October 2007
Dr Gerhard Steenkamp

A 6 year-old Cross breed dog is presented with halitosis.  On examining the oral cavity you see the following:

a What dental disease could be a sequel to this foreign body stuck transpalatal?
b How would you diagnose dental disease in this patient?
c What treatment options are available?

MEMO

a A transpalatal foreign body like a sosatie stick, that gets lodged between the carnassial teeth may lead to periodontal disease.  The gingival/mucosa can be damaged by trauma when the stick is initially bitten, but will then be aggravated by pressure from the foreign body, as well as acting as a nidus for infection.  It appears that after initial discomfort these patients does not appear to be too painful as they very seldom get presented early on in the process, with pain.

b The stick needs to be removed under a general anaesthesia by cutting it in half, preventing further trauma to the tissues.  Both carnassial teeth (108, 208) needs to be evaluated using a dental probe.  The clinician should look for loss of attachment (recession/periodontal pockets) as well as furcation defects (loss of bone between the rostral and caudal roots).  Clinical evaluation should also be followed up with dental radiography of these teeth.

c As with any other periodontal diseased tooth, the severity of the disease will determine the action you need to take.  If you catch this a day or 2 after the initial incident, removal of the stick together with a professional cleaning and daily oral rinsing for a week with a antiseptic mouth rinse should be sufficient.  Should there be:
- attachment loss/pockets in excess of 5mm,
- a furcation defect where there may be severe bone loss between the roots
- mobility of the tooth/teeth
- signs of periapical pathology extraction of the affected teeth are indicated

The accompanying photo shows a different case that developed osteomyelitis around the 208 after a transpalatal foreign body was removed.