16 Dec When is Tooth Extraction Necessary for Dogs?
Tooth extraction is a surgical procedure that your veterinarian may recommend. The most common reason for tooth extractions is due to advanced periodontal disease. However, additional reasons other than dental disease may include tooth fractures, persistent deciduous puppy teeth, tooth resorption, impacted teeth, gingivostomatitis, and malocclusions.
Seven Reasons Your Dog May Need a Tooth Extraction
1. Periodontal disease.
Periodontal disease is the most common reason for tooth extraction recommendation. Periodontal disease starts with plaque accumulation on the surface of teeth. Plaque mineralizes within 72 hours to form calculus, also known as tartar. When plaque and calculus accumulate near the gumline, gingivitis occurs. Gingivitis refers to inflammation of the gingiva. Inflammation associated with gingivitis will progress to affect the tooth’s supporting tissues, leading to periodontitis. Supportive tissues of the tooth are referred to as the periodontium and include gingiva, alveolar bone, cementum, and periodontal ligament. When greater than 50% of the surrounding tooth structure is lost, extraction therapy of the affected tooth or teeth is recommended.
Approximately 60% of tooth structure (root) is under the gumline. If over 50% of the supportive tooth structure is lost, then less than 30% of the total tooth structure is anchored in the oral cavity. This is not conducive to a functional tooth or teeth. Unfortunately, antibiotics will not be adequate to restore normal tooth structure. Prescribing antibiotics as a sole treatment for end-stage periodontal disease would be akin to painting the outside of a building set to be demolished. It simply is not a good idea and is a wasted treatment. In mild to moderate bone loss cases, procedures such as closed root planing, and open root planing should be considered. Certain breeds (small >large dogs), along with a familiar history and any concurrent medical conditions, may lead to a predisposition for periodontal disease.
2. Tooth Fractures
If a tooth is fractured, it does not automatically mean it should be extracted. Instead, it depends on the fracture type present, if the tooth is infected, or if other suitable treatment options are available. If the tooth has an enamel dentin fracture, also known as a chip fracture or uncomplicated crown fracture, the tooth can be treated with an odontoplasty, or bonded sealant procedure. If the tooth has an enamel dentin fracture with pulp exposure, then treatment options for that tooth are limited to endodontic therapy or extraction.
Endodontic therapy includes vital pulp therapy and root canal therapy. If the dog is <2 years of age and the fracture is recent (<24-36 hours), vital pulp therapy may be considered. In vital pulp therapy, a small amount of (infected) pulp tissue is removed, followed by the placement of a pulp dressing, and dental restoration. Vital pulp therapy allows the tooth to continue to mature. In root canal therapy, the necrotic pulp tissue is removed, disinfection of the pulp cavity, placement of a filling material, and placement of a restoration. This allows the tooth structure to remain, even if the tooth will no longer continue to mature as it would as a live or vital tooth. Extraction therapy can be elected if root canal therapy is not viable.
3. Persistent Puppy Teeth.
Dogs have two sets of teeth: primary (deciduous) and permanent. If the primary teeth do not exfoliate (fall out) normally, this can lead to overcrowding and occlusion abnormalities. Persistent primary teeth may be referred to as retained teeth. These are teeth that are not falling out in a timely fashion for the permanent tooth to take its place. Persistent deciduous teeth are seen more commonly in small-breed dogs than in larger-breed dogs.
4. Tooth Resorption
Tooth resorption is an often painful oral disease where the body’s own cells destroy the tooth structure. It is the most common form of oral disease seen in felines. Dogs (and humans) may experience tooth resorption from chronic chewing. Teeth with resorptive lesions above the gumline will have small defects or holes in the tooth structure. Defects in the tooth structure expose the inner sensitive tooth structure and nerves, contributing to oral discomfort and infection. Tooth resorption is more commonly present in older dogs that have been chronic chewers for a large portion of their life.
5. Gingivostomatitis
Gingivostomatitis in dogs is a hypervigilant immune condition that affects a dog’s mouth and oral health. It is characterized by inflammation and ulceration of the gums and mucous membranes lining the oral cavity. This condition can be very painful for the dog, with the following symptoms.
- Severe oral malodor (bad breath)
- Challenges with eating and drinking—dropping food, growling at the food bowl, and only eating when extremely hungry.
- Pawing at the mouth due to oral discomfort from oral ulcers
- Excessive drooling
- Weight loss
Gingivostomatitis may be seen in any dog (or cat). Still, certain breeds, such as Maltese, Cavalier King Charlies Spaniels, Greyhounds, and Labrador Retrievers, along with others, may be predisposed to its occurrence. Whole mouth extraction therapy, along with medical management, may provide a resolution to chronic pain. Gingivostomatitis was previously referred to as CUPS but now is referred to as CCUS or Canine Chronic Ulcerative Stomatitis. CCUS is diagnosed by surgical biopsy.
6. Impacted Teeth
Impacted teeth are teeth that have not erupted and remain below the gumline. All 42 teeth of dogs should be erupted by nine months of age. A large percentage of unerupted teeth will form cysts around them. These cysts are expansive and can weaken the jaw. Areas in the mouth where teeth are ‘missing’ should be imaged to determine if an unerupted or impacted tooth exists. In impacted teeth, the unerupted tooth is surgically extracted along with surgical removal of the cyst lining.
7. Malocclusion.
The normal occlusion of dogs is referred to as a ‘scissor bite’ where teeth interdigitate while the mouth is closed. The exception to this is the incisors or front teeth. The maxillary incisors will occlude slightly in front of the mandibular incisors. If the mouth cannot close comfortably due to a malposition of a tooth or teeth, or a discrepancy in jaw position, then that is referred to as a malocclusion. Several orthodontic procedures can be completed to restore a normal occlusion. However, in some cases, extraction therapy may be recommended to allow the mouth to close comfortably.
Dog Dentist in Colorado Springs
It is important to consult with your primary care veterinarian or a veterinary dentist (specialist) to determine if tooth extraction is necessary for your dog. In some instances, other treatment options may exist. An anesthetized oral exam with imaging (radiographs and or cone beam CT imaging) will determine the best treatment options for your dog’s teeth. Dental imaging is imperative to evaluate oral health, as 60% of the tooth structure is below the gumline. A dental cleaning is called a COHAT (Comprehensive, Oral, Assessment, and Treatment). An annual COHAT is recommended for most dogs. Some tiny breed dogs with a greater propensity for periodontal disease may benefit from a COHAT every 6-9 months.
Our mission at Animal Dental Care and Oral Surgery is to provide excellent oral care for dogs and guidance for their owners. If you have concerns about your dog’s oral health, don’t hesitate to get in touch with us at (719) 536-9949.
Images used under creative commons license – commercial use (12/15/2023). Photo by Daniel Hering on Unsplash