Common conditions treated at Elizabeth Street Pet Hospital
Periodontal disease is a disease of the tissues that support the teeth in the mouth. Both bacterial infection and inflammation play a role in this pervasive disease of dogs, cats and people. These tissues are the gums, the jaw bone, and the periodontal ligament which connects the tooth to the bone. Periodontal disease occurs when the body's immune system reacts to the bacteria and toxins which are constantly forming on the teeth in the form of plaque.
If plaque is not removed, it will eventually accumulate and harden into dental calculus, also called tartar. Calculus can become a hard yellow brownish covering over the crowns of the tooth. It's like cement and is difficult to remove. With heavy build-up, calculus can also cover the gum so that the plaque beneath the gum-line cannot be cleaned. This build-up exacerbates the situation, creating a nice environment in which the nastiest plaque bacteria thrive. The plaque beneath the gum-line is the real enemy in periodontal disease. Fortunately plaque that is above the gumline is easy to remove with tooth brushing.
As the plaque accumulates and the bacteria multiply, the pockets around each tooth become deeper and more painful for your pet. An early sign of this stage is a swelling and reddening at the gum-line around each tooth. If you touch this area, your pet may shy away and the gums may bleed. This is gingivitis, the earliest form of periodontal disease. Gingivitis is a reversible inflammation of the gums. If the teeth and gums are cleaned now, the mouth can be "as good as new." However, if the pockets around the teeth are deep enough, the gums recede, or the bone supporting the teeth begin to resorb, irreversible changes have occurred in the mouth. This is advanced periodontal disease. At this stage the disease can be arrested, but the damage it has caused cannot be completely reversed.
Systemic disease has been associated with periodontal disease. However, it is very difficult to prove a "cause and effect" relationship. The bacteria and their toxic by-products can travel through the blood stream. This, along with inflammatory mediators associated with the periodontal disease, may contribute to damage of other organs in the body, such as the liver, kidney, heart and lungs.
Periodontal disease can be insidious. Many pets do not show obvious symptoms until significant damage has occurred. An annual dental cleaning, an oral exam under anesthesia, dental radiographs and daily oral hygiene are helpful in screening, prevention and control of periodontal disease.
Stomatitis is a severe inflammation of the oral cavity in cats caused by an exaggerated inflammatory response to the plaque bacteria in the mouth. The inflammation causes the gum tissue and oral cavity to become swollen, red, and very painful. The exact cause of stomatitis is unknown though most patients with stomatitis have an underlying viral infection. Calici and Herpes are common viruses that can be seen in cats with stomatitis. If your cat has stomatitis and has no record of being tested for FeLV and FIV previously, we may recommend testing for these viruses. Calici and Herpes are also contagious to other cats, but are not typically life threatening. Cats with stomatitis are typically very painful. Often they will stop grooming and their coat becomes dull and unkempt. Patients with stomatitis may show interest in food but be reluctant to eat because of the associated pain. They may also cry when yawning or chewing food. Excessive drooling and bad breath are also common symptoms. Frequently, cats with stomatitis are antisocial and hide because of chronic pain. A thorough oral exam under anesthesia is critical to diagnose stomatitis. Dental radiographs and surgery to extract most or all teeth have a high success rate, although some patients need ongoing medical care.
Just like humans, pets can break their teeth. A tooth fractures due to trauma, such as chewing on something that is too hard. The most common causes of fractured teeth that we see are: cow hooves, hard nylon toys, ice cubes, rocks, and marrow bones. A fractured tooth with pulp exposure allows bacteria to enter the tooth, leading to pain and infection. Often a stoic animal may not show outward signs of oral pain but will show dramatic signs of improvement once the tooth is treated surgically. It is not unusual for an owner to be unaware that their pet has a fractured tooth until the infection has become so bad that it causes facial swelling. Antibiotics will help to temporarily treat the infection, but once the medication is stopped, the infection will return. We always recommend treating a fractured tooth with pulp exposure either with root canal therapy or extraction. Sometimes our doctors will recommend placing a crown to help prevent further fracture and provide support.
A malocclusion is an abnormal bite. In a normal occlusion, the upper incisors should be in front of the lower incisors. The lower canines should fit in the space between the upper canines and the third incisor teeth in what is called a "scissor bite". (See pictures below.) The most common malocclusion we see at Veterinary Dental Services, LLC is a Class II malocclusion, which is sometimes referred to as an overbite. Often it is accompanied by linguoverted (directed inwards or towards the tongue) mandibular canine teeth. This is also called "base narrow" canine teeth (see first image.) This type of malocclusion can be painful because the lower canine tooth is contacting the hard palate and making an indent, or sometimes even a hole that connects with the nasal sinus. This is referred to as an oronasal fistula. Many malocclusions are genetic, although some are caused by trauma. Some malocclusions are considered normal for the breed. Our goal at Veterinary Dental Services, LLC is to provide our patients with a comfortable and functional bite. Treatment options may include moving teeth with orthodontics, extracting teeth, or crown shortening with vital pulp therapy.
Persistent Primary Teeth
Puppies and kittens have a set of primary or deciduous teeth that are eventually replaced by adult, or permanent teeth. At 4-6 months of age you will notice that your puppy or kitten is starting to lose its primary teeth and that adult teeth are becoming visible. Sometimes, the adult tooth will erupt before the baby tooth has fallen out. This can prevent the adult tooth from erupting in its appropriate place. We recommend extracting any persistent primary teeth as soon as possible to help prevent a malocclusion, or a misaligned bite.
Feline Tooth Resorption
Tooth resorption has been called cervical line, lesions, neck lesions, kitty cavities, and Feline Odontoclastic Resorptive Lesions (FORLs). This condition is most common in cats over 2 years of age. It results in the loss of tooth structure. The pulp canal contains blood vessels and nerves which once exposed can cause pain and serve as a route for infection to enter the tooth. These lesions are not cavities or caries, which are virtually never seen in cats. Although this condition is painful, cats typically continue to eat. Common symptoms include drooling, vomiting unchewed food, changes in behavior, and bad breath. Some cats will "chatter" if the affected areas are touched, due to the associated pain. If you look into your cat's mouth you might notice an area of gum tissue starting to grow onto the tooth. This begins as a small pin point area of pink tissue on the tooth and continues to grow over the tooth as the destruction occurs. We recommend a yearly oral exam with dental radiographs to screen for tooth resorption. The exact cause of tooth resorption is unknown. Once a tooth with resorption has been identified in a cat's mouth, it is very common for additional lesions to occur. We recommend rechecks every 6-12 months for a cat with a history of tooth resorption.
Cats and dogs can have many different kinds of growths in their mouths. These masses can be benign or malignant. Early detection is important so that treatment can be started. It is often difficult to distinguish between benign gingival hyperplasia and an oral mass. We biopsy any suspicious growths in the mouth and send it to a pathologist for review. Some of the more common malignant masses we see are squamous cell carcinoma, melanoma and fibrosarcoma. If you suspect your cat or dog has an oral mass, please contact our office to schedule an appointment with one of our doctors.
A root canal is performed in order to save your pet’s tooth when it has disease of the pulp, also known as endodontic disease. The pulp tissue is made up of tiny blood vessels, nerves, lymphatic and connective tissues. An injury to the pulp can lead to pain, infection, and death of the pulp tissue. Endodontic disease can be caused by multiple factors. By far the most common cause is a fractured tooth, or a tooth that has sustained some trauma, often causing discoloration of the tooth. If left untreated for long periods of time the tooth may eventually abscess, resulting in facial swelling and potentially drainage of pus. Root canal therapy relieves pain and treats infection.
All of your pet’s teeth are very important to daily activities. The canine teeth, or “fang” teeth in the front of the mouth, are used to puncture and hold things, similarly to how we use our thumb and first finger. The carnassial teeth are the four large teeth in the back of the mouth. These teeth are important in chewing and shearing. The incisor teeth are in the front of the mouth, and are useful in picking things up. The incisor, canine and carnassial teeth are commonly injured, and because of their importance, we recommend saving them if possible.
Enamel is the hard outer surface of a tooth. In fact, it is the hardest tissue in the body. When the enamel does not form correctly or is damaged during development it is referred to as enamel hypoplasia. This condition is seen is dogs that had high fevers or an illness such as distemper as a puppy. The loss of enamel exposes the dentin and weakens the tooth. Dentin is a porous material that can allow fluid and bacteria into the nerve of the tooth. This condition can cause pets to have sensitivity to hot or cold. Loss of enamel makes the surface of the tooth rough and therefore more attractive to plaque bacteria. It is recommended that this condition be treated to prevent bacteria from entering the tooth.
Gingival hyperplasia, or enlargement of the gum tissues, is most commonly seen in dogs, particularly boxers. Often we are not able to identify the cause of the hyperplasia. Some drugs such as cyclosporine have shown to cause gingival hyperplasia. Plaque and tartar are also thought to play a role in development of this condition. Gingival hyperplasia is usually benign, although the only way to know for sure is to submit a biopsy for a pathologist to review. This condition can be very painful, especially when the gingival covers the teeth, because the pet is chewing on their own gum tissue. Frequently owners will notice bleeding gums, halitosis, and difficulty eating. Treatment involves surgery to trim overgrown gum tissue.