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Tooth Abscess
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JTB
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 Posted: Sat Feb 16th, 2019 05:06 am
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It worked! Thanks for the tips Dr Deb!

Attachment: Little0005-crp.jpg (Downloaded 81 times)

Last edited on Sat Feb 16th, 2019 05:12 am by JTB

JTB
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 Posted: Tue Mar 26th, 2019 07:20 am
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Hi Dr Deb, Little finally gets her tooth out next Monday...April the 1st! Be so good to have this sorted.

Re the converting the jpg image to tiff, so the images keep longer with no loss of quality. Is there a way of doing this for multiple images at once or do I do each one by itself?
I have spied the post of images wanted, yipee will have a look at my collection. Super fun clinic thank you for coming.
Kind Regards
Judy

DrDeb
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 Posted: Tue Mar 26th, 2019 08:40 am
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Judy, so far as posting images into the Forum, so far as I know, you can only put in one image per post. So if  you want to post three images, for example, you post the first one and then "reply" to yourself two more times.

As for converting .jpg's to .tiff's (or the reverse), yes, either .tiff or .bmp are the only two formats that do not involve compression upon re-save. In other words, with a .jpg or a .png or any other format, if you take that image that's in that format and open it and then maybe you work on it or change something about it and then you hit "save", the algorithm selectively removes pixels. Different formats, i.e. .jpg as opposed to .png for example, use different criteria as to exactly which pixels they remove, but all of them remove them. That means that if you save a .jpg once, and then open it and save it again, and keep doing this, eventually the image will degrade to pixel mush. This is similar to what happens when you make a photocopy of a photocopy of a photocopy...
eventually it's so "dirty" and so full of "static" that the image is obscured.

I know of no way to batch-convert .jpg's to .tiff's or the reverse. To convert a .jpg to a .tiff you just "save as" a .tiff. Please note the big difference between "save" and "save as" !

Let us know how Little's surgery goes, and thanks very much for noticing I need photos of students doing their "homework" at home. The new website is going to be AWESOME. Cheers -- Dr. Deb

JTB
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 Posted: Tue Apr 16th, 2019 08:54 am
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Little had her tooth extracted on the first of April. They ended up removing it through her mouth and no hole was made in her skull. The hole the tooth had come from was not packed with anything and 16 days later she is eating soaked hay and looking like nothing has happened. I have attached some pictures of the tooth. The vet/dentist who removed the tooth was excellent. He found a small dental remnant which is pictured. It took two hours to gently wriggle the tooth...well the dentist was sweating and we were cold....Then more x rays were taken to make sure all the tooth was gone. It has started to go a bit squashy on the root tips so it was high time it came out. A good job done. :-)

Attachment: tooth 1.jpg (Downloaded 38 times)

JTB
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 Posted: Tue Apr 16th, 2019 08:55 am
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Root of the tooth.

Attachment: tooth2.jpg (Downloaded 39 times)

JTB
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 Posted: Tue Apr 16th, 2019 08:57 am
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Some of the students who watched the extraction enjoyed sticking a needle into the hole!

Attachment: tooth3.jpg (Downloaded 39 times)

JTB
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 Posted: Tue Apr 16th, 2019 08:58 am
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Eight year old Little's tooth next to a 25 year old Shetland tooth that was so wiggly the dentist was able to remove it quite easily.

Attachment: tooth6.jpg (Downloaded 39 times)

DrDeb
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 Posted: Tue Apr 16th, 2019 12:08 pm
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Judy, "a bit squashy" would hardly describe it, I think....it should have stunk to high heaven.

The reason the students wanted to put a wire or needle into the tooth root was that they were probing for a defect in the way the tooth formed. There has to have been a reason why Little got the abscess in the first place; these things don't just develop out of thin air. So either the tooth is in fact fractured -- which your vets are saying is not the case and that's what the XRays show too, no fracture; or else there was a malformation.

This would show up clearly in the one view of the tooth which you do not present, which is the occlusal or chewing surface...if you get time, it would be nice to see this view. There must be a channel through the length of the tooth whereby food material can be packed down through it, through the length of the tooth and into the depths of the tooth, and then ferment and rot, and eventually with continued chewing or pressure from the bolus in the mouth, this stream of tiny rotting particles gets pushed all the way through the length of the tooth and emerges through the tooth root into the maxillary sinus. The large radiolucent (clear black) area on the XRays shows the amount of pus which had accumulated in the pony's maxillary sinus, the pressure from this expanding wad of pus being great enough to actually warp the bone of her face outward to form the bump that warned you in the first place that something was amiss.

I attach an image of the interior structure of a horse's cheek tooth (any of the three large premolars and three large molars that comprise the cheek-tooth row in each quarter of the mouth, of which the extracted tooth is one, to wit, the third from the front, which is the most posterior premolar tooth). You see in the drawing I attach a couple of things:

(1) Horse teeth are formed of three biogenic materials, enamel, dentine, and cementum (colored differently in the drawing). These materials appear to be interfolded when you look at the occlusal surface of the tooth -- the enamel in real life not being purple, but having a whitish appearance similar to cloudy quartz crystal. The dentine and cementum are both in actuality yellowish, although the dentine is of two types, primary and secondary, with the secondary dentine a darker yellow verging on brown.

(2) I said the three tooth materials 'appear' to be interfolded when you look at the occlusal surface. In actuality what you're seeing on the occlusal surface is a cross-section of a bundle of tubes the size of small straws. The surfaces of the tubes are highly wrinkled -- look closely at the wiggliness of the enamel outlines -- but nonetheless when you turn the tooth 90 degrees and consider its length, its length is the length of the bundle of tubes and its circumference is the circumference of the bundle plus the bundle's rather thick wrapping. The bundle's wrapping is cementum, so that the bundle is wrapped like a hot dog cooked inside of a biscuit (do you do this in New Zealand? They're good at a barbecue, and in America they're called 'pigs in a blanket').

(3) The deficit of which I spoke above is rather common, and represents a failure during the development of the tooth which occurs before the tooth erupts, while it is still developing inside the horse's skull or jaws. The failure is of the deposition of cementum. The generative tissues which lay down the fibrous architecture of the tooth and then precipitate the mineral substances which make the tooth hard are a perfect template for the tooth's complex interfolding. But some of those foldings or wiggles are so tiny that the generative tissue in that area is either too thin or never forms, so that whatever tooth substance that particular ply of tissue was supposed to have laid down never gets laid down. This is especially likely to happen with the cementum, which is found in two places in cheek teeth -- on the outside, as I mentioned previously, to form the 'blanket' for the pig-in-a-blanket. But it also is supposed to pack the infundibulae -- the infundibulae are supposed to be filled with cementum from the tooth base near the roots, all the way to the occlusal surface.

The infundibulae are marked on the drawing; they are also called enamel lakes, because their 'shorelines' are formed by enamel. Visualize them as an enamel tube filled with cementum (green) that runs the length of the tooth from root to occlusal surface, as the illustration shows. When an infundibulum doesn't fill with cementum during development, the tooth erupts into the mouth having a hole in it, i.e. one of the tubes is empty or partly empty. When food gets packed down into the dark, airless base of the empty tube, it ferments and produces acids which then erode the enamel 'cup' and the dentine zone which are supposed to separate the root from the infundibulum. Notice that the purple enamel at the bases of the infundibulae is comparatively thin.

There is also another possible channel where a wire could be passed through a tooth, and that would be through the so-called 'dental star' which represents the appearance of the distal end of the pulp cavity at the occlusal surface. These are never supposed to be open under any circumstances, because the pulp itself is full of thousands of tiny arterioles, i.e. it has a rich blood supply, and if the pulp cavity is opened the tooth will bleed and then it will most certainly abscess.

In a normal horse, the act of chewing and the wear that this produces on the tooth are coordinated with the deposition of secondary dentine, which is there in order to keep the pulp cavity roofed over. Also, certain cells in the pulp are pressure-sensitive and as the tooth wears down these cells signal the pulp to continually retreat toward the roots so that there is no danger of the distal end being broached. However, it can occur that secondary dentine is not laid down quickly enough, or that something the horse is eating is creating an acid environment in its mouth, or that the grind is out of equilibration enough that the horse can't clean (and this creates an acid mouth also), and under those circumstances you essentially get a cavity in the tooth which opens the dental star at the top. Food then gets packed into that, which ferments and acid-erodes the secondary dentine, thus broaching the pulp cavity and quickly leading to abscessing.

So what the students were doing with the wire was probing into the tooth roots to see if they could get the wire to emerge through one of the infundibulae or else the dental star at the occlusal surface, because this would prove the existence and position of an open channel.

Your lesson in equine anatomy for the day. Cheers -- Dr. Deb


Attachment: Horse tooth 3 materials infundibulae SM.jpg (Downloaded 36 times)

Aloha
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 Posted: Tue Apr 16th, 2019 08:49 pm
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I haven't used Photoshop in years, but it does have the ability to run a "batch" program. I would think you could batch convert the files from one format to another.

Dr. Deb, doesn't Photoshop do this?
Other imaging handling programs may have a similar feature.

I can explain more the process I used to use in Photoshop if that would be helpful.

Very interesting thread. Thank you for sharing.

DrDeb
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 Posted: Tue Apr 16th, 2019 11:15 pm
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Aloha, I don't understand your comments. Are you in the wrong thread? -- Dr. Deb

Aloha
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 Posted: Tue Apr 16th, 2019 11:42 pm
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Sorry! Judy asked above (see 2nd post above on this page) about converting multiple JPGs to TIFs.

DrDeb
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 Posted: Wed Apr 17th, 2019 02:22 am
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Oh. Well, I have no way to do that on my computer and never have had. If someone else knows how to do that, well the knowledge would certainly be handy. Be aware that I am still running Windows XP (with back versions of all software, which I had previously purchased) but peoples' comments would probably apply to later DOS's. Cheers -- Dr. Deb

JTB
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 Posted: Wed Apr 17th, 2019 09:28 am
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Thanks Aloha, I have stopped worrying about doing batches of photos as I had the wrong end of the stick. I have it all sorted out now!

Dr Deb, thanks for the tooth anatomy lesson, I had lots of questions about it and you have answered them, I was going to try and find the answers in my notes from when you came and did the teeth talk years ago. I have attached the images you requested. There are two black holes in the chewing surface, I have poked a needle into these holes and it goes in about two millimeters without me pushing too hard!

As an aside- I have the tooth in a plastic bag in the fridge and how am I best to preserve it, the Shetland tooth was dry and just needed a wash when it came out so I didn't 'do' anything to it. Shall I leave it out in the sun for the flies to clean up?

I took the tooth to my own dentist and he was only mildly interested, wanted to know how they got it out.

Is this issue likely to flair up in some of Little's other teeth if it is a malformation?

Thanks heaps for your time.
Kind Regards Judy

Attachment: tooth4.jpg (Downloaded 19 times)

JTB
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 Posted: Wed Apr 17th, 2019 09:29 am
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Another photo without the Shetland tooth.

Attachment: tooth7.jpg (Downloaded 19 times)

DrDeb
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 Posted: Wed Apr 17th, 2019 03:38 pm
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Aha. Well, you can see for yourself that two of the infundibulae do indeed have deficits, they are not completely filled with cementum, so that you can see a 'hole' on the occlusal surface. The inner edges of the deficits are smooth rather than eroded and rough; the latter would indicate caries. The dental stars and secondary dentine are normal.

Now, the tooth as a whole as viewed from the outside appears somewhat abnormal; it is plumper at the center than most, and somewhat twisted or spiraling. This may indicate that the tubes wander or spiral in about the same degree. Sometimes also, when serial sections are cut of a tooth (cutting it into slices like a loaf of bread), one finds that the infundibulae (or sometimes the pulp tubes) pinch off down to a tiny pinprick in the middle but reappear at normal size as you go out to either the root or crown ends. But it may also be that the infundibulum is clogged with packed food debris -- and I actually think this likely even if the tooth is somewhat malformed.

This will be cleared out as you clean the tooth up. Just put it in a pot of water and set the pot outdoors in some sunny spot. There, all the fleshy remnants and the blood, as well as any food particles, will rot. This technique of specimen preparation is called 'maceration'. You'll need to keep the pot topped up with water, and leave it for quite a while -- since it is coming winter now in NZ, you are probably looking at next spring or even later.

Alternatively, you can prep the specimen on the stove. Get a pot and put a layer of wire in the bottom -- this can be a folded piece of wire screening, or perhaps you have a big pot that's used for canning and they come with wire 'bumpers' that you put in the bottom so the glass jars aren't sitting right flat on the bottom of the pot when it's on the fire, which might overheat them and cause them to burst. That's the idea here too; the specimen must not be allowed to touch any of the metal surfaces of the pot.

Once you've fixed it up so this won't happen, then put the pot on 'simmer' -- not boil -- and give it an hour. Then, using tongs, remove the tooth (it will be very hot) and lay it on a paper towel until cool enough to handle; then rinse and try your wire again.
You may need to 'simmer' two or three times to get it as clean as possible. Use a small, intense flashlight to look up into the roots to see if there's still material up in there, or probe gently with your wire to see if any rubbery-like material comes loose.

DO NOT put lye in the water; that will decalcify the specimen, and for the same reason, DO NOT bleach it with household bleach after you finish. You can put a little Pine-Sol (stuff you mix to mop the kitchen floor with) in the water; that will make the specimen smell nicer and the mild kind of soap they make that cleanser with will help clean the specimen without damaging it.

The other thing I wanted to mention is, notice how much bigger the openings for the pulp at the root are in Little's tooth are, than in the more worn tooth from the old pony. This is because, as the horse and its teeth age, the circulation to the pulp gradually dies and the pulp itself gradually dies at the root end. As this happens, the cells that maintain the tooth and that lay down cementum close the holes in the tooth roots through which the circulation to the pulp enters, until those openings are no bigger than pinholes. Then when the dentist comes to help the horse get rid of an old, loose tooth it comes out easily. Little's tooth was not 'supposed' to come out at such a young age, so the surgeon had to work at it considerably to get the vessels feeding the pulp to break. You probably, at some point, if you were in the surgery room, heard a 'sucking' sound from the tooth; that's the moment when the circulation got broken.

Further, horse teeth are held into their long sockets, which are like farm silos, by strong ligaments which span from the inner surfaces of the sockets to the exterior surface of the tooth. These ligaments help the tooth erupt iteratively as it wears, so that the height of the cheek tooth battery within the mouth is continuously maintained. But when extracting a young tooth, the dentist has to break a whole length of them because younger teeth are longer. In the geriatric pony, there were hardly any stabilizing ligaments left, and indeed if the dentist hadn't happened to come along, the pony would have spat the expired tooth out itself at some point.

The last thing is this: your occlusal-view shots make this show up very clearly. Notice that on the lingual (tongue) side of the tooth which shows in the photo, (and almost certainly also on the buccal or cheek side of the tooth), there is a rough, eroded band which would have been located just above the gum when the tooth was still in the mouth. This is the result either of feeding sugary bagged feed, something else sugary, or else the whole dentition is far out of equilibration so that the horse can't fully excurse the jaws (move them from side to side) when it chews and thus cannot clean the buccal pouches. Do you have 'Wheat Thins' crackers in NZ? I'm sure if not sold by that name there is something similar: thin, crisp little squares with a sweet-nutty flavor but BOY do they stick to one's teeth. So you take your tongue and you put it in the space between your teeth and your cheek and you work at cleaning the gummy stuff off the outsides of your teeth. Or maybe you use your finger or a toothbrush. But the horse has no fingers and no toothbrush, and he also cannot put his tongue into the buccal pouch.

Little's teeth are not out of equilibration, however; I have mentioned this for the benefit of other readers. In her case, the eroded band -- which is called 'gum line caries' -- is the result of something sugary in the diet. What could that be in her case? Ordinary sugary grass doesn't cause gumline caries, and neither does ordinary hay. Is she getting some kind of numnuts or sweetfeed?

Insofar as she has gumline caries, I also have to suspect that once you get your tooth cleaned up by maceration or simmering, you will be able to pass the wire cleanly through.

And by the way thank you VERY much for the photos -- they'll appear in our new ESI website when that's ready, probably in another month. Cheers -- Dr. Deb


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