Small Animal Radiology and Ultrasound: A Diagnostic Atlas and Text

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Chapter Five The Skull 647 animals. It usually appears as a radiolucent, cystic lesion that may be expansile. Compound odontoma may also include well-formed tooth elements. Aging Changes. There are changes in the teeth and surrounding alveolar bone that should be recognized in order to distinguish normal aging changes from dental disease. The size of the pulp cavity is large in young animals and becomes small and nearly disappears in old dogs. Reabsorption of alveolar bone horizontally along the axis of the mandible or maxilla is a common finding in older dogs and may represent the effects of low-grade, chronic Fig. 5-43 A, A 5-year-old male Maltese had a draining tract from his lower jaw for months. The lateral oblique view of the mandibles revealed an angular deformity of the roots of both fourth premolars with the roots angled toward each other (arrows). B, A fistulogram in the same case reveals that the fistula arises from the apex of the abnormal tooth. Diagnosis: Dilaceration with V-root malformation and fistula formation. A B
648 Small Animal Radiolo g y and Ultrasono graphy periodontal disease. 146,147 Hypercementosis, or deposition of excessive amounts of secondary cementum on the tooth roots, resulting in root thickening and bulbous apical enlargement of the tooth roots is an uncommon but normal aging change. 17,148 Idiopathic dental root replacement resorption has been reported in older dogs. 149 Radiographically abnormal and or partially resorbed roots with replacement of root structures by radiographically normal trabecular bone is noted. Histology reveals that the resorption is not associated with inflammation of hypercementosis. Periodontal Disease. The most common problems that affect teeth result from gingivitis, or gum inflammation. Gingivitis is more common in smaller breed and older dogs as well as cats. 150,151 Gingivitis may be primary and associated with accumulation of plaque and calculus or occur secondary to the presence of tooth root fragments retained from inadequate tooth extraction or fracturing of teeth below the gum line (Fig. 5-44). Gingivitis progresses to inflammation of the periodontal ligaments, which causes resorption of the walls of the alveolus, destruction of the periodontal ligament and adjacent bone, and ultimately results in the loosening of the tooth (Fig. 5-45). Active efforts at periodontal care are usually not successful in preventing periodontal disease, although they may lessen its severity. 152 Gingivitis and periodontal disease may cause focal or generalized loss of bone. In most instances the radiographic findings lead one to underestimate the extent of the bony lesion, because a loss of greater than 30% to 50% of bone mineral is required before radiographic lucency can be appreciated. 144 Periodontal disease is classified in five stages based on the degree of clinical and radiographic changes. Stages I and II have no radiographic changes. In stage III the alveolar crest becomes indistinct and rounded. In stage IV there is loss of integrity of the lamina dura, an increase in periodontal space, and destruction of bone between the tooth roots. Further loss of bone is indicative of stage V disease. 4 In some instances of chronic infection, there may be partial resorption of the tooth root and enlargement of the bony alveolus (Fig. 5-46). Another manifestation is formation of a periapical lucency. This is seen radiographically as a focal loss of bone density with variable degrees of sclerosis at the borders of the lesion (Fig. 5-47). These may be due to formation of granulomas, cysts, or abscesses. 4 In severe cases of periodontal disease there may be extension of the infection into the nasal cavity or spread of infection diffusely into the supporting bone. Caries and Acquired Lesions. Although uncommon in dogs and cats, dental cavities, or caries, do occur. Radiographically they appear as focal lucencies within the tooth (Fig. 5-48). Feline odontoclastic resorption lesions, previously referred to as cervical line erosions, neck lesions, or feline cavities, start as defects in the tooth near the gum line. 153 These Fig. 5-44 An 8-year-old male Cocker Spaniel with halitosis. Physical examination revealed active gingivitis. The lateral oblique radiograph isolated the left maxilla and revealed resorption of alveolar bone from the area around the first premolar and the area of absence of the second, third, and fourth premolars. Close scrutiny revealed root tips embedded in the bone where the teeth were missing. There are indistinct zones of lysis around these roots (black arrows) indicating active infection. Diagnosis: Gingivitis and osteomyelitis.
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SAUNDERS An Imprint of Elsevier Sci
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C H A P T E R O N E Introduction GE
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Chapter One Introduction 3 Fig. 1-1
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metal. Soft tissues or organs surro
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Chapter One Introduction 23 24. Lev
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26 Small Animal Radiolo g y and Ult
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A B C Fig. 2-63 A 10-year-old male
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100 Small Animal Radiolo g y and Ul
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Fig. 2-101 A 7-year-old male mixed
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Fig. 3-234 A 7-year-old female Brit
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Fig. 4-59 A 9-year-old female Russi
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Fig. 4-73 A 2-year-old female Saint
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Fig. 4-97 A 10-year-old male mixed
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Fig. 4-107 A 4-year-old male Chow C
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I N D E X A Abdomen, abnormal prese
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Index 729 Bone, cysts of, 525-527,
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Index 731 Ear, abscess of—cont’
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Index 733 Hydrocephalus—cont’d
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Index 735 Lungs. See also Pulmonary
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Index 737 Pregnancy, determination
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Index 739 S-shaped aortic deformity
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