S M I L E B O O K I VS M A L L A N I M A L D E N T A L A N A T O M Y , P A T H O L O G Y A N D C H A R T I N G

B Y J A N B E L L O W S , D . V. M . D I P L O M AT E , A M E R I C A N V E T E R I N A R Y D E N TA L C O L L E G E

2 SmileBook IV

INTRODUCTION

Pfizer Animal Health understands the importance of small animal dentistry and is

committed to the well-being of companion animals everywhere. In demonstration of

this commitment, Pfizer Animal health sponsored Dr. Jan Bellows in this publication,

Smile Book IV, Small Animal Dental Anatomy, Pathology, and Charting. The small

animal practitioner and technician will find Smile Book IV a valuable aid in advancing

their dental knowledge.

Pfizer Animal Health would like to thank Dr. Bellows for authoring this publication and

veterinary dentists, Drs. Gregg DuPont, Gary Goldstein, Fraser Hale, Barron Hall,

Steven Holmstrom, Ken Lyon, and Frank Verstraete for their contributions.

ABOUT THE AUTHOR

Dr. Jan Bellows is a Diplomate of the American Veterinary Dental College and also a

Diplomate of the American Board of Veterinary Practitioners. He has authored two

books on veterinary dentistry in addition to the Smile Book series and has lectured

extensively in the United States and Europe. You can reach Dr. Bellows through his

Web site, www.dentalvet.com.

SmileBook IV 3

Dental Charting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Canine Dental Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Feline Dental Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Normal Canine Dental Anatomy—Immature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Normal Canine Dental Anatomy—Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Normal Feline Dental Anatomy—Immature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Normal Feline Dental Anatomy—Adult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Congenital/Developmental Dental Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Periodontal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Periodontal Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

The Traumatized Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Fractured Tooth Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Feline Odontoclastic Resorption Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Malocclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Benign Oral Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Malignant Oral Masses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

TABLE OF CONTENTS

4 SmileBook IV

DENTAL CHARTING

The dental chart is a permanent record of a patient’s dental care including dental history,tooth abnormalities, radiographic findings, periodontal examination, proposed, actual,declined, and future treatment plans as well as home care instructions.

Recording the condition of all teeth, as well as soft and hard tissues, is necessary to providequality care. The charting of existing conditions provides basic information for an accurate,comprehensive treatment plan.

A thorough clinical examination must be conducted to complete the chart. Helpful handinstruments include a periodontal probe, explorer, and dental mirror. Excellent lighting andmagnification are also necessary to clinically evaluate the oral cavity.

The dental chart includes:

• Dental history- Has the patient had professional oral treatment in the past? What isthe patient’s diet? What is the client doing for home dental care?

• Skull type (brachycephalic-flat faced, mesaticephalic-medium faced,dolichocephalic-long nosed)

• Occlusion abnormalities

• The amount of plaque and calculus present

• Tooth abnormalities

• Radiographic findings

• Periodontal abnormalities including inflammation, gingival edema, periodontal pocketdepths, attachment loss, gingival recession or hyperplasia, furcation involvement, andmobility

• Proposed/ declined treatment

• Actual treatment• Future treatment plans• Home care instructions including proposed re exam appointments

HOW TO CHART

Before anesthesia the animal is given a general head examination with attention tostructures around the mouth (facial swellings, painful areas, lymph nodes). The mouth isopened and shut to check for pain, crepitus, decreased range of motion, and occlusion.

SmileBook IV 5

DENTAL CHARTING

Anesthesia is essential for thorough examination and charting. To evaluate each toothindividually, complete immobilization is necessary. Generally, the mouth is charted beforecleaning and can be recharted if a significant amount of calculus has been removed

Two person (“four handed”) charting is a fast and efficient way to record dental disease.One person examines the mouth while the other records information on the chart. Underanesthesia, charting begins with evaluation of the mouth for presence of plaque andcalculus on the teeth. Next, the mouth is examined for missing teeth. A circle is placed onthe chart around missing teeth. Enamel and dentin fractures are then noted, includingpulpal exposure if present. A periodontal probe with millimeter gradations is inserted atthe interface between the free gingiva and tooth surface. The probe is gently advanced tothe bottom of the sulcus or periodontal pocket and “walked” around the tooth. Abnormalmeasurements at the four corners of each tooth are recorded. The attachment loss andprobe depths are noted on the chart. Finally, other lesions are observed and noted.

1. Examine rostral and distal occlusion before intubation, record abnormalities.

2. After intubation, examine the mouth and circle all visibly missing teeth on the dentalchart.

3. Record any fractured teeth.

4. Check for tooth mobility using an instrument handle pressed against the tooth.Record abnormal mobility (M1, M2, M3).

5. Record amounts of plaque and/or calculus accumulation.

6. Record abnormal probing depths and/or attachment levels around each tooth.

7. Expose and process dental radiographs where indicated.

8. Clean the teeth.

9. Reprobe, if a significant amount of calculus is removed.

10. Formulate a treatment plan through tooth by tooth evaluation—draw a diagonalline though teeth which need to be extracted, record a “PCT” (perioceutical) next toteeth which can be helped with local antibiotic application.

11. Calculate fees for the treatment plan and contact the owner for approval while thetechnician is completing the teeth cleaning process.

12. Once the owner approves, complete the initial treatment and record all care on thedental chart.

6 SmileBook IV

CANINE DENTAL CHARTCanine Dental Chart

AL––––– Attachment LossAT––––– AttritionCA–––––CariesCWD–––CrowdingED –––––Enamel DefectEP –––––EpulisFE ––––– Furcation ExposureFX–––––FractureGH–––––Gingival HyperplasiaGV/GP ––Gingivectomy/PlastyLPS ––––Lymphocytic, Plasmacytic, StomatitisM––––––Mobile Tooth

–––––– Missing ToothOP –––––Odontoplasty

OM––– Oral MassONF–– Oronasal FistulaPE––––Pulp ExposurePP–––Periodontal PocketRD––– Retained DeciduousRE––––Root ExposureRL––––Resorptive LesionROT–– Rotated ToothRPC––Root Planing, ClosedRPO–– Root Planing, OpenRTR–– Retained RootX–––––ExtractionXS –––Extraction, SectionedXSS––Extraction, Surgical

Pet’s Name:

Breed:

Date:

Sex:Age:

Presenting Complaint:

Signs:

Diagnosis:

Treatment:

Clean/Polish/Fluoride:

Root Planing/Packing:

Comments:

Antibiotics Dispensed:

Pain Medications: Inj:Dispensed:

Diet: Home Care:

Recheck:

Routine Extended

X-rays:

Procedure Record

Abbreviation Key

MaxillaRight Left

Mandible

AIF 0603108

Antirobe® and Clavamox® are registered trademarks and Doxirobe™ is a trademark of Pfizer Animal Health. Adapted with permission of Johnathon R. Dodd, DVM, FAVD, Dip. AVDC and Robert B. Wiggs, DVM, FAVD, Dip. AVDC.

© 2003 Pfizer Inc

Medical Alert:

SmileBook IV 7

FEL INE DENTAL CHARTFeline Dental Chart

MaxillaRight Left

Mandible

AIF 0603108

Antirobe® and Clavamox® are registered trademarks of Pfizer Animal Health. Adapted with permission of Johnathon R. Dodd, DVM, FAVD, Dip. AVDC and Robert B. Wiggs, DVM, FAVD, Dip. AVDC.

© 2003 Pfizer Inc

AL––––– Attachment LossAT––––– AttritionCA–––––CariesCWD–––CrowdingED –––––Enamel DefectEP –––––EpulisFE ––––– Furcation ExposureFX–––––FractureGH–––––Gingival HyperplasiaGV/GP ––Gingivectomy/PlastyLPS ––––Lymphocytic, Plasmacytic, StomatitisM––––––Mobile Tooth

–––––– Missing ToothOP –––––Odontoplasty

OM––– Oral MassONF–– Oronasal FistulaPE––––Pulp ExposurePP–––Periodontal PocketRD––– Retained DeciduousRE––––Root ExposureRL––––Resorptive LesionROT–– Rotated ToothRPC––Root Planing, ClosedRPO–– Root Planing, OpenRTR–– Retained RootX–––––ExtractionXS –––Extraction, SectionedXSS––Extraction, Surgical

Pet’s Name:

Breed:

Date:

Sex:Age:

Presenting Complaint:

Signs:

Diagnosis:

Treatment:

Clean/Polish/Fluoride:

Root Planing/Packing:

Comments:

Antibiotics Dispensed:

Pain Medications: Inj:

Dispensed:

Diet: Home Care:

Recheck:

Routine Extended

X-rays:

Procedure Record

Abbreviation Key

Medical Alert:

AIF 0603108

Antirobe® and Clavamox® are registered trademarks and Doxirobe™ is a trademark of Pfizer Animal Health. Adapted with permission of Johnathon R. Dodd, DVM, FAVD, Dip. AVDC and Robert B. Wiggs, DVM, FAVD, Dip. AVDC.

© 2003 Pfizer Inc

8 SmileBook IV

ORAL HYGIENE V IS IT—COMPLETED DENTAL CHART

AB abrasionAL attachment levelAPG apexogenesisAPX apexificationAT attritionB biopsyB/E biopsy excisionalB/I biopsy incisionalBG bone graft (includes placement of bone

substitute or bone stimulant material)C canineCA cariesCBU core build upCFL cleft lipCFL/R cleft lip repairCFP cleft palateCFP/R cleft palate repairCMO cranio–mandibular osteopathyCR crownCR/M crown metalCR/P crown preparationCR/PFM crown porcelain fused to metalCRA crown amputationCRL crown lengtheningCRR crown reductionCS culture/sensitivityCWD crowdingDT deciduous (primary) toothDTC dentigerous cystE enamelE/D enamel defectE/H enamel hypocalcification or hypoplasiaF flapF/AR apically repositioned periodontal flapF/CR coronally repositioned periodontal flapFE furcation exposureF/L lateral sliding periodontal flapFB foreign bodyFGG free gingival graftFRE frenoplasty (frenotomy, frenectomy)FX fracture (tooth or jaw)FX/R repair of jaw fractureFX/R/P pin repair of jaw fractureFX/R/PL plate repair of jaw fractureFX/R/S screw repair of jaw fractureFX/R/WIR wire repair of jaw fractureFX/R/WIR/C cerclage wire repair of jaw fractureFX/R/WIR/ID interdental wire repair of jaw fracture

FX/R/WIR/O osseous wire repair of jaw fractureG granulomaG/B buccal granuloma (cheek chewing lesion)G/E/L eosinophilic granuloma–lipG/E/P eosinophilic granuloma–palateG/E/T eosinophilic granuloma–tongueG/L sublingual granuloma (tongue chewing

lesion)GH gingival hyperplasia/hypertrophyGR gingival recessionGTR guided tissue regenerationGV gingivoplasty (gingivectomy)I1,2,3 Incisor teethIM impression and modelIMP implantIO interceptive (extraction) orthodonticsIO/D interceptive orthodontics deciduous

(primary) toothIO/P interceptive orthodontics permanent

(secondary) toothIP inclined planeIP/AC acrylic inclined planeIP/C composite inclined planeIP/M metal (i.e. lab produced) inclined planeIRR internal root resorptionLAC lacerationLAC/B laceration buccal (cheek)LAC/L laceration lipLAC/T laceration tongueM1,2,3 molar teethMAL malocclusionMAL/1 class I malocclusion (normal jaw

relationship, specific teeth are incorrectlypositioned)

MAL/2 class II malocclusion (mandible shorterthan maxilla)

MAL/3 class III malocclusion (maxilla shorter thanmandible)

MAL/AXB anterior crossbiteMAL/BN base narrow mandibular canine toothMAL/PXB posterior crossbiteMAL/WRY wry biteMN mandible or mandibularMN/FX mandibular fractureMX maxilla or maxillaryMX/FX maxillary fractureOA orthodontic applianceOA/BKT bracket orthodontic applianceOA/BU button orthodontic appliance

SmileBook IV 9

ABBREVIAT IONS

10 SmileBook IV

ABBREVIAT IONS (CONTINUED)

OA/EC elastic (power chain) orthodontic applianceOA/WIR wire orthodontic applianceOAA orthodontic appliance adjust OAI orthodontic appliance installOAR orthodontic appliance removeOC orthodontic/genetic consultationOM oral massOM/AD adenocarcinomaOM/EPA acanthomatous ameloblastoma (epulis)OM/EPF fibromatous epulisOM/EPO osseifying epulisOM/FS fibrosarcomaOM/LS lymphosarcomaOM/MM malignant melanomaOM/OS osteosarcomaOM/PAP papillomatosisOM/SCC squamous cell carcinomaONF oronasal fistulaONF/R oronasal fistula repairOR orthodontic recheckOST osteomyelitisPC pulp cappingPC/D pulp capping directPC/I pulp capping indirectPCT perioceutical treatmentPD0 normal periodontiumPD1 gingivitis onlyPD2 < 25% attachment lossPD3 25-50% attachment lossPD4 >50% attachment lossPDI periodontal disease indexPE pulp exposurePM1,2,3,4 premolar teethPT palatal traumaPRO periodontal prophylaxis (examination,

scaling, polishing, irrigation)PU pulpitisR restoration of toothR/A restoration with amalgamR/C restoration with compositeR/CP restoration with compomerR/I restoration with glass ionomerRAD radiographRC root canal therapyRC/S surgical root canal therapyRD retained deciduous (primary) toothRE root exposureRL resorption lesion

RL1 RL into enamel onlyRL2 RL into dentinRL3 RL into pulp or root canalRL4 RL3 + extensive structural damageRL5 RL crown lost, root tips remainRPC root planing–closedRPO root planing–openRRT retained root tipRRX root resection (crown left intact)ROT rotated toothS surgeryS/M mandibulectomyS/P palate surgeryS/X maxillectomySC subgingival curettageSN supernumerarySPL splint SPL/AC acrylic splintSPL/C composite splintSPL/WIR wire reinforced splintST stomatitisST/CU stomatitis–contact ulcersST/FFS stomatitis – feline faucitis-stomatitisSYM symphysisSYM/S symphyseal separationSYM/WIR wire repair of symphyseal separationT toothT/A avulsed toothT/FX fractured toothT/I impacted toothT/LUX luxated toothT/NE near pulp exposureT/NV non-vital toothT/PE pulp exposureT/V vital toothTMJ temporomandibular jointTMJ/C temporomandibular joint condylectomyTMJ/D TMJ dysplasiaTMJ/FX TMJ fractureTMJ/LUX TMJ luxationTMJ/R reduction of TMJ luxationTP treatment planTRX tooth partial resection (e.g. hemisection)VPT vital pulp therapyX simple closed extraction of a toothXS extraction with tooth sectioning,

non-surgicalXSS surgical (open) extraction of a tooth

SmileBook IV 11

NORMAL CANINE DENTAL ANATOMY—IMMATURE

Right buccal Anterior Left buccal

Right buccal Anterior Left buccal

OCCLUSION

Right buccal Anterior Left buccal

Occlusal

Occlusal

MAXILLA

MANDIBLE

12 SmileBook IV

NORMAL CANINE DENTAL ANATOMY—ADULT

Right buccalOcclusal

Occlusal

Anterior Left buccal

MAXILLA

MANDIBLE

Right buccal Anterior Left buccal

OCCLUSION

Right buccal Anterior Left buccal

SmileBook IV 13

MAXILLA

NORMAL FEL INE DENTAL ANATOMY—IMMATURE

Right buccal Anterior Left buccal

MANDIBLE

Right buccal

Occlusal

Occlusal Anterior Left buccal

OCCLUSION

Right buccal Anterior Left buccal

14 SmileBook IV

NORMAL FEL INE DENTAL ANATOMY—ADULT

MAXILLA

Right buccalOcclusal Anterior Left buccal

MANDIBLE

Right buccalOcclusal Anterior Left buccal

OCCLUSION

Right buccal Anterior Left buccal

SmileBook IV 15

CONGENITAL/DEVELOPMENTAL DENTAL PATHOLOGY

ENAMEL DEFECTS

Enamel hypoplasia (EH) Enamel hypomineralization(EH)(hypocalcification)

Clinically missingmandibular firstpremolar

Radiograph displayingdiagonally impactedfirst premolar

Clinically missingmandibular canine

Radiograph displayingembedded malformedcanine

CLINICALLY MISSING TEETH

Radiograph confirmsmissing tooth

Clinically missingmandibular firstpremolar

Radiograph displayinghorizontally impactedfirst premolar andbone loss

Clinically missingmandibular secondpremolar

Yellow stained incisors,canines and premolarsfrom tetracycline use

DENTIN STAINING

Yellow stained incisorsfrom tetracycline use

16 SmileBook IV

CONGENITAL/DEVELOPMENTAL DENTAL PATHOLOGY

ROTATED TOOTH (ROT)

FUSION GEMINI

PERSISTENT PRIMARY (DECIDUOUS) TEETH (DT) CANINE

Persistent mandibularincisors and canines

Persistent maxillary canine Persistent mandibular fourthpremolar

Fusion of the left first andsecond maxillary incisors

Clinical appearance of fusedmaxillary incisor

Gemination of the maxillaryfirst premolar

Radiograph of thegeminated tooth

Incisor Maxillary left thirdpremolar

Supernumerarymaxillary incisor

Supernumerarymaxillary first premolar

SUPERNUMERARY TEETH (SN)

Gemination of the maxillaryleft second primary incisor

Radiograph of impactedpermanent mandibularfourth premolar

PERSISTENT PRIMARY (DECIDUOUS) TEETH (DT) FELINE

Maxillary persistent canines(anterior view)

Maxillary persistent canine(buccal view)

SmileBook IV 17

PERIODONTAL D ISEASE

NORMAL GINGIVA (PD 0)

Canine Feline

GINGIVITIS (PD 1)—INFLAMMATION ONLY NO SUPPORT LOSS

EARLY PERIODONTAL DISEASE (PD 2) <25% SUPPORT LOSS

Periodontal probe showing<25% support loss

Radiograph withprobe inserted

Feline maxillary fourthpremolar

Radiograph of thefeline mandibularmolar showing earlyperiodontal disease

Canine Feline

•Healthy gingiva can be graded as PD 0

Periodonal disease is graded: •Stage 1 (PD 1) (gingivitis) appears as aredness of the gingiva with no attachmentloss.•Stage 2 (PD 2) (early periodontitis) showsan increase in inflammation and edema. Instage 2 there will be less than 25% ofsupport loss when probed.•Stage 3 (PD 3) (moderate periodontitis)occurs when there is a moderate loss ofattachment or moderate pocket formationwith between 25-50% support loss.Furcation exposure and mobility may bepresent. The gingiva will bleed upon gentleprobing at this stage.•Stage 4 (PD 4) (advanced periodontitis)occurs when there is breakdown of thesupport tissues with severe (>50% supportloss) pocket depth or recession of thegingiva.

18 SmileBook IV

PERIODONTAL D ISEASE

MODERATE PERIODONTAL DISEASE (PD 3) 25-50% SUPPORT LOSS

ADVANCED PERIODONTAL DISEASE (PD 4) >50% SUPPORT LOSS

Periodontal fistula 9mm attachmentloss (gingivalrecession)

Feline gingivalrecession

Supereruption (extrusion)of the left mandiblarcanine

Canine Mandibular fourthpremolar

Feline maxillary fourthpremolar

Radiograph of themandibular molarshowing moderateperiodontal disease

Radiograph of felinealveolar bone expansion

Feline alveolar boneexpansion

SmileBook IV 19

PERIODONTAL D ISEASE

GINGIVAL RECESSION (GR)

Canine maxillary fourthpremolar/first molar

Feline mandibular molar Canine maxillary fourthpremolar

MUCOGINGIVAL DEFECTS

Boxer’s mandibular incisorscovered with hyperplasticgingiva

In grade 3 furcationexposures theperiodontal probeadvances “throughand through”.

Dehiscence - partial root Dehiscence - complete root Cleft Fenestration

FURCATION INVOLVEMENT AND EXPOSURE

In grade 1 theperiodontalprobe just entersthe furcation

Grade 1 (F1) furcationinvolvement

Grade 1 (F1) and grade 2(F2) furcation involvement

Grade 3 (F3) furcationexposure

GINGIVAL HYPERPLASIA (GH)

20 SmileBook IV

PERIODONTAL D ISEASE/STOMATIT IS

ORONASAL FISTULA (ONF)

10mm feline palataldefect

10mm canine palatal defect View into nasal cavity spacewhere maxillary canineresided

CANINE STOMATITIS (ST/CU)

Canine ulcerative paradentalstomatitis (CUPS, kissinglesions)

Maxilla Maxillary buccal teethand gingiva affected

FELINE GINGIVOSTOMATITIS (ST/FFS)

Proliferative inflammation ofthe caudal oral mucosa

Gingivostomatitisinflammation surroundingmaxillary cheek teeth

Gingivostomatitis and faucitis

PALATAL POCKET

SmileBook IV 21

PERIODONTAL EXAMINATION

PROBING DEPTHS IN PERIODONTAL POCKETS (PP)

Williams periodontal probebefore insertion

ATTACHMENT LEVEL (LOSS) MEASUREMENT (AL)

5mm attachment level 14mm attachment level 3mm AL mandibular fourthpremolar, 5mm AL molar-feline

HYPERPLASIA MEASUREMENT

Before probe insertion 5mm pseudo pocket

6mm periodontal pocket

22 SmileBook IV

PERIODONTAL EXAMINATION—GINGIVITIS AND PLAQUE GRADING

PLAQUE INDEXCanine

Feline

Canine

Feline

PI 1 PI 2 PI 3

CALCULUS INDEX

PI 1 PI 2 PI 3

CI 1 CI 2 CI 3

CI 1 CI 2 CI 3

CALCULUS INDEX (CI #) refersto the amount of calculus ona tooth.• CI 0 no observable calculus• CI 1 scattered calculus

covering less than one thirdof the buccal tooth surface.

• CI 2 calculus coveringbetween one and two thirdsof the buccal tooth surfacewith minimal subgingivaldeposition.

• CI 3 calculus coveringgreater than two thirds ofthe buccal tooth surfaceand extending subgingivally.

PLAQUE INDEX (PI #)

• PI 0 no observable plaque• PI 1 scattered plaque

covering less than one thirdof the buccal tooth surface

• PI 2 plaque coveringbetween one and two thirdsof the buccal tooth surface

• PI 3 plaque covering greaterthan two thirds of thebuccal tooth surface

Canine

Feline

GINGIVAL INDEX

GI 1 GI 2 GI 3

GI 1 GI 2 GI 3

GINGIVITIS INDEX (GI #) is thenumber assigned to designatethe degree of gingivalinflammation.• GI 0 normal healthy gingiva

with sharp non inflamedmargins.

• GI 1 marginal gingivitis withminimal inflammation andedema at the free gingiva. Nobleeding on probing.

• GI 2 moderate gingivitis witha wider band of inflammationand bleeding upon probing.

• GI 3 advanced gingivitis withinflammation clinicallyreaching the mucogingivaljunction usually withulceration. Periodontitis willusually be present.

PERIODONTAL EXAMINATION—GINGIVITIS AND PLAQUE GRADING

SmileBook IV 23

24 SmileBook IV

THE TRAUMATIZED TOOTH

Pink discoloration Purple discoloration Yellow discoloration Grey discoloration

ENDODONTIC PATHOLOGY

Endodontic fistula due topulpal exposure (slab fracture)

Resorption in a caninemaxillary fourth premolar

Resorption in a felinemaxillary fourth premolar

Canine pulpal granuloma

ABNORMAL WEAR

Worn maxillary incisor teeth (AT) Wear facet of themandibular rightcanine (AT)

Craze lines

Luxated maxillary right canine Avulsion gingival injury Avulsed Tooth (T/A)

Carious lesion on the occlusalsurface of the maxillary firstmolar of a dog

Feline pulpal granuloma

PULPITIS

LUXATION/AVULSION

SmileBook IV 25

FRACTURED TOOTH CLASSIF ICAT ION

Class 1(uncomplicated - enamel only)

Class 2(uncomplicated - near pulpexposure

Class 2b(uncomplicated nearpulp/root fracture)

Class 3(complicated - enters the pulp chamber)

Class 3b(complicated - crown/root fracture)

Class 3b Class 4

Mandibular canine Maxillary canine Mandibular canine

Feline maxillary canine acutefracture (red pulp)

Mandibular caninechronic fracture(brown pulp)

Fractured primary maxillaryincisor causing an endodonticabcess

Pulp exposed after slabremoved (black arrow)white arrows indicatesubgingival involvement

Root fractureSlab fracture of maxillaryfourth premolar

26 SmileBook IV

FEL INE ODONTOCLASTIC RESORPTION LESIONS

Stage 2 (RL2) Radiographshowing enameland dentininvolvement

Radiograph showingresorption into thepulp of themandibular thirdpremolar

Radiograph showingremaining rootfragment in stage 5resorptive lesion

Stage 5 crown cannot bevisualized (RL5)

Stage 4 partial crownremains (RL4)

Stage 3 (RL3) mandibularfirst molar

Type 1 Type 2

Note, cervical lesion on the fourth premolarwith normal appearing apical root structure

Root replacement resorptionand ankylosis of themandibular canines

FELINE RESORPTION LESIONSTAGES/TYPES

• Stage 1 (RL1) extend intocementum only on the rootsurface. At one time, stage 1referred to lesions that onlyinvolved enamel. This definition isoutdated.

• Stage 2 (RL2) have destroyed asignificant amount of dentin andcementum but has spared thepulp.

• Stage 3 (RL3) enter the pulpwithout extensive crowndestruction.

• Stage 4 (RL4) have extensiveroot and crown damage.

• Stage 5 (RL5) lack a clinicalcrown but root fragments remainon radiographs.

• Type I lesions arise in thecervical area of the tooth andextend inward and/or up anddown the root. Type I lesions areinflammatory in nature.Radiographically Type I lesionshave relatively normal rootstructure.

• The more common Type II lesionbegins subgingivally.Radiographically the rootsappear to be resorbing. Theperiodontal ligament will not bereadily recognizable due toankylosis in Type II lesions.

SmileBook IV 27

SHORT MUZZLE (BRACHYCEPHALIC BREEDS)

MEDIUM MUZZLE (MESATICEPHALIC BREEDS) OCCLUSION

Persian cat

LONG MUZZLE (DOLIOCHOCEPHALIC BREEDS)

Greyhound

OCCLUSION/NORMAL

Siamese cat

American Bulldog Buccal Anterior

Buccal Anterior

Buccal Anterior

Buccal Anterior

Buccal Anterior

28 SmileBook IV

MALOCCLUSION

Feline

Feline

Canine

MANDIBULAR BRACHYGNATHISM (MAL 2)

Canine

MANDIBULAR PROGNATHISM (MAL 3)

Canine

LEVEL BITE OPEN BITE

Canine Canine

Mandibular gingival ulceration frommaxillary incisors

SmileBook IV 29

MALOCCLUSION

ANTERIOR CROSSBITE (MAL/AXB)

Canine

POSTERIOR CROSSBITE (MAL/PXB)

Canine

WRY BITE (MAL/WRY)

Immature canine

Mature canine Immature feline

30 SmileBook IV

MALOCCLUSION

NORMAL CANINE POSITION

Canine - 9 months old Feline

GENETIC OR NOT?

Normal interdigitation of cheek teeth Abnormal interdigitation geneticmalocclusion and posterior crossbite

LINGUALLY DISPLACED (BASE NARROW) MANDIBULAR CANINES (MAL/BN)

Lingually displaced primary mandibularcanine causing palatal trauma (PT)

Lingually displacedpermanent mandibularcanine causing palataltrauma (PT)

Vertical orientation of mandibularcanines

Excessive freeway space - genetic defect

Canine - 18 months old

SmileBook IV 31

ANTERIOR DEVIATED MANDIBULAR CANINES

Canine Feline

MALOCCLUSION

CROWDED INCISORS

Canine Feline

Feline

MESIAL VERSION MAXILLARY CANINES

Canine - mesial deviation of maxillary canine Feline - mesial deviation of maxillary canine

ANTERIOR DEVIATED MAXILLARY CANINES

Canine Feline- anterior deviation ofmaxillary canine

32 SmileBook IV

Focal fibrous hyperplasia(EP/F)

Peripheral otontogenicfibroma (EP/O)

Canine acanthomatousameloblastoma (EP/A)

Gum Chewers Lesion (G/B) Feline eosinophic granulomacomplex (G/E/P)

Dentigerous cyst (DTC)Buccal gingival mass Radiograph revealingimpacted supernumerary firstpremolar

BENIGN ORAL MASSES

Viral papilloma

EPULIDES

SmileBook IV 33

MALIGNANT ORAL MASSES

Malignant melanoma (MM)

Feline squamous cellcarcinoma (SCC)

Squamous cell carcinoma(SCC)

Fibrosarcoma (FSA)

Malignant lymphosarcoma (LS)

Canine oral osteosarcoma(OSC)

CANINE

FELINE

34 SmileBook IV

AABRASION is the mechanical wearing of the crown by non-toothstructures.ATTRITION is loss of tooth structure caused by tooth-to-toothcontact. Attrition can occur through the normal aging process(physiologic attrition), or through malocclusion (pathologic attrition).ANTERIOR CROSSBITE is a condition where one or more of themandibular incisors are positioned rostral to their maxillarycounterparts.APICAL refers to the area of the tooth toward the apex (root tip) oraway from the incisal or occlusal surfaces.ATTACHED GINGIVA covers the external aspect of the gingivalsulcus between the marginal gingiva and alveolar mucosa at themucogingival junction.ATTACHMENT LOSS (ATTACHMENT LEVEL) is measured from thecementoenamel junction to the depth of the periodontal pocket.Attachment loss is the combination of the probing depth and gingivalrecession measurements.

BBASE NARROW CANINES are lingually displaced mandibularcanines caused by a too narrow mandible or persistent primarymandibular canines.BRACHYCEPHALIC: is a head type typified by a short wide muzzle,e.g., Boxer, Bulldog, Pug, Shih Tzu, etc.BRACHYGNATHISM (RETROGNATHISM) occurs where one of thejaws is caudal to its normal relationship with the other jaw.Mandibular brachygnathism (retrognathism, Class II occlusion) existswhen the mandible is shorter than the maxilla.

BUCCAL pertains to the surface of the premolars and molars facingthe cheek.

CCALCULUS is mineralized material on the tooth surface.CALCULUS INDEX (CI#) refers to the amount of calculus on atooth.• CI 0 no observable calculus• CI 1 scattered calculus covering less than one third of the buccal

tooth surface.• CI 2 calculus covering between one and two thirds of the buccal

tooth surface with minimal subgingival deposition.• CI 3 calculus covering greater than two thirds of the buccal tooth

surface and extending subgingivally.CLEFT is a longitudinal fissure or opening in the marginal gingivaexposing the underlying tooth root.COMPLICATED FRACTURE involves pulp in the fracture line.CRAZE LINES are tiny cracks that affect only the outer enamel ofthe tooth. They do not extend into dentin. Craze lines are the resultof “wear and tear” on teeth and need no treatment.

DDEVELOPMENTAL DENTAL DISORDERS may be due toabnormalities in the differentiation of the dental lamina and the toothgerms (anomalies in number, size, shape) and/or to abnormalities inthe formation of the dental hard tissues (anomalies in structure).DEHISCENCE is the incomplete coverage by bone over an area ofa root that includes the cementoenamel junction.DENTIN is the main component of teeth. Dentin is normally coveredby enamel on the crown and cementum on the tooth’s root. DOLICHOCEPHALIC is a head type: typified by a long, narrowface, e.g., Rough Collie, Borzoi, Doberman or Greyhound.

EEMBEDDED tooth is an unerupted tooth covered with bone.ENAMEL is the hard covering of the crown.

ENAMEL DEFECTS are small pits or other malformations on theenamel surface.ENAMEL HYPOPLASIA occurs when there are areas on the teethwithout enamel (enamel is quantitatively defective resulting in enamelthickness variation).EPULIS is a mass on the gingiva.

FFACIAL is the part of the tooth that faces the lips or cheek.FELINE ODONTOCLASTIC RESORPTION LESIONS There are fiverecognized stages (based on clinical and radiographic findings). andtwo types (based on radiographic findings) of feline resorption lesions.

• Stage 1 (RL 1) extend into cementum only on the root surface.At one time, stage 1 referred to lesions that only involved enamel.The definition is outdated.

• Stage 2 (RL 2) have destroyed a significant amount of dentinand cementum but has spared the pulp.

• Stage 3 (RL 3) enter the pulp without extensive crowndestruction.

• Stage 4 (RL 4) have extensive root and crown damage • Stage 5 (RL 5) lack a clinical crown but root fragments remain

on radiographs. • Type I lesions arise in the cervical area of the tooth and extend

inward and/or up and down the root. Type I lesions areinflammatory in nature. Radiographically Type I lesions haverelatively normal root structure.

• The more common Type II lesion begins subgingivally.Radiographically the roots appear to be resorbing. Theperiodontal ligament will not be readily recognizable due toankylosis in Type II lesions.

FENESTRATION is a window of bone loss which exposes the rootsurface to the gingival or alveolar mucosa. The fenestration isbordered by alveolar bone on the coronal surface.FREE GINGIVAL MARGIN is the coronal edge of the marginalgingiva.FREEWAY SPACE is the space between the maxillary andmandibular premolar teeth cusp tips when the mouth is closed.FURCATION INVOLVEMENT/EXPOSURE -the furcation is thearea where multiple roots diverge from the tooth. Furcationinvolvement or exposure occurs secondary to periodontal disease.The degree of furcation disease can be recorded as grades:• F 1 (furcation involvement) is a depression in the furcation area

that extends less than half way under the crown in a multirootedtooth.

• F 2 (furcation involvement) exists when a depression in thefurcation area extends greater than half way under the crown butnot through and through.

• F 3 (furcation exposure) exists when a periodontal probe extends“through and through” from one side of the furcation out the other.

FUSION is the joining of two tooth germs, resulting in a single largetooth. Fusion may involve the entire length of the teeth, or only theroots, depending on the stage of development of the teeth at thetime of the union. Usually there will be two separate root canals.With fusion, the tooth count will reveal a missing tooth when theanomalous tooth is counted as one.

GGEMINATION is defined as an attempt to make two teeth from oneenamel organ. This results in a structure with two completely orincompletely separated crowns with a single enlarged root and rootcanal. With germination the tooth count will be normal when theanomalous tooth is counted as one.GINGIVAL CLEFT is an area of isolated gingival recession occurringover a dehiscence of the bone covering the root.GINGIVITIS INDEX (GI#) is the number assigned to designate thedegree of gingival inflammation.

GLOSSARY

SmileBook IV 35

GLOSSARY (CONTINUED)

• GI 0 normal healthy gingiva with sharp non inflamed margins.• GI 1 marginal gingivitis with minimal inflammation and edema at the

free gingiva. No bleeding on probing.• GI 2 moderate gingivitis with a wider band of inflammation and

bleeding upon probing.• GI 3 advanced gingivitis with inflammation clinically reaching the

mucogingival junction usually with ulceration. Periodontitis will usuallybe present.

GINGIVAL RECESSION is a pathological movement of the gingivalmargin away from the tooth. This causes the root surface to beexposed. Gingival recession is measured from the cementoenameljunction to the gingival margin.GINGIVAL HYPERPLASIA is the proliferation of the attached gingiva.Gingival hyperplasia is measured from the cementoenamel junction tothe gingival margin.GUM (TONGUE) CHEWERS LESIONS are areas of proliferativegranulation tissue below the tongue in small animals that appear topant frequently. The lesion is caused by the tongue’s ventral surfacearea rubbing against the mandibular cheek teeth. Dogs with theselesions appear to chew gum.

IIMPACTED is a dental disorder involving failure of a tooth to fullyemerge through the gingiva.

LLEVEL BITE exists when the incisor teeth meet edge to edge orpremolars occlude cusp to cusp. LYMPHOCYTIC PLASMATIC STOMATITIS SYNDROME(GINGIVOSTOMATITIS) is characterized by a generalizedinflammation of the oral mucosa in cats.

MMANDIBLE is the lower jaw bones.MAXILLA is the upper jaw.MARGINAL GINGIVA is the most coronal portion of the gingivawhich lies passively against the tooth. The marginal gingiva forms theouter wall of the gingival sulcus.MESATICEPHALIC is a head type of medium length and width ofthe muzzle e.g., most terriers, hounds, and retrievers.MOBILITY of teeth exists from trauma, endodontic, and/ orperiodontal disease. Mobility can be graded:• (M0) indicates no mobility• (M1) indicates the tooth moves less than 1 mm when an instrument

is applied to the crown• (M2) exists when the tooth is still firmly attached in the alveolus but

moves greater than 1 mm laterally• (M3) occurs when the tooth freely moves in the alveolus laterally

and apically.MUCOGINGIVAL DEFECTS are deviations from the normalanatomic relationship between the gingival margin and themucogingival junction (MGJ). Common mucogingival conditions arerecession, absence or reduction of keratinized tissue, and probingdepths extending beyond the MGJ.

OOCCLUSAL is the articulating or biting surface of the tooth.

OPEN BITE occurs when part or all of the incisor teeth are preventedfrom contacting normally when the mouth is fully closed.

PPARTIALLY ERUPTED TOOTH is a tooth that has failed to eruptfully into a normal position. The term implies that the tooth is partlyvisible.PERIODONTAL DISEASE is graded or staged on the dental chart.Healthy gingiva can be graded as PD 0.

• Stage 1 (PD 1) (gingivitis) appears as a redness of the gingiva and noattachment loss.

• Stage 2 (PD 2) (early periodontitis) shows an increase in inflammationand edema. In stage 2 there will be less than 25% of support losswhen probed.

• Stage 3 (PD 3) (moderate periodontitis) occurs when there is amoderate loss of attachment or moderate pocket formation withbetween 25-50% support loss. Furcation exposure and mobility maybe present. The gingiva will bleed upon gentle probing at this stage.

• Stage 4 (PD 4) (advanced periodontitis) occurs when there isbreakdown of the support tissues with severe (>50% support loss)pocket depth or recession of the gingiva.

PERIODONTAL POCKET is a gingival sulcus that has experiencedan apical extension of the epithelial attachment.PALATOGLOSSITIS (“faucitis”, caudal stomatitis) inflammation ofcaudal oral mucosa lateral to glosso-palatine folds (isthmus of thefauces) and tongue which occurs in some cases of LPGS.PLAQUE is a mass of bacteria that are adherent to the enamelsurface of the tooth.PLAQUE INDEX (PI #)• PI 0 no observable plaque• PI 1 scattered plaque covering less than one third of the buccal

tooth surface• PI 2 plaque covering between one and two thirds of the buccal

tooth surface• PI 3 plaque covering >two thirds of the buccal tooth surface

POSTERIOR CROSSBITE occurs when one or more permanentmaxillary posterior teeth occlude palatally rather than buccally withtheir mandibular counterparts. PROBING DEPTH (POCKET DEPTH) is the measurement of thegingival sulcus or pocket as measured from the gingival margin to theapical limit of the sulcus or pocket. Depending on the tooth, probingdepths greater than 4 mm in large dogs, 2 mm in small dogs, and 1mm in cats are abnormal and should be charted.PROGNATHISM is a forward relationship of one jaw relative to theother jaw. Prognathism should be qualified by the adjectives“maxillary” and “mandibular”. Mandibular prognathism (Class 3) hasmaxillary incisors occluding lingual or caudal to the mandibularincisors. PULPITIS is the inflammation of the pulpal tissue, often discoloringthe tooth.

SSUPERNUMERAR`Y tooth is any tooth in addition to the normaldentition primary or secondary.

UUNERUPTED TEETH have not perforated the oral mucosa. Refers toa normal developing tooth, an embedded tooth, or an impacted toothentirely covered by soft tissue and partially or completely covered bybone.

UNDERERUPTED TEETH erupt far enough to break through thegingiva but a significant portion of the crown remains under thegingiva.

WWEAR FACET is a localized worn area on a tooth often associatedwith malocclusion. WRY BITE is a condition where one or more of the jaw quadrants areout of proportion to the other three, causing a deviation from themidline.

(medetomidine hydrochloride)

Sterile Injectable Solution—1.0 mg/mLSedative and Analgesic

For intramuscular and intravenous use in dogs only

NADA #140-999, Approved by FDA

CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

DESCRIPTION: DOMITOR (medetomidine hydrochloride) is a synthetic α2-adrenoreceptor agonist withsedative and analgesic properties. The chemical name is (±)-4-[1-(2,3-dimethylphenyl) ethyl]-1H-imidazole monohydrochloride. It is a white, or almost white, crystalline, water soluble substance havinga molecular weight of 236.7. The molecular formula is C13H16N2•HCl and the structural formula is:

Each mL of DOMITOR contains 1.0 mg medetomidine hydrochloride, 1.0 mg methylparaben (NF), 0.2mg propylparaben (NF), 9.0 mg sodium chloride (USP), and water for injection (USP), q.s.

CLINICAL PHARMACOLOGY: Medetomidine is a potent non-narcotic α2-adrenoreceptor agonist which produces sedation and analgesia.These effects are dose dependent in depth and duration. Profound sedation and recumbency, with reduced sensitivity to environmentalstimuli (sounds, etc.), are seen with medetomidine.

The pharmacological restraint and pain relief provided by medetomidine facilitates handling dogs and aids in the conduct of diagnosticor therapeutic procedures. It also facilitates minor surgical procedures (with or without local anesthesia) and dental care where intubationis not required. Spontaneous muscle contractions (twitching) can be expected in some dogs sedated with medetomidine.

With medetomidine administration, blood pressure is initially increased due to peripheral vasoconstriction and thereafter drops to normalor slightly below normal levels. The initial vasopressor response is accompanied by a compensatory marked decrease in heart ratemediated by a vagal baroreceptor mechanism. The bradycardia may be partially prevented by prior (at least 5 minutes before) intravenousadministration of an anticholinergic agent (see PRECAUTIONS). A transient change in the conductivity of the cardiac muscle may occur,as evidenced by atrioventricular blocks. Cardiovascular changes (such as profound bradycardia and second degree heart block) equallyaffect both heartworm negative and asymptomatic heartworm positive dogs.

Respiratory responses include an initial slowing of respiration within a few seconds to 1–2 minutes after administration, increasing tonormal within 120 minutes. An initial decrease in tidal volume is followed by an increase. When medetomidine was given at 3 and 5 timesthe recommended dose IV, and 5 and 10 times IM, effects were not intensified but were prolonged.

INDICATIONS: DOMITOR is indicated for use as a sedative and analgesic in dogs over 12 weeks of age to facilitate clinical examinations,clinical procedures, minor surgical procedures not requiring muscle relaxation, and minor dental procedures where intubation is notrequired. The IV route of administration is more efficacious for dental care.

WARNING: Keep out of reach of children. Not for human use.

Medetomidine hydrochloride can be absorbed and may cause irritation following direct exposure to skin, eyes, or mouth. In case ofaccidental eye exposure, flush with water for 15 minutes. In case of accidental skin exposure, wash with soap and water. Removecontaminated clothing. If irritation or other adverse reaction occurs (e.g., sedation, hypotension, bradycardia), seek medical attention. Incase of accidental oral exposure or injection, seek medical attention. Precaution should be used while handling and using filled syringes.

Users with cardiovascular disease (e.g., hypertension or ischemic heart disease) should take special precautions to avoid any exposureto this product.

The material safety data sheet (MSDS) contains more detailed occupational safety information.

To report adverse reactions in users or to obtain a copy of the MSDS for this product call 1-800-366-5288.

NOTE TO PHYSICIAN: This product contains an alpha-2-adrenergic agonist.

CONTRAINDICATIONS: DOMITOR should not be used in dogs with the following conditions: cardiac disease, respiratory disorders, liver orkidney diseases, dogs in shock, dogs which are severely debilitated, or dogs which are stressed due to extreme heat, cold or fatigue.

PRECAUTIONS: In extremely nervous or excited dogs, levels of endogenous catecholamines are high due to the animal’s state of agitation.The pharmacological response elicited by α2-agonists (e.g., medetomidine) in such animals is often reduced, with depth and duration ofsedative/analgesic effects ranging from slightly diminished to nonexistent. Highly agitated dogs should therefore be put at ease andallowed to rest quietly prior to receiving DOMITOR. Allowing dogs to rest quietly for 10 to 15 minutes after injection may improve theresponse to DOMITOR. In dogs not responding satisfactorily to treatment with DOMITOR, repeat dosing is not recommended.Caution should be exercised when handling sedated animals. Handling or any other sudden stimuli may cause a defense reaction in ananimal that is sedated.

DOMITOR is a potent α2-agonist which should be used with caution with other sedative or analgesic drugs. Additive or synergistic effectsare likely, possibly resulting in overdose. Although bradycardia may be partially prevented by prior (at least 5 minutes before) intravenousadministration of an anticholinergic agent, the administration of anticholinergic agents to treat bradycardia either simultaneously withmedetomidine or following sedation with medetomidine could lead to adverse cardiovascular effects.

Special care is recommended when treating very young animals and older animals. Information on the possible reproductive effects ofmedetomidine is limited; therefore, the drug is not recommended for use in dogs used for breeding purposes or in pregnant dogs.

ADVERSE REACTIONS: As with all α2-agonists, the potential for isolated cases of hypersensitivity, including paradoxical response(excitation), exists. Incidents of prolonged sedation, bradycardia, cyanosis, vomiting, apnea, death from circulatory failure with severecongestion of lungs, liver, kidney and recurrence of sedation after initial recovery have been reported.

SIDE EFFECTS: Bradycardia with occasional atrioventricular blocks will occur together with decreased respiratory rates. Bodytemperature is slightly or moderately decreased. Urination typically occurs during recovery at about 90 to 120 minutes posttreatment. Inapproximately 10% of treated dogs, occasional episodes of vomiting occur between 5 to 15 minutes posttreatment. An increase in bloodglucose concentration is seen due to α2-adrenoreceptor-mediated inhibition of insulin secretion.

ANIMAL SAFETY: In target animal safety studies, medetomidine was tolerated in dogs at up to 5 times the recommended IV dose andup to 10 times the recommended IM dose. A single IV administration of 10 times the recommended dose in dogs caused a prolongedanesthesia-like condition accompanied by an increased level of spontaneous muscle contractions (twitching). Repeated IV doses of 3 or5 times the recommended dose caused a profound sedation, bradycardia and reduced respiratory rates over several hours, accompaniedin some animals by occasional spontaneous twitching. Death (approximately 1 in 40,000 treatments) has been noted in clinical use withdoses at 2 times the recommended dose of DOMITOR.

DOSAGE AND ADMINISTRATION: DOMITOR should be administered at the rate of 750 mcg IV or 1000 mcg IM per square meter of bodysurface. Use the table below to determine the correct dosage on the basis of body weight.

Body Weight (lb) Injection Body Weight (lb)IV Administration Volume (mL) IM Administration

3–4 0.15–7 0.15 4–58–11 0.2 6–7

12–15 0.25 8–916–21 0.3 10–1422–31 0.4 15–2032–43 0.5 21–2744–55 0.6 28–3556–68 0.7 36–4469–82 0.8 45–5383–97 0.9 54–6398–121 1.0 64–78122–156 1.2 79–101157–194 1.4 102–126

195+ 1.6 127–1652.0 166+

Following injection of DOMITOR, the dog should be allowed to rest quietly for 15 minutes.

STORAGE: Store at controlled room temperature 15°–30°C (59°–86°F). Protect from freezing.

HOW SUPPLIED: DOMITOR is supplied in 10-mL, multidose vials containing 1.0 mg of medetomidine hydrochloride per mL.

U.S. Patent Nos. 4,544,664 and 4,670,455DOMITOR® is a trademark of Orion Corporation.

(atipamezole hydrochloride)

Sterile Injectable Solution—5.0 mg/mLMedetomidine Reversing Agent

For intramuscular use in dogs only

NADA #141-033, Approved by FDA

CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian.

DESCRIPTION: ANTISEDAN (atipamezole hydrochloride) is a synthetic α2-adrenergic antagonistwhich reverses the effects of DOMITOR® (medetomidine hydrochloride) in dogs. The chemical nameis 4-(2-ethyl-2,3-dihydro-1H-inden-2-yl)-1H-imidazole hydrochloride. The molecular formula isC14H16N2•HCl and the structural formula is:

Each mL of ANTISEDAN contains 5.0 mg atipamezole hydrochloride, 1.0 mg methylparaben (NF), 8.5mg sodium chloride (USP), and water for injection (USP).

CLINICAL PHARMACOLOGY: Activation of peripheral and central α2-adrenergic receptors is known to induce a pattern ofpharmacological responses including sedation, reduction of anxiety, analgesia, bradycardia, and transient hypertension with asubsequently reduced blood pressure. Atipamezole is a potent α2-antagonist which selectively and competitively inhibits α2-adrenergicreceptors. The result of atipamezole administration in the dog is the rapid recovery from the sedation and other clinical effects producedby the α2-adrenergic agonist, medetomidine. Atipamezole is not expected to reverse the effects of other classes of sedatives, anesthetics,or analgesics.

Rapid absorption occurs following intramuscular injection, with a maximum serum concentration reached in approximately 10 minutes.Onset of arousal is usually apparent within 5 to 10 minutes of injection, depending on the depth and duration of medetomidine-inducedsedation. Elimination half-life from serum is less than 3 hours. Atipamezole undergoes extensive hepatic biotransformation, with excretionof metabolites primarily in urine.

A transient, approximately 10% decrease in systolic blood pressure occurs immediately after administration of atipamezole tomedetomidine-sedated dogs, followed by an increase in pressure within 10 minutes to the pre-atipamezole level. This is the opposite ofthe response to α2-agonist therapy, and is probably due to peripheral vasodilation.

Atipamezole will produce a rapid improvement in medetomidine-induced bradycardia. An increase in heart rate is usually apparent withinapproximately 3 minutes of injection, but approximately 40% of dogs are not expected to immediately return to presedative rate. Somedogs may experience brief heart rate elevations above baseline. Respiratory rate also increases following atipamezole injection.

INDICATIONS: ANTISEDAN is indicated for the reversal of the clinical effects of the sedative and analgesic agent, DOMITOR(medetomidine hydrochloride), in dogs.

WARNING: Keep out of reach of children. Not for human use.

Atipamezole hydrochloride can be absorbed and may cause irritation following direct exposure to skin, eyes, or mouth. In case ofaccidental eye exposure, flush with water for 15 minutes. In case of accidental skin exposure, wash with soap and water. Removecontaminated clothing. If irritation or other adverse reaction occurs (e.g., increased heart rate, tremor, muscle cramps), seek medicalattention. In case of accidental oral exposure or injection, seek medical attention. Precaution should be used while handling and usingfilled syringes.

Users with cardiovascular disease (e.g., hypertension or ischemic heart disease) should take special precautions to avoid any exposureto this product.

The material safety data sheet (MSDS) contains more detailed occupational safety information.

To report adverse reactions in users or to obtain a copy of the MSDS for this product call 1-800-366-5288.

NOTE TO PHYSICIAN: This product contains an alpha-2-adrenergic antagonist.

PRECAUTIONS: ANTISEDAN can produce an abrupt reversal of sedation and, presumably, analgesia. The potential for apprehensive oraggressive behavior should be considered in the handling of dogs emerging from sedation, especially those individuals predisposed tonervousness or fright. Persons handling dogs that have recently received ANTISEDAN should use caution and also avoid situations wherea dog could fall.

Information on use of atipamezole with concurrent drugs is inadequate; therefore, caution should be exercised when administeringmultiple drugs. Animals should be monitored closely, particularly for persistent hypothermia, bradycardia, and depressed respiration, untilthe animal has recovered completely. Caution should be used in administration of anesthetic agents to elderly or debilitated animals.

While atipamezole does reverse the clinical signs associated with medetomidine sedation, complete physiologic return to pretreatmentstatus may not be immediate and should be monitored.

ANTISEDAN has not been evaluated in breeding animals; therefore, the drug is not recommended for use in pregnant or lactating animals,or in animals intended for breeding.

SIDE EFFECTS: Occasional vomiting may occur. Rarely, a brief state of excitement or apprehensiveness may be seen in treated dogs.Other potential side effects of α2-antagonists include hypersalivation, diarrhea, and tremors.

ANIMAL SAFETY: Atipamezole was tolerated in healthy dogs receiving doses 10-fold the recommended dose and in dogs receivingrepeated doses at 1-, 3-, and 5-fold doses, in the absence of medetomidine. Signs of overdose were dose-related and consistent withthose expected in nonsedated dogs having received a stimulant. Signs seen at elevated doses included excitement, panting, trembling,vomiting, soft or liquid feces or vasodilation (injection) of the sclera. Some localized skeletal muscle injury was seen at the injection site;but no associated clinical signs or complications were observed. Dogs receiving the proper dose in the absence of medetomidine, or 3-fold overdose after medetomidine sedation, exhibited no significant clinical signs.

DOSAGE AND ADMINISTRATION: ANTISEDAN is administered intramuscularly regardless of the route used for DOMITOR. Theconcentration of ANTISEDAN has been formulated such that the volume of injection is the same (mL for mL) as the recommended dosevolume of DOMITOR, and may be given at any time following DOMITOR administration. Although injection volumes are the same, theconcentration of ANTISEDAN (5.0 mg/mL) is 5 times that of DOMITOR (1.0 mg/mL). Dogs that are sedated but ambulatory may be treatedwith ANTISEDAN, if warranted.

The dosage of ANTISEDAN is calculated based upon body surface area. Use the table below to determine the proper injection volumebased on body weight:

ANTISEDAN Injection Body Wt (lb) If Body Wt (lb) IfVolume (mL) IM DOMITOR Given IM* DOMITOR Given IV*

0.1 3–40.15 4–5 5–70.2 6–7 8–110.25 8–9 12–150.3 10–14 16–210.4 15–20 22–310.5 21–27 32–430.6 28–35 44–550.7 36–44 56–680.8 45–53 69–820.9 54–63 83–971.0 64–78 98–1211.2 79–101 122–1561.4 102–126 157–1941.6 127–165 195+2.0 166+

*The IM dose of DOMITOR is 1.0 mg/m2 of body surface area and the IV dose is 0.75 mg/m2.

STORAGE: Store protected from light at controlled room temperature 15°–30°C (59°–86°F).

HOW SUPPLIED: ANTISEDAN is supplied in 10-mL, multidose vials containing 5.0 mg of atipamezole hydrochloride per mL.

U.S. Patent No. 4,689,399Antisedan® and Domitor® are trademarks of Orion Corporation.

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Pfizer Animal Health 150 East 42nd Street New York, NY 10017-5755www.pfizerah.com

Copyright ©2004 Pfizer Inc. All rights reserved. AIF0504019