13 Feb Diagnosing & Treating a Dog Tooth Abscess
How to treat a dog tooth abscess is a common question for general practitioners and board-certified veterinary dentists. It’s a question that is first answered with more questions.
What is the cause of the tooth abscess? Is it the only tooth in the mouth of a canine patient that is abscessed? Is the tooth truly abscessed or are just the surrounding tissues infected, but able to be treated? Has the dog had a history of other teeth being abscessed? Why does the dog owner believe their pet has an abscessed tooth? What are the clinical signs that may be consistent with a tooth abscess? Did the owner notice signs of facial swelling and/or pain? Is the dog still eating? Have they noticed changes in the pet’s eating and chewing behavior?
First, A Comprehensive Oral Exam is Necessary
How can a diagnosis be made, and the questions noted above answered? It must start with an oral examination by your veterinarian. Most dogs will allow an initial oral examination while they are awake. Sometimes the diagnosis is obvious with a problem like a fractured tooth or severe periodontal disease.
However, a complete oral examination that can lead to an appropriate diagnosis often requires that the dog be safely placed under anesthesia. While a pet is under anesthesia, a complete oral examination and charting can be performed as well as dental imaging.
Why are Dental Radiographs Important?
Dental radiographs (x-rays) have been available to veterinarians now for decades. The technology of dental radiographs has progressed dramatically over the years. Full-mouth dental radiographs have become the minimum standard of care for veterinarians. It simply is not possible to provide quality veterinary dental care without dental radiographs.
It has been documented that performing full-mouth dental radiographs in dogs and cats will diagnose significantly more dental abnormalities than if radiographs are taken of only teeth that have some type of grossly observed abnormality.
Without full-mouth dental radiographs, it is likely that painful dental problems will be left untreated, and the pet left in pain.
The Use of Cone Beam Computed Technology by Vet Dentists
A new diagnostic tool being employed by many board-certified veterinary dentists is cone beam computed tomography (CBCT). This is a “cat scan” device that is very reliable for evaluating teeth and surrounding bone in a dental patient. It is my opinion that CBCT technology has significantly surpassed that of dental radiographs and is particularly useful in diagnosing abscessed teeth. Animal Dental Care and Oral Surgery in Colorado Springs was the first veterinary facility in Colorado to have a cone beam CT unit installed.
Oral & Dental Pain is The Biggest Issue We are Addressing
Pain is an important topic to cover when discussing a dog tooth abscess. It is not a question of “if” a dog is in pain, but more of a question of how could they not be in pain when dealing with an abscessed tooth?
Dogs, and especially cats, are notoriously stoic when they are dealing with oral pain. It goes against their genetic makeup to show outward signs of pain in the mouth. To show pain is to show weakness and be more susceptible to being prey for another animal. Even though most dogs and cats are not dealing with predators in their environment, the predator-prey fight-or-flight mechanism is still very much part of their genetics.
It is not uncommon for a veterinarian to see a pet with a severely infected mouth, most often from untreated periodontal disease, that is still eating and behaving “normally”. The genetic drive to eat is so strong that they simply will not give it up. This is why it is so important to appropriately diagnose and treat a tooth abscess in a pet.
What are The Causes of an Abscessed Tooth in a Dog or Cat?
Periodontal disease is easily the most common disease condition found in veterinary patients. Its inciting cause is always oral plaque bacteria. Sometimes it is diagnosed early in the disease process and has manifested simply as gingivitis (inflammation of the gums). However, dogs and cats often have periodontal disease that has progressed well beyond gingivitis and has started to cause a breakdown of the surrounding tissues of teeth.
Periodontal disease that has gone beyond gingivitis is referred to as periodontitis. Periodontitis can often be treated and even reversed if caught early enough. Procedures such as closed root planing and open root planing will often stop the progression of periodontal disease and even start to regenerate periodontal tissues.
Unfortunately, veterinarians often diagnose teeth that are dealing with what is called end-stage periodontal disease where the tooth or teeth cannot be saved and must be surgically extracted.
When periodontal disease has led to an abscessed tooth it is most often due to the initial infection migrating down the root of a tooth and leading to the breakdown of surrounding tissues.
The infection can penetrate all the way to the tip of the root and infect the endodontic (pulp) portion of the tooth. This is referred to as a “perio-endo” tooth and extraction is most often the only treatment choice. Again, the question must be asked, how painful was it for the dog or cat to go through this process prior to the extraction being performed?
Endodontic disease is another common cause for an abscessed tooth. This involves an infection of the pulp system of a tooth.
The pulp lies in the center of the tooth and is made up of blood vessels, nerve fibers and many other cellular components. It is surrounded by dentin, which makes up the bulk of tooth structure as the tooth develops.
Pulp is the “lifeblood” of a tooth and causes significant pain when it is infected. As noted above, this can happen secondary to periodontal disease, but there are other ways the pulp canal system can become infected.
Fractured teeth are probably the most common cause of pulp infection. When a dog or cat fractures a tooth and exposes the pulp in its crown it is a free ride for bacteria to infect the pulp and travel throughout its canal.
Sometimes the pulp is not directly exposed in a fractured tooth and it is able to “defend” itself by laying down dentin internally. However, many fractured teeth without pulp exposure are not able to repair themselves, “give up the ghost” and become abscessed. When this happens it always leads to an infection deep in the root and surrounding bone. If this happens in a maxillary (upper) toot, it is often manifested with facial swelling.
How are teeth that are abscessed from a pulp infection treated? There are only two options.
Surgical extraction by a veterinarian is the most common treatment choice and must be performed under anesthesia. While invasive, this surgical procedure removes a painful and infected tooth. The dog or cat is far better off without this painful tooth than if it was left untreated.
Surgical extractions are often not the only treatment option. Root canal therapy performed by a board-certified veterinary dentist can save a tooth and have a very good prognosis. The pet does not have to go through a surgical extraction and can keep the structure and function of the tooth.
This is a very detailed procedure that veterinary dentists go through extensive training over many years to become proficient at. Root canal therapy is most often performed on what are called “strategically” vital teeth, such as the canines (fangs) and the carnassial teeth (upper 4th premolar and lower 1st molar). Root canal procedures are not limited to these teeth and can be performed on other frequently fractured teeth, such as the upper 3rd incisor.
Sometimes teeth will become abscessed for no obvious reason and only be discovered on oral examination with the aid of dental radiographs or CBCT scanning.
It is possible that bacteria have penetrated the pulp system by blood-borne infection, but this is believed to be rare.
Additional Points That Should be Discussed Involving the Treatment of Abscessed Teeth
No amount of antibiotics will ever cure an abscessed tooth. Perhaps no other class of drugs have been overused more than antibiotics. While these drugs can be potent, and even lifesaving, for infections in other parts of the body, their benefits are often overstated in veterinary dentistry.
These drugs simply do not penetrate to the root of the infection (sorry for the pun) and will only provide symptomatic relief at best. They should never be relied upon as a singular therapy for treating an abscessed tooth.
Some pets are dealing with so many infected teeth that they become candidates for full-mouth extractions. These are referred to as edentulous (or toothless) pets. Pet owners will frequently ask how their pets will eat when they are toothless. Truth be told, these pets actually eat better than they did before. Once rid of their abscessed and painful teeth, they will eat soft food quite well.
Board-Certified Vet Dentists in Colorado
Abscessed teeth are a common problem seen by both general practice and board-certified veterinary dentists. Fortunately, with proper diagnostics and treatments, these pets can quickly be returned to a normal and pain-free quality of life.
If you are concerned that your pet may be dealing with an abscessed tooth or teeth, the doctors and staff at Animal Dental Care and Oral Surgery in Colorado Springs are here to help you with your much-loved pet.