of thought-leaders, this AAHA-sponsored document lays out how ALL practices offering any level of dental care should be doing so. It was published in 2005. An updated version is expected in the spring of 2013 and will be posted as soon as I receive it.
Treat or Extract The decision whether to extract or treat/salvage a diseased tooth is based on consideration of many factors as outlined here.
Bones This two-page notice is from the FDA website and outlines ten good reasons why you should never give your dog bones to chew on. The number one reason stated is fractured teeth. The other nine are nasty as well.
CVO Statement The College of Veterinarians of Ontario is the licensing and regulating body for veterinarians in the province of Ontario. Canada. In the fall of 2008 they published a Position Statement on Veterinary Dentistry and this paper examines some of the highlights.
Phone Estimates A brief explanation of why any relationship between a phone estimate and the actual invoice is purely coincidental.
Team Work Providing optimum client and patient care is a team-efforts. This is a guide for the referring veterinarian regarding what you can to do for me and what I will do for you so that we can both do the best for your patients and their owners.

Dental Mythology

From some of the questions I get, it is apparent that there are still a number of misconceptions about dental issues. This article should help dispel some of these myths.

Mythological Creatures

There is no such thing as a "routine dental prophy" and "tooth root abscesses" are as rare as hen's teeth.

Ethics & Orthodontics

Every animal is entitled to a comfortable bite, but they do not need a perfect bite. Performing cosmetic orthodontic work on pets raises a number of ethical issues.

Sutures, Suturing and Flaps

Extraction sites should be sutured for optimum post-operative comfort and healing. This article discusses my preferred suture material as well as flap design and suturing techniques.
Why Antimicrobials are of such limited use Antibiotics and antiseptics are often used in an attempt to manage periodontal disease but they simply do not work. This paper explains why.

Antibiotics in Veterinary Dentistry

In my opinion, antibiotics are vastly over- used in the treatment of oral conditions.

The Role of the Veterinary Technician in the Delivery of Dental Care

The College of Veterinarians of Ontario and the American Veterinary Dental College have guidelines regarding what procedures veterinary technicians should and should not be doing. This article emphasizes the many ways in which a properly trained technician can be a valuable part of the dental care team.
NFCO Many dental procedures are Not For the Casual Operator. This short piece cautions general practitioners to be cautious when undertaking procedures normal done by a specialist (in any area of practice) unless that have taken considerable post-graduate training in that field.
Web Site Tour A brief explanation of each of the pages on this website.
Sweet Dreams All dental diagnostic and therapeutic procedures in dogs and cats require general anesthesia. Let's make the journey a safe one.
Local Anesthesia While all dental and oral procedures must be done under general anesthesia, local anesthetics are also of tremendous value when performing oral surgery.
Envelop Flaps Why to avoid vertical releasing incisions whenever possible.
B.A.R.F Diets May people are turning to raw diets for their dogs and cats. This article discusses some serious concerns about these diets, whether home made or commercially prepared.
Dental Truths The other side of the dental mythology coin, this piece outlines some things that are very well known to veterinary dentists, but may not be common knowledge among general practitioners and pet owners.
Language The bit provides links to some excellent resources including templates for dental charts as well as the currently accepted dental nomenclature, classifications and abbreviations. A virtual dental dictionary.
Just Say No to Bad Medicine What to do when we offer a client a choice between Plan A and Plan B (both medically appropriate) and they decline both but request Plan C (not medically appropriate)? The College of Veterinarians of Ontario tells us we are obliged to refuse to provide inappropriate care, even when the owner requests it.
Who Is Responsible? Many breeds are deformed by design. That is to say, they have been selectively bred to have some structural deformity such as short legs (Bassett Hound) or a short maxilla (boxer). If these genetic deformities result in situations that require treatment, who is responsible for paying for that care? Some would suggest that the breeder ir responsible, but the people who purchase these deformed animals need to take responsibility for their breed-choice decision.
Things I tell clients There are several illustrations and analogies I use to help pet owners understand various issues. Here are a few of them. Feel free to use them yourself.
Carrot or Stick

There are a great many excellent medical and business justifications for general practices to offer basic but high quality veterinary dental care (the carrot). There are also a number of reasons to ensure that the level of care you provide is up to current standards (the stick).

The Popularity Paradox Published in the Canadian Veterinary Journal in April of 2015, this paper explains a conflict of interest we are all in. Our clients rely on us for medically accurate assessments and advice, but if we were really truthful, they might find what we have to say troubling and they will stop coming to visit us.

 

General Anatomy and Physiology
Periodontal Disease and Home Care
Endodontic (Pulp) Disease
Developmental Problems
Traumatic Injuries
Other Oral Pathology
Feline Issues
Intra-Oral Dental Radiology 
Equipment
Miscellaneous Topics

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