Page 769 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

744 CHAPTER 4

VetBooks.ir 4.47 dal premolars and molars associated with secondary
Cases of dental pulpitis affecting maxillary cau-

dental sinusitis usually present with a malodourous
unilateral nasal discharge, submandibular lymph-
adenopathy and reduced resonance to percussion
over the affected sinuses.

Differential diagnosis
Mandibular fractures, dental cysts, primary maxil-
lary sinusitis (if nasal discharge present) and trau-
matic lesions.

Diagnosis
Examination of the occlusal surface of both maxil-
lary and mandibular cheek teeth can reveal dentinal
Fig. 4.47 A fissure in the secondary dentine raises defects in secondary occlusal dentine overlying
suspicion of exposure of the underlying pulp. dental pulp horns in 57% of cases. Gross caries and
dental fracture can be observed in some cases, and
such fractures are pathological as the tooth is struc-
maxillary apical infections frequently discharge turally weakened after pulp necrosis and cessation of
into the maxillary sinuses resulting in a sinus empy- secondary dentinogenesis.
ema, which can involve the rostral maxillary, caudal The diagnosis can be confirmed radiographi-
maxillary or ventral conchal sinuses, depending on cally or by using CT images (Figs. 4.48, 4.49).
which tooth and dental roots are involved. It is rare Multiple radiographic projections including lat-
to have involvement of more than a single tooth, and eral, lateral 30º dorsolateral and dorsoventral views
the suppuration is usually localised to a single dental should be obtained in the standing sedated horse.
root, although necrosis of multiple root pulps may Radiographic changes associated with dental api-
occur due to pulp communication. cal infections include the presence of a radiolucency

4.48 4.49

Fig. 4.48 An oblique radiograph of the upper molars Fig. 4.49 Transverse CT reconstruction showing
on the right side. Note the distorted caudal root of 108 maxillary 09s with buccal fractures and apical pulpitis
with surrounding maxillary bone lysis (arrow). of 109 (arrows).