Monday, October 31, 2016

Gingival Pathology, Gingival Hyperplasia, Gingival Neoplasia

Centers for Oral Care
Veterinary Dentistry
2nd Opinion



Animal Dentistry Solutions
No. 4 October 2016---31October2016
A BLOG by DH DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com and DoctorDeForge@yahoo.com



Gingival Pathology
Gingival Hyperplasia
Gingival Neoplasia


Gingival hyperplasia has been defined as enlargement of the gingiva due to an increase in the number of cells and hypertrophy as enlargement due to an increase in the size of the cells. 

Gingival hyperplasia secondary to periodontal disease is frequently seen in patients with unattended oral pathology with no professional care and minimal home care.

Enlargement of the gingiva is common in Boxers, Great  Danes, Collies, and Dalmations and is thought to be a familial trait.

Drug reactions can also cause gingival hypertrophy.  It is very important to keep an exact list of all medicines being used if consulting with an animal dentist because of overgrowth of the gingival tissues.

There are aggressive non-cancerous oral tumors and malignant oral tumors that mimic benign hyperplasia.

It is essential to see your local doctor of veterinary medicine and consider a referral to an animal dentist if you note overgrowth of your pet’s gum tissues.

There are wonderful NEW oral surgery techniques to safely remove the abnormal oral tissues.  At the same time the tissue is removed, it will be sent to an oral pathologist to help define a cause of the hypertrophy.

One technique commonly used to remove hypertrophied gingival is Radiosurgery [4.0 MHz]. The waveform chosen with a specific active electrode allows operative efficiency and minimizes postoperative discomfort.  It prevents seeding of bacteria into the incision site and eliminates scar tissue formation.  Radiosurgery controls hemostasis as it cuts through hyperplastic gingival tissue.

It is very important to radiograph all dentition at or near the site of the hypertrophied gingiva.  The overgrowth of gingiva creates periodontal pockets that can lead to advanced periodontal and/or endodontic pathology.

Pain control is paramount and is accomplished with local infiltration, regional, and/or periodontal ligament never blocks.

The patients are always discharged on pain medicine and antibiotics if there is periodontal pathology present.  The veterinary dentist sets up the proper re-check appointments and counsels on the treatment of other pathology identified at the time of the gingival recontouring.   A report on the oral pathology specimen[s] sent to the histopathologist is made to the client as soon as the report reaches the dentist’s desk.




If you have questions about gingival hyperplasia contact Dr. DeForge at:
DoctorDeForge@yahoo.com or call 1-800-838-3368.

Don DeForge, VMD
Fellow of the Academy of Veterinary Dentistry

After graduating from the University of Pennsylvania School of Veterinary Medicine, Dr. DeForge developed a special interest in oral care.  In 1996, he was honored as North East Practitioner of the Year by the American Animal Hospital Association.  That same year he received the Peter Emily Residents Award in Small Animal Dentistry.

Dr. DeForge lectures on small animal dentistry and oral surgery emphasizing practical applications for the general practitioner. His past columns in companion animal dentistry have appeared in DVM Newsmagazine and Veterinary Practice News for over a decade.  Dr. DeForge is co-editor of An Atlas of Veterinary Dental Radiology along with Ben H Colmery III, DVM, DAVDC.

As a Fellow of the Academy of Veterinary Dentistry, he has been honored by human dentistry. Dr. Jeffrey A. Sherman, DDS, Diplomate of the American Board of Oral Electrosurgery and Executive Director of the World Academy of Radiosurgery writes: “Your years of lecturing and writing on the subject of radiosurgery have not gone unnoticed.  I believe your efforts in creating the E-Journal of Radiowave Radiosurgery will help your colleagues and makes us all proud of your efforts.  Your discovery of Indirect Radiowave Radiosurgery Coagulation has brought new insight into the use of radiosurgery in all fields of medicine and should be one of your proudest accomplishments.  It is with honor that I call you colleague and friend.  Please continue all of your fine efforts in the field of radiosurgery and know that sharing your knowledge is the greatest gift you have given to the profession.”


Oral Fracture Repair Oral Orthopedics in Animal Dentistry and Oral Surgery

Centers for Oral Care
Veterinary Dentistry
2nd Opinion


Animal Dentistry Solutions
No. 3 September 2016
A BLOG by DH DeForge, VMD
Volume I Number 3 Sept 2016
Fellow of the Academy of Veterinary Dentistry
1-800-838-3368
Call for Oral Care Satellite nearest your practice
Eight satellites in Connecticut



Oral Fracture Repair
Oral Orthopedics in Animal Dentistry and Oral Surgery

Your worst nightmare now becomes Dr. DeForge’s privilege to treat and return to a quality-pain free life.

For years the fracture of the mandible was treated with internal fixation plates and lag screws.  The problems with these techniques centers on damage to the dentition or potential nerve damage upon application  Many animal orthopedists still utilize these techniques when animal dentists are not available for consultation.

Fixation failure can lead to infection; malunion; or non-union.  Fixation instability results in inaccurate reduction.





The above x-ray shows a patient that did not have complete reduction and a malocclusion occurred after the surgical fixation attempt.  The general practice veterinarian used the wrong size wire with a wiring technique that did not produce the correct reduction and stabilization of the fracture.  This patient needed additional surgery by an animal dentist and must be followed radiographically every 3 months until complete healing has occurred.  Dental X-rays are the best way to evaluate jaw fractures.

With any jaw fracture a dental radiograph is an essential first step to evaluate the bone and confirm that all the tooth roots are intact. Treatment x-rays are essential as well as follow up healing post-treatment radiography at 3/6/12 and 18 months. There are many non-invasive options for dealing with a fractured jaw utilized by animal dentists. Ignoring the problem is not a good choice.

Animal dentists use wiring techniques and extraoral acrylic splints to stabilize jaw fractures. Radiographic evaluations of patients following the treatment of jaw fracture trauma can help minimize serious postoperative complications and permit early detection of problems. Diligent homecare of the repaired site as outlined by the animal dentist will help minimize postoperative pain and allow expedient healing.  

Don DeForge, VMD
Fellow of the Academy of Veterinary Dentistry

After graduating from the University of Pennsylvania School of Veterinary Medicine, Dr. DeForge developed a special interest in oral care.  In 1996, he was honored as North East Practitioner of the Year by the American Animal Hospital Association.  That same year he received the Peter Emily Residents Award in Small Animal Dentistry.

Dr. DeForge lectures on small animal dentistry and oral surgery emphasizing practical applications for the general practitioner. His past columns in companion animal dentistry have appeared in DVM Newsmagazine and Veterinary Practice News for over a decade.  Dr. DeForge is co-editor of An Atlas of Veterinary Dental Radiology along with Ben H Colmery III, DVM, DAVDC.

As a Fellow of the Academy of Veterinary Dentistry, he has been honored by human dentistry. Dr. Jeffrey A. Sherman, DDS, Diplomate of the American Board of Oral Electrosurgery and Executive Director of the World Academy of Radiosurgery writes: “Your years of lecturing and writing on the subject of radiosurgery have not gone unnoticed.  I believe your efforts in creating the
E-Journal of Radiowave Radiosurgery will help your colleagues and makes us all proud of your efforts.  Your discovery of Indirect Radiowave Radiosurgery Coagulation has brought new insight into the use of radiosurgery in all fields of medicine and should be one of your proudest accomplishments.  It is with honor that I call you colleague and friend.  Please continue all of your fine efforts in the field of radiosurgery and know that sharing your knowledge is the greatest gift you have given to the profession.”



Thank you,
DH DeForge, VMD
Call Dr. DeForge at 1-800-838-3368

E-Mail Dr. DeForge at DoctorDeForge@yahoo.com

Consider a Root Canal

Centers for Oral Care
Veterinary Dentistry
2nd Opinion


Animal Dentistry Solutions
No. 2 August 2016
A BLOG by DH DeForge, VMD
Volume I Number 2 August 2016
Fellow of the Academy of Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com

Consider a Root Canal before tooth extraction!

The Root Canal-A Non-Invasive-Non-Painful Treatment!

Forget the unnecessary extraction of the past!



A radiograph is an essential first step, to evaluate the bone and confirm that the root is intact. There are two options for dealing with a fractured tooth that has exposed the pulp chamber. Ignoring the problem is not a good choice.

Option #1 is root canal and Option #2 is extraction.  Never extract a tooth without FIRST offering root canal treatment.  Never extract a tooth if the root canal is refused without pre-and post dental x-rays.

A root canal is a treatment to repair and save a badly damaged or infected tooth. The procedure involves removing the damaged area of the tooth (the pulp), cleaning and disinfecting it and then filling and sealing it. The common causes affecting the pulp are a cracked tooth, a deep cavity, repeated dental treatment to the tooth or trauma. The term "root canal" comes from cleaning of the canals inside the tooth's root.

What to Expect During a ROOT CANAL
If you think you need a root canal, consult with Dr. DeForge who is an animal dentist. There are a number of steps that occur!
1.   X-ray – if Dr. DeForge suspects you may need a root canal, he will first take a dental X-ray under general inhalation anesthesia  or examine existing X-rays to show where the pathology is located.
2.   Anesthesia – after pre-anesthesia testing, safe Gas Inhalation anesthesia is administered to treat the affected tooth. Contrary to popular belief, a root canal is no more painful than a filling.  The patient experiences minimal to zero pain after anesthesia.  Patients are sent home with analgesics only to guard against the minor local discomfort reported in people.  The pain noted in people, after root canals, is usually from neglected visits to the dentist and resultant tooth root abscesses prior to root canal treatment.  Root canals in cats and dogs are most frequently performed after trauma to the mouth.  Dr. DeForge always monitors his patients to be sure there is no discomfort even in the most minor oral procedures.
3.   Pulpectomy – an opening is made and the diseased tooth pulp is removed.
4.   Filling – the roots that have been opened (to get rid of the diseased pulp) and then are filled with gutta-percha material and a sealant  cement.  A restoration is placed.
5.   Follow-up x-rays are recommended in one year
6.   If the patient dislodges the restoration-filling… Dr. DeForge would then recommend a full jacket titanium alloy crown.

Why a root canal?
Non-invasive
Non-painful
Recovery is short
Dentition retained for prehension and mastication of food!


Don DeForge, VMD
Fellow of the Academy of Veterinary Dentistry

After graduating from the University of Pennsylvania School of Veterinary Medicine, Dr. DeForge developed a special interest in oral care.  In 1996, he was honored as North East Practitioner of the Year by the American Animal Hospital Association.  That same year he received the Peter Emily Residents Award in Small Animal Dentistry.

Dr. DeForge lectures on small animal dentistry and oral surgery emphasizing practical applications for the general practitioner. His past columns in companion animal dentistry have appeared in DVM Newsmagazine and Veterinary Practice News for over a decade.  
Dr. DeForge is co-editor of An Atlas of Veterinary Dental Radiology along with Ben H Colmery III, DVM, DAVDC.

As a Fellow of the Academy of Veterinary Dentistry, he has been honored by human dentistry. Dr. Jeffrey A. Sherman, DDS, Diplomate of the American Board of Oral Electrosurgery and Executive Director of the World Academy of Radiosurgery writes: “Your years of lecturing and writing on the subject of radiosurgery have not gone unnoticed.  I believe your efforts in creating the E-Journal of Radiowave Radiosurgery will help your colleagues and makes us all proud of your efforts.  Your discovery of Indirect Radiowave Radiosurgery Coagulation has brought new insight into the use of radiosurgery in all fields of medicine and should be one of your proudest accomplishments.  It is with honor that I call you colleague and friend.  Please continue all of your fine efforts in the field of radiosurgery and know that sharing your knowledge is the greatest gift you have given to the profession.”

Thank you,
DH DeForge, VMD
Contact Dr. DeForge at 1-800-838-3368

or E-Mail to DoctorDeForge@yahoo.com

The Mandibular Iatrogenic Fracture

Centers for Oral Care

Animal Dentistry Solutions
No. 1 July2016
A BLOG by DH DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
1-800-838-3368
DonDeForge100@gmail.com



The Mandibular Iatrogenic Fracture
Why call upon Dr. DeForge to help with the Periodontal Care of Geriatric Dogs?

Iatrogenic fractures are common when attempting to remove the distal mandibular molars and the mandibular canine teeth.  With 20 years of experience as an animal dentist, Dr. DeForge utilizing human oral surgery techniques can easily remove these teeth without any trauma to the manidble.  Many of these patients present with pathoogical fractures that are not visible without pre-treatment oral radiology.  A pathologic fracture is a bone fracture caused by disease that led to weakness of the bone structure. This process is most commonly due to advanced periodontal disease but can also be related to bone cancer, infection, inherited bone disorders, or bone cysts.

Guided Bone Regeneration is the key to the repair of these sites after stabilitzaiton.  Radiowave Radiosurgery is the cutting modality of choice to allow exposure of the fracture and allow extraoral stabilization of the fracture.

Pain control and antibiotic therapy is essential.  The patients in most instances need Elizabethan collars to be worn post-surgically to prohibit damage to the surgical repair sites for 30-60 days.

Some patients will need an Esophagostomy tube placed  for medicine administration and for liquid food supplement alimentation during recovery.

With careful monitoring and with the following of all post-care instructions, a patient will make an expedient recovery in 90 days.  Bone healing can taken 12-18  months in the geriatric patient.


   
Don DeForge, VMD
Fellow of the Academy of Veterinary Dentistry

After graduating from the University of Pennsylvania School of Veterinary Medicine, Dr. DeForge developed a special interest in oral care.  In 1996, he was honored as North East Practitioner of the Year by the American Animal Hospital Association.  That same year he received the Peter Emily Residents Award in Small Animal Dentistry.
    
Dr. DeForge lectures on small animal dentistry and oral surgery emphasizing practical applications for the general practitioner. His past columns in companion animal dentistry have appeared in DVM Newsmagazine and Veterinary Practice News for over a decade.  Dr. DeForge is co-editor of An Atlas of Veterinary Dental Radiology along with Ben H Colmery III, DVM, DAVDC.
     
As a Fellow of the Academy of Veterinary Dentistry, he has been honored by human dentistry. Dr. Jeffrey A. Sherman, DDS, Diplomate of the American Board of Oral Electrosurgery and Executive Director of the World Academy of Radiosurgery writes: “Your years of lecturing and writing on the subject of radiosurgery have not gone unnoticed.  I believe your efforts in creating the
E-Journal of Radiowave Radiosurgery will help your colleagues and makes us all proud of your efforts.  Your discovery of Indirect Radiowave Radiosurgery Coagulation has brought new insight into the use of radiosurgery in all fields of medicine and should be one of your proudest accomplishments.  It is with honor that I call you colleague and friend.  Please continue all of your fine efforts in the field of radiosurgery and know that sharing your knowledge is the greatest gift you have given to the profession.”

Dr. DeForge has performed CE on the local, regional, and national level and is well respected by the academic community.  All of his lectures are RACE approved for CE. 
   


DH DeForge, VMD
Call: 1-800-838-3368
E-Mail: DoctorDeForge@yahoo.com