Common Oral Diseases

Tooth Resorption:

In this condition, the tooth is broken down, internally at the root or externally at the crown. Sometimes it can be noted by localized inflammation but it often goes unnoticed in the bone below the gumline. The best way to identify this condition is by examination under anesthesia and using dental radiographs. The general findings are spotted by red tissue on the tooth, some of the tooth missing, or the tooth completely gone and replaced by an overlay of gum. This condition is found in about 70-80% of cats but can also occasionally be found in dogs. In cats, this condition is the main reason why they lose their teeth, and in dogs, it can be misdiagnosed as irregular roots radiographically. The cause of tooth resorption is still unknown and the only treatment is extracting the affected teeth. Due to this being a progressive condition, the tooth will eventually be lost if left untreated and can be a very painful process. Signs to watch for in your pet are difficulty chewing, losing appetite, bleeding gums, and rubbing or pawing at the mouth

Stomatitis:

Feline: This is a condition, most likely caused by a viral infection and primarily seen in cats, where the oral cavity has severe inflammation and is driven by plaque on the teeth. This is an area of active research. This condition is excruciating in cats, both the gums and oral cavity are swollen often making it difficult to eat or drink. In cats, this condition is never truly cured, however, it can go into remission when all teeth and tooth ligaments are removed from the bone, accompanied by other medical therapies aimed at reducing the chronic inflammation present. With close veterinarian monitoring, cats can be weaned off the medications slowly over time. The condition goes into total remission in approximately 80-90% of cases, yet some may still require ongoing medical care.

Canine: Although seen less frequently, dogs can also contract stomatitis. Canine Chronic Ulcerative Stomatitis (CCUS, formally CUPS), is also driven by plaque on the teeth. This condition is excruciating in dogs, the gum is swollen with ulcerations making it difficult to eat or drink. For most dogs, the optimal route of treatment is to remove all teeth that have inflammation and ulcers on gums or oral mucosa that is in contact with the tooth surfaces. Once the teeth are removed and with close monitoring by a veterinarian, the condition typically is resolved. There are also some medical approaches in dogs that can be utilized with or without selective extractions, regular cleanings and intensive home care to actively remove plaque daily has been seen to improve this condition.

Oral Masses:

There are different types of growths in the mouth. Some can be benign which means that it can be locally expansive but not able to spread to the other parts of the body. Others can be malignant, which can spread aggressively locally and throughout the body. The treatment for the benign cases is removal of the mass with or without the tooth, depending on how the tooth is affected, and send out for histopathology to determine the type of mass. If the mass is large or possibly malignant then a biopsy is taken to determine the tumor type via histopathology,
prognosis and treatment options.

Gingival Hyperplasia:

The most common type of benign oral growth is gingival hyperplasia, an overgrowth of the gums over the teeth. This can be treated by surgically removing the overgrown gum tissue to expose the tooth; however, the gums will slowly regrow over the years. This is commonly seen in Boxer breeds and English Bulldogs.

Retained Deciduous Teeth:

This condition occurs during the early stages of puppyhood primarily, where the deciduous tooth, also known as a baby tooth, occupies the same place where the adult teeth are supposed to be. This causes the adult tooth to erupt abnormally, resulting in an abnormal bite, also known as a malocclusion. This abnormal bite causes other teeth to come in contact with each other or impale the hard palate. This is most common in smaller breeds and brachycephalic breeds, which are dogs with short or flat faces like Bulldogs, Boxers, Pugs, and Boston Terriers. Retained Deciduous Teeth can also cause crowding in the mouth and increase the chance for tartar and calculus to be stuck between teeth. The teeth commonly affected are canines and incisors, where the only treatment for this condition is extraction of the baby tooth or teeth.

Oronasal Fistulas:

An Oronasal Fistula is a hole in the hard palate that’s located under the nasal cavity. This is due to the little bone between the upper canine tooth root and the nasal cavity. The most common cause of this condition is severe periodontal disease, where the severity of the infection causes tissue and bone decay. Oronasal fistulas can be easily identified during an oral exam, along with symptoms of persistent sneezing and yellow or green nasal discharge from the side of the affected tooth. This condition can happen in cats and dogs, and is more common in smaller breeds like Daschunds due to their large canine teeth and narrow faces. To treat this condition, one must remove the teeth affected by the severe periodontal disease. Most importantly, once the canine tooth is extracted, the flap of gingiva that held the tooth will be used to close the hole.

Periodontal Disease and Gingivitis:

By 3 years old, about 75% of dogs and cats have diseased teeth and gums, known as periodontal disease. This condition is brought on by bacteria, food, and saliva mixing and creating plaque on the tooth’s surface. If this plaque is not removed it will mineralize over time and harden creating calculus. When calculus is formed it cannot be removed by normal home care and needs to be removed by scaling and polishing the teeth. Plaque and calculus also affect the tooth under the gums, and creates a pathway for toxins to enter the body and if left
untreated can destroy gum tissue and bone, causing loose teeth and dental abscesses. Gingivitis is a term used to describe the reversible stage where the gums become inflamed and swollen. Periodontal disease is the multiple stages beyond gingivitis where the bone around the tooth starts to decay. Gingivitis and very early periodontal disease is reversible with professional dental cleaning and ongoing home care, moderate cases can be treated with dental cleaning, antibiotics, bone grafting, and persistent, ongoing home care. The only way to treat severe periodontal disease is to extract the affected teeth.

Root Canal Therapy:

This treatment is primarily done on dogs with a canine or other large important tooth fracture when the soft tissue inside the tooth, known as the pulp, is exposed. The pulp being composed of nerves and blood vessels it’s susceptible to bacteria entering and causing peri-apical bone abscesses. Root canal therapy involves removing the infected pulp from the root canal, disinfecting the cavity, and filling it with inert dental material. The goal of the procedure is to keep the tooth, even though it is no longer alive, and maintain its function. The procedure should be executed by a veterinarian that is specialized in dentistry, due to each step in the procedure being intricate, where drilling or disinfecting the canal too far into the tooth could result in the tooth being lost. The upkeep after the procedure requires dental radiographs 6 months post procedure to make sure the dental material in the tooth is still intact and no root abscess has formed, and regularly thereafter every 1-2 years.

Vital Pulp Therapy:

As an alterative to extraction or root canal, a procedure known as vital pulp therapy can be done to preserve the tooth structure and keep the tooth alive. This treatment may be an option following a fracture of the tooth but must be done within 48 hours, success of this treatment is significally reduced after the intial 48 hours after fracture occuring. This treatment may also follow a procedure called crown reduction, where the crown of the tooth is shortened. Typically seen in dogs that have malocclusions, where there is trauma to another area of the mouth caused by the teeth that are not in the correct position. In these cases, the crowns of the teeth are shortened and vital pulp therapy is done to avoid extraction of an otherwise healthy tooth.

Tooth Root Abscess:

This condition is caused by diseased teeth that have been fractured or severe periodontal disease associated. It can also appear normal, yet radiographically there is a dark halo surrounding the root of the affected tooth. The most common tooth affected is the upper fourth
pre-molar. This can also have facial swelling associated with it, where it can create a draining tract below the eye of the animal due to the infection working its way through the bone. The facial swelling is typically treated with antibiotics; however, the tooth needs to be extracted to fully resolve the abscess.

Tooth Fractures:

There are two kinds of fractures that can occur; uncomplicated where the pulp is not exposed, and complicated, where the pulp is exposed. In the case of a healthy tooth, an uncomplicated fracture is usually resolved with dentin bonding which helps lower sensitivity of the tooth and smooth the surface. Complicated tooth fractures are considered serious due to pulp exposure leading to a non-vital (dead) tooth. This can be very painful initially for the pet since the sensitive nerves are exposed. Common signs of oral pain include: drooling, pawing at the mouth,
changes in eating habits, or facial swelling. When a pulp is exposed bacteria can enter the interior of the tooth and eventually cause an infection There are two treatments options, root canal therapy or extraction. Root canal therapy is most successful if there is no sign of infection when the tooth is radiographed. If the tooth does show signs of infection, a root canal could still be attempted but has a greater chance of not being successful. For several reasons an extraction would be recommended, for example the fracture going below the gumline into the root, infection of the bone, or to resolve the damaged tooth in one visit without the need for follow up as would be needed for root canals.

Malocclusion

A malocclusion, or abnormal tooth alignment can have a genetic or traumatic origin. malocclusions can be remedied through orthodontics such as ball therapy, tooth extractions, and/or crown amputations. Sometimes orthodontic appliances are used but treatment in dogs and cats can be challenging to keep devices in place. Treatment plans vary depending on the severity of the malocclusion. Detecting a malocclusion at an early age is also important in order to reduce trauma and pain for the pet.

Discolored Teeth

Discoloration of teeth can be due to internal factors such as pulpitis or external factors such as tooth staining and tartar buildup. If the discoloration is due to tartar buildup, then cleaning the teeth will resolve the issue. Pulpitis is inflammation of the pulp which can occur from a fractured tooth. If the tooth presents lighter shades of pink/purple/blue then there is a chance that the pulpitis can be reversed and the tooth can be saved; however, if the tooth presents dark colors such as gray/black/brown then the pulpitis is irreversible meaning the tooth has died. Dental Radiographs are needed to determine the state of the tooth. Treatment options for discoloration of teeth include root canal therapy or extraction.