ISSN 2398-2950      

Radiology: dental

ffelis

Introduction

  • The bulk of the tooth (roots and most of the periodontium) can only be visualized by means of intra-oral radiographs.
  • Around 70% of cats over 3 years have some form of dental disease and as much as 70% of the pathology in the mouth may go undetected without dental radiography.

Radiographic considerations

  • Fine detail screens are required.
  • Non-screen film (eg dental film, size 2) or a small flexible cassette and screen is ideal for nasal chambers.
  • To accurately assess each tooth in a cats mouth 10 films should be taken :
    • Upper incisors, upper left canine (anterior-posterior oblique and lateral), upper right canine (anterior-posterior oblique and lateral), upper left maxillary premolars and molar, upper right premolars and molar, lower canines and incisors, lower right mandibular teeth, lower left mandibular premolars and molar.
  • Full mouth radiographs are more likely to be of benefit in older cats.
  • Dental film sizes 0/1 and 2 are ideal.
  • A useful screen for FORLS (feline odontoclastic resorptive lesions   Odontoclastic tooth resorption (resorptive lesions)  ) in cats over 3 years old which do not show lesions clinically consists of 2 films: right mandibular premolars and molar, left mandibular premolars and molar. This makes use of the fact that the most frequently first affected teeth are 307 and 407 (left and right 3rd mandibular premolars - though 1st visible - respectively). Lesions present on the roots can thus tbe detected and x-ray survey expanded where necessary.
  • As technology advances many dentists and veterinary dentists have started using digital x-ray systems for intra-oral radiographs   Dental radiography: digital 01    Dental radiography: digital 02  . A sensor is placed in the patient's mouth instead of an x-ray film and exposed   Dental radiography: digital sensor  . Both direct and indirect systems are available.
  • Direct digital: the image is transferred directly via the sensor to a computer. The advantages of using direct digital systems are that a much lower exposure is required and the time saved during procedures. The software package allows one to view and enhance images and provides images in more detail. Currently there are 3 systems available - Kodak, Eva and Schick. Disdvantages are cost and size of sensor (only size 2 is available as yet). Despite this, the direct system offers the greatest benefit over traditional dental film and processing.
  • Indirect digital: the image is transferred via a digital accessing system from the sensor to a computer. The advantages of using indirect digital systems are that a much lower exposure is required and both film sizes 2 and 4 are available. The software package allows one to view and enhance images and provides images in more detail. Disadvantages are the cost of sensor renewal (its potential for scratches/damage), sensor size limitation and slower image production compared to direct digital.

Restraint

  • Dental radiography requires general anesthesia   General anesthesia: overview  . This is the only way to obtain accurate projections and avoid trauma to film, sensor or operator!

Indications

  • Some lesions may be detected clinically but the full extent of the lesion or disease can only be accurately assessed with radiographs.
  • Much pathology will be detectable only with radiography.
  • With the high incidence of feline odontoclastic resorptive lesions, feline dentistry should not be performed without the use of radiography.

Radiographic anatomy

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Interpretation

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Additional studies

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • DuPont G A (2005) Radiographic evaluation and treatment of feline dental resorptive lesions. Vet Clin North Am Small Anim Pract 35 (4), 943-962, vii-viii PubMed.
  • Gioso M A, Carvalho V G (2005) Oral anatomy of the dog and cat in veterinary dentistry practice. Vet Clin North Am Small Anim Pract 35 (4), 763-780, v PubMed.
  • Niemiec B A (2005) Dental radiographic interpretation. J Vet Dent 22 (1), 53-59 PubMed.
  • Heaton M, Wilkinson J, Gorrel C et al (2004) A rapid screening technique for feline odontoclastic resorptive lesions. J Small Anim Pract 45 (12), 598-601 PubMed
  • Niemiec B A, Sabitino D, Gilbert T (2004) Developing dental radiographs. J Vet Dent 21 (2), 116-121 PubMed.
  • Lommer M J, Verstraete F J (2001) Radiographic patterns of periodontitis in cats: 147 cases (1998-1999). J Am Vet Med Assoc 218 (2), 230-234 PubMed.
  • Lommer M J, Verstraete F J (2000) Prevalence of odontoclastic resorption lesions and periapical radiographic lucencies in cats: 265 cases (1995-1998). J Am Vet Med Assoc 217 (12), 1866-1869 PubMed.
  • Eisner E R (1998) Oral-dental radiographic examination technique.
     Vet Clin North Am Small Anim Pract 28 (5), 1063-1087, v PubMed.
  • Verstraete F J, Kass P H, Terpak C H (1998) Diagnostic value of full-mouth radiography in cats. Am J Vet Res 59 (6), 692-695 PubMed.

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