7299 West U.S. Highway 52

New Palestine, Indiana 46163

P: 317-623-5019     F: 317-623-5025

7

*

*

8

*

You can easily see the facial abscess on the left side of "Madison's" face. This abscess connects to and is a result of her tooth abscess. This abnormal connection due to infection is called an orofacial fistula. Even under anesthesia (right), you can still easily visualize the external facial wound.

2

*

*

*

4

The photo on left supports that the cause of the facial abscess is the fractured left maxillary fourth premolar tooth.  This tooth is referred to as the 208 and can be seen above the orange asterisk in the photo to the left.


This 208 tooth sits just below the location of the wound on "Madison's" face. Note that this tooth is fractured and does not have a distinct pointed tip to the crown.


Compare this fractured 208 seen on the left to the photo on the right, which shows another patient's normal, healthy fourth premolar tooth (above the purple asterisk). Also compare the color of the gums. The photo to the left reveals that the gums are very inflamed and painful as compared to the normal photo on the right.


*

*

The fourth maxillary premolar tooth (208) in dogs is a carnassial tooth, meaning that it has three roots because it is responsible for a large portion of chewing duties. For this reason, it is very common for dogs to fracture this tooth, especially if they are heavy chewers like "Madison".


The most common concern with any dental disease in pets is that once one tooth is affected, the neighboring teeth are also at great risk for infection, tooth loosening, tooth loss, jaw bone loss, and other dental disease! 


Looking into "Madison's" mouth during oral examination revealed that she had gum inflammation (gingivitis) as seen by increased bleeding around the 207 (green asterisk; the tooth toward the nose from the 208) as well as around the 208 (orange asterisk).


"Madison" also had a loose molar (210)  with a large pocket in the gums present around the 210 (white asterisk). 




*

*

6

1

*

 

2) "Madison's" dental radiographs of the 207 (green asterisk) and 208 (orange asterisk). These radiographs revealed that a tooth abscess has infected all three of the 208 tooth roots (pink asterisks) and all of the surrounding jaw bone has been eaten away by infection (dark areas). The jaw bone around the root of the 207 is nearly entirely gone and can barely hold this tooth in the mouth.

A gingival (gum) flap was made over both the 207 and 208 so that the roots could be accessed more easily, making extraction faster.


4) The first picture shows the gingival flap after the flap was created and released from the bone beneath.

5) The second photo shows the same gingival flap raised up.



The jaw bone surrounding the 208 is then drilled away to expose the roots. The crown (the white exposed part of the tooth you normally see outside the gums) is also drilled into three parts (one part over each root) so that the tooth can be loosened and removed easily.


6) The gingival flap lifted up after the bone is drilled away so that the root is exposed for easily extraction. This photo was taken after the back half of the 208 crown and one of its root was removed.

7) After all crown and roots are removed from the 207 (green asterisk) and 208 (orange asterisk). 


After all extractions are performed, repeat post-extraction dental radiographs were taken to ensure that no root or bone fragments remained. If any tooth or bone pieces are left behind, it can result in continued infection or pain if left in the mouth.

8) "Madison's" post-extraction radiographs look just as we would want them to after extraction of the 207 and 208!




*

10

*

5

*

9) A dental radiograph of "Madison's" 210 molar tooth (white asterisk) further back in the mouth also revealed infection and bone loss around the tooth roots.


The infected and loose 210 molar tooth was also extracted.


10) Post-extraction radiograph reveals that all of the 210 was extracted. (You can see a sharp jaw bone that was later drilled smooth; yellow asterisk).

*

*

3

*

*

*

*

3) A different angle of the 207 (green asterisk) and 208 (orange asterisk). to show the large amount of jaw bone loss and areas of infection (dark areas).


The 207 and 208 need to be extracted to prevent further infection and pain! 



Case Studies: "Madison" Feels Better After Several Extractions

*

*

*

*

Sharp areas of jaw bone are then drilled smooth so that "Madison" has an easy, uncomplicated recovery process. 


After the bone is smoothed, the gingival flap is sutured back together so that healing can begin! These type of sutures dissolve on their own inside the mouth.


The asterisks reveal the locations where teeth were extracted today: 207 (green), 208 (orange), and 210 (white).


"Madison" is an 11-year-old Labrador Retriever and Beagle Mix who came to The Vet because her first sign of a severe tooth abscess was the presence of a fistula (an extension of the tooth abscess to the face) that was visible on her left cheek!


On awake dental examination, Dr. Keating noted that "Madison" had several fractured teeth and "Madison's" owner noted that she was indeed an avid chewer! One of the fractured teeth was just under the fistula that had formed on her face.


"Madison" also had moderate dental calculus accumulation and bad breath. However, she was eating well and no other dental signs were noted at home, as "Madison" was acting very normally!

*

*

*

9

"Madison" did wonderfully under anesthesia, recovered well, and was feeling better after her oral surgery! The photo to the right is just 10 days after surgery and "Madison's"face is already healing well!

Has your furry best friend had a dental cleaning? If they are older than one year of age, then the answer should be an emphatic,"Yes!" Many dogs and cats are in chronic low levels of pain due to poor oral health and do not show it at home until it is very severe.


"Madison" had severe dental disease but could not tell her owner where she hurt until she had a large infection!


Call our Care Team at The Vet at 317-623-5019 today for more information about dental cleanings or  Request an Appointment here

*

1) A dental radiograph of "Madison's" normal 107 (green asterisk) and 108 (orange asterisk). 


The 107 and 108 are the same type of teeth as the 207 and 208, but on the right side of the mouth.

*

the best care for your best friend