The importance of xrays for diagnosing malocclusion.

pinta

Post   » Wed Oct 23, 2002 8:54 pm


If your pig is suffering from what appears to be mouth problems - weight loss, slobbering, difficulty chewing - and your vet can´t see anything obviously wrong, demand xrays.

Bloom was exhibiting all the signs of teeth problems with one weird twist - her tongue was swollen. I was pretty convinced there was molar entrapment going on and last Friday I insisted my vet sedate her and take a really good look. This was after an examination without sedation. No entrapment.

After much head scratching Bloom was given an injection of Dexamethasone to reduce the swelling. Saturday, her tongue looked better but her lips were swelling and I brought her in for another shot of Dex. This time she was given a higher dose. We figured if the tongue went back to normal we could attribute the swelling to an allergy to apples(not usually given but the pigs have been pigging from a really good harvest).

Big improvement Sunday and she looked great at the vet on Monday. Monday night the Dex wore off and she was in bad shape. Depressed, slobbering, not eating.

This time we called in the big guns - Dr. Legendre. Tuesday, Bloom was sedated once again and Dr. Legendre examined her carefully. Nothing obviously wrong - slightly overgrown tooth but not enough to cause troubles. He planed the tooth that was long at the requisite 15 degree angle and then took an xray.

Diagnosis: Root elongation on both the upper and lower cheek teeth. This problem can only be seen by xray. By the time you would see it in the mouth - it would be too late. When it goes too far the roots interfere with the eye socket and sinuses causing runny eyes and bulging eyeballs. He thinks we caught it in time. Root elongation can be arrested (but not reversed) if the molars are kept in contact for constant grinding. He also noticed that when he pushed down on the gums, the teeth were longer than they initially looked. I assume the gums were swollen along with the lips and tongue. Apparently it is possible that the irritation from the root elongation would cause swelling. The condition means every chew hurts like hell.

Dr. Legendre did what is called a crown amputation (fancy way of saying he planed the teeth really short) to compensate for the elongation and take the pressure off when she chewed. She was prescribed Meloxicam as a pain killer for 3 or 4 days and is to have another xray in 4 to 5 weeks to see how the roots look.

Without the xray, Bloom would have gone undiagnosed and would have been in ever increasing pain.


I am wondering if some inexperienced vets are aware that pigs´ teeth should be planed at a 15 degree angle. Rabbits´ teeth are planed flat. If vets are planing pigs´ teeth flat it could explain why some pigs take so long to start eating on their own again. Bloom started eating a bit almost immediately although it´s obvious her mouth was pretty sore from the procedure.

[X-ray photos from Pinta. - Lynx]

This x-ray shows Bloom's elongated roots:

Image

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Lynx
RESIST

Post   » Wed Oct 23, 2002 9:17 pm


Could a weakening of the supporting bone structure be partly to blame for this?

I´m thinking of moving this thread to the reference forum. Okay with you?
Last edited by Lynx on Sun Nov 03, 2002 9:08 am, edited 2 times in total.

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melcvt00

Post   » Wed Oct 23, 2002 9:22 pm


Question.....15 degrees which way? Is the lower side at the front or back?

And I´m assuming it was a dental x-ray, right?

I´ve been thinking about knocking out CP to see if he suddenly developed malocclusion that caused his incisors to fracture. I´m still searching for the answer on that one....

[Mel -- sorry to stick this here but it doesn't work on my post -- Lynx]

Second x-ray from Pinta:
This is Willie's normal x-ray:

Image

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Lynx
RESIST

Post   » Wed Oct 23, 2002 9:27 pm


I wondered about that too (which way the angle goes -- side to side, front to back and where is the high edge).

-------------------

Clarification: Dr. Legendre says it should be a 30 degree angle. I did a sketch of the teeth using as a guide, a more detailed skull illustration appearing in Self-Assessment Color Review of Small Mammals by Susan A. Brown and Karen L. Rosenthal, page 78. The grey sections are the roots. They also specify a 30 degree angle:

Image
Last edited by Lynx on Sat Aug 14, 2004 2:03 pm, edited 2 times in total.

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Becky

Post   » Wed Oct 23, 2002 10:46 pm


How is a dental x-ray different? I mean, is special x-ray equipment needed? This whole dental thing is really interesting, but I know very little about it.

pinta

Post   » Wed Oct 23, 2002 11:38 pm


The dental xray plate is very small compared to the regular xray. I don´t know if regular xrays will give the same information.

The upper teeth have a 15 degree slant so that the planed surface is pointed outward (reminded me of tusks). I didn´t see the lower teeth but I assume they would fit with the uppers. This is something that I assume can be referenced.

This is what I remember but I will try to get confirmation.

Lynx - move it wherever you want.

I think the real cause of the root elongation may be lack of contact of the molars due to weak jaw muscles. I base this theory on the fact that root elongation can be arrested if the teeth get lots of grinding action. Bloom is supposed to get alfalfa for the benefit of teeth wearing. My regular vet doesn´t want all the pigs on alfalfa because of the calcium so Bloom will get private feedings.

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melcvt00

Post   » Thu Oct 24, 2002 6:47 am


Becky, doing a dental x-ray on an animal is very comparable to doing a dental x-ray on a human. The dental films are smaller, and because of the smaller area being x-rayed, dental films show much more detail that a regular x-ray. A regular x-ray might reveal most of the same information, but it´s much more difficult to get that way because the film is so much larger than the mouth, especially in a guinea pig´s case.

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Josephine
Little Jo Wheek

Post   » Thu Oct 24, 2002 9:53 am


Plus the type of film is different to provide that detail. One of my pigs went for complete jaw xrays. They didn´t use dental film and a dental xray, but a regular xray and mammography film. It provided good detail on my sow with wave jaw. As long as you collimate, collimate, collimate! ;) (Medical people will appreciate that. You can turn down the area that is exposed to xrays for better technique).

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kleenmama
I GAVE, dammit!

Post   » Thu Oct 24, 2002 11:01 am


Could you explain collimate for the rest of us "yahoo´s" in case we need to tell the vet to do it??

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Josephine
Little Jo Wheek

Post   » Thu Oct 24, 2002 5:59 pm


Nope. I already did. It means to turn down/concentrate the xray beam over the area you are xraying. It is part of taking decent and diagnostic xrays. If they don´t know that, they´re probably doing much more wrong and needlessly exposing their personnel to extra radiation (in addition to getting crappy xrays).

I suppose I could have replaced "you can..." with "it means to..."
Last edited by Josephine on Thu Oct 24, 2002 6:03 pm, edited 1 time in total.

pinta

Post   » Fri Oct 25, 2002 2:03 am


I emailed Dr. Legendre and here is his response - in Greek:

My email: I assume the lowers fit with the uppers so the slant is opposite on the lowers. Is that right? Any reference book to point them towards?

Not really! (I´m assumimg the "not really" is to the reference book)

The 15 degrees goes from the dorsal of the inside of the upper cheek teeth to the ventral and lateral of the cheek teeth and it is parallel on the lower cheek teeth.


Hopefully vets or vet techs can make sense of this.
Last edited by pinta on Fri Oct 25, 2002 2:04 am, edited 1 time in total.

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Karen
Slug Whisperer

Post   » Fri Oct 25, 2002 10:43 am


Pinta just wondering, did you notice at all if the tongue has any lacarations from the overgrown teeth or can the tongue get caught under them??

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Josephine
Little Jo Wheek

Post   » Fri Oct 25, 2002 9:59 pm


I can´t figure out dorsal on a tooth. Dorsal should be the roots. It means "back." Hmmmm.... Don´t they use buccal and lingual to describe teeth there? I´ll ask my vet on Monday.

pinta

Post   » Sat Oct 26, 2002 4:24 am


The tongue was fine - I asked.

J - beats me.

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melcvt00

Post   » Sat Oct 26, 2002 7:48 am


The 15 degrees goes from the dorsal of the inside of the upper cheek teeth to the ventral and lateral of the cheek teeth

Here´s my take on this.....means the angle goes from the inside of the upper molar to the outside, which would make the "point" on the outside.

and it is parallel on the lower cheek teeth

Parallel means "same angle". So, I´m assuming that on the bottom, the angle would go from the inside to the outside, making the "points" of the upper and lower molars meet together on the cheek side of the guinea pig´s mouth.

Now...I´m just wondering how right I am. :)

pinta

Post   » Sun Oct 27, 2002 6:19 am


Parallel means "same angle". So, I´m assuming that on the bottom, the angle would go from the inside to the
outside, making the "points" of the upper and lower molars meet together on the cheek side of the guinea pig´s
mouth.


From Dr. Legendre:
No the "points" on the lower cheek teeth are on the lingual side of the teeth. If they overgrow they form an arch over the tongue and trap it.
Last edited by pinta on Sun Oct 27, 2002 6:19 am, edited 1 time in total.

pinta

Post   » Sun Nov 03, 2002 10:14 pm


Willie's xray was from the Canadian Veterinary Journal - a scan of a printed page. I'm going to try and get a good xray of a mouth with a proper bite. Willie's xray was after he had been using the Chin-Sling for a few months and proved that the Sling alone was keeping his molars ground down. Previously he had been getting his teeth planed every 4 to 6 weeks and kept losing weight, regardless.

pinta

Post   » Tue Jan 14, 2003 8:56 pm


Although I was given information that the molars should be planed at a 15 degree
angle - my dental vet has told me now it should be 30 degrees. Go figure. Personally
I think it's a plot to drive me crazy. I double-checked and asked for a confirmation
as to which it was and this is the answer(whatever the heck it means).

Is it 15 or 30 degrees?

30 degrees

When you look at the GP head on the occlusal tables form an open V
Loïc Legendre, DVM, FAVD
Diplomate AVDC, EVDC

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Charybdis

Post   » Tue Jan 14, 2003 10:25 pm


Pinta, I'm glad you moved this thread up. Sam has overgrown molars arching over the tongue, a head tilt, and bulging eyes. He is supposed to have his teeth ground down on Thursday but I think now I will ask for x-rays too. Wonder if this will change the way the vet is supposed to grind them. I'll see if I can get him to read this thread.

pinta

Post   » Tue Jan 14, 2003 10:43 pm


Dr. Legendre planed Bloom's teeth more than usual to compensate for the root elongation. The latest set of xrays(6 weeks after initial dental work) shows the elongation has been arrested, which means the Chin-Sling has worked thus far. Her jaw muscles are more built up since wearing it too.

She is wearing the Chin-Sling 12 hours a day.

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