So welcome to CR. What am I looking at in that mouth? As veterinary nurses and veterinary surgeons were often presented with animals for a dental check or perhaps they're in for any other reason.

And the owners noticed something a little bit different in their mouth, and they're a little bit concerned. And also perhaps we should be looking in mouths a little bit more often. They maybe they've come in for a vaccination or a booster, or they've come in to be spayed or castrated or any other reason.

Maybe we should be having a look in that mouth and seeing what's going on, so we can be more preventative with our care. But it's all very well having a look in the mouth if we don't know what we could be seeing and what that could mean for our patients. So we're gonna go through this together, it's gonna be really pictorial, and then hopefully you'll be a lot more confident looking in animals' mouths and establishing what may or may not need treatment and also what might be going on so you can help educate your owners that little bit better.

So my name's Stacey Parker. I qualified as a registered veterinary nurse in 2014, and I've done my ISFM nursing certificate and my NSA in anaesthesia and dentistry. I'm currently in the middle of my advanced anaesthesia certificate and my official job role is that I'm a referral anaesthesia.

And dental nurse. I also provide in-house and external CPD and we produce learning aids and patient warming packs as well. I'm very welcome for you to get in touch with me through any of the ways listed here.

If you think of something that I wasn't quite clear about or you have any questions or wanted some more information, then I'd love for you to get in touch. I work with Rachel Perry, who is a European specialist in veterinary dentistry and oral surgery. I'm very lucky there's only 7 in the UK, so I get to see lots of interesting cases, and we work predominantly out of North Down specialist referrals, which is a multidisciplinary referral centre in Bletchingley in Surrey in the UK.

We also get to go to Marwell Zoo occasionally, and we help treat the leopards and tigers and red pandas, binturongs, so we get to treat lots of exotic species there as well. Thank you very much for the webinar vet for hosting and for having me for this webinar. I'm very, very grateful for the opportunity and it's a lovely team to be working for.

So today's objectives is we're gonna go through different oral presentations and you're gonna have a little bit of time on each one to decide what you think it might be before I disclose what it is with a full explanation. And I'll also let you know the potential work up or treatment required as well. So let's get started.

Have a little look at this picture. Some pictures are submitted by owners and that's why gloves aren't worn. We always use gloves when we're handling them out in the hospital and we advise that you do as well.

But particularly over COVID times, we were sent lots of pictures by owners who obviously don't have gloves at home to be wearing. So this is an aulus or epula they're sometimes called, and this is a swelling of the gingula in the area of the teeth. Now these lumps can be firm or they can be friable, they could be hanging on or they could be really cemented in there.

They can appear absolutely anywhere in the mouth. And it's a clinical description, Aulus or epuli or epulid. It's not actually a diagnosis, so we can't just say, oh, that's nepulid and just think that that's fine.

It could potentially be a fibroma, a non neoplasticodontogenic tumour, or a neoplastic tumour. So we do recommend that we take dental radiographs to see how much of the tooth root is involved here, or how much of the jawbone might be involved, if any. And we also would then take a sample or remove it if we could send for histopathology.

So we always recommend that these are looked into. Now this is hyperplastic gingivitis, and now this is a very extreme version in this picture. This is a middle aged boxer.

He's actually been on atopica which can actually cause hyperplastic gingivitis. So if you're seeing this in some patients and wondering what on earth this is happening for, then that could potentially be why. Now hyperplastic gingivites is a significant inflammation confined to the ginger bit, you can see it doesn't cross over to the mucosa.

The patient will often bleed when they're eating or chewing, and there'll be marked heliosis. We'll need to get dental radiographs to confirm the bone quality or any involvement as well. And as I said, it can be caused by some medications, one of them being atopica.

This will need a gingivectomy and real, a real gingivectomy in, in this example that's quite bloody. After which we need meticulous home care and just to protect the teeth and to get rid of any plaque that might be building up again that might cause some more inflammation. So it's more common that we see this in dogs, less common in cats, so to get this picture on the right was quite good.

So what do you think could be going on here? This is what we call lance canines, and this is classed as the class one Maloclusion. The jaw lengths are correct, but one or more teeth are out of alignment, and that has a really high instance in Shetland sheepdogs, Italian greyhounds, and Persian cats.

We think it's most likely hereditary. It can occur unilaterally or bilaterally, and it can be in erupted, causing a periodontal pocket as well. These tend to cause attrition to the incisors.

And crowding which can cause periodontal disease. The upper lip may catch on the mandibular canines which could be uncomfortable, and we do recommend dental radiographs are required to see where on earth that route is headed and what direction that's decided to be in. Treatment options could be orthodontic therapy, so it could be moving the canines, but that does take a little while and several treatments are involved.

We can look at shortening the canine if that would be suitable, so a crown shortening followed by vital pulp therapy so the tooth is alive and still in situ, but it's no longer causing any concerns. Or we could extract the tooth, which would be a one stop shop if you're confident in extracting quite healthy canines. So what do you think could be happening with these two pictures?

And there's a video here as well. Play that again for you. This is a class 2 maleclusion, and I think this is one of the most commonly seen maleclusions also used to be called an overshot or mandibular braism or an overbite.

The lower molar is positioned distal to the upper molar. So basically we have a jaw length discrepancy here. The mandible is shorter than the maxilla.

They think it's primarily primarily genetic, so we don't recommend breeding from dogs that have this. And Rhodesian ridgebacks and Labradors are definitely overpresented. Generally this will also be present in the deciduous dentition and therefore we do recommend extraction of the deciduous mandibular canines at 12 weeks of age.

12 weeks of age, we like to think that the anaesthetic can be a little bit safer. If you're not comfortable anaesthetizing such young patients, then look at referring to someone with a specialist anaesthesia team. If you're not happy extracting such small teeth, then you can also look at referring to a dentistry team.

We like to think that if we can extract those teeth at 12 weeks, the jaw will then have the time to grow to its full potential. However, we never know what that full potential may be, so the jaw may not grow any longer than when the adult teeth come through, you will have the same problem. And therefore, you will have to look at different treatment options such as an inclined plane to try and move the teeth out slightly.

You can do ball therapy if the teeth are digging in inwards. That's not appropriate for deciduous teeth, that's only for the adult teeth. We do a little crown shortening for these, so we remove the height of the lower canines so they can no longer dig into the roof of the mouth as you can see in this picture, and we perform a vital pulp therapy on those.

That does come with a review 3 months after the initial procedure to make sure the tooth is still alive and happy, and then again a year after. The other option is to extract the adult canine teeth as well. But there are options to save them.

There is a risk that you could lose the upper canines and also have oral nasal fistula forms if you do not treat, and you can imagine that this patient, certainly the amount of pain they must be every single time they close their mouth. So what about this one? What do we think's going on here?

And there's some more examples, a little bit more obvious here, and these cute faces. This is what we call a class 3 man occlusion, so the undershot jaw. This is where the mandible is longer than the maxilla.

It's genetic and it's often present in the deciduous dentition too. So attrition can occur other premolars as well, and attrition is where teeth are rubbing on one another. And the incisors can get worn down if they rub as well.

It's often just a cosmetic issue, but we do need to ensure that there's nothing more going on. As you can see some mandibular tissue damage and cars can form in that area. And it's not often that you'd see it in cats, but it can cause upper lip ulcers in cats, not so much from a maoclusion because that's not very common.

It doesn't say it's not out there, but it's not that common. If you're extracting the upper canines in cats, and particularly if they have quite a lot of folds at the mouth, so Persian cats or a little sphinx naked cats, you may then see this. And therefore we do then need to either remove the, reduce the height of the lower canines or extract those teeth altogether.

Don't have a picture yet for a Class 4 manoclusion, but Class 4 is classed as a yebite, and that's where the dual length discrepancy where one of the mandibles is shorter than the maxilla. So the face is really quite wonky. It's not just one, the maxilla or the mandible being slightly longer or not, it's one part of the mandible being shorter.

So these definitely look quite wonky and it feels like they've got all the malelusions going on in one go. We do think it's genetic and early trauma can also be a cause, such as if they've been bitten as a puppy while all the jaw bones are still forming. Or if they had previous severe infection.

TMJ luxation can also be a sudden cause, particularly in your older patients if it hasn't been noticed before, or a mandibular fracture would be another differential diagnosis. If there's no trauma, then this will sometimes be purely cosmetic, and we don't need to do anything. If all the feet, if all the teeth are sitting quite nicely, then there's no reason for us to do any surgery just because they don't look quite right.

And we never do any dentistry for cosmetic concerns. It's always because it's in the patient's best interest to do so. It's kind of a game of Tetris of working out how all the teeth can fit quite nicely without causing any trauma to the mouth or the tongue or other teeth.

It doesn't mean that we have to make every mouth look perfect and move teeth into position as to where they should be. That's not our goal. It's for the teeth to sit comfortably with these manocclusions and allow the jaw bones to grow if necessary by removing teeth that might be preventing that.

But just making sure that that mouth is as comfortable as possible, even if that means. Different teeth are extracted for different types of maoclusion, so it's what I'm saying is it's all a very personal decision for each patient, depending on the level of maoclusion and what the owner would like us to do as well. So how about these pictures?

What's going on here? These are retained deciduous teeth, also called persistent deciduous teeth caused normally by the permanent dentition not taking the correct eruption route. It is genetics, so we don't recommend breeding from these guys, and it's most common in toy breeds.

They've still got the same amount of teeth as our large wolf type dogs, but a very, very small area for them all to come out, and that's the same with our brachycephalics. It's often bilateral, and the most affected teeth we see are the canines followed by the incisors. This causes overcrowding and periodontal disease as they share the same gingivo collar, so you don't have a nice accurate seal.

You can see on the picture on the right there, they're sharing it and therefore you can get the periodontal pockets building up because you don't have a good gingival seal. So that's why we recommend extraction of retained deciduous teeth. This isn't to be confused with supernumerary teeth, which we will cover a little bit later as well.

Retained assiduous teeth as well they're retaining their baby teeth, not that they have extra teeth that are all adult. How about this picture? Have any of you seen?

This presentation This can very, very easily be confused with staining of the teeth or the owner and the vets and the team may feel like there's plaque formation here. But this is actually enamel hyperplasia. That's an enamel defect that occurs during tooth development and as I said, it can often be confused for other things.

Now the surface around that brown line downwards will be quite rough and that attracts plaque to build up. Which obviously is not a good thing. It can be caused by trauma to an unrupted tooth or an infection or trauma to a deciduous tooth.

It can also be caused by distemper in the past, but in the UK, certainly we seem to be vaccinating that out, but we're seeing more and more dogs brought over from Europe or maybe further afield, and I would say that a lot of these rescue dogs we are seeing more commonly enamel hyperplasia with those rather than all our other patients that we've been historically seeing that haven't come from around Europe. Doesn't tend to be painful, but obviously if that plaque buildup on the rough surface builds up to gingivitis and then into perdontitis, it can very easily become painful. It can affect just one tooth or numerous teeth, and what we do is we actually place sealants to protect the exposed softer dentin.

We can't get the enamel back and we don't want the dentin exposed because the dentin can work a bit like a sponge and allow things through to the pulp. Which can then be tender. So we place sealants, it's not painful to do.

It does have to be performed under anaesthesia, and it's normally something that a dental specialist or someone with a further certificate or interest in dentistry will do purely so they've got the equipment and the skills to do so. It doesn't take too long and then they. I have a smooth surface of the tooth, so we're not gonna have all that horrible plaque and tartar building up.

Now decaying teeth, we don't see that too often in animals in comparison to humans, we're really naughty. We have lots of wine and coffee and high levels of sugar, and that makes our teeth decay. You do see it in dogs, often it's dogs that are fed quite a lot of sugar in their diet, if they have quite a lot of yoghurt or human food.

The teeth will often be mobile and painful. They would have been favouring one side. I certainly wouldn't want to be chewing on that tooth.

Quite smelly breasts of heliotosis, a lot of plaque and build up and probably starting to get an infection there. It's often the very back molars that seem to decay quicker, and dental radiography is an absolute must because we just need to understand what's going on with the roots and make sure we get every piece of those teeth out. So therefore, extractions are required here.

There's no saving that tooth. And often teeth can have extra roots as well, so as long as all the other many reasons we should be taking dental radiographs. And then we need to establish why is this dog or cat, but that's very rare.

Why is this dog having decayed teeth? What is in this dog's diet? Are they doing a home diet?

Are they getting lots and lots of treats from the kids in the house or dog walkers and things? We need to try and remove the sugar from that diet so that we're not seeing this happen again. No, I didn't put this as a guess what's going on because I feel like, particularly in first opinion dentistry, and certainly for us, we still see cases like this.

This may well be the predominant workload that's coming through dentistry. The matted, gooey, infected teeth are almost falling out, but they haven't done anything for a while because the dog was a bit old, but now it's even older, and here we are in quite the state. So this is what we would class as severe periodontal disease, and it really is quite likely they're showing links that affect that.

Heart and kidney function and just overall the well-being will be very, very poor in this patient. And we're really trying to look into the link between internal organs and dentistry because if you had this state of something anywhere else in the body, on the wound, or of a wound, on the leg, in an organ, on the eye, you just wouldn't leave it. But I think because the mouth is closed, we see it as elective and we don't need to do anything just because they're old, but actually, The mouth and the bacteria and this state in the mouth really can affect their major organs.

And as I said, the quality of life will be quite poor. You have one tooth that hurts and it gives you an absolute face and headache, so you can imagine if you've got lots of periodontal disease under all of this and you can only seefurcation exposure and such, how uncomfortable this will be and the relief you would feel once this was treated, so it's all about the quality. And if owners are really concerned about anaesthesia, you can always look at referring them to teams that have specialist anaesthesia teams, and we certainly, I would say 50% of our referrals come in for actual dentistry concerns, and 50% come in because they do need dentistry, obviously, but because they want the anaesthesia team to work alongside the dental specialist because they have concerns about the anaesthetic.

This will be painful, you can imagine this is really going to smell, and teeth are like be very mobile, it could just be the tartar that's keeping these teeth hanging on in there. We need to give all those teeth a good clean, even if we think they're coming out, we want a nice clean surgical site as possible. And we then need to get clear dental radiographs, which you won't get with a high level of plaque and tartar.

You often see this kind of state in a geriatric patient and therefore they may have coexisting diseases such as mitral valve disease, or kidney disease or liver concerns, and the list goes on. So you do need to plan these cases appropriately and if the owner doesn't want referral but they do want the work done, then you're very welcome to email specialist teams of anaesthesia, and they're always very happy and welcoming to give out advice to support you through an anaesthetic episode. Now, when you look at this mouth, you think this is gonna take you quite a while and perhaps you haven't realised or someone else scheduled it in for you.

So I think it would be good at this point to call the owner and suggest that it might need staging and performing two anaesthetics instead of 1. Just because it's going to be very long and no one can concentrate for such a huge huge period of time if that's what's needed. So it might be that this time you give that mouth really good clean.

And you start the animal on pain relief and you take X-rays and you remove any teeth that are very obviously causing a huge amount of pain in the time frame that you have. And then they come back for stage 2, where their mouth is in a better situation, maybe 3 to 5 weeks later. And then you've got a cleaner mouth to start with.

You've already got your dental rads so you know exactly what you're going in for, so you can have two shorter anaesthetic periods and two shorter surgery times because everyone asks how long should you allow an anaesthetic for dentistry to go on for. If you're supporting it appropriately and the patient's doing OK, then the answer is as long as you need. Our concern is how long can you concentrate appropriately for such severe anaesthesia and for such an intense dental surgery.

Is that fair on the patient and yourselves? Can you concentrate for 4 hours in a row extracting teeth, or would it be better for yourself and the patient to do 2 sets of 2 hours? And obviously with periodontal disease as bad as what that could be, we could be worried that there's jaw fractures in there and we're only not seeing that because the plaque is holding all the teeth together.

But when we remove that, we may realise that there are some fractures of the jaw. Or perhaps we've lost so much jaw bone that us accidentally causing a jaw fracture is a possibility. And again, that's something to warn the owners when you see mouses like this.

And also it might be another reason you might wish to refer a patient as well. So we move on. What do you think's going on with this tooth here?

You can see it's kind of a purply pinky colour in comparison to the other teeth. This is normally caused by a blunt trauma to the tooth. They've normally run into something or caught something, and I haven't broken the tooth, but they've caused internal bleeding in that tooth.

So the staining is the blood staining from the pulp into the dentin, and now we can see that because the level of enamel is very, very thin in our patients' mouths. If they seem comfortable, then you can keep an eye on its progression as it may disappear. This is a bruise essentially inside the tooth, so we tend to ask them to take a picture every week and send it to us unless they have any concerns that their patient is in pain.

If it doesn't get better or it gets worse, or as I said, if the patient isn't any sign of discomfort, we'll get them booked in as soon as possible for dental radiographs to check if the tooth has died. That the tooth has died, we don't necessarily have to extract it. We can look at root canal treatments.

Anti-inflammatory medication can be good here. It's a bruise, so it's swollen. It's bleeding inside that hurts, but antibiotics are not required.

They're not thinking about infection in these cases, but we do need to put them on some pain relief. What's going on here? There's several things going on here, we've got some warm teeth.

And I've been wearing down on other. Surfaces, we've got some attrition as well from teeth on teeth. We've also got some supernumerary teeth, so extra teeth on top of the normal dentition.

This isn't normally an issue. It doesn't mean you have to extract them just because they haven't got a textbook mouth. It can cause overcrowding and periodontal disease, but they can also sit quite happily and have their own gingival seal.

Not be disturbing anyone with their roots, but to establish that we do recommend dental radiographs to ensure that the roots are not compromising other important teeth, and therefore we would extract them if need be. However, if we're not causing any problems, then we would leave them alone. So, this is more what you'd see in your puppies, perhaps.

This is a cleft palate. This is a midline defect of the maxillary bone, it's congenital. The cleft creates a communication between the oral and nasal cavities and displays a sneezing, your patient is likely underweight, difficulty suckling and aspiration pneumonia.

They do need to be tube fed until they're 6 to 6 to 8 weeks of age, and surgical correction is needed and the first surgery carries the best success rate. So if the. If you're not familiar with performing these surgeries and the owner is comfortable to, it might be worthwhile referring these to the soft tissue surgeons or dental surgeons, and they may be able to have the best success rate for you.

It's not the best thing to be just having a go with for these guys because it really is the first surgery carries the best success rate, and the vision surgeries can get quite difficult. So what's going on here? So this is a fractured tooth, and we often see them in dogs, but I wanted to include a picture of cats because it really does happen with cats too, and I think we just don't notice it as much.

Now any teeth can get fractured, and if the pulp is exposed then it will be painful. They should be checked with a dental radiography and an explorer probe, only under GA we should not be using the Explorer probe on these patients consciously. Most commonly with cats it's the canine teeth that are fractured and that's normally on impact from jumping off something or trauma or being hit by a car and such.

And it can commonly be the carnassial teeth and canines in dogs. Now both can receive root canal treatment in certain cases, as long as the fracture hasn't gone too much under the gum line and the root is quite happy and depending on the age of the patient and if they have any other dental concerns around that tooth. As I said, cats will often fractures been jumping from a height or trauma, but dogs, it tends to be when they're given the wrong thing to chew or they pick something up on the walk.

So sticks, stones, antlers, raw hides, nyler bones. We all recommend they don't have those. And also catching pebbles or stones at the beach seems to be quite popular in the summer.

We get a lot of fractured canines from those. It's just all about educating our owners as to what potentially could cause dental concerns. There's another fractured tooth, the fractured carnaste there and the brachycephalic.

There's a lot of force in the jaw and objects that are very, very hard. Go in between that jaw and then something has to give, and the jaw is strong, the tooth is strong. The antler, for example, is strong, but the tooth is the weakest of the three, and that will be the thing that breaks.

It can be trickier for us to perform root canal treatment on carnasios because the fractures are normally quite large and in several places, and these teeth have 3 roots. It doesn't mean we can't do it. We do do it, but the success rate is slightly lower.

Fractured teeth can cause tooth root abysses and also oral nasal fistulas, and you can often see a fistula for drainage form like a small raised spot as well. And these are really, really uncomfortable. We should not be watching and waiting to see because I'm not quite sure what you're watching and waiting to see.

We know that animals hide pain very well. The owners aren't going to see it very regularly because the teeth are hidden in the mouth. They might just be favouring another side, and you could be just waiting for infection to happen.

So fractured teeth should always be investigated under anaesthesia with an explorer probe and using dental radiography. There are always options to refer, and you can always email pictures to referral clinics to see if a tooth is appropriate for root canal treatments and find out wait times to see if that's appropriate as well. Because some owners may have wanted that option but haven't been offered it.

But others. Offered it, but then don't want to have the reviews that we have to do for root canals, which is at 6 months and 12 months, and we'd actually prefer to have it removed. But like with anything, we could always be offering both the option of first opinion treatment or referral if they can offer something different to what you can currently do in-house.

So what's going on with this one here? This is actually a worn tooth, and it's often very confused with a fractured tooth, and quite rightly so, I can see why. The pulp doesn't tend to be exposed with these worn teeth, but tertiary dentin has been laid down as the enamel in dentin is slowly worn down, and that can often see as a brown dark spot in the middle of the tooth, which we worry that is the pulp.

Generally with dogs, this is caused by tennis balls, pebbles, chewing on sticks or chewing on the bars of the cage. We need to work out what's caused this so that if we do need to place sealants or if they have worn through and we do need to do a root canal. We can make sure the tooth is protected in the future, otherwise it's just going to carry on and on and on.

So we need to look at stopping whatever behaviour it is. And as I said, we can place sealants over the teeth to protect the dentin from having any further exposure or being worn down, but nothing we place is going to be any stronger than the tooth that we had in the first place. So we really need to reiterate what has been causing this.

Now this looks very, very sore. And it's something that can be confused quite often for other diagnosis. And it's not something I'd heard of until I was working in veterinary dentistry.

So the next slide's a bit chunky, and I think it's really important because we do see many of these cases where they've been struggled to manage and they've sort of been referred as a sort of a last port of call. So I think it's really important that we're all aware of chronic ulcerative parental stomatitis. It often presents a severe halitosis with bleeding from the gums, red inflamed gums with really thick, stringy, disgusting hyper salivation.

The patients are less keen to hold hard toys or eat biscuits. They can even become quite anorexic. They can become quite aggressive with anyone going near their mouths.

And the presentation is often mostly confused for nausea or toxicity, chemical or electrical burns, general periodontal disease, or maybe they think the ulcers are caused by renal concerns and more. If we go back to the picture here, you can see there is ulcers, but you can see that it directly correlates to when you put that lip back down. It correlates to where there's plaque on the teeth.

And that's what's causing the ulcers. It can affect any tissue within the mouth that comes into contact with the plaque or tartar, so always check the inside of the mouth and the tongue, the side of which can become really quite painfully ulcerated. We can distinguish this from normal periodontal disease by the kissing lesions as I've just shown you on the picture.

You'll note the ulcerated areas in the mucosa which, when in a normal position, will directly correlate to the tooth and the plaque on it. And remember, you won't see plaque with the naked eye, so you could have a very, very clean tooth. But if that ulcer at the top and that sore area is still correlating to where it touches a tooth, it could still be this.

I remember, plaque builds up within hours of us performing a scale and polish, so you may well have just done a clean and a really good one at that a week ago, and already you're seeing these areas aren't going away or they're building back up. It can develop very suddenly or gradually over time, and it is very, very, very painful, but remember that so many dogs are very stoic, and they won't tell you. Steroids aren't indicated as such because they do not numb the pain or any pain, but that's another subject.

So lots of decent pain relief is required. It's caused by the pet's immune system becoming hypersensitive to plaque and having this immense reaction that we're seeing there. Cases that are caught early on can be medically managed with articulate daily home care of the teeth being brushed, as well as some medication.

Biannual annual cleanings are still needed professionally to keep the disease at bay in the majority of cases. If there's advanced periodontal disease is present, then multiple or full mouth extractions may be needed under radiographic control to ensure that all roots are extracted fully because the gum will still be very cross if you leave any roots behind and you will not be curing your patient of their problem. If you do have a patient present in a similar fashion, then take lots of pictures and get in touch with a veterinary dentist who can guide you on the appropriate first stage of treatment and medication, or perhaps offer them a remote consultation for the owner to discuss what you feel might be going on.

And greyhounds and spaniels are particularly overrepresented. It can occur, however, in any breed. And this is kind of like the dog version of feline gibo stomatitis.

So, back to the felines. What do we think is happening here? Now I wouldn't blame you if you said you think that's feline gingivar dermatitis.

There is quite a lot of information there. And we do get many, many cases referred for having ginger stomatitis or the owners have been told they need to have all the cat's teeth out. But sometimes that's not the case and it's actually a little bit of a misdiagnosis.

This is feline juvenile gingivitis, which can lead on to juvenile perdontitis. And as I said, it is often mistaken for gingivo stomatitis. However, with feline juvenile gingivitis or perdontitis, the cadal mouth and forces aren't affected, and they typically grow out of this by the time they are 2 or 3 years of age.

Treatment for this case is gingivectomy and cleaning of the teeth. Now the teeth don't look too bad, but remember we can't see plaque with the naked eye, so yeah, we're still gonna scale and polish correctly without causing any damage to these teeth to remove that horrible biofilm that can be causing this reaction. Now this is overpresented in Siamese and Maine Coons, and I feel like we've seen a lot of British shorthairs with this recently as well.

Now it's gonna be quite smelly in there with all that extra tissue, and they're probably gonna be bleeding when they eat or chew. Dental radiographs must be performed because yes, it could just be gingivitis once you've done the gingerectomy, but it could have already escalated into perdontitis, so yes, extractions are then required. So catching these kids early is so important and referring them early if that's what you need to do to get the dental radiographs to assess and cut back that gingiva is key.

And diligent home care can be required. However, we all know that cats are likely to not accept that. So we'd often see these patients back 6 months after their initial treatment as a consultation to see if they do need any other professional cleaning or help, and we'd hope that we would be able to support them until they get to the age where they grow out of this condition.

I'm not really sure what causes it or why they grow out of it. Like most feline things, they write their own rulebook, but it's definitely something we're seeing a lot of. OK, so another kitty mouth here.

The one on the right is upside down. Just to orientate you, all our patients lay on their back for dentistry, so some of our pictures will be that way. Now this looks very, very sore.

As an owner I'd be really horrified to see this. I'd instantly be very concerned that there was some sort of oral cancer in my cat's mouth. What we call this is a little bit misleading but a pyogenic granuloma.

This is an older terminology it's not actually caused by pus. It's a proliferative mass which is caused by the tooth contacting the gingiva and mucosa, often caused by a caudal maleclusion, causing them to chew differently, which then causes this soft tissue trauma, which is this large swelling that you can see. It's really common in brachycephalic cats, particularly when they're a little bit younger.

It is painful. Imagine having that in your mouth and keep chowing down on it, it's very, very sore. It's seen in much younger cats and they can grow out of it, so we're often seeing this in sort of 8 to 10 month old cats.

Doesn't mean you don't treat it just because they're gonna grow out of it because that swelling is still there and it's still painful and we must do something about it. So under anaesthesia, we would remove and send this away just in case it is something nasty as well. And we would also extract the teeth that were causing the trauma or in the referral setting.

If appropriate, we can reduce the height of these teeth and place the sealan. So sometimes you just need to take the edge of the upper premolars and molars, and that will allow the teeth. To sit nicely and stop causing that contact, but that must be done in a referral setting because you can't just bear or reduce the height of teeth without placing a sealant because you'll be exposing the dentin which can then be porous and be quite sensitive.

It can also be caused by the lower molars being extracted because of periodontal disease or such, then we haven't thought what's gonna happen to the tissue below by those upper molars still being there, which can then cause this horrible trauma to the lower gum. So what's going on with this one? This looks really sore.

It's our patient on the left who's had some gabapentin, we've been able to have a look in his mouth. We can see all the swelling on the right once our patient's incubated in that middle picture. The canine teeth and around the incisors don't look too bad, do they?

Not too inflamed, not like gingivitis, but the back of the mouth and the forces of the mouth and the caudal area of that mouth, very, very inflamed. We can already see gum recession, and in fact the canines don't look too good on the picture on the right. The lower ones in the middle don't look too bad.

This is gingerbo dermatitis. Now this is the most common thing we have cats referred to us for. And sometimes, as I said, it's a misdiagnosis and that's great for the patient, but we are commonly seeing these cats referred to us because they do tend to need multiple extractions under radiographic control.

Now this is inflammation and proliferation of the gingiva and oral mucosa and in chronic cases the tissues can actually become ulcerated. It can extend into the gingiv mucosa, pharynx, tongue, forcess, and this is when we call it cordal stomatitis. The cause is still unknown, but we, what we do know and what we must focus on is that this is very, very, very painful.

We need a lot of analgesia. That might be putting them on meacam, gabapentin and buprenorphine. You may need some antibiotics just to reduce any infection before.

Before we start doing any surgery in there just to become a healthier, surgical site. What won't work is if you just keep giving them antibiotics. That's not the cause.

This isn't an infection that's causing it. This infection could be will be secondary. So we can't just keep putting these guys on steroids and antibiotics and expecting it to, to get better.

Treatment is unlikely extraction therapy under radiographic guidance and your patient will be very unkempt, probably very cross, very hedge shy, very stiff, excessive drooling, grumpy, have stained saliva. They might cry when they eat, they might eat their biscuits so quickly that they just launched into the back and then throw them all up within moments. So the main thing is, is these guys are very, very painful.

And treatment must be looked at. And the sooner we get these patients for treatment, the better their prognosis is. We would do viral testing but only of FELV FIV because that would potentially change our prognosis as to how well they may respond.

And there are medical. Potentials to try and help these guys, once you've performed the extractions that are required, they won't work with the teeth still in the mouth. These extractions must, must be done with dental radiography.

If you leave one part of a tooth in there, the inflammation will still happen and your cat will still be very painful. So if you feel like it's gingerba dermatitis, get some pictures, get some history, speak to a veterinary dentist, see what they're thinking. They can guide you if the owner can't afford or doesn't wish to refer, or if you want to refer the sooner the better before they've been on months or years of steroids and things which will change their prognosis as well.

So we're still looking at the kitty cats here in particular on the left picture you can see that little red circle on the lower tooth. And on the canine on the right. What do you think's going on there?

This is what we call resorptive lesions, so it's adontoplastic destruction of the teeth. Cats like to destroy their own teeth. Like I said, they write their own rulebook, and I think it's a protective mechanism in the world in that they will start resorbing their own teeth if they're having issues with them, because then eventually at some point that tooth falls out.

It's a painful process that is still unknown. Type 1 is where the tooth is not replaced by bone and therefore the treatment is full extraction, and there's also type 2 where the tooth is replaced by bone, and treatment is therefore crown amputation, which makes for a much nicer day. However, you're not going to know which one it is unless you have dental radiography, so you really shouldn't be doing feline dentistry.

Without dental radiography, and if you are, you must be telling the owners that you don't have dental radiography. They're making informed, educated consent as to what they're doing. I think most owners would just presume that you've got dental radiography because I've never had a tooth out without having a dental X-ray taken, so we must make sure we're educating them as to what we have to offer.

This progresses in varying rates. It wax and wanes, so you might have a tooth that's early resorption and then it might accelerate very quickly or do nothing for quite some time. It can occur in dogs, but it is most common in cats, and as I said, we must be using dental radiography to know what type of extraction is needed, Type 1 or type 2, the full tooth or just the crown, and some teeth will have both going on in different routes.

So we really do have to take a dental radiograph to guide our treatment. It'll also make your ops day a lot speedier once you've got the hang of taking the radiographs because then you know exactly what treatment you're doing. You'd never treat a fractured leg without taking a dental radiograph, so these teeth that are undergoing resorption, we should always take a dental radiograph so we can see exactly what we're doing and check we've got all the tooth out if that's what we are intending to do.

Just like when you fix a leg, you'll take an x-ray of it preoperatively, you'll fix it, you'll take a post-op x-ray, and I believe that dental radiography should be used in that manner too. So when you do that, What do you think is going on with this now? Two different mouths, we're looking at the upper du on the left.

And the lower jaw on the right. These are missing teeth. There can be multiple reasons, and I know this guy has a deciduous canine as well, but there's multiple reasons why teeth could be missing.

They may have never erupted. They may have fallen out through a resorption that we've just discussed. They may have fallen out from a fracture, but the root remains in the gum line.

There could have been previous dental work. And just so you're aware, hypodontia is the term for congenitally absent teeth. If the tooth is sat below the gum line, this can cause a dentage of a cyst, which is a fluid-filled structure causing bone destruction, which isn't good, and we do need to treat these as soon as possible.

It's usually a genetic cause, and the 1st and 2nd premolars are the most likely to be absent, and we find it very commonly in our brachycephallic breeds, particularly boxes, as there's just not enough space for all the teeth to come out, so some of them stay under the gum line. Dental radiographs, therefore, because those teeth could be under the gum line, are 100% required, and dentedous cysts will need surgery to extract the tooth and all of the cyst lining. If you just drain the cyst and the tooth is still there and the lining, it will just come back.

If you just remove the tooth but leave the cyst lining, it will just keep building up the fluids, so you do have to treat them appropriately. So always email her at dentistry specialist if you're not used to dealing with these. They're not difficult, you just need to know what to do.

And you can see there, we needed to move both teeth because the tooth that hadn't erupted has caused this dentiguous cyst which has now started to impact the tooth behind it. Luckily it hasn't impacted too heavily on the canine and we were able to preserve that and we took X-rays six months later to see how that canine was doing. And luckily everything was OK and they kept that tooth.

Now we're looking at the red line. And on the lower left jaw there behind the canine. Where teeth should be, it's quite rather inflamed, do you think?

A gingival inflammation without the presence of teeth is very likely where teeth roots are remaining. So again, we need to make sure we're using dental radiography, both pre and post-operatively with all of our patients. All the tooth could have resorbed and the root has been left behind.

Or unfortunately, and we do get a lot of referrals for these root remnants have been left behind during dental work because dental radiography either wasn't in the practise or it wasn't used postoperatively. And that's when owners get quite confused because again they've made an assumption that if you're offering dentistry, you're offering it in the same way as human dentistry, and of course you'd be taking a dental radiograph because it doesn't make much sense not to. So therefore we must be, if we have it, using dental radiographs for extractions pre and postoperatively.

And if you're looking to invest something within your clinic, then dental radiography is a really good way to go. And lastly, we should be looking under the tongue for all of our patients, particularly cats. They really hard for the owner to have noticed anything under the tongue, and lots of dogs don't like their mouth being open either.

So take the opportunity under every anaesthetic to look under the tongue. We're not going to be looking under the tongue at intubation, but make sure once your patient's got the good safe airway when you're looking at the mouth, or even if they're in, as I said at the beginning of this lecture, another procedure, having a good look because these things. Seen early.

If they are a grain of cell sarcoma or anything awful, catching them small and early could be saving that patient's life until they're much bigger and aggressive. Equally it could be an ulcer which could be caused by trauma, if there's a fractured tooth that's rubbing against or they just caught their tongue on something, or they could have burnt it or licked something. It can also be caused by periodontal disease or a change in the way that they chew in their tongues being caught up with them.

And as I said, it could be something awful such as a squamous cell carcinoma, so we must biopsy any abnormalities in the mouth, such as this, just to rule it out because these things, especially squamous cell carcinomas, can grow so quickly and become non-surgical very, very quickly, so it's best for us to have a good look in that mouth and sort it out much sooner rather than later. So thank you very much for spending the last nearly an hour with me going through what you may or may not see in your patients' mouths. I hope we've covered as much as you wanted to see.

There are obviously lots of other things we see in mouths, but we only had an hour together today. If you've got any questions about anything that I've gone through, or you'd like any advice, or you'd like to know how to speak to a dental specialist, then here are all the ways that you can get in touch with them. And if you wanted to look at tailored webinars or lectures or interested in any of our patient warming packs, this is how you can get in touch with us.

So thank you very much. I hope you now have more confidence going forward to look in your patient's mouth. It's been lovely to have you with me for the last hour, and I hope you enjoyed it.