elena nenciulescu

Learn and Travel ….. story from vets

67509335_393199464955171_7827241570955952128_nDr Elena Nenciulescu from Romania has done her externship with Ana Nemec, DVM, PhD, Dipl. AVDC, Dipl. EVDC at our project LEARN AND TRAVEL with Vets on The Balkans.

We would like to express our gratitude as well to The University of Ljubliana, Faculty of Veterinary Medicine in Slovenia for the opporunity!

 

Let her tell us her story:

Last week I had the amazing opportunity to assist Dr. Ana Nemec during dental procedures and dental consultations. It really was AMAZING!learn and travel

I arrived in Ljubljana on Sunday, July 27th. I had a little rest and the next day my journey in the Slovenian world of veterinary dentistry began. The weekly schedule is usually like this: Monday, Tuesday, Thursday and Friday are for dental procedures (2-3 cases per day) and Wednesday is only for consultations.

On the first day, Dr. Nemec showed me the clinic (very well equipped, with ultrasound machine, X-ray machine and CT). What really impressed me was the dentistry room. It is fantastic: dental unit, dental X-ray machine, dental table (custom made) and all dental instruments and materials that you need for dental materials for exodontics, endodontics, orthodontics, orthopaedics and oral surgery. It was like heaven for me!

All the dental procedures that I assisted had the following steps:

  1. Dental consultation under anaesthesia and filling the dental chart (using the periodontal probe, every tooth was examined – mobility, gingival retraction, furcation exposure, gingivitis, periodontal depth)
  2. Full mouth dental X-rays and interpretation
  3. Sonic scaling and polishing
  4. Surgical extractions (the teeth were extracted based on the clinical and radiological findings)

It is important to perform all steps correctly and not to miss any of them. 90% of dentistry cases in general practice are periodontal patients that need periodontal therapy, so this is what all vets should learn to do properly.

Dental chart for cats Dental table prepared for the patient Dental unit, dental table, intraoral X-ray and equipment for anaesthesia

I had the chance to see a wide range of cases: mild to severe periodontal disease, stomatitis, tooth resorption, tooth avulsion, crown fractures, chin eosinophilic granuloma, peripheral odontogenic fibroma, intraosseous squamacell carcinoma, endodontic treatment re-check, but also cases of no dental disease that came in only to learn oral homecare which is also a big must for maintaining the oral health of our pets. All cases were discussed in detail.

Dr. Nemec is such a positive person, teaching dentistry is something natural for her. She answered all my questions (and there were many of them). I consider myself very lucky to be given this opportunity. I learned a lot!

But it was not all dental work for me last week, I also visited the city. Ljubljana is beautiful: the castle, the city centre, the museums, the Tivoli Park. It is worth visiting. I enjoyed my stay there very much. On Saturday, August 3rd I traveled back home.

Vets on the Balkans and Luba Gancheva, thank you for giving me this opportunity. Learn and Travel is a fantastic chance to grow professionally. Dr. Ana Nemec, thank you so much sharing all you knowledge with me! I am really grateful for this experience.

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Pink teeth in a 10 months old Cane Corso

 

30595139_1823183557733595_5657871534119714816_nDr Elena Carmen Nenciulescu

Bucharest, Romania

 

 

 

Hera, a 10 months old female Cane Corso, was presented on the 15th of October 2018 for a dental consultation. She had pink teeth, a strong halitosis, „wasn’t eating like she used to” and showed signs of pain (didn’t let anyone touch her mouth or look at her teeth).

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Crown fracture with pulp exposure 304 and 404

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Image 1 – Abnomal density of the cortical bone

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Image 3 – X-ray of the rostral maxilla

 

 

 

 

 

 

 

 

 

 

 

 

 

X-rays showed a very large pulp cavity in all teeth, very thin dentin and enamel, crown fracture with pulp exposure in 304 and 404 (Image 2), but also an abnomal density of the cortical bone in the mandible (Image 1) . The owner reported that the deciduous teeth were pink too.

 

 

 

 

 

 

 

 

 

 

 

 

The dog previosly had 2 surgeries in both elbows in another clinic (bilateral elbow dysplasia). Hera is also blind with both eyes (there is no vascularization in the eyes).

Antibiotics (amoxicillin with clavulanic acid 20 mg/kg/12 h) and analgesia (meloxicam 0.1 mg/kg/day) were immediately started and the patient was scheduled for a dental procedure a week later.  CBC and routine biochemistry were normal.

The dental examination under aneshesia revealed 6 crown fractures with pulp exposure (109, 110, 209, 210, 304, 404). We extracted these teeth and tried to seal  with the remaining ones. The dental extractions were very difficult, but the healing was good (as you can see in the images from the second dental procedure).

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Image 4 – Complicated fracture 304

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Image 5-404 pulpar granuloma and 404 extraction

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Image 6- 404 pulpar granuloma and 404 extraction

At this first dental procedure (Images 4 – 11), we took a blood sample to see what were the vitamine D3, calcium and parathoyroid hormone levels. When results came, we found out that Hera had hypoparathyroidism (PTH level was 1.2 pg/ml, almost 16 times lower then the physiologic range) and recomanded a thyroid ultrasound, which is not availiable unfortunately.

Also Vitamine B12 was low, so the patient recieved treatment for that too.

 

 

 

 

 

 

 

 

After the first procedure, the recovery was fast, the dog started to eat the next day, but only very soft food.

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Image 8- Clinical view of the right maxilla

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image 9-Clinical view of the right maxilla

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Image 10 – Clinical view of the right mandible

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Image 11 – Clinical view of the left maxilla

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Image 12 – Clinical view of the right maxilla and mandible – tooth wear of all teeth is more pronounced

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Image 13 – Clinical view of the lower incisors that are even „pinker” then the first time

The second dental procedure (Images 12 – 16) together with  the ovariohysterectomy took place on the 23rd of February 2019, when we performed extractions of 208 and 209 retained roots and full 405 was extracted for histopathological examination (that will be performed at Histovet by Dr. Teodoru Soare). The recovery was even better than the first one. Hera received clindamycin 11 mg/kg/day, 7 days and meloxicam 0.1 mg/kg/day, 4 days. Unfortunatelly, because a second set of radiographs were not available for this dental intervention.

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Image 14 – Closer look of the right maxilla

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Image 15 – Left upper premolars

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Image 16 – Left maxilla and mandible

 

 

 

 

 

 

 

 

 

 

 

The dental pathology of this patient might be a very rare congenital dental condition called „shell teeth”, in which teeth have large pulp chambers and insufficient coronal dentin. The treatment of this dental disease is full mouth extractions, but given the very high level of difficulty of the extractions, we chose to extract only the fractured teeth. It may be a consequence of a congenital hypoparathyroidism, which would also explain the other pathological signs (blindness, bilateral elbow dysplasia).

Hera is a very interesting case with high didactic value. She remains supervised for evaluation of her clinical evolution.

Both interventions took place at QincyVet and were performed together with Dr. Raluca Zvorasteanu.