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FELINE DENTISTRY
Oral Assessment, Treatment, and Preventative Care

FELINE DENTISTRY
Oral Assessment, Treatment,
and Preventative Care
Jan Bellows
A John Wiley & Sons, Inc., Publication
Edition fi rst published 2010
© 2010 Jan Bellows
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Library of Congress Cataloging-in-Publication Data
Bellows, Jan.
Feline dentistry : oral assessment, treatment, and preventative
care / Jan Bellows.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-8138-1613-5 (hardback : alk. paper) 1. Veterinary
dentistry. 2. Cats–Diseases. I. Title.
[DNLM: 1. Tooth Diseases–veterinary. 2. Cats. 3. Dental
Care–veterinary. 4. Mouth Diseases–veterinary. SF 867 B448f
2010]
SF867.B447 2010
636.8′08976–dc22
2009031848
A catalog record for this book is available from the U.S. Library
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Set in 9.5/12 pt Palatino by Toppan Best-set Premedia Limited
Printed in Singapore
1 2010
Dedication

This text is dedicated to
Dr. Colin E. Harvey
Throughout his professional life, Dr. Colin Harvey
has taught and mentored others while creating and
maintaining the foundation of veterinary dentistry in
the United States and around the world.
Dr. Harvey graduated from the School of Veterinary
Science at the University of Bristol, England, in 1966. He
completed an internship and residency in small animal
surgery at the University of Pennsylvania, receiving the
Diploma of the American College of Veterinary Sur-
geons in 1972.
Dr. Harvey is a diplomate of the American College of
Veterinary Surgeons (1972), member of the Organizing
Committee and charter diplomate of the American Vet-
erinary Dental College (AVDC, 1988) and the European
Veterinary Dental College (1998), and also a charter dip-
lomate of the European College of Veterinary Surgeons
(1993). He was section chief of Small Animal Surgery
(1974 – 80) and vice - chair of the Department of Clinical
Studies (1996 – 2002) and was the founding head of the
Dentistry and Oral Surgery Service at the University of
Pennsylvania (the fi rst dentistry and oral surgery service
to be established at a veterinary school in North
America).
Dr. Harvey has received numerous university,
national, and international awards for excellence in
teaching, research, and clinical work. He was elected a
fellow of the College of Physicians of Philadelphia in
1980. Dr. Harvey has been a board member (1978 – 83) of

the Comparative Respiratory Society, secretary (1985 –
89) of the American Veterinary Dental Society, president
(1990 – 92) and executive secretary (2002 – present) of the
American Veterinary Dental College, cofounder (1985)
of the International Veterinary Ear Nose and Throat
Association, charter fellow and secretary - treasurer
(1987 – 89) of the Academy of Veterinary Dentistry, and
director (1997 – present) of the Veterinary Oral Health
Council.
Dr. Harvey was editor of the Journal of Veterinary
Surgery from 1982 to 1987 and editor of the Journal of
Veterinary Dentistry from 1994 to 2000 and has been a
reviewer or review board member for numerous other
journals. His publications include approximately 70
chapters in textbooks, 130 papers in peer - reviewed jour-
nals, and over 100 abstracts and other papers on surgical
and dental topics. He has written, edited, or coedited
fi ve books on small animal surgery and dentistry.
Dr. Harvey ’ s research interests include veterinary and
comparative periodontal disease (including compara-
tive microbiology, standardization of periodontal
scoring, and prevention and treatment); the interaction
of infectious oral diseases, particularly periodontal
disease, with the rest of the body, specifi cally, distant
organ and systemic effects; and the utility and effective-
ness of antimicrobial drugs in the management of
patients with oral diseases.
Feline dentistry has been of special interest to Dr.
Harvey. Much of what we know about feline dentistry
today is largely due to his and his mentees ’ uncompro-

mised research and discovery efforts.
v

Contents
vii
Preface, viii
Acknowledgments, ix
Introduction, x
Section I. Oral Assessment, 3
Chapter 1. Anatomy, 5
Chapter 2. Oral Examination, 28
Chapter 3. Radiology, 39
Chapter 4. Charting, 84
Chapter 5. Oral Pathology, 101
Section II. Treatment, 149
Chapter 6. Equipment, 151
Chapter 7. Anesthesia, 169
Chapter 8. Treatment of Periodontal Disease, 181
Chapter 9. Treatment of Endodontic Disease, 196
Chapter 10. Treatment of Tooth Resorption, 222
Chapter 11. Treatment of Oropharyngeal Infl ammation, 242
Chapter 12. Treatment of Occlusion Disorders, 269
Chapter 13. Oral Trauma Surgery, 280
Chapter 14. Treatment of Oral Swellings/Tumors, 290
Section III. Prevention, 297
Chapter 15. Plaque Control, 299
Index, 305
viii
by the body ’ s own tissues for reasons that are still not
clear, and our frustrations are heightened by the lack of

success of restoring feline teeth undergoing resorption.
Squamous cell carcinoma is by far the most common
feline oral neoplasm, benign or malignant; and it resists
all standard treatments used in management of other
malignancies. When we add in that anesthesia is essen-
tial for all feline dental procedures (lest our fi ngers be
impaled by the needle - like, plaque - coated canine teeth)
and that cats have such a little mouth compared with
dogs, it is not surprising that there is some love - hate
aspect to the relationship of veterinary dentists to cats.
The challenge is one to rise to, and the companionship
cats offer makes it all worthwhile.
A book dedicated to feline dentistry and related topics
is overdue. I am pleased that Dr. Bellows has found the
time to pull the material together in a coherent format,
so that others may build upon the accumulated experi-
ence and knowledge that are described here. Those deli-
cate feline oral structures require all the skill and
knowledge that we have and deserve our best efforts to
ensure that we are not continuously restarting the steep -
slope part of the learning curve.
Colin E. Harvey

Preface
Ah, Cats.
What would veterinary dentistry be without them!
For sure, a lot simpler and less frustrating. Even for
procedures so apparently “ simple ” as a tooth extraction,
the cat often has the last word, when we as veterinary
dentists hear that quiet but awful ‘ snick ’ that means that

a tooth root has fractured, leaving a root tip somewhere
down there. …
Since the fi rst - reported mention of oral disease in cats
in the 1920s, a lot of progress has been made, but some
key knowledge is not yet available. The immunological
function of the cat does not seem to obey the same rules
as rodents, dogs, and humans; and as a result, immuno-
logically based conditions such as stomatitis continue to
frustrate veterinary dentists. Teeth in cats are attacked
ix
Additionally, I acknowledge the American Veterinary
Dental College (AVDC) in their efforts to “ get things
right. ” I have had the pleasure and honor of being a
member and chairman of the college ’ s nomenclature
committee since 2004, during which time the college has
improved classifi cations for tooth resorption stages and
types, fractures, periodontal disease, and many anatom-
ical terms.
I acknowledge and thank Dr. Paul Pion, the originator
of the Veterinary Information Network (VIN). Dr. Pion
strives to improve the veterinary community on all
levels. Through the give and take on VIN ’ s message
forums, we learn from each other. I also thank Dr. Pion
for the use of his talented full - time graphic artist, Tamara
Rees, who provided illustrations for the AVDC and this
text.
Finally, I can ’ t say enough about the publisher of this
text, Wiley - Blackwell. Working with Nancy Simmer-
man, the Editorial Assistant, has been a pleasure from
our initial discussions, in early 2006, throughout the

process to the fi nal submission of the manuscript.
Acknowledgments
The author acknowledges and greatly appreciates the
selfl ess efforts of many in the production of this text.
First to my wife Allison who has always supported
and encouraged my passion to do the best for my
patients and help other veterinarians do their best too.
Next my children Wendi, David, and Lauren who have
helped in the practice and have been there every step of
the journey.
Dr. Carlos Rice, currently a dental resident at Univer-
sity of Wisconsin, on a four - month volunteer stint at All
Pets Dental in Weston helped catalog thousands of
images from our client base to be considered for inclu-
sion in this text. Dr. Rice also reviewed the fi nal text.
Dr. Gary Edelson also volunteered to review the text
word by word multiple times. His attention to detail is
much appreciated.
Drs. Gregg DuPont and Alex Reiter reviewed every
word and image in this text. They are expert veterinary
dentists with decades of teaching and practical experi-
ence. Both share a passion for the best in companion
animal dental care based on solid peer - reviewed infor-
mation where available. Their input resulted in the work
you have before you.
x
little doubt that periodontal disease will either continue
or worsen. Plaque control methods must be specifi cally
tailored to the patient and client in order to be
effective.

Through daily use of the oral assessment, treatment,
and prevention process, patients can get the best in vet-
erinary dentistry, which is our ultimate goal.
Although a genuine effort has been made to assure
that the dosages and information included in this text
are correct, errors may occur, and it is recommended
that the reader refer to the original reference or the
approved labeling information of the product for addi-
tional information. Dosages should be confi rmed prior
to use or dispensing of medications.
Jan Bellows, D.V.M.
Diplomate, American Veterinary Dental College
Fellow, Academy Veterinary Dentistry
Diplomate, American Board of Veterinary Practitioners

Introduction
Cats are not dogs. Small dogs are plagued primarily
with various degrees of periodontal disease (gingivitis
and periodontitis). Large dogs more commonly present
with gingivitis, fractured teeth, and oral masses. Feline
Dentistry: Oral Assessment, Treatment, and Preventative
Care was born primarily to give cats their fair due, a
book on dentistry dedicated solely to their species.
Cats also are affected by periodontal disease and frac-
tured teeth, but their main oral pathologies include
tooth resorption, oropharangyeal infl ammation, and
maxillofacial cancer. Plaque prevention products and
techniques covered in this text also differ from those
used in dogs.
The second goal in writing this text is to introduce to

some and reinforce to others the paradigm shift elimi-
nating the terminology “ doing a dentistry, ” “ performing
a prophy, ” or “ Max is in for a dental. ” Replacing the old
terminology with “ oral assessment, treatment, and pre-
vention, ” better represents what we do as veterinary
dentists.
Assessment involves evaluation of the patient before
the anesthetic procedure and includes medical and
dental history, feeding management, home oral hygiene,
and physical and laboratory testing. Once the patient is
anesthetized, a tooth - by - tooth examination is conducted
to create a treatment plan.
Treatment with the goal of eliminating non - functional
abnormalities uncovered during assessment is next. The
treatment plan often can be accomplished within one
anesthetic visit. In some instances, multiple visits or life-
long therapy are indicated.
Prevention of periodontal disease is aimed at control-
ling plaque. Prevention is as important as the assess-
ment and treatment steps. Without prevention, there is
FELINE DENTISTRY
Oral Assessment, Treatment, and Preventative Care

Oral Assessment
Section I

5
nerve. The body (the rostral two - thirds) of the tongue is
attached ventrally to the midline of the fl oor of the
mouth by the lingual frenulum.

Tongue
The tongue has important functions in grooming, eating,
drinking, and vocalization. The tongue is composed of
both striated intrinsic and extrinsic muscles. The body
of the tongue comprises the rostral two - thirds. The root
comprises the caudal one - third and is attached to the
hyoid apparatus.
The dorsal surface of the tongue is covered by keratin-
ized stratifi ed squamous epithelium that forms papillae.
The tongue of a cat is populated by fi liform, fungiform,
vallate, foliate, and conical papillae. Filiform and fungi-
form papillae occupy the dorsal surface of the tongue
body. Vallate papillae separate the tongue body and root
dorsally. Vallate, foliate, and conical papillae occupy the
tongue root (fi gs. 1.2 a, b).
Pillars of mucosa and the palatoglossal folds extend
to the soft palate at the base of the tongue (fi g. 1.3 ).
The ventral tongue surface contains less cornifi ed
mucosa. The lingual frenulum connects the tongue to
the fl oor of the mouth within the intermandibular space.
Innervation
Sensory input is received from maxillary and mandibu-
lar divisions of the trigeminal nerve. The maxillary
branch leaves the trigeminal ganglion, then exits the
cranial cavity through the foramen rotundum, courses
through the alar canal and the pterygopalatine fossa to
enter the infraorbital canal. Just before entering the
caudal limit of the infraorbital canal, the nerve branches
to become the major and minor palatine nerves. These
nerves innervate the hard and soft palates and the naso-

pharynx. The palatine nerves are desensitized with the
maxillary nerve block.
Anatomy
Chapter 1
An understanding and appreciation of feline dental
pathology, treatment, and prevention requires a deep
awareness of the structure and function of oral tissues
that are composed of the teeth and supporting tissues.
Oral Cavity
The oral cavity extends from the lips to the pharynx,
bounded laterally by the cheeks, dorsally by the palate,
and ventrally by the tongue and intermandibular tissues.
The oral cavity is divided into the oral cavity proper and
the oral vestibule. Within the oral cavity proper are
the hard palate, soft palate, tongue, and the fl oor of the
mouth. Caudally, the oral cavity proper ends at the
palatoglossal folds. The oral vestibule spans between
the lips, cheeks, and dental arches. The labial vestibule
is the space between the incisors, canines, and lips. The
buccal vestibule is the space between the cheek teeth and
the cheeks (fi gs. 1.1 a – g).
Mucosa
Oral mucosa covers the surface of the mouth. The outer
layer is composed of variably pigmented nonkeratinized
and parakeratinized stratifi ed squamous epithelium.
The submucosa is composed of loose connective tissue,
salivary glands, blood vessels, muscle fi bers, lymphat-
ics, and salivary ducts. The submucosa of the palate is
composed of dense collagen.
Muscles

The muscles of mastication that close the jaws are the
temporal, masseter, and medial and lateral pterygoid
muscles, all of which are innervated by the mandibular
nerve (the only motor branch of the trigeminal nerve).
The digastricus muscle opens the mouth. Its rostral belly
is innervated by the mandibular branch of the trigeminal
nerve, while its caudal belly is innervated by the facial
6
a
b
c
d
e
f
Figure 1.1 a – g Mucosal surfaces of the oral cavity (all images © 2009
Dr. Alexander M. Reiter) .
7
g
a
b
Figure 1.2 a. Tongue and papillae 1. Filiform papillae; 2. Fungiform papillae; 3. Foliate papillae; 4. Vallate papillae. b. Filiform papillae.
Figure 1.3 Palatoglossal fold infl ammation.
Figure 1.1
Continued
8 Feline Dentistry
The maxillary arteries also give rise to the major pala-
tine arteries, which anastomose with the infraorbital
arteries. The infraorbital arteries exit at the infraorbital
foraminae to supply the rostral muzzle.
Lymph from the oral cavity drains into the parotid,

mandibular, lateral, and medial retropharyngeal, super-
fi cial, and deep cervical lymph nodes.
Salivary Glands
The major salivary glands in the cat include the parotid,
zygomatic, mandibular, and sublingual. Saliva from the
parotid gland exits at a papilla in the alveolar mucosa,
just caudal to the maxillary fourth premolar. Saliva from
the zygomatic gland exits at a papilla in the alveolar
mucosa near the maxillary fi rst molar. Saliva from the
mandibular and sublingual glands enters the oral cavity
through the sublingual caruncles located ventral and
rostral to the base of the tongue (fi gs. 1.4 a, b).
Cats have four molar salivary glands. The buccal
molar glands empty into the oral cavity through several
small ducts. The lingual molar glands are located in the
membranous molar pad linguodistal to the mandibular
fi rst molar teeth (fi g. 1.5 ).
Periodontium
The term periodontium is used to describe tissues that
surround and support the teeth, including the gingiva,
periodontal ligament, cementum, and alveolar bone.
Gingiva
The cat ’ s oral cavity is lined with keratinized and non-
keratinized stratifi ed squamous epithelium. Gingiva
refers to the keratinized oral mucosa that covers the
alveolar process and surrounds the cervical portion of
the tooth crowns. Unlike the epithelial lining of the
digestive tract, the gingiva does not have absorptive
capacity but acts as a physiologic permeable barrier that
protects underlying structures (fi g. 1.6 ).

The gingival epithelium is composed of the
following:

•
The oral epithelium, also called the outer gingival
epithelium, which is keratinized or parakeratinized
and covers the oral surface of the attached gingiva
and gingival papillae.

•
The sulcular epithelium is a nonkeratinized exten-
sion of the oral epithelium into the gingival sulcus.
The bottom of the gingival sulcus in a periodontally
The maxillary branch of the trigeminal nerve also
gives off the caudal maxillary alveolar nerve, which
innervates the maxillary fi rst molar, the buccal gingiva,
and mucosa. This area is blocked with the infraorbital
nerve block.
After giving off the caudal maxillary alveolar nerve,
the maxillary nerve enters the infraorbital canal, where
it is called the infraorbital nerve. While the infraorbital
nerve is traversing the infraorbital canal, it gives off two
more branches that exit ventrally from the canal. The
middle maxillary alveolar nerve innervates the premo-
lars and associated buccal gingiva. The rostral maxillary
alveolar nerve supplies the canines, incisors, and associ-
ated buccal gingiva. The remaining fi bers of the infraor-
bital nerve then exit the rostral extent of the infraorbital
canal to innervate the lateral and dorsal cutaneous struc-
tures of the rostral maxilla and upper lip. The middle

maxillary alveolar, rostral maxillary alveolar, and the
infraorbital nerves are anesthetized by the rostral infra-
orbital nerve block.
The mandibular division of the trigeminal nerve arises
from the trigeminal ganglion, exits the cranium via the
foramen ovale, and divides into multiple branches. The
divisions include the sensory buccal nerves, lingual
nerve, and mandibular (inferior alveolar) nerve. The
buccal nerves receive stimuli from the facial muscula-
ture, skin and mucosa of the cheek, and buccal gingiva
along the caudal mandible.
The hypoglossal nerve innervates the tongue, the fl oor
of the mouth, the lingual gingiva, and the mandibular
salivary gland. The mandibular nerve enters the man-
dible on the lingual side, via the mandibular foramen.
The nerve then courses rostrally within the mandibular
canal to innervate the mandibular teeth to the midline.
This nerve can be blocked with the mandibular (inferior
alveolar) nerve block. Rostral to the third premolar
tooth, the mandibular nerve gives off mental nerve
branches. These branches exit through the mental foram-
ina (rostral, middle, and caudal) and innervate the cuta-
neous areas of the chin and lip, and the rostral buccal
gingiva and mucosa. These nerves are blocked with the
mental nerve blocks (usually the middle mental nerve is
blocked).
Blood Supply and Lymphatic Drainage
The external carotid arteries branch off to the maxillary
arteries. They further supply the mandibular (inferior
alveolar) arteries, which enter the mandibular foramina

on the medial sides of the mandibles and then course
rostrally in the mandibular canals, where they exit
through the mental foramina.
Anatomy 9
a
b
Figure 1.4 a and b. Sublingual caruncle.
Figure 1.6 Oral mucosa in a patient with gingivitis, periodontitis, and
caudal mucositis.
healthy tooth should be slightly coronal to the
cementoenamel junction.

•
The junctional epithelium attaches to enamel of the
most apical portion of the crown by means of
hemidesmosomes and lies at the fl oor of the sulcus,
immediately coronal to or at the cementoenamel
junction. The junctional epithelium and gingival
connective tissue separate the periodontal ligament
from the oral environment. The fl oor of the gingival
sulcus is located on the most coronal junctional epi-
thelial cells.
Marginal gingiva is the most coronal (toward the
crown) aspect of the gingiva that is not attached to the
tooth but lies passively against it. When healthy, it
appears coral - pink, fi rm, and with knife - edged margins.
Pigment may or may not be normally present. The space
between the tooth and the marginal gingiva is the gin-
gival sulcus (or crevice). The normal depth of the sulcus
is less than 1 mm in cats.

The free gingival margin is the coronal edge of the
marginal gingiva. Marginal gingiva is demarcated from
Figure 1.5 Membranous bulge linguodistal to the mandibular fi rst molar
tooth containing a minor salivary gland (lingual molar gland).
10 Feline Dentistry
ment near the apex of the root and from lateral aspects
of the alveolar socket and branch into capillaries within
the ligament along the long axis of the tooth. Collagen
fi bers also run through these spaces. The blood vessels
are closer to the bone than to the cementum. Venules
drain the apex through apertures in the bony wall of the
alveolus and into the marrow spaces.
Nerve bundles enter the periodontal ligament through
numerous foramina in the alveolar bone. They branch
and end in small rounded bodies near the cementum.
The nerves carry pain, touch, and pressure sensations
and form an important part of the feedback mechanism
of the masticatory apparatus.
The periodontal ligament has great adaptive capacity.
It responds to chronic functional overload by widening
to relieve the load on the tooth. Vascular communica-
tions between the pulp and periodontium form
pathways for transmission of infl ammation and micro-
organisms between the tissues.
Cementum
Cementum covers the root and provides attachment for
the periodontal ligament. Cementum is produced con-
tinuously, slightly increasing in thickness throughout
life. Acellular cementum is present at the coronal one -
third of the root. Cellular cementum is present at the

apical two - thirds of the root. It is capable of formation,
destruction, and repair. It is avascular but is nourished
from vessels within the periodontal ligament. Cemento-
cytes in cellular cementum communicate with each
other via canaliculi and with underlying dentin.
Alveolar Bone
Alveolar processes house the alveoli, which support the
teeth by providing attachment for fi bers of the periodon-
tal ligament. An alveolus can be divided into two parts:
1. Alveolar bone proper, which is a thin layer of bone
surrounding the root and allowing attachment to the
periodontal ligament.
2. Supporting alveolar bone, which consists of compact,
cortical, or cancellous bone on the vestibular and
oral aspects of the alveolar process.
The alveolar bone and cortical plates are thickest in
the mandible. The shape and structure of the trabeculae
of spongy bone refl ect the stress - bearing requirements
of a particular site. In some areas, alveolar bone is thin
with no spongy bone. The alveolar bone proper is also
referred to as the cribriform plate and is identifi ed on
radiographs as lamina dura (fi g. 1.10 ).
The alveolar bone height is an equilibrium between
bone formation and bone resorption. When bone
the attached gingiva by the gingival groove, a slight
depression on the gingiva corresponding to the normal
sulcus depth (fi g. 1.7 ).
In the cat, the healthy free gingival margin of premo-
lars and molars lies between 0.5 and 1 mm coronal to the
cementoenamel junction, where root cementum meets

crown enamel.
The attached gingiva is located apical to the marginal
gingiva and is normally tightly bound to the periosteum
of alveolar bone. Attached gingiva is keratinized to
withstand the stress of mastication. The width of the
attached gingiva varies in different areas of the mouth.
The attached gingiva is widest at the maxillary canines.
The fi rmly attached gingiva is contiguous with loose
alveolar mucosa at the mucogingival junction, also
referred as the mucogingival line. The mucogingival
junction remains stationary throughout life, although
the gingiva around it may change in height due to
attachment loss (fi gs. 1.8 a, b).
The gingival sulcus is a shallow space between the
marginal gingiva and the tooth. The sulcus depth is
generally under 1 mm but varies depending on the spe-
cifi c tooth and the size of the cat. In cases of periodontal
disease, the abnormal sulcus is termed a pocket, which
extends further apically due to destruction of the peri-
odontium (fi gs. 1.9 a, b).
Periodontal Ligament
The periodontal ligament is a dense, fi brous connective
tissue that attaches the tooth root to the bony alveolus.
The periodontal ligament also acts as a suspensory
cushion against occlusal forces and as an epithelial
attachment to keep debris from entering deeper tissues.
The blood supply to the periodontal ligament origi-
nates from the alveolar artery. Arterioles enter the liga-
Figure 1.7 Gingival structures surrounding the left maxillary fourth
premolar.

11
a
b
Figure 1.8 a. Gingival structures surrounding the right maxillary cheek teeth. b. Mandibular fourth premolar area.
12 Feline Dentistry
a b
Figure 1.9 a. Periodontal probe with millimeter markings before insertion. b. 3 - mm palatal probing depth of the left maxillary canine.
Figure 1.10 Lamina dura (arrows pointing to the white line surrounding the
tooth root).
resorption exceeds formation, the alveolar bone height
is reduced (fi gs. 1.11 a, b).
Bones and Joints
Cranium
The dorsal aspect of the cranium is composed of the
paired frontal and parietal bones. The occipital region of
the cranium is the caudal aspect of the skull formed by
the occipital bone. The temporal region is composed of
the lateral walls of the cranium formed by the temporal
bones. The rostral wall of the cranium is formed by the
ethmoid bone (fi gs. 1.12 a, b).
Facium
The facial part of the skull, which encloses the nasal and
oral cavities, is divided into oral, nasal, and orbital
regions. The oral region surrounding the oral cavity is
composed of the incisive, maxillary, palatine, and man-
dibular bones.
The region surrounding the nasal cavity is composed
of the nasal, maxillary, palatine, and incisive bones. The
orbital region is formed by the frontal, lacrimal, palatine,
13

a
b
Figure 1.11 a. Alveolus encasing a fractured maxillary canine tooth. b. Decreased alveolar margin height (arrows) secondary to periodontal disease.
a
b
Figure 1.12 a. Left lateral aspect of
the skull with the zygomatic arch
removed; 1. Parietal bone; 2. Squamous
temporal bone; 3. Sphenopalatine
foramen; 4. Maxilla; 5. Incisive bone; 6.
Frontal bone; 7. Lacrimal bone; 8. Optic
canal.
b. Medial aspect of a sagittal section
of the left aspect of the skull: 1. Incisive
bone; 2. Maxilloturbinates; 3. Nasal
bone; 4. Nasal septum; 5. Palatine bone;
6. Pterygoid bone; 7. Ethmoid bone.
c. Dorsal aspect of the skull: 1. Incisive
bone; 2. Nasal bone; 3. Maxilla; 4.
Frontal bone; 5. Zygomatic process of
frontal bone; 6. Zygomatic bone; 7. Pari-
etal bone; 8. Zygomatic process of tem-
poral bone; 9. Lacrimal foramen; 10.
Infraorbital foramen.
d. Ventral aspect of the skull: 1. Inci-
sive bone; 2. Palatine process of the
maxilla; 3. Major palatine foramen; 4.
Vomer bone; 5. Pterygoid bone; 6. Frontal
bone; 7. Palatine bone; 8. Temporal
process of the zygomatic bone; 9. Zygo-

matic process of the temporal bone; 10.
Retroarticular process; 11. Mandibular
fossa of the articular surface of the tem-
poromandibular joint. (Images reprinted
with permission of Morton Publishing
Company.)