September Case of the Month: A Pain in the Mouth
Rouleaux is Dr. McDonald’s 5-year-old warmblood mare, who was found on a routine dental to have a cheek tooth that had shifted to an abnormal angle and developed a small fracture between her twice yearly dental exams. Dr. McDonald radiographed that tooth a few days later to evaluate the overall health of the tooth and determine what treatments may be necessary, suspecting that a root abscess may have been present. As you can see in the radiographs she took, the root of Rouleaux’s fourth cheek tooth (tooth 209) is very abnormal, with the normal structure of the root being completely replaced by lumpy and abnormal dental/boney material. Because this abnormal tooth root is so large, Dr. McDonald elected to have the mass biopsied before deciding how to proceed with treatment. Rouleaux had sinus surgery to expose the mass, and several pieces of the hard, white, boney mass were chipped off and sent to a pathologist for diagnosis. The histopathology results indicated that Rouleaux’s mass is an osteoma. Osteomas are benign tumours of bone; they do not spread or invade into the tissues around them but can continue to increase in size and become problematic through deforming normal structures or obstructing the normal function of nerves, ducts, blood vessels, etc around them, or triggering sinus infections. Because surgery to remove this large mass would involve removing one, and potentially two of Rouleaux’s cheek teeth -which can lead to the risk of on-going complications – Dr. McDonald has elected to closely monitor the mass for any changes with regular radiographs and will pursue removal of the mass and the affected teeth only if the osteoma is continuing to increase in size and cause Rouleaux problems.
