Making gold-standard recommendations in dentistry

Stephanie Goldschmidt School of Veterinary Medicine, University of California-Davis

Search for other papers by Stephanie Goldschmidt in
Current site
Google Scholar
PubMed
Close
 BVM&S, DAVDC
and
Elke Pollaris Equine Clinic de Morette, Asse, Belgium Equine Care Group

Search for other papers by Elke Pollaris in
Current site
Google Scholar
PubMed
Close
 PhD, DEVDC Eq

Click on author name to view affiliation information

F1

Dr. Stephanie Goldschmidt

Citation: Journal of the American Veterinary Medical Association 261, S2; 10.2460/javma.261.s2.s4

F2

Dr. Elke Pollaris

Citation: Journal of the American Veterinary Medical Association 261, S2; 10.2460/javma.261.s2.s4

Dear readers,

We are pleased to serve as guest editors for this JAVMA special issue, which is focused on making gold-standard recommendations in dentistry in both small and large animal settings. We have recruited both impactful original research articles in addition to comprehensive reviews on a wide range of oral pathologies to help guide clinical decision-making. We hope that you find these articles as informative and inspiring as we did!

Small Animals

Oral diseases present a distinct challenge to the small animal clinician, often leading to significant quality-of-life concerns if not treated promptly and properly. Here we present several manuscripts focused on management of challenging oral and maxillofacial diseases. The focus of these manuscripts is to help support clinicians in making evidence-based diagnostic and treatment recommendations.

First and foremost, we tackle one of the most challenging topics in veterinary dentistry: the decision to prescribe antibiotics while continuing to practice antibiotic stewardship. Montebello et al1 report on the knowledge, attitude, and practice toward antibiotic use among diplomates of the American Veterinary Dental College, revealing the high level of variation among specialists and the need for established antibiotic-use guidelines.

Speaking of guidelines, there are also no widely available practice guidelines on preoperative screening for odontogenic and nonodontogenic tumors, making recommendations on the risk-benefit analysis of staging tests for oral cancer difficult. Goldschmidt et al2,3 evaluated the diagnostic yield of 4-site screening (head, neck, chest, and abdomen) for oral cancer, reporting the likelihood of diagnosing metastasis or major incidental findings in a variety of oral tumor histologies and locations. Risk analysis allows the clinician to properly inform owners of the likelihood of finding significant disease with each screening test separately as well as the combined diagnostic yield of 4-site screening.

Next, we move to management of challenging surgical diseases in companion animals. Castejón et al4 provide a narrative review of cleft palates in dogs culminating in a decision algorithm to help guide surgical options for various congenital orofacial defects. Arzi5 presents an expert opinion review on diagnosis, treatment, and long-term outcomes of fractures of the temporomandibular joint in both dogs and cats, providing valuable insight into how to manage these challenging fractures. In rabbits, the surgical management of odontogenic abscess with secondary osteomyelitis is formidable and, to date, only case reports are published on the treatment and prognosis of these cases. Jekl et al6 report on the surgical treatment regimen and associated outcome of odontogenic abscess and osteomyelitis in 200 rabbits.

Shifting from a surgical to oral medicine focus, a narrative review and decision tree on the classification and proper diagnosis of canine oral mucosal lesions including ulcers, leukoplakia, and pigmentation is presented by Anderson.7 Concurrently, Soltero et al8 present on clinicopathologic presentation and management of cats with oral eosinophilic lesions, an often highly frustrating disease with limited literature available. Read on to learn how to make gold-standard recommendations for these challenging dental disorders in your practice.

Large Animals

Dentistry and the importance of oral health are unfortunately an undervalued topic for many large animal species. In humans and small animal species, the consequences of some oral diseases are better documented and sometimes even shown to be life-threatening. Luckily, there is a positive evolution and growing interest in recognizing, diagnosing, and treating oral and dental problems in certain large animal species (eg, horses, donkeys, and alpacas). The manuscripts shared in this issue focus on common dental problems in equines and adequate treatment options, thereby aiming to inform clinicians and guide them in their diagnostic and treatment plan.

A very common but often overlooked pathology in the equine dentition is the presence of peripheral caries. Jackson and Kelty9 present an overview of this dental pathology, its risk factors, and a recommendation for a treatment strategy in a comprehensive review. This disease is immediately a good example of how changes in the assessment of oral health in large animals are still needed. Furthermore, impactful improvements are sometimes possible with simple changes (eg, in feeding management).

An extensively described and better-known condition is sinusitis in horses. Although this disease can have multiple causes, a very important underlying cause is often dental infection. Leps et al10 present the outcome of surgical treatment of horses referred for chronic sinusitis in an extensive case series.

Welcome examples of advances in equine dentistry and disciplines in continuing development are the endodontic treatments in horses. Endodontic treatments aim at preserving instead of extracting affected teeth. For the first time, a clinical study on endodontic treatments in equine incisors is published. du Toit and Pearce11 present the results of the orthograde endodontic treatment of incisors, whereby the importance of case selection, knowledge, and technique is emphasized.

An example of teeth that should not be selected for endodontic therapy include incisor teeth affected with equine odontoclastic tooth resorption and hypercementosis, a common and painful disease for which, up to date, the only treatment remains extraction of the affected incisors. Tretow et al12 highlight the very high prevalence of equine odontoclastic tooth resorption and hypercementosis among German Icelandic horses, even in horses that were not suspected to be affected prior to radiographic screening. In this study, the possible role of environmental factors in the development of this disease is also discussed. Concurrently, Hain et al13 present a study about the impact of dental treatment and the keeping and feeding management on the health of the rostral oral cavity.

The last manuscript of this special issue provides a review on the dental management in the equine geriatric patient. Geriatric horses have a high prevalence of dental disease; therefore, timely recognition and adequate treatment is very important for our growing elderly horse population. du Toit14 provides an overview on the most prevalent pathologies and how to recognize and tackle them.

Respectfully,

Stephanie Goldschmidt BVM&S, DAVDC

School of Veterinary Medicine, University of California-Davis

Elke Pollaris PhD, DEVDC Eq

Equine Clinic de Morette, Asse, Belgium

Equine Care Group

References

  • 1.

    Montebello JA, Granick JL, Bollig ER, Goldschmidt SL. Variation in knowledge, attitude, and practices toward antibiotic use among diplomates of the American Veterinary Dental College: a survey-based study. J Am Vet Med Assoc. 2023;261(suppl 2):S6S13. doi:10.2460/javma.23.06.0304

    • Search Google Scholar
    • Export Citation
  • 2.

    Goldschmidt S, Soltero-Rivera M, Quiroz A, et al. The diagnostic yield of preoperative screening for oral cancer in dogs over 15 years, part 1: locoregional screening. J Am Vet Med Assoc. 2023;261(suppl 2):S14S23. doi:10.2460/javma.23.05.0299

    • Search Google Scholar
    • Export Citation
  • 3.

    Goldschmidt S, Soltero-Rivera M, Quiroz A, et al. The diagnostic yield of preoperative screening for oral cancer in dogs over 15 years, part 2: distant screening. J Am Vet Med Assoc. 2023;261(suppl 2):S24S33. doi:10.2460/javma.23.05.0300

    • Search Google Scholar
    • Export Citation
  • 4.

    Castejón-González AC, Reiter AM. Surgical treatment for cleft palate in dogs yields excellent outcomes despite high rates of oronasal fistula formation: a narrative review. J Am Vet Med Assoc. 2023;261(suppl 2):S34S43. doi:10.2460/javma.23.06.0330

    • Search Google Scholar
    • Export Citation
  • 5.

    Arzi B. Contemporary management of temporomandibular joint fractures in dogs and cats: review and expert insights on diagnostic imaging, treatment strategies, and long-term outcomes. J Am Vet Med Assoc. 2023;261(suppl 2):S44S51. doi:10.2460/javma.23.04.0211

    • Search Google Scholar
    • Export Citation
  • 6.

    Jekl V, Jeklova E, Hauptman K. Radical debridement guided by advanced imaging and frequent monitoring is an effective approach for the treatment of odontogenic abscesses and jaw osteomyelitis in rabbits: a review of 200 cases (2018–2023). J Am Vet Med Assoc. 2023;261(suppl 2):S52S61. doi:10.2460/javma.23.06.0332

    • Search Google Scholar
    • Export Citation
  • 7.

    Anderson JG. Canine oral lesions: a decision-tree approach to ulcers, leukoplakia, and pigmented lesions. J Am Vet Med Assoc. 2023;261(suppl 2):S62S69. doi:10.2460/javma.23.05.0294

    • Search Google Scholar
    • Export Citation
  • 8.

    Soltero-Rivera M, Del Toro Quinones MP, Arzi B, Vapniarsky N. Importance of early diagnosis, multimodal treatment, and a multidisciplinary approach for oral eosinophilic lesions in cats: a retrospective study of 38 cases (1997–2022). J Am Vet Med Assoc. 2023;261(suppl 2):S70S78. doi:10.2460/javma.23.06.0312

    • Search Google Scholar
    • Export Citation
  • 9.

    Jackson K, Kelty E. Recent advances in the treatment and prevention of equine peripheral caries. J Am Vet Med Assoc. 2023;261(suppl 2):S79S86. doi:10.2460/javma.23.01.0036

    • Search Google Scholar
    • Export Citation
  • 10.

    Leps A, Korsos S, Clarysse M, Vlaminck L. Efficient primary surgical treatment of equine infectious sinusitis reduces postoperative aftercare and increases outcome results: a retrospective study of 130 cases. J Am Vet Med Assoc. 2023;261(suppl 2):S87S95. doi:10.2460/javma.23.05.0298

    • Search Google Scholar
    • Export Citation
  • 11.

    du Toit N, Pearce CJ. Long-term follow-up of equine incisor endodontic treatments using an orthograde technique. J Am Vet Med Assoc. 2023;261(suppl 2):S96S101. doi:10.2460/javma.23.07.0398

    • Search Google Scholar
    • Export Citation
  • 12.

    Tretow M, Hain AM, Bienert-Zeit A. Widespread prevalence of Equine Odontoclastic Tooth Resorption and Hypercementosis detected in German Icelandic horse population: impact of anamnestic factors on etiology. J Am Vet Med Assoc. 2023;261(suppl 2):S102S107. doi:10.2460/javma.23.05.0301

    • Search Google Scholar
    • Export Citation
  • 13.

    Hain AM, Þórisdóttir SL, Tretow M, Bienert-Zeit A. Potential impact of natural conditions on the rostral oral health: a study of horses in Iceland. J Am Vet Med Assoc. 2023;261(suppl 2):S108S113. doi:10.2460/javma.23.06.0303

    • Search Google Scholar
    • Export Citation
  • 14.

    du Toit N. Advances in dental management in the equine geriatric patient: strategies for improved welfare. J Am Vet Med Assoc. 2023;261(suppl 2):S114S120. doi:10.2460/javma.23.06.0350

    • Search Google Scholar
    • Export Citation
  • 1.

    Montebello JA, Granick JL, Bollig ER, Goldschmidt SL. Variation in knowledge, attitude, and practices toward antibiotic use among diplomates of the American Veterinary Dental College: a survey-based study. J Am Vet Med Assoc. 2023;261(suppl 2):S6S13. doi:10.2460/javma.23.06.0304

    • Search Google Scholar
    • Export Citation
  • 2.

    Goldschmidt S, Soltero-Rivera M, Quiroz A, et al. The diagnostic yield of preoperative screening for oral cancer in dogs over 15 years, part 1: locoregional screening. J Am Vet Med Assoc. 2023;261(suppl 2):S14S23. doi:10.2460/javma.23.05.0299

    • Search Google Scholar
    • Export Citation
  • 3.

    Goldschmidt S, Soltero-Rivera M, Quiroz A, et al. The diagnostic yield of preoperative screening for oral cancer in dogs over 15 years, part 2: distant screening. J Am Vet Med Assoc. 2023;261(suppl 2):S24S33. doi:10.2460/javma.23.05.0300

    • Search Google Scholar
    • Export Citation
  • 4.

    Castejón-González AC, Reiter AM. Surgical treatment for cleft palate in dogs yields excellent outcomes despite high rates of oronasal fistula formation: a narrative review. J Am Vet Med Assoc. 2023;261(suppl 2):S34S43. doi:10.2460/javma.23.06.0330

    • Search Google Scholar
    • Export Citation
  • 5.

    Arzi B. Contemporary management of temporomandibular joint fractures in dogs and cats: review and expert insights on diagnostic imaging, treatment strategies, and long-term outcomes. J Am Vet Med Assoc. 2023;261(suppl 2):S44S51. doi:10.2460/javma.23.04.0211

    • Search Google Scholar
    • Export Citation
  • 6.

    Jekl V, Jeklova E, Hauptman K. Radical debridement guided by advanced imaging and frequent monitoring is an effective approach for the treatment of odontogenic abscesses and jaw osteomyelitis in rabbits: a review of 200 cases (2018–2023). J Am Vet Med Assoc. 2023;261(suppl 2):S52S61. doi:10.2460/javma.23.06.0332

    • Search Google Scholar
    • Export Citation
  • 7.

    Anderson JG. Canine oral lesions: a decision-tree approach to ulcers, leukoplakia, and pigmented lesions. J Am Vet Med Assoc. 2023;261(suppl 2):S62S69. doi:10.2460/javma.23.05.0294

    • Search Google Scholar
    • Export Citation
  • 8.

    Soltero-Rivera M, Del Toro Quinones MP, Arzi B, Vapniarsky N. Importance of early diagnosis, multimodal treatment, and a multidisciplinary approach for oral eosinophilic lesions in cats: a retrospective study of 38 cases (1997–2022). J Am Vet Med Assoc. 2023;261(suppl 2):S70S78. doi:10.2460/javma.23.06.0312

    • Search Google Scholar
    • Export Citation
  • 9.

    Jackson K, Kelty E. Recent advances in the treatment and prevention of equine peripheral caries. J Am Vet Med Assoc. 2023;261(suppl 2):S79S86. doi:10.2460/javma.23.01.0036

    • Search Google Scholar
    • Export Citation
  • 10.

    Leps A, Korsos S, Clarysse M, Vlaminck L. Efficient primary surgical treatment of equine infectious sinusitis reduces postoperative aftercare and increases outcome results: a retrospective study of 130 cases. J Am Vet Med Assoc. 2023;261(suppl 2):S87S95. doi:10.2460/javma.23.05.0298

    • Search Google Scholar
    • Export Citation
  • 11.

    du Toit N, Pearce CJ. Long-term follow-up of equine incisor endodontic treatments using an orthograde technique. J Am Vet Med Assoc. 2023;261(suppl 2):S96S101. doi:10.2460/javma.23.07.0398

    • Search Google Scholar
    • Export Citation
  • 12.

    Tretow M, Hain AM, Bienert-Zeit A. Widespread prevalence of Equine Odontoclastic Tooth Resorption and Hypercementosis detected in German Icelandic horse population: impact of anamnestic factors on etiology. J Am Vet Med Assoc. 2023;261(suppl 2):S102S107. doi:10.2460/javma.23.05.0301

    • Search Google Scholar
    • Export Citation
  • 13.

    Hain AM, Þórisdóttir SL, Tretow M, Bienert-Zeit A. Potential impact of natural conditions on the rostral oral health: a study of horses in Iceland. J Am Vet Med Assoc. 2023;261(suppl 2):S108S113. doi:10.2460/javma.23.06.0303

    • Search Google Scholar
    • Export Citation
  • 14.

    du Toit N. Advances in dental management in the equine geriatric patient: strategies for improved welfare. J Am Vet Med Assoc. 2023;261(suppl 2):S114S120. doi:10.2460/javma.23.06.0350

    • Search Google Scholar
    • Export Citation

Advertisement