Monday, June 3, 2019

Increased Number of Iatrogenic Jaw Fractures in General Veterinary Practice~#37

Tri-State Consultations and Oral Surgery
Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Practice Limited to Dentistry

The Global Veterinary Ethics Congress [GVEC]
The Human-Animal Bond and Preservation of the Five Freedoms
"Addressing connections between Ethics and the Human-Animal Bond"

Image result for X-ray of a mandibular jaw fracture in a dog

#37 Increased Number of Iatrogenic Jaw Fractues Reported in General Practice Animal Dentistry!

The Answer: Oral Radiology and Telemedicine Dental X-ray Interpretation and Referral to an
Animal Dentist

Small breed dogs and cats are prone to jaw fractures in advanced periodontitis during exodontia in general practice.

The question remains why are extractions being performed without pre-operative dental x-rays?

Commmon areas of fracture of the mandible are:

1] The Mandibular Symphysis
2] The Anterior Mandible
3] Distal Mandible Pre-Molar and Molar Extractions

What to looks for in your pre-operative dental x-rays:

 1] Roots of the pre-molars or molars are within millimeters of  the ventral cortex of the mandible
2] Vertical bony defects affecting the alveolar bony plates
3] Greater than 50% loss of the interdental septal bone
4] Apical osteolytic changes in close proximity to the vental cortex of the mandile
5] Non-separated pathologic fracture[s] from advanced periodontal disease~commonly these are bilateral nut just unilateral pathology
6] Decrease in bone dentisty
7] Sclerosing osteomyelitis with advanced corital bone resorption-especially in the anterior mandible
8] Neoplasia-over-looking extent of disease and need for a biopsy
9] Idiopathic Root Resorption
10] Root ankylosis

Advanced Periodontal Disease contributes to bone loss and increased risk of iatrogenic trauma~

How to Avoid Iatrogenic Fractures:
1] Pre-Oral X-ray of ALL dentition in ALL patients with advanced gingivitis/periodontitis before anticipated EXTRACTION!  Not all mobile teeth need exodontia. Exodontia is confirmed by oral radiology as well as intraoral examination. After oral radiology, absolutely no extractions without signed pet parent consent.
2] Detailed education of pet parent about oral pain and oral pathology after oral radiology.
3] Discussion with pet parent about REFERRAL to a veterinary dentist if there is a pathologic fracture already present from advanced periodontal disease
4] REFERRAL to an animal dentist if the general veterinarian's comfort zone in oral surgery has been surpassed based on oral x-rays
5] Send oral x-rays digitally to a Veterinary Dentist for interpretation prior to extractions; i.e. this mans re-scheduling extractions or referral to an animal dentist only after dental x-ray interpretation [E-Vet Diagnostics]
9] Veterinary telemedicine is an easy and inexpensive tool that helps veterinarians provide their patients with expert radiology service. You simply upload your cases to the radiology consultant servers and veterinary radiology consultants will read them and report back their diagnoses. [ is an example of a Telemedicine Radiology Service for general practitioners]

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