Last time I discussed the importance of dentistry in our pets. Today I want to discuss common problems I encounter and procedures we perform.
Periodontal disease: By far the most common problem I encounter in a dog’s mouth is periodontal disease. Over 80% of all dogs have some degree of this disease. The periodontal pockets are located between the gingiva (gum line) and the base of the tooth. Food debris can accumulate in these pockets creating an environment for bacteria to grow. A dog’s mouth contains a variety of bacterial strains of which a few or all can be involved in this process. The bacteria propagate as they invade the gingiva and support bone around the tooth. They produce toxins that participate in putrefaction of the tissue resulting in bone destruction. As time passes the pockets deepen with the end result being total destruction of support bone, abscessation, and tooth loss. During all dental procedures the periodontal pockets are measured for depth. Any exposed roots are cleaned and the pocket is injected with a slow release antibiotic gel. Prevention is good home dental care along with timely professional cleanings*.
Fractured teeth: I will commonly see the crowns of teeth fractured from chewing on hard objects. The most common teeth fractured are also the most important teeth in the dog’s mouth, the canine teeth and the 4th premolar or carnassial tooth. Most fractures are deep enough to expose the root canal. If diagnosed early the tooth is x-rayed and if the canal is normal with no evidence of infection, endodontics (root canals) can be performed. If infection is found, extraction is necessary.
Caries: These are commonly referred to as cavities. These are relatively rare in dogs. However, I’m starting to see an increase in incidence. If found in early stages, they can be “burred” out and filled. However, they are usually found in severely diseased mouths and too much destruction has occurred leaving extraction as the only treatment.
Malocclusion and crowding of teeth: Crowding of teeth result in food accumulation leading to periodontal disease. If problematic, I will extract the crowding tooth.
Retained deciduous (baby) teeth: If baby teeth are not shed in a timely fashion, they can crowd the adult tooth or even keep it from erupting. I usually extract these baby teeth at spay/neuter.
A word on extractions: Most people do not realize the depth of the dog’s tooth roots. They are at least the length of the visible tooth. Because they have such a powerful bite, the roots are deeply imbedded in the bone. The roots of the multi-rooted teeth flare out from each other making the tooth even more stable. Unless the tooth is loose, extraction is difficult. Multi-rooted teeth are cut into halves or trisected, to enable complete removal of roots. Often incisions in the gingiva and burring away of support bone is necessary to allow complete removal.
Periodontal disease: As with the dog this is a very common problem that if left intact leads to serious problems. Currently, the most accepted theory in cats is that inflammation leads to a dramatic immune response that can lead to the the problems listed below. Annual or semi-annual professional cleanings* are the most effective preventative.
Gingivitis/stomatitis: Certain cats’ immune system “over react” to the bacteria in the mouth and gingivitis develops. This is an inflammation of the gum line causing redness and swelling. This can lead to stomatitis which is a severe inflammation of the mouth usually starting at the gumline and spreading. Swelling, discharge, odor, and pain develop. If antibiotics and anti-inflammatories don’t help or fail after a few treatments, extraction of involved teeth is the only treatment. If advanced, extraction of all the cats teeth may be necessary.
Feline erosive lesions: These look like cavities but the pathology is totally different. Again the theory is related to gingivitis. The cat’s immune system, while combating the bacteria in the periodontal pockets, takes a “wrong turn” and starts to attack the enamel of the involved teeth. The enamel is eroded and eventually the pulp canal is exposed. Eventually enough damage has occurred that the tooth fractures off. These lesions are painful and once the disease develops multiple teeth will eventually be involved. Extraction is the only treatment.
Tooth fractures: The canine teeth are the most common fractured teeth in cats. Endodontics can be performed if no infection is present.
Retained deciduous teeth: As in dogs, I extract them at neuter/spay.
A word on extractions: As with dogs, extractions are difficult. Most work is done under magnification and multiple extractions are done surgically. Incisions are made and the gingiva resected back to allow access to the roots and diseased bone. In stomatitis, after the teeth are removed the bone is burred down to healthy tissue and the gingiva is sutured over the defect. Once the disease is out the cats do well. We see many cats with only canine teeth and sometimes no teeth. They actually eat better because of the lack of pain.
So what do I want you to take from this?
Prevention will deter almost all of this. Annual or semi-annual professional cleanings* and home dental care will extend your pet’s life, keep it pain free, and relieve you from expensive dental procedures.
*Professional cleanings refer to dental prophylactic procedures done by a veterinary technician while the animal is anesthetized. This includes removal of calculus, cleaning, root planing, periodontal pocket assessment, polishing, fluoride treatment, and sealant application.