Intraoral radiographs: Take the giant leap

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Intraoral radiographs: Take the giant leap

Five reasons you'll be over the moon about that veterinary dental radiography unit.

(Shutterstock)

As veterinary dentist Dr. Barden Greenfield puts it, if you don’t have the ability to take intraoral radiographs in your veterinary practice, it’s like going to the moon without a navigation system. A great adventure to be sure—but extremely perilous. Neil Armstrong would not approve.

To ensure that Houston the hound doesn’t have a problem, it’s crucial to attain this standard of care. Then get ready to see your patients’ teeth like you’ve never seen them before. Here are just a few of the out-of-this-world things you can achieve by adding an oral radiographic examination to your dental cleanings and treatments, which Dr. Greenfield covered at a recent CVC.

1. Prove you did your job

If you need to extract a tooth, obtaining radiographs before and after is paramount. “As a radiograph is a legal document, this is the only confirmation that the procedure you charged for was done to completion,” says Dr. Greenfield. “Tooth root fragments and remnants are quite commonly left in the mouth with extractions.”

2. Detect unerupted teeth

If a tooth hasn’t erupted in a patient’s mouth, before declaring it’s nonexistence, go get that radiograph and make sure something more sinister isn’t going on. Dr. Greenfield says that many teeth never erupt and get trapped. The sinister part: That unerupted tooth can become a dentigerous cyst. “Enamel does not belong below the gum line,” he says. “It becomes a foreign body causing an osmotic gradient, which leads to bone destruction.”

An embedded incisor that was picked up on radiography. (Photos courtesy of Dr. Barden Greenfield)

3. Clue in to whether a mass is benign or malignant

Yes, histopathology is the only way to absolutely determine whether an oral mass is malignant, but a radiograph can provide some guidance while you’re waiting on the official histopath results. “If a destructive mass is present but the teeth are not deviated from their normal anatomical positions, you can assume it’s a malignant mass,” says Dr. Greenfield. “Odontogenic tumors tend to move teeth as they grow.”

A dentigerous cyst of the right mandibular first premolar tooth.

4. Determine whether a tooth is still vital

Did you know that the narrower the dentin wall and the wider the pulp cavity, the younger the pet? Yep, pulp matures as a pet ages. Dr. Greenfield says this fact can help you determine whether a tooth has died. “One way to assess the vitality of a tooth is to radiograph the contralateral tooth to assess pulp cavity width,” he says. “Premature maturation, or tooth death, results in a static pulp canal width.”

A radiograph of a nonvital tooth. Note the wide pulp cavity indicating premature maturation (tooth death).

5. Go digital for out-of-sight results

Digital or conventional radiography? That might be your next question. You can go either way, but Dr. Greenfield is firmly on the digital side. “Digital radiography produces images that are easily manipulated, catalogued, and visualized, and in many instances, superior to film,” he says. (Click here to read another veterinarian’s view on this question.)

A radiograph from a dog that had a normal looking tooth with no probing pathology. This blood-borne abscess is called anachoresis and can only be diagnosed via dental radiographs.

Dental positioning tools

Great article highlighting the diagnostic benefits of dental radiology. Depending on the skill level, extended anesthesia and repeated exposures are some of the potential setbacks. If you have ever struggled to capture a diagnostic x-ray with either the bisecting angle or parallel technique their is something new that really does work. Diane K Schaller, DVM and myself have watched numerous Youtube videos claiming to simplify the technique using cotton swabs, crooked lines drawn in space, references to an angle size but not the reference from which it was taken, etc. Together we have developed an inexpensive tool that improved her standard of care from occasional x-rays to requiring full mouth x-rays on every dental. It's amazing what this new standard of care uncovered in just the first two months! Check out the video https://www.youtube.com/watch?v=trNmUwVz8MQ and decide for yourself.