Case of the Month- A Bad Tooth!

Sam, a 4 year old mixed breed dog, presented one morning with a broken tooth.  He didn’t seem uncomfortable, and his behavior hadn’t changed.  He was playing the day before and spit out a piece of tooth.  The only abnormalities on physical exam were that he had 2 discolored teeth on the right side of his mandible (lower jaw), and the biggest tooth (the 1^st molar) was missing its front half.  Sam had been adopted two years prior and had a discolored tooth at that time.

Sam’s physical exam was otherwise normal, and his laboratory tests were unremarkable.  Sam was given a premedication to alleviate any pain, prior to the induction of anesthesia.  He was then maintained on gas anesthesia, given intravenous fluids, hooked up to multiple monitors to ensure anesthetic safety, and placed under a forced-air warming blanket.

We then performed what is referred to as a COHAT procedure – comprehensive oral health and treatment.  First, we do a full oral exam under anesthesia.  Sam had a mild amount of calculus built up on the crowns of his teeth (the part you can see), a little bit of gingivitis, and 2 purplish teeth – his lower right 4^th premolar (#408) and lower 1^st molar (#409).  His 1^st molar was also missing part of its crown, and had a hole in it.

 

Sam’s nose is pointing to the left, and you are looking into his mouth, at his lower right teeth.  His tongue is being pulled back, and you can see its edge on the right side of the photo.  The teal arrows are pointing to the 2 discolored teeth, and the orange arrow is pointing to the hole.  The part of the tooth that is missing was covering up the hole.

Next we x-ray the teeth.  We have a digital dental x-ray unit that makes this very quick and easy!  The x-ray showed that all 4 roots of the 2 affected teeth were abscessed, and that the teeth had been dead for quite some time (see text box).

Now Sam’s nose is to the right, and you are looking at the outside of his teeth.  Look at the normal tooth in the lower right corner of the x-ray – can you see the dark line running from the root into the crown?  In the crown, it is called the pulp chamber, in the root it is the root canal.  See how narrow it is?  Compare that to the very wide pulp chamber and root canals of the other two teeth.  Those wide chambers/canals mean that these teeth died when Sam was 6 months to a year old.  This means that those two rotten teeth have been in Sam’s mouth for about 3 years!

Our licensed veterinary technician, Magda, then scaled all but these two teeth, both ultrasonically and by hand, and then polished them (all 40 that were left) with our low-speed handpiece.

Sam then had an intraoral mandibular nerve block with bupivacaine.  A mucosal flap was made to remove the gum tissue over the periosteal bone which surrounds the tooth roots.  The periosteal bone was then burred away with a round burr to expose the roots.  The teeth were sectioned with a drill bit in our high-speed handpiece, and each root was extracted separately.

Sam’s nose is again facing to the right.  His mouth is wide open, and you can see the endotracheal tube in his mouth delivering his anesthesia.  My blue-gloved thumb is on the lower edge of the photo.  The 4^th premolar has already been extracted above my thumb, and the 1^st molar has been sectioned (cut into 2 pieces) and is waiting to be extracted.

The bone was then burred smooth and flushed thoroughly with an antibacterial solution.  The flap was then released and sutured with absorbable suture.

Here’s a photo of the sectioned tooth after extraction.  The dental probe, which is L-shaped, is sitting within the center of the hollowed out (rotten) tooth with its tip sticking through the end of the root.

Sam was given additional pain medication while he was waking up, and was sent home with antibiotics and pain medication for one week.  He was rechecked in one week and was doing great.  His incision sites were healing beautifully!