Core

A step-by-step presentation with clinical photographs will be presented for identifying and treating common maxillary canine tooth oronasal fistulas in the dog. A single buccal mucoperiosteal technique will be presented to teach the participant the key principles to have a successful repair with the first surgery. Recognition, pathophysiology, treatment principles, and post-operative care will be outlined for success.

Learning Objectives:

1. Participants will learn to recognize inapparent and apparent oronasal fistulas of the maxillary canine teeth.
2. Participants will learn how to be successful with the single buccal mucoperiosteal and keep surgical techniques simple for a repair.
3. Participants will learn the key recommendations such as width of the flap for the defect, tension releasing mucoperiosteal flap, suture technique, and post-operative home care.
4. Participants will learn the first attempt at repair is the best attempt at repair and more advanced techniques are rarely needed.

Recent research has revealed a high level of microbial contamination in dental units water, coupled with limited implementation of disinfection protocols. These findings identified the pressing need to establish clear guidelines regarding acceptable microbial levels in water derived from dental units used in small animal dentistry, as well as standardized approaches to disinfection.
However, ensuring asepsis in veterinary dental procedures extends beyond the management of dental unit water systems. Critical considerations also include adequate preparation of both the patient and surgical personnel, maintenance of the surgical environment and equipment beyond dental units, and sterilization of critical surgical instruments and materials.
Adherence to aseptic principles not only safeguards patient health but also reduces the need to use antimicrobials. Moreover, integrating additional preventive measures, such as attention to ergonomics, minimizes the risk of occupational diseases among veterinary staff.
This lecture will examine these critical components, identify gaps in the current evidence base concerning veterinary dentistry, and propose general recommendations for both routine clinical practice and future research.

Canine tooth extraction is a procedure that is commonly performed in cats, but one that is fraught with potential complications. Among those complications are morbidity associated with prolonged anaesthesia, local tissue trauma, wound dehiscence, hemorrhage, nerve damage, loss of jaw structure and mandibular fracture. Risk factors for jaw fracture include tooth resorption and ankylosis, excessive alveoplasty, and improper extraction technique. Fractures typically occur through the alveolus but can also involve the mandibular symphysis. Proper case selection based on diagnostic imaging is important in preventing mandibular fractures during extraction, as is appropriate extraction technique. Mandibular fracture repair options include soft fixation with a muzzle, mandibular cerclage wiring, internal fixation, acrylic splinting.

Learning Objectives
Attendees will be able to:

1. review mandibular and dentoalveolar anatomy in the cat
2. understand the mechanism and common configuration of iatrogenic jaw fracture associated with canine tooth extraction in the cat
3. consider extraction techniques to make mandibular canine extraction easier, while decreasing the risk of iatrogenic complications
4. evaluate extraction-related mandibular fracture and
5. implement effective repair techniques

With the proper training, equipment and instruments, tooth extractions can often be successful, and the removal of a chronic source of inflammation is good for the patient. Complications will happen on a fairly regular basis, so this lecture includes discussion on challenges with extractions that may lead to complications, and how to deal with those issues.
While sometimes out of our control, time can place a large burden on the veterinarian. We are often limited by the available hours in our schedule, and when unexpected pathology is found, this can lead to the need for hurrying/rushing and loss of concentration, a bad combination that can lead to complications. Schedule planning can help to avoid ‘overbooking’ advanced procedures in the same day, and having the option to stage a procedure can be valuable.
Having the right equipment and instruments and keeping them` maintained and sharpened is so important. Without the optimal tools, extractions will be frustrating and can often lead to problems. Less than ideal sectioning of the tooth will also cause difficulties. Inadequate access to an extraction site may tempt us to use more force than finesse, and that can result in fracturing the tooth. Removing those root tips is typically warranted, but excess force can cause their displacement into the nasal cavity or mandibular canal, requiring options for retrieval
Not identifying, or not being cautious at extraction sites with compromised bone can lead to jaw fractures that must be managed further. Damage can occur to soft tissues if they are not protected, leading to lingual/sublingual tears, salivary duct injury, emphysema in underlying tissues and even air emboli.
Post extraction complications sometimes occurs due to patient self-trauma, so adequate analgesia and protection may be needed. Gingival flap dehiscence may occur if there was too much tension on the flap during closure. Even with good flap technique and adequate tension release, oronasal fistulation may recur, and gingival flaps and mandibular canine sites may have problems. Particularly in cats, sites in the region of an extracted tooth may experience trauma from the tooth directly opposite it. Pyogenic granulomas may occur at the site of mandibular first molar extraction due to maxillary premolar contact trauma, and lip entrapment may occur when maxillary canine teeth are extracted.

To understand the causes and nature of pathological processes (pathogenesis) it is important to research the microbiome of the oral cavity with an emphasis on the connection between the composition of the microflora, fluctuations in the Ph of saliva and the severity of the inflammatory process, which in turn gives an opportunity to provide effective treatment at various stages of a disease. Also, it helps to improve methods of oral cavity hygiene.
We conducted a study of the microbiome of the oral cavity in dogs and cats together with A.A. Smorodintsev Scientific Research Institute of Influenza of the Ministry of Health of the Russian Federation (abbreviated name: Research Institute of Influenza) and the veterinary laboratory POISK (Saint Petersburg).

The extent of periodontal disease (PD) can vary from patient to patient and even from tooth to tooth in the same patient. It is critical to fully evaluate the extent of attachment loss to initially ‘stage’ the tooth, but also to determine appropriate therapy options. In teeth with stage 1-2 periodontal disease, it is an easy decision to clean and treat those teeth to maintain them in a healthy periodontal state. Mild to moderate suprabony pockets require excellent management of the subgingival surfaces, including curettage. Perioceutical materials may be considered for use, but only have the cleaning is complete. Minor gingivoplasty may be appropriate in some cases.
Stage 4 PD teeth also lead to an easy decision to treat. In the great majority of cases, extraction is the best option, though considerations in teeth with F3 furcation involvement (theoretically in stage 4), we may have some alternatives.
When it comes to stage 3 periodontal disease, many factors must be taken into account to determine appropriate therapy. If it is a strategic tooth (canine and carnassial teeth), additional effort may be afforded, depending on the level and character of attachment loss, including alveolar bone. Assessment of adjacent teeth can often provide superior access to the strategic tooth by extracting the smaller tooth and proper soft tissue management keeping the goal of periodontal treatment in mind. Newer products are available to assist in the management of periodontal disease, even when furcation exposure is involved.
The patient status is also important when making a decision to provide advanced periodontal care. Due to the potentially longer anesthetic times, and likely more frequent anesthetic procedures to maintain periodontal health, a patient with systemic issue may benefit more from extraction and removal of the chronic inflammation. Even the client should be considered: while they might want to ‘save all the teeth’, will they be willing to provide adequate home care and regular professional therapy?
Our periodontal therapy options may range from non-surgical pocket curettage and perioceutics to minor gingivoplasty. With large or infrabony pockets, surgical intervention is needed with gingval flaps (+/- adacent tooth extraction) for adequate exposure. Regenerative procedures, particularly with infrabony pockets, is often considered and will be discussed briefly. Resection procedures are just as important when pocket depth involves more soft tissue, or non-harmonious osseous levels are found. Particularly with mandibular canines, deep pockets may be present, but extraction of adjacent incisors with soft (and bone) tissue management can remove proliferative, redundant or diseased tissue around the canine, partnered with appropriate alveoloplasty, to improve the situation of the tissues of the periodontium and overall periodontal health.
Recent advances in products that help provide scaffolding to enhance the healing of the cells of the periodontium

Regional anesthesia is a valuable adjunct in veterinary dentistry and oral surgery. Although patients are under general anesthesia, local blocks reduce inhalant requirements, smooth recovery, and improve comfort at discharge. The complex anatomy of the oral and maxillofacial region offers multiple opportunities for effective blockade.

Methods
A review of clinical practice, current literature, and the author’s experience was used to evaluate the benefits, techniques, and risks of regional anesthesia. Four commonly applied blocks were emphasized: infraorbital, caudal maxillary, middle mental, and caudal mandibular (inferior alveolar). Standard dosing and drug selection (lidocaine, bupivacaine) were summarized.

Results
Regional anesthesia provides analgesia intraoperatively and postoperatively, reducing the animal’s nociceptive response and minimizing reliance on inhalant anesthetics. Polypharmacy benefits include prevention of peripheral/central sensitization, reduced adverse drug effects, and improved postoperative pain management. Minimum alveolar concentration studies confirm decreased inhalant requirements with local blocks.
• Drug selection: Lidocaine (2%) offers rapid onset but short duration; bupivacaine (0.5%) provides longer analgesia (6–10 hrs, occasionally up to 3 days). Recommended doses: ≤5 mg/kg (dogs) and ≤2 mg/kg (cats).
• Techniques: Four sites can provide near-complete oral analgesia with small volumes (0.1–0.3 mL/site depending on size).
• Adjuncts: Combining local anesthetics with opioids (e.g., buprenorphine) may prolong analgesia, especially in chronic pain conditions.
• Complications: Reported risks include paresthesia, self-trauma, intravascular injection (leading to seizures or cardiotoxicity), and rare iatrogenic globe penetration. Avoiding tumor seeding, limiting volumes, and careful aspiration improve safety.

Conclusions
Regional anesthesia is not a substitute for general anesthesia but a cornerstone of multimodal pain management. When applied accurately, local blocks reduce anesthetic complications (e.g., hypotension, dysrhythmias, hypercapnia, hypoxemia), improve recovery quality, and enhance patient welfare in veterinary dental and oral surgical procedures.