Piedmont gets a new home (and no teeth)

Piedmont is a lovey, very friendly adult kitty that had spent the last 2 years at the Durham APS shelter waiting to be adopted.  She had all the qualities of a perfect feline companion; that is until one looked in her mouth.  She had severe dental disease that would require advanced oral surgery to correct.  She needed all her teeth removed.  So she waited until Westside offered to treat her at no charge to her new owner. 

So Piedmont was adopted and presented for oral surgery by her new owner a few weeks ago.  I can honestly say she that she had some of the most severe dental disease that I have seen in a kitty.  She also has an incredibily sweet personality.

Here is some of what we discovered in her mouth.

The left upper canine had severe periodontal disease, teeth resorption and a fractured root tip.

The same was true on both mandibles.  These areas were very sensitive and painful.
So I removed all her teeth.

Here she is about 4 hours after the start of anesthesia enjoying her new life without teeth.
It is always gratifying to see dogs and cats from Durham APS go to good homes, but it is especially great to see older pets adopted to loving homes.  Piedmont is in a wonderful new home and her new owner is so happy to have her.  The picture at the top of the blog is from the 2 week recheck.  Piedmont was healing great and seemed like a new cat to the owner.

Kudos also go to Durham APS for loving and keeping Piedmont for such a long time until just the right owner came along.  Piedmont is one of those pets that make veterinary dentistry fun!

Deaca gets a filling

This is Deaca (can you guess which ACC team her owner's cheer for?).  She is an extremely energenic and friendly one year old Standard Poodle.  She presented yesterday for treatment of an abnormal maxillary canine tooth.  The left upper tooth looked like this:

This tooth was missing a large area of enamel.  Enamel is the hardest and most dense biological structure in mammals.  Dogs have a relatively thin layer of enamel compared to people.  If the enamel does not form normally it can be weak and brittle.  Deaca's tooth was probably damaged during early development and the result was a an area of abnormal enamel.  In some cases the tooth will actually die because too much dentin is exposed, but Deaca's tooth still appeared to be viable.  So to prevent further damage the tooth was restored with a light-cured composite.  First the diseased enamel, tartar and plaque were gently removed:

Some staining of the enamel remained.  Next the surface was prepared by acid etching. 

The tooth was rinsed and the excess moisture was removed.  The restorative composite was applied in several layers and smoothed with finishing discs.

Deaca did very well during the procedure and was a pleasure to treat!

You can visit westsideanimal.com to learn more about pet dentistry.

Root canal therapy

I do feel a little sorry for the endodontists of the world because just the mention of the phrase "root canal" makes people unhappy. ( I know it did for me and that was long before I even knew what a root canal was!)

An endodontist is a dentist that has had special training in the diagnosis and treatment of diseases of the pulp systems of teeth.  The pulp system is made up of the blood vessels and nerves inside the teeth.  Endodontists spend most of their work days doing root canal therapy (aka root canals) on teeth.  Root canal therapy involves several steps:  removing the diseased pulp of the tooth, cleaning and reshaping the pulp canal, filling the pulp canal and restoring the access to the pulp.  Root canal therapy stops the pain and infection associated with dead or diseased pulps.

There are many reasons that a tooth pulp may become diseased.  In people a common reason is advanced decay (cavities), but in dogs and cats the most common reason is trauma to the tooth.  Fractured canine teeth in dogs and cats are common.  Dogs also commonly fracture the maxillary (upper) 4th premolar tooth.  If the pulp of a tooth becomes exposed to the oral cavity, then the tooth must be extracted or it can be saved with root canal therapy.

Meet Maizie Rose.  She came to her current owner with several broken teeth.  I did root canal therapy on both lower canine teeth when I first met her almost 2 years ago. Root canal therapy enabled her to keep the teeth and avoid major surgery (to remove them). Maizie Rose was back a few weeks ago to clean her teeth and recheck the teeth that had previously been treated.  The previously treated teeth look great, but we found a new problem. 

Her left mandibular first molar appeared normal.

But the radiograph demonstrated periapical bone loss (dark areas around the tooth roots) consistent with a dead tooth.

So Maizie Rose had another root canal to save this very large and important tooth.  Here is a radiograph that was taken after the pulp canals have been cleaned, treated and filled.

Maizie Rose did great with yet another root canal procedure. She is very fortunate to have such a loving and caring owner. 

Enough teeth to make a shark proud!

Macie was referred last week because her baby teeth were not falling out!  Puppies normally start to lose their baby teeth at about 4 months of age.  By 7 months of age the baby teeth should be all out and the permanent dentition should be present.  Macie is 8 months of age and her mouth looked a lot like a shark!



The retained baby teeth were preventing the adult teeth from erupting in a normal occlusion.  So I extracted 13 baby teeth and 2 permanent teeth to make room.  She did really well with the surgery and she is such a sweet puppy.

Better out then in

Meet Badger.  He is as nice as he is handsome.  He is lovely 17 pound ragdoll kitty. 

Badger was referred by his family veterinarian because he had severe dental disease and stomatitis.
Stomatitis simply means inflammation of the mouth.  Stomatitis can be very painful for cats and the causes of stomatitis are not entirely clear.  Badger really seemed to be suffering.  The owner was extremely concerned about his quality of life and was fearful that he may have to be euthanized.  Badger's family veterinarian had encouraged the owner to consider full mouth extractions, but as you may image it is very hard to think about having to remove all your cat's teeth.  After a review of Badger's history and an examination it was clear that Badger needed all of his remaining teeth removed.  I explained to the owner that cats do not need their teeth and that most cats with stomatitis will be cured or have significant improvement after the teeth are removed.

This is how Badger's mouth looked before surgery.

So we removed all of Badger's remaining teeth.  We talked to his owner the next day and she could not believe how well he was doing.  I think he really liked his pain medications!

I saw him a few days ago.  He was about 2 weeks out from surgery.  His owner was so pleased.  She said that he seems like a new cat!  It is very rewarding to be able to help cats like Badger be free of pain.

Classic tooth resorption in a kitty

Allie is a very sweet kitty that was presented for regular professional dental care.  She had some very classic tooth resorption.

First a little background information about tooth resorption (TR) in cats.  TR in cats is a common problem that is characterized by a progressive resorption of dental hard structures.  Prevelance rates vary widely but more than 50% of cats over 5 years of age may be affected. We still do not understand why cats develop TR, but we do know that it is not just a recent problem.  Cats have had TR lesions for a long time.  One study from the Schlid excavation of a 13th and 14th century German village found several cat mandibles and one skull that had visual TR.   We also know that it can be very painful as the crown is destroyed.  And it is the most common dental problem that I see in cats.

Back to Allie.  The reason I say that Allie had classic lesions is because of the specific teeth that were affected in her mouth.  It seems that the mandibular 3rd premolars in our domestic cats have the greatest tendency to be affected by TR.  One study found that the mandibular 3rd premolars were affected over 90% of the time that a cat has any TR in the mouth.  So on all our kitty examinations we always look very closely at the teeth, but pay special attention to the mandibular 3rd premolars for this reason. 

In the first image of her right mandible the 3rd mandibular premolar is the first tooth after the large canine tooth.

Here is a close-up.

And here is the radiograph.

The crown and the distal root are diseased.  The root structures were visible on the radiograph so they needed to be extracted.  In some cases the root structure has completely resorbed and been replaced by bone.  In these cases the roots may not need to be removed.  The decision to remove roots is determined by review of dental radiographs.  This is just one more reason that modern veterinary dentistry requires dental radiographs.

Allie's other mandibular 3rd premolar also needed to be extracted.  She did great with the surgery and was a pleasure to treat.

Visit westsideanimal.com to learn more about veterinary dentistry.

A week of diseased canine teeth in cats

It seems like some weeks have themes.  This week it was diseased canine teeth in cats.  You may have already read about Sadie.

There was this tooth in an geriatric kitty named Trixie.

The root was undergoing external resorption from an old fracture and had severe periodontal disease.

The tooth had to be extracted.  And the other upper canine was not in much better shape and needed to be extracted as well.  Trixie is a very sweet kitty and did great.  Even at age 13!

Then there is this kitty.  She is only seven years old and had all her cheek teeth removed about 3 years ago.  Since then she has had progressive periodontal disease of all 4 canine teeth.  So we went ahead and removed the all remaining teeth.  I was hoping that when we removed all of her other teeth 3 years ago that she would be able to keep these for longer, but some animals have more severe periodontal disease for reasons that we do not entirely understand.

Cats do amazingly well without their teeth.  I have lots of kitty patients without any teeth. It is much better to have healthy gums than diseased teeth.  

I wonder what next week's theme will be?

Cats get dental disease too!

This is Sadie.  She is a much loved member of her family.  She has chronic kidney disease, but is doing great.  (She is a little sleepy from the pre-medication as she would not stay still for her pre-operative photo session!)

My posts thus far have focused on dogs (plus one Lemur) so I want to give some examples from the feline species.  Cats have dental problems that are similar to dogs, although cats are more prone to a condition called tooth resorption.  Sadie was referred because the family veterinarian discovered this during a dental cleaning.

The canine tooth on this upper jaw is obviously fractured and the surrounding bone is enlarged.  The radiographs looked like this.

The bone surrounding the tooth has been destroyed over time by the infection that resulted from the pulp canal being exposed.  The tooth died and the root is also being destroyed. 
The treatment was surgical extraction of the tooth and removal of all the diseased tissue.  Here is how it looked after surgery.

And here is Sadie about one hour after recovering from anesthesia.  She woke up hungry!

Sadie was a pleasure to treat.  I am sure she will feel much better with the diseased teeth gone.

Some dogs have all the (bad) luck when it comes to teeth

This is Zeb. You will have to agree that Zeb is one of the cutest dogs ever.  He came in for a dental evaluation and treatment with a history of severe halitosis and numerous extractions due to periodontal disease.  It was obvious during the physical examination that Jeb was one of the unlucky dogs when it comes to teeth. He had severe and chronic periodontal disease.  Periodontal disease is the most common infection in dogs and cats.  Most dogs and cats over 5 years of age will have some level of periodontal disease.  The disease is caused by a combination of many factors including plaque, type of bacteria in the mouth (over 700 different anaerobic bacteria have been isolated from under the gums in dogs alone!), breed, general health, dental home care and genetics to name a few.  In most dogs and cats the combination of regular professional cleanings and home care will allow them to keep healthy teeth well into their later years of life, but some dogs seem to have severe disease even with really good care.  Such is the case with our happy and very friendly dog, Zeb.  Dogs like Zeb probably have some superinfection of bacterial that result from an ineffective immune response.  The good news is that removal of the teeth stops the infection, odor and pain. 

As always, radiographs of all the teeth are needed.  This did not look all that bad.

But look at the radiograph.  There is very little bone supporting the teeth.

Again this looks normal.

But once again the radiographs tell the story.

In addition to the severe bone loss, two of the incisors in the image had wide pulp cavities compared to the other teeth.  This indicates that these teeth died when Zeb was young.

We had to remove most of the remaining teeth in Zeb's mouth and he was just a happy to see us after surgery as before!  I was happy to tell the owner that fresh breath is here to stay!

I love boxer dogs!

I really love boxers. I seem to see a lot of them in my practice.  It may be because one of my clients travels the Carolinas rescuing boxers that find their way into shelters.  He takes them home and works with a great organization, Carolina Boxer Rescue, to help find them good homes. One of their boxers even ended up at my house to live out her last years.  Her name was Brandy and she was one of the sweetest dogs I have ever met.  But I digress!  I may also see a lot of boxers becuase they have a bunch of interesting dental problems not limited to: traumatic occlusions, gingival hyperplasia, missing adult teeth, extra adult teeth, and impacted adult teeth.  Last week we treated Alex III (from a long line of great boxer dogs).

Alex III had several of the common boxer dental problems. This included impacted teeth, as seen on the dental radiograph below.

There was also an extra premolar and all the premolars visible had significant tooth root resorption.  Alex III also had an extra maxillary first premolar as seen on this dental radiograph below.

Alex III did not need the extra teeth, and the impacted teeth can result in cyst formation so we removed them. He did great and served as a reminder that all boxers need dental radiographs!

Visit westsideanimal.com to learn more about veterinary dentistry.

Where did the roots go?

I had a very interesting case last week that further illustrates why dental radiographs are necessary to practice modern veterinary dentistry.  Bailey is a very sweet, 11 year old Golden Retriever that was referred because she had several broken teeth that looked like the upper 4th premolar pictured below.

This tooth did not need any treatment beyond cleaning, but the same premolar on the other side had to be extracted due to advanced endodontic disease and external tooth root resorption. But as often is the case we found some other problems.  The tooth that is pictured above on the lower jaw in the very back of the mouth appeared very normal, but look at the radiograph.

This second mandibular molar should have 2 tooth roots, but as you can see they were missing.

A very similar problem was discovered in the other side.

On the left mandible the second and third premolars had disappearing roots. 

We do not know what causes this problem, called tooth resorption, and it is much more common in cats.  The only treatment is extraction.  The affected teeth were extracted and Bailey did great.

Sometimes baby teeth just will not go away

Hurley

I saw a very sweet mixed breed dog today named Hurley (not sure if he was named after one of my favorite characters on Lost - I really miss that show).  He served as a good reminder that some baby teeth (aka deciduous teeth) do not fall out like they should.  Most dogs start losing their baby teeth around 4 months of age.  In most breeds all the baby teeth are lost and all the adult teeth are present by 6 months of age. 

Hurley is 7 months old and was still hanging on to several of his baby canine teeth.  The general rule is that two teeth should not occupy the space where only one tooth belongs.  The crowding caused by the retained baby teeth can cause problems with the adult teeth so they needed to be extracted.  The right upper jaw of Hurley's mouth looked like this:

The baby tooth is the short tooth directly behind the large canine tooth.  Of particular interest is that this baby tooth is fractured.  The fracture has resulted in an infection at the root of the tooth.  If you look closely at the image you may be able to notice a small tract that looks like a pimple just above the first premolar.  I have treated quite a few puppies with fractured baby canine teeth and infected tooth roots are common when the tooth pulp is exposed.  Fortunately removal of the tooth will usually allow for complete healing.  Hurley did great today and was a real pleasure to treat.

Fun with lemurs

Root Canal Therapy on a Red-bellied Lemur

I was just a little nervous when Dr Schopler, one the veterinarians at the Duke Lemur Center, said, "there are only 7 other red-bellied lemurs in captivity in North America" as they started the anesthesia.  Fortunately the veterinarians and support staff at the Center are excellent when it comes to anesthesia in lemurs.  The staff has years of experience and training plus the latest in veterinary technology to insure that the risk of anesthesia is minimized.  I think it is safe to say that nobody knows more than the Duke Lemur Center about caring for and treating lemurs in the whole world.

I was there to try to save Hopi's left maxillary canine tooth.  Hopi is a female red-bellied lemur and about 20 years old.  She had worn down the tooth, exposed the pulp and now had a swelling on the same side of her face from the tooth root infection.  The only treatment options for a dead tooth like this are extraction (which requires oral surgery) or root canal therapy.  It turns out that lemurs use their teeth more for social interaction than for eating.  Losing the canine teeth can really upset the social order, so the veterinarians were excited about the chance to save the tooth. 

Thanks to some recent donations of equipment from the people dentists at Duke Pediatric Dentistry the Lemur Center now has dental radiograph capability.  This capability is essential when it comes to performing root canal therapy.  Root canal therapy involves cleaning, filling and sealing the inside of the tooth.  The root canal was not easy due to Hopi's age, but Hopi did great with anesthesia.  We we will have to wait and see if the root canal treatment resolves her infection. 

If you live around Durham, then I would encourage you give the folks at the Lemur Center a call and setup a tour.  It is an amazing place with some really cool animals.  It is just one more reason why I love living and working in Durham.