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SAVE THE DATE: Tuesday, March 29th, 2016
VCA Alameda East Staff Meeting Room 
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Dear Doctors,

February is National Dental Health Awareness month, so we have a featured article from our very own board-certified veterinary dentist, Dr. John F Huff, III.  Dr. Huff and our dental team are in the office Monday through Thursday for questions.  

Also don't forget that we are here for you whenever you need us! Please keep in mind that we have Surgery, Neurology, and Internal Medicine doctors available 7 days a week.   Please contact our Specialty Coordinators (referral coordinators) at 720.975.2804 or at [email protected] with any questions.  We are here 7 days a week for you and will do our best to help facilitate appointments, phone consults, records, and anything else!

Our Neurology team has been out and about visiting practices this past month.  We hope to see you soon and please call if you would like us to stop by for an informal meeting so we can get to know our referring veterinarians.
 
Best regards,  
 
Angela Starkel  
Specialty Client Care Coordinator


 
     



Elise Contreras
Specialty Client Care Coordinator
Veterinary Orthodontics 
by John Huff, DVM
Diplomate American Veterinary Dental College
Fellow of the Academy of Veterinary Dentistry    
 
Braces for dogs! That's what most of our clients think when they here about orthodontics. Usually breeders want their show dog to have that perfect winning smile, just as we think of ourselves with perfect teeth. But that's not what veterinary orthodontics is all about. Our job is to provide an atraumatic occlusion. So many of our patients suffer needlessly from a traumatic occlusion where the dentition contacts either soft or hard tissue structures. Our job is not to provide the "perfect smile", but to prevent pain and suffering of all our patients.
 
Orthodontics comes from the Greek word orthos meaning "straight or proper" and odous meaning "tooth". In veterinary orthodontics we're not so concerned about "proper" or "straight", just comfortable and pain free. As a general practitioner for over twenty years, I didn't have the training or the knowledge to recognize that most malocclusions are painful for the animal. Tooth on tooth or tooth on soft tissue contact IS painful. How do I know? I started correcting these malocclusions and then evaluated my patients response and LISTENED to my clients. The owner and the animal will tell you.

As you know, most animals continue to eat despite great oral pain. How many obese patients do you see that have HORRIBLE periodontal disease? They simply swallow their food whole without chewing. The same is true for our orthodontic patients. If the pet cannot close the mouth complete ly without "hitting" other teeth or soft tissue, they are in pain, but will usually continue to eat. Once I started to correct these malocclusions, I was able to see the difference in my patients and hear the difference from my clients.
 
Veterinary orthodontics can be divided into three distinct categories. The first interceptive orthodontics, is the extraction or crown reduction of deciduous or permanent dentition that are contributing to alignment problems. The most common clinical example is the extraction of deciduous teeth that may be preventing normal jaw growth either in the mandible or maxilla. This is typically seen in a class III malocclusion (undershot) of the deciduous dentition where the upper incisors get "caught" behind the mandibular incisors causing pain and hindering normal jaw development. We try to "intercept" the orthodontic problem before it gets worse by extracting dentition, usually from the shorter jaw. In this case, we extract the maxillary incisors and maybe the maxillary canines to correct the "interlock" and allow the jaws to grow without interference. Interceptive orthodontics cannot correct genetically predetermined jaw length and must be timed correctively to have maximum effect.
 
The second category of veterinary orthodontics is preventative. It can be defined as the evaluation and elimination of condit ions that would lead to an orthodontic problem. This category can be divided into three subcategories which include occlusal assessment/supervision, spac e control and behavioral control. Deciduous exfoliation and perma nent dentition eruption are critical to normal occlusion. It is our job to assess this normal process and recognize any abnormalities. If abnormalities exist then we can take action (interceptive orthodontics). The interdental spaces, or diastenum, are sometimes just as important as where the teeth are. Crowding in particular can lead to malocclusion and predispose the area to periodontal disease. Managing these spaces falls under preventative orthod ontics. Behavioral habits and anxiety reactions can also affect the occlusion and correcting these behaviors is a part of this category.
  
Enough of the didactic lecture, let's get to the exciting part...BRACES FOR DOGS! Corrective orthodontics is the application of an orthodontic device to restore dental occlusion to a reasonably functional state and correct a traumatic occlusion. There are two stages of corrective orthodontics. The first stage is the active stage where the orthodontic devise is causing active resorption and deposition of bone to allow the dentition to move. Once the teeth have moved into their new position, the secon d stage, the retention stage, begins where the bone returns to a normal physiological state. The bone literally reforms into the new position and stays there. 
 
During the active stage of corrective orthodontics, teeth can move in six different ways. The six basic tooth movements include tipping, radicular (root movement), translation (whole tooth movement), rotation, extrusion (movement out of the alveolus) and intrusion (movement into the alveolus). Tipping is where the crown of the tooth carries the primary movement. Tipping is the most common movement in veterinary dentistry.    

A common clinical application of a tipping movement is to tip the maxillary canine distally when an animal has a rostromesial inclination. This is most commonly seen in Shelties where it is called a "Lance" tooth, but it can be seen in any breed. In order for the target tooth (the maxillary canine in this case) to move, there must be a stable foundation. This is the purpose of the anchor teeth. In this example, the anchor teeth are the combined resistance of the maxillary fourth premolar and the first molar. Orthodontic brackets are attached to the anchor teeth and the target tooth and an elastomeric chain is applied between the two. The placement of the brackets is critical. By placing the brackets near the gingival margin of the anchor teeth and placing the bracket coronally on the target tooth, I can take advantage of leverage to tip the maxillary canine distally.
 
The chain provides an intermittent force in which there are periods of force application interspersed with periods of rest. The patient is monitored weekly and the chain is replaced. The fresh elastomeric chain is tightened providing the active phase and as the tooth moves, the process enters the rest phase. Once the tooth has reached its final position, the chain is applied in a neutral position to act as a retainer. This typically needs to be twice as long as it took to move the tooth.
 
Another clinical application of corrective orthodontics would be the application of an incline plane to correct lingually displaced mandibular canines. This is a common class I malocclusion that results in the mandibular canines being displaced lingually and usually causing trauma to the palate. I have seen this so severe that the malocclusion causes an oronasal fistula! The correction of this problem involves creating an appliance to tip the mandibular canines buccally. An acrylic compound is applied to the maxillary canines and lateral incisors in such a way that it forms a "ramp" to engage the mandibular canines. At first the patient cannot completely close its mouth, but as the mandibular canines tip into a more normal position, the animal can close its mouth completely. At this point, the appliance stays in the mouth with the dentition in the corrected position to act as a retainer to complete the retention stage. The appliance is removed and the normal canine interlock maintains the atraumatic occlusion.
 
Veterinary orthodontics is a frustrating, challenging and rewarding aspect of veterinary medicine. The first step is to be critical of every animal's occlusion. It's amazing what you find when you look. As my professor in veterinary school always said, "to miss a diagnosis for not knowing is forgivable, but to miss a diagnosis for not looking is inexcusable." So keep on looking for those malocclusions.
 
John Huff, DVM
Diplomate American Veterinary Dental College
Fellow of the Academy of Veterinary Dentistry

Dr. Huff grew up in Littleton, Colorado, graduating from Arapahoe High School. He attended Colorado State University for seven years obtaining a Bachelor's degree in Chemistry with high honors in 1979 and his DVM in 1983 in the top 25% of his class. After practicing small animal medicine and surgery in Arizona for one year, Dr. Huff was accepted into and completed a rotating internship at the Animal Medical Center in New York City. After practicing in Michigan for seven years and in Utah for eleven years, Dr. Huff moved back home to friends and family in Colorado.

His professional achievements include traveling to England to help eradicate foot and mouth disease and special training in soft tissue and orthopedic surgery. Since 2003 Dr. Huff has pursued an interest in veterinary dentistry, obtaining the status of a Fellow in the Academy of Veterinary Dentistry in 2008 and Diplomate in the American Veterinary Dental College in 2009. Dr. Huff's practice is limited to veterinary dentistry with emphasis on endodontics (root canals), prosthodontics (crowns), orthodontics (braces), periodontology (gum disease) and oral surgery.

Outside of work Dr. Huff enjoys skiing, snowboarding, back country skiing, music, hiking, and camping. He has built a wood strip canoe, two guitars and has climbed all the peaks over 14,000 feet in Colorado. 


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