Dental Disaster

Signalment: Ginger is a 7 year old female spayed Golden Retriever.

History: The owners noticed over the past few months that Ginger has really bad breath. She didn’t want to eat her rawhides for the past few days and last night, Ginger’s owners noticed a swelling beneath her right eye.

Physical Examination: Ginger is BAR (bright, alert and responsive) with a body condition score (BCS) of 7/9, meaning that she is overweight. Her heart and lungs sound normal on auscultation; her abdomen palpates normal. Her ears are dirty and an ear swab for cytology is obtained. An ear cytology is performed and numerous yeast is found. No lymph nodes are enlarged. Ginger has nuclear sclerosis in both eyes-this is a degenerative change to the lens that is common in older dogs. It is not painful nor does it affect their quality of life. Ginger has a large firm, slightly painful swelling just under her right eye. When her teeth are examined, she has bad breath and stage III dental disease with severe plaque and tartar over many of her teeth including over the 4th premolar on the upper right side.

Diagnosis: Carnassial (4th premolar) abscess, yeast ear infection
Plan: An antifungal and ear cleaner is prescribed for the ear infection. Antibiotics and pain medications are prescribed for the abscess and Ginger is scheduled for a dental cleaning for the next week. The abscessed tooth will need to be removed.

Discussion: Dental cleanings sound very simple and they can be however, our pets require general anesthesia to allow us to manipulate their heads to allow us access to all of the surfaces of their teeth. Additionally, many pets do not receive daily home care so their teeth are in much worse shape than their owners. Removing tartar and plaque can be a mildly painful procedure in this case. In severe cases, teeth may require extraction. Finally, placing a pet under general anesthesia allows their airway to be protected from the large volume of water that is generated in cleanings. Pets simply don’t understand to sit still and allow a cleaning and polishing to take place!
Carnassial abscess can be common in dogs with significant dental disease. The lump noted under Ginger’s eye is a very typical presentation. It often resolves with medical treatment (pain control and antibiotics) but can reoccur if the tooth is not extracted.
Ginger had bloodwork performed before her dental because of her age. This pre-anesthetic bloodwork looks at the CBC (complete blood count) and chemistry values. The blood chemistry measures electrolytes, liver values, kidney values and blood sugar. Because of Ginger’s reoccurring ear infections and increased weight, a thyroid level is also ran. Ginger, luckily, has all normal bloodwork. It is safe to place her under general anesthesia for her dental procedure.
Dental procedures are the last procedures of the day and Ginger waited patiently. An initial survey of her mouth is performed and heavy tartar is cracked off from her teeth. Several teeth in addition to the 4th premolar (carnassial) appear to need to be removed. Often, radiographs of the teeth are performed to make the decision if the tooth can be salvaged or should be removed.
The carnassial tooth is the largest of the teeth in the dog. It has three roots. To remove it, unless it is severely diseased, the tooth must be split into several pieces. Then each piece can be loosened and removed. In the case of an dental abscess, the holes from the roots is left open to drain otherwise, the surrounding gum can be sewn over the holes.
After the removal of the teeth, Ginger’s teeth are scaled with an ultrasonic scaler then receive a polishing. Ginger’s mouth is rinsed of the fluoride paste then she is allowed to wake up. She is to continue the antibiotics and pain meds that were previously prescribed.
Ginger’s owners want to do more to prevent her from having such bad breath in the future. At home dental care was discussed in depth with them. The best thing that can be done with a pet’s teeth is brushing them. A pet toothpaste should be used but a piece of gauze wrapped around a finger can serve as the brush. Additional products that can provide good oral health include various treats and chews. Some of these chews promote good oral hygiene in the way they are shaped while others are infused with antibacterial compounds such as chlorahexidene. Water additives can be a good option. These often serve to reduce the bacterial load in the mouth. Finally, there are many diets on the market that promote good oral health. Hill’s t/d is one such product. Feel free to ask your veterinarian or veterinary team member about what may be good choices for your pet!

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