Your Pet's Best Friend

More retained baby teeth.

Last summer I did a short post on a kid with 10 retained baby teeth.  What a piker.

This is Abby.  She's not showing you much of her smile. At this point, you wouldn't have minded seeing it, but you surely wouldn't have wanted to smell it.  She has a lot of baby teeth that failed to move on when the time came.  She's a little bit of a late bloomer.  At nine months old, not only has she not shed all the deciduous teeth, but her permanent canine teeth look like they are not quite fully erupted.

The reason you wouldn't have wanted to smell her breath is that all these extra teeth are pretty bad about catching a lot of junk.  She had wads of thread and hair jammed between the over-crowded teeth.  Some teeth are coming in crooked.  There's gum disease, and a suprising amount of calculus (tartar) accumulation, considering that she's only nine months old.

Here are FIFTEEN baby teeth that should have come out on their own.  Three of them were just crown-caps with the roots dissolved, but they were still in place, and still trapping crud.  The tooth with bloody roots at "10 o'clock" is the opposite number to the little cap at "2 o'clock".  It was pretty solid, but it had one bad root, and was crowding three other teeth.  It left a big enough hole that we had to suture it.  That's a little unusual for a baby tooth.

  Here's part of Abby's new smile with a normal number of teeth.  Her mom is committed to keeping her in shape, and I'll bet that her smile just gets better. I don't think she'll ever end up like this dog.

Severe dental problems are not always obvious.

This is Tommy.  He came in to get a skin problem checked out.  Since a skin problem is sometimes just "the part you can see" of a whole-body problem, we always do a complete physical examination.  In checking Tommy's teeth, I found that his left upper cheek tooth was the wrong shape, covered with tartar, and loose.  "Well, you know, he hasn't wanted hard food for quite a while.  He will only eat soft food.  He doesn't act like he's in pain, though.  He still jumps and plays."   Gee, I think that if he's got a broken tooth wiggling around in his mouth, it probably does hurt.  Why don't we take care of that, and clean up the rest of them while we're at it? "Well...yeah!"  So we did.

The little chunk on the left is what I was wiggling around during the exam.  It came out easily, didn't even leave much of a hole (though we did stitch it closed).  The tooth on the right was more of surprise.  When we cleaned off all the tartar that was covering it up, it just didn't look right.  It looked like...half a tooth.  What's worse than finding a worm in your apple?  That's right: finding half a worm in your apple.

Here's a different view.  You can see the split surface with the open pulp cavity.  Ouch!  Isn't it amazing that "the cat doesn't act like he's in pain"?  For a moment, imagine yourself biting down on something that splits a molar tooth in half, leaving the open pulp exposed.  Imagine not being able to do anything about it for months.  You don't even want to imagine it, do you?  Now, imagine yourself pretending that... it doesn't hurt!  Good luck with that.

So now those teeth are out, the socket is filled with Consil synthetic bone graft, and the holes are sewn shut, and lots of nice pain medicine has gone home with Tommy.  I'm looking forward to hearing about his return to eating whatever he wants, and to the surprising improvement in his behavior (the kind you get when constant pain goes away, as in a previous post).

He is NOT too old to get his teeth cleaned.

This "Beau".  He is thirteen years old, and this picture was taken about 15 minutes after we finished cleaning his teeth.  His teeth were really covered with calculus (tartar), and he had a little gum disease.  Cleaning his teeth was especially important because of his other medical problems.  Not his lower back problems (which have been really bad at times), and not his low thyroid condition (for which he takes medicine twice day), but because he has severe heart problems. 

Beau has congestive heart disease.  He has been on twice-daily medications for four years.  You may not have looked at many chest X-rays, but take my word for it:  this is a big heart.  It looks like a basketball, double the size it ought to be.  It's not big and strong, either.  It's stretched out of shape and weak and flabby.  His cardiac output when he's wide awake is worse than most dogs while they are under anesthesia.  SO... who's up for knocking him out to clean his teeth?  [I can't hear you.]

Anything you do involves making a decision as to whether the risks outweigh the benefits.  When they dropped off Beau, the last thing the owners said was, "Don't kill him."  Hey, no pressure.

First the Benefits: clean teeth, fresh breath, healthy gums... so what?  Just don't look at his mouth and you can pretend he has all those.  Then there's the fact that you get rid of the zillions of bacteria that his mouth is constantly dumping into his bloodstream -- bacteria that are clogging up his kidneys and damaging them, and that would love to colonize his damaged heart valves.  Okay, that's a little harder to ignore.

What about the Risks?  Well, he's thirteen years old and has had heart disease for four years and he might die with clean teeth.  We could have stopped right there, but we didn't.  We decided to look at his actual risks.  First, his bloodwork is good -- no problems with liver or kidney function.  Second, if you look at that chest X-ray again, you'll see that the lungs are clear -- no fluid and looking good.  Third, his electrocardiogram got a pass from the cardiologist at Idexx telemedicine.  So...a lot of his "risk factors" are actually not so risky.

We put Beau on I.V. fluids and kept his anesthesia light (with easy-to-adjust Sevoflurane gas), monitored him closely, and I worked at a furious pace.  My receptionist wandered back to see how we were doing and said, "Your next appointment has cancelled, so you can take your time."  Wrong.  No matter how good his labwork was, there's no point in pushing our luck with that big, weak heart.

The point of the post is this:  you folks with your 9-year old dogs with healthy hearts have got to stop using the "he's too old" excuse for not getting those mouth problems handled.

My First Orthodontic Appliance

Well, not actually my first braces or retainer (that was 44 years ago, after all).  I mean the first one that I've applied to a patient.  In a previous post we talked about how retained baby teeth can lead to malocclusion: teeth that grow in where they don't belong.  On little Cocoa here, I failed to get a good "before" picture of that (before I did anything, that is).

This is a "before picture" as far as the teeth are concerned.  The white blob is the acrylic appliance I built up in the roof of Cocoa's mouth.  You can't see the  grooves that are cut in the wedge sticking down, but they are there.  What you can see are that the lower canine teeth (bottom fangs) are coming straight up so that they were hitting the roof of the mouth.  See how straight up and down they are?  They should have been angled out to wind up between the upper teeth.  As Cocoa closes her mouth, those teeth encounter the wedge now, and the grooves direct her teeth outward.

Here's a side view, showing the acrylic blob that covers part of the roof of her mouth, anchored to her upper teeth.  It's pretty thick in this picture.  After two weeks, the teeth had moved enough that the wedge wasn't hitting her teeth anymore, but was hitting the bottom jaw.  We shaved the blob down and cut new grooves to direct her teeth.  I was in a hurry that day, and didn't make time to get pictures of stage two, unfortunately.

Here she is at four weeks, minus her appliance (i.e. blob of acrylic plastic).  You can see that the lower fang is now directed outside her upper teeth and into the groove where it belongs.  This is pretty cool, and much less uncomfortable than having her bottom fangs poking her in the palate.  I'm glad I got the chance to do it, but if I'd gotten the chance to extract those funky baby teeth back in March, Cocoa wouldn't have needed this repair.

Watch out for those baby teeth when the permanent teeth come in.  If they aren't getting loose by the time the permanent tooth is halfway in, it's time for a visit to your veterinarian.

Retained Baby Teeth

This is the special outlet where my new dental X-ray machine will soon be installed.  I had to get a dedicated circuit put in (I can hardly wait for the electrician's bill).

There are lots of good reasons to take dental X-rays when you're working on a pet's teeth, but I'm only going to talk about one of them today.

Like people, dogs and cats start out with a set of deciduous, or baby, teeth.  These are quite small.  As the animal grows, these teeth don't.  By the time the pet is about three months old, the teeth look too small for the animal, and there is noticeable space between them.  That's because the jaws are growing and the teeth aren't.   At roughly sixteen weeks, permanent teeth begin to emerge.  The first ones will be the upper incisors -- the two teeth right in the middle of the front on the upper jaw (numbers 101 and 201 for your dentists out there).  By five to six months, most pets have all of their permanent teeth, with the canine teeth (fangs) coming in last.  As the permanent teeth come in, the roots of the baby teeth dissolve, and they just fall out to make room for the new tooth... most of the time, that is.

It's very common to see some baby teeth retained.  The permanent tooth has come in beside them, and now we have two teeth in the space meant for one.  This is most common with the canine teeth, the fangs, and it's not good.  The bottom fang should come up and rest in a groove just in front of the upper fang.  If the upper "baby fang" is still present, it pushes the permanent tooth forward, making that groove too small.  If the lower "baby fang" doesn't go away, the permanent tooth comes up into the roof of the mouth, instead of that groove.  So, if you see permanent teeth coming in while the baby teeth are still there, it's important to have those baby teeth extracted.  We want the permanent teeth to come in to the right spot. It's not just a matter of a pretty smile: think how it would feel to have one of your teeth always poking you in the roof of the mouth -- OUCH.

When the baby tooth's root has not dissolved, it can be quite long. In the case of the canine tooth (fang), the root is about twice as long as the tooth you can see.  This requires general anesthesia to extract, as you've got to do a bit of digging to get it out in one piece.

These teeth are the  reason that I started the post by talking about a dental X-ray unit.  This six-months old Yorkie puppy looked like it had a mouth full of permanent teeth, and we just needed to get those two baby fangs that were hanging on.  Danged if she didn't have TEN baby teeth hanging around.  Some were pretty loose, having no roots, and others were still pretty firm.  They all needed to come out and make room for the permanent teeth.  Were there more than ten baby teeth hanging on?  I don't think so; I do think I got them all, but I don't know for sure.  I need that dental X-ray.

Dental Seminar: It must have been the right seminar.

I said before I went that I was looking for the seminar that would make dentistry fun.  It must have happened, at least to some degree.  This afternoon a good client brought in her old cat because she thought her mouth had been injured. The cat was drooling, and wouldn't eat well.

On examination, we found that Lovie's left upper canine tooth (or #204, as we veterinary dentists call it) was missing and it's socket was filled with pus.  She was actually down to six teeth, plus a couple of broken snags.  She was also hurting.  The owner makes a forty-minute drive to see us and asked if we could just keep her this evening (it was already after five) and take care of her tomorrow.  We aim to please, so we fixed her a lovely private room for the night.

The schedule for tomorrow is already over-full.  How will I work in a dental case?  Gee, I hate to disappoint my good client...and I get to use of some of my new-found knowledge already. 

Even though I had worked until six, gone to the CASA training until eight-thirty and didn't finish supper until nearly nine, I came back to the clinic.  And here I am at eleven-twenty, blogging about it.  The other upper canine tooth was extremely loose and had to come out.  In fact, Lovie is down to three teeth and no broken snags now.   Where those big fangs come out, you have a nice big hole that will probably break into the nasal passages (if it hasn't already).  I scraped those nasty sockets out and filled them with Consil synthetic bone graft material, then sutured the gums shut and they should do great. 

A little pain medicine, some antibiotics for a week, and soft food for a while, and she ought to feel much better.  Once her mouth heals, she can probably even handle dry food without much trouble: it pretty much dissolves in the stomach whether they chew it or not. 

I must be having fun -- why else would I still be here?

Dental seminar was great!

After work Friday, we made the six-hour drive to Columbia, Missouri, arriving around eleven-thirty.  On Saturday, I arrived at the veterinary school for my dental seminar.  It snowed a lot, and it snowed for a lot of the year back when I was in school there (1972-1978).  Having snow in spring was a nice touch of nostalgia when I returned to my alma mater.  Having it all melted off by evening was an even nicer touch.

Dr. Jonathon (Bert) Dodd gave most of the lectures and video demonstrations on Saturday.  He's a member of the faculty at the veterinary college at Texas A&M University.  Usually after about an hour in a lecture, either my behind or my brain goes numb, with the other following shortly thereafter.  Dr. Dodd was such a great teacher that I was surprised to find two hours had gone by when we stopped for a break.  I will say that nine hours of class time is a big change from my usual more active day.  The time was well spent:  not only did I learn a lot about the technical aspects of dentistry, I also gained a new perspective on how to fit dental care into the "whole-patient" care.

On Sunday we moved to the anatomy laboratory where we had our "wet lab".  It's a much nicer facility than the one I studied in, with better lighting in the student work-stations than many surgery suites have.  However, I did find this group of old friends back in the corner.  They may be the only surviving relics of the time when I was at the college. [That big blob in the foreground is the back of an elephant skull.]

Dr. Richard Meadows heads up the department of clinical practice at Mizzou, teaching students how to actually deal with clients and their pets.  He also is the dental specialist, and (with help from several visiting veterinary dentists) gave a lot of individual attention to the twenty veterinarians who attended.  I learned new skills, and improved old ones.  I also got to try out some pretty neat equipment that goes on my wish-list now.

There's always something new to learn, so continuing education is important.  It's really nice when it's also this enjoyable.

Dental procedure training.

In ancient times when I went through veterinary school,  our dental training was pretty limited.  In latter years I have bought textbooks, read journals and attended training courses.  There are still plenty of things to learn, though, and I'm off to Columbia, Missouri for a 2-day dental training course.  Saturday it's lectures all day, while Sunday it's all "hands-on" (what we in the profession call a "wet lab").

I'm really not too crazy about performing dental procedures, so I'm hoping this is the course that makes it fun to clean teeth.  Heaven knows that an awful lot of my patients need it.

Here's Peanut.   He's a cute little guy, isn't he?

Here are Peanut's teeth.  They're not so cute, are they?  The darker tan junk covering is teeth is tartar (also known as dental calculus).  It's hard, brittle, and 50% bacteria by weight.  The white, gooey-looking stuff around the gum-line is pus.   Yeah, he stinks.  Don't let your pet's mouth get in this condition.

Record number of lost teeth today.

You may remember the case of Cinnamon from a previous post.  She made it in today to get her dental work.  All of her teeth were still in her mouth when she arrived, but not many of them had much to hang on to.  Once we began cleaning off the pus and tartar they began to fall by the wayside pretty quickly. 

Not counting the broken root that I found and extracted, she lost twenty-two teeth today.  Actually, they had been deceased for a while, but they were still hanging around their old stomping grounds (chomping grounds?).  Sort of the "dead man walking" thing.  You probably can't see this, but there is no pink tissue on these teeth, meaning that they had no living attachment to the gums.  There are also no cavities -- just gum disease.  You're lucky you can't smell them, too.

There were no problems with her anesthesia, even though she's fifteen years old.  She's going to feel so much better without all those loose teeth and the concommitant gum infection.  I just wish we could have done this three years ago.  I think all those teeth would still be in her mouth instead of a ziploc bag.

Here are some other postings on dental care.

Rawhide Chews

After reading yesterday's post, one of our flock asked for more information on rawhide chews.  If you're here reading, you probably already know that rawhide is supplied in a variety of forms.  You can get potato-chip size chips, little strips, little strips rolled into "straws", big strips, big strips tied into a bone-shape, and a variety of shapes that are molded from chopped rawhide that has been pressed into a solid material.  It comes in plain, peanut-butter flavor, barbecue flavor, and who knows what all.  If the dogs were buying for themselves, it would probably come in horse-manure flavor.

In the last 28 years, the only problem that I have seen with rawhides was with some chews that were coated with "Special plaque-fighting enzymes", the C.E.T. chews.  Most dogs had no problem with the product.  There were a couple of dogs that had vomiting problems every time they chewed on these, but had no problems with plain rawhide.

In a study evaluating the effectiveness of different and treats and chews in reducing dental tartar, rawhide chew were found to significantly reduce tartar in about 40 to 50 percent of dogs.  As in incidental finding, the investigators noted that dogs in this treatment group tended to consume several chunks of rawhide daily and they observed no ill effects from this.  Apparently the rawhide softens up enough in the stomach acid that it rarely causes blockages when swallowed.

That being said, big chunks swallowed without chewing are pretty stiff and could certainly cause a blockage in the esophagus (or "goozle" as we like to say in redneck land) before they ever get to the stomach.  Some rawhide products are brittle and can actually splinter and lodge in the mouth or elsewhere.  If a dog were to swallow a big enough hunk, it could certainly cause a blockage. I have known dogs to eat panty-hose, socks, shop-towels, rocks, corn cobs,steel balls, and extension cords.  A big enough hunk of anything can cause a blockage.

Sadly, nothing is guaranteed safe, not even lying at home in bed with the lights off.  Dogs enjoy chewing and need to do so.  The watch-word is caution and judgment.  If your dog is feeling bad and yesterday's chew-toy has disappeared, it's time for a trip to the veterinarian.