Jump to content
BC Boards

tooth again - Melanie and AK dog doc


BigD
 Share

Recommended Posts

Hi ladies...the endodontist for dogs finally got back to us on costs. NOT bad. All will run about $800. BUT, his first comment was - they usually try and wait until the dog is at least 18 months old.

 

He said in the younger dogs, the root canal is still bigger than later in life. So, the hole or cave will be bigger and thus, the tooth generaly weaker than if it was an older tooth with more of a wall.

 

Aghgh! So, it could happen that if we do this now, the tooth will be weak because it's thin AND as it drys out, it will be more pront to split and break. :rolleyes: (Then we got to put a crown on it! $$$$$$)

 

We could try and put another filling on it again and cross our fingers that it will hold a few more months. (She's just over 14 months old now.) The last filling held 2 months. But that also means she will be under anestesia again...only to go under it another time as soon as that filling pops off. :D

 

What to do!

 

The vet is willing to put a new filling on it for $100. Also, the younger tooth will mean longer under anestesia - could go about 2 hours - as there is more to root pull out.

 

they use isoflorane (I'm sure I spelled that wrong) and she's been under twice there with no adverse affects.

 

Suggestions? It's been about 8 days since the filling came off and she's been on antibiotics for 5 of those days. The Dr. is concerned that she has not had a filling on the tooth...basically he says we need to fill it asap or do the root canal. I sent him digital photos and he's going to get back to me.

 

Any advice would be, as usual, awesome!

 

Denise

Link to comment
Share on other sites

AK dog doc and Melanie are the experts here, but I have a friend who has a 13-year-old border collie who had a broken canine tooth when my friend got her 10 years ago. Her vet told her at that time that she should get a root canal done or otherwise she ran the risk of infection, abcess, etc. She never did, and the dog has never had a problem (not even any pain, apparently). It may not be as bad a break (although it looks similar to your pix and the doc said the dentine is exposed), and maybe my friend just beat the odds, but maybe waiting four months without a filling before doing root canal is a viable option? Did you discuss that possibility at all with the endodontist? Was he the one who said you had to either fill or do the root canal, or was that your regular vet?

Link to comment
Share on other sites

Hi Eileen -

 

Dr. Pearson - endodontist - said he was concerned that the filling had come off and had not been replaced.

 

My regular vet - didn't even mention it. Just put her on antibiotics to fight off any infection.

 

On your friends dog - is the root exposed? Marzipan's is exposed - was a pen point of blood before filled. Now it's just a grey dot. (The grey is the filling material)

 

Denise

Link to comment
Share on other sites

Hi Denise

This is a bit hard to judge without seeing it, but it's possible that the root canal is scarred down a bit from the previous work, so that there is no vital pulp exposed right now. If that is so, the tooth is somewhat vulnerable, but probably isn't painful. The exposed but scarred-down pulp isn't as strong as the composite would be if a root canal or another filling or cap was done, so it's at more risk than if a root canal was done - but it might not be in any imediate danger. We have any number of sled dogs up here (who are as a rule very hard on their teeth) who have done as Eileen's friend's dog did - fractured a tooth into the pulp, never had a repair, and after a time sort of scarred it down on their own and never had a long-term problem (this apparently works better in dogs than people since the teeth are, evidently, more vascular). Honestly, if Finn had broken an incisor, I'd never have done a root canal on it - partly because it's a smaller root, so would likely scar down faster with less risk of serious deep infection (shallower root), and so would be less painful and less likely to abscess - and also I'd consider an incisor a less important tooth so les "worth it" for the cost (about $450, but that's with me not charging myself for Xrays and anesthesia and physical exams and so on). If the tooth is not at immediate risk of a deeper fracture - and this I can't judge without seeing it in person - then you MIGHT be fine to wait. I'm sorry I can't be more exact, but it's one of those things I'd have to lay eyes on to judge, and we must bear in mind I'm not a boarded dentist. Can you ask the dentist about the liklihood of complications if you wait a month (or whatever your time frame is)? My dentist was kinda of the opinion that if we had a failure we could always re-do the root canal, so I don't think you're losing your chance to do a root canal in a month, so long as it doesn't get infected or otherwise damaged in such a way as to require extraction.

 

Hope that's helpful, though I feel as though I'm being vague... and as for house-swapping, it's JUUUUST starting to get chilly here now, so I'm thinking speculatively about beaches.... :rolleyes:

Link to comment
Share on other sites

Hi Denise,

 

I couldn't see any blood in the tooth, but the tooth was already broken off when my friend got the dog, and had been for at least a couple of months, I'm sure. It was noticeably shorter than the other upper canine, and the texture and color of the broken part looked different, but I didn't ever see any red in it.

 

Tough decision for you -- wish I could be more help.

Link to comment
Share on other sites

I really don't know. I wasn't aware that root canals were more complicated in young dogs than in older dogs. I guess if it were my dog I'd opt for a root canal now with the possibility that it might need to be redone (can they be redone? dunno) later. The other option is to pull the tooth and not worry about it anymore but with a tooth like a canine I'd opt for just about anything other than extraction.

 

There are any number of dogs out there who break teeth and never get treatment and appear to do fine. I personally did not feel comfortable going this route. I feel that when dogs "get away with it," it really is a matter of luck. If an infection occurs it is not likely to cause any symptoms until it's pretty advanced. I'm no dentist, but it seems to me that a canine abscess would be a pretty major problem -- just look at how long the root is and where it ends up.

 

Not that this has anything to do with canine dentistry, but... dental disease is pretty rare in human fossils. It's something that came along with more processed diets -- you don't really see it archaeologically until you have agricultural populations. But there is one Middle Pleistocene fossil from Africa, Kabwe or Broken Hill ("archaic" Homo sapiens or H. heidelbergensis or H. rhodesiensis depending on who you talk to) that has extensive dental disease including abscesses that have eaten away areas of the upper jaw. I've seen this fossil, and if there is a better advertisement for why it's important to take care of your teeth, I've never seen it. Anyway, dogs aren't cavemen and cavemen aren't dogs, but abscesses are nothing to sneeze about and I wouldn't personally risk one in my own dogs. But that's just my opinion.

Link to comment
Share on other sites

I have a 9 1/2 year old border collie who broke three teeth fence fighting when he was younger. One was the canine(lower) He has never had any problems and eats well. I`m not sure they go through the same concerns as we do. He still chews on his bones. In fact even the 14 year olds with a bit of cleaning to be done never had problems. I just scrape a bit off once in a while when the bones don`t do enough.

Link to comment
Share on other sites

About abscesses - our old Aussie has worked cattle for us for years. One day, the side of his face swelled up tremendously, yet didn't seem tender or sore. I assumed a wasp sting, as the swelling went down within a couple of days.

 

The same thing happened again a couple of months later, not so badly, but I took him to the vet as I realized it couldn't be just a sting.

 

It turned out he had a vertically cracked molar (actually, the same one on the other side, as well) that had abscessed, probably into his sinuses. We had both teeth removed - problem solved.

 

Now, both teeth appeared to have been broken/cracked for quite some time. I was puzzled that his cheek did not seem painful to him when I touched/examined it. However, it was very obvious that this was something that we needed the vet to deal with.

 

I guess my question for AKDogDoc and Melanie is, why do you not simply remove the broken canine? Is it for cosmetic or other reasons? Is it something you feel the dog requires for working purposes (gripping)? Or, is it just what you choose to do (and that's fine, too).

 

I had never heard of root canals or caps for dogs' teeth and would find it (for me) hard to justify financially.

Link to comment
Share on other sites

Sorry, this got kinda long, and isn't exactly an answer to the original question, but very related!

 

Ah, dog teeth, one of favorite subjects!

 

I got Lucy when she was 3.5 yo, and she had bad teeth then - I think she spent lots of her younger years chewing on ROCKS! (Now she has lots of fleecy toys...) Her two lower canines were quite worn down, and one had a very brown "coating" on top. Her four lower incisors were barely showing above the gum line.

 

I had my regular vet look at them, and he said the canine had sealed itself, and should be no problem. So we went on about life.

 

When she was not quite 8, I had noticed a small irregularity (dunno what else to call it - like a small cut) on her lower gum, below the incisors. My local vet said it was probably related to the incisors, and he recommended removing them (which by this time were really not visible above the gums!). He could not do dental x-rays, and said while he'd do the surgery, he would recommend x-rays.

 

So, we found a vet who does ONLY dental work (400 miles away...). He did x-rays, did a root canal on the canine (and put a protective cap on it), and pulled the incisors. He said that the incisors had actually created the gum thing - a drain for the abcess! When he pushed down on the incisors, gunk squirted out. UGH!! To think the poor dear had been running around with her mouth like this for at least a month....

 

He also said the canine had obviously been dead for several YEARS, and was also causing some inside-gum problems.

 

The key thing was - there was absolutely no sign that anything was wrong with her mouth. She ate fine, played with lots of toys, continued to pick up sticks or rocks if I'd let her (tried not to!), and was as active as I could imagine a dog to be.

 

When I picked her up at the dental vet's, he said, "I think you'll notice a big difference in her." What, I said? "She'll probably sleep less, and be more attentive!" While that was a Very Scary Thought at the time, I do believe it's true!

 

BTW, the cost for the entire procedure was just over $800 - I figure $100 per year of her life wasn't really that bad!

 

I would never have guessed that anything was wrong, yet after the dental work, I think she's happier and healthier than ever. (See my other post on incontinence...)

 

So, just a word of warning to those who say, "My dog had a broken tooth (or whatever), and its never been a problem." These dogs do compensate, and if I hadn't noticed the little gum thing, I would never have known there was a problem!

 

Brush them teeth regularly too!

 

diane

Link to comment
Share on other sites

Some things the vet did say on extraction -

 

1. the dog then looses the "use" of the lower canines as there is now no leveage.

 

2. the lip caves in and the bottom tooth can cause ulcers or even punctures into the lip. At which point you may have to shave down the lower canine.

 

3. It's very invasive into the skul and sinus area. (Aprox. 2 to 3" above the gum line) And involves lots of work, cutting of the gums, etc.

 

She doesn't work sheep, so I'm not worried about the gripping thing. She isn't a confirmation dog either, so her teeth don't have to be perfect. I just want to do what's best.

 

The vet did say that dogs can deal with much more dental pain than humans...could be in pain and not show it. Sooo...that's a worry for us too.

 

The vet has sent my pix to a specialist on the mainland for review. As soon as I hear back from them, I'll let you know. I'd like to wait as long as we can before we do the root-canal. But we will do that for sure...just not sure if it will be now or in 3 months.

 

Thanks guys!

 

(Oh - AK dog doc...I don't do well in cold. No, I take that back - I do horrible in cold. When it's 78 here, I'm in long underwear with wool socks and flannel PJ's. I'm a light weight. So...let's do a swap in May...spring time... So I don't freeze to death in 50 degree weather!)

 

Denise

Link to comment
Share on other sites

I don't have any pictures, but I've had several dogs break teeth at the level that your dog has and they are fine years later without any particular intervention. The one dog that was worse, Sally, broke her lower left incisor at the gum line, with verticle cracks into the remaining tooth extending below the gumline, had a simple removal ($10 in addition to the spay we were going to do anyway) and she's fine. One incisor is not going to change the shape of the mouth set substantially, if at all.

 

When researching what to do about the smaller breaks I ran into a vast split of opinion and cost. Basically the following:

 

canine dentists, board certified - OH MY GOD your dog needs tons of work, and it will be at least $2000 to repair X, Y, and Z

 

DVM, small animal specialties: Most wanted to do at least a root canal ($800-1000) or pull the tooth and pack the hole ($400-600)

 

DVM, general practice. Varied from $100 to $300 to pull the tooth and most thought the root canal idea was not worth the trouble. Several comments of "why bother" were incurred once they knew the dog was a working dog. All felt tooth breakage was a normal canine progression into old age.

 

Who's right and Who's wrong? I don't think that more money means anymore right of a decision than less does myself.

 

As a working dog user and owner I feel I can tell when my dogs teeth are hurting them. If they are eating with a relish, working well, and the gums look fine I'm not going to subject them to unecessary anesthesia or surgical pain without just cause.

Link to comment
Share on other sites

Oh god you guys! I think I'd be better off just flipping a coin! On one hand, she COULD be in some pain...we could be getting some infection that I may not know about for years and at which point it will mean big bills and lots of work - worst case.

 

On the other hand - we could just leave it as is and while SHE might feel it a bit, she will deal with it and be fine.

 

Aghgh!

 

I need to teach my dog how to tell me her tooth hurts! Bark twice and put your paw over you nose. Yeah...that will do it.

 

 

 

Ok, thanks all for your input...I guess we will just have to see what the vet says and then discuss it. Looks like we have a 50/50 chance either way.

 

Thanks again,

 

denise

Link to comment
Share on other sites

  • 2 weeks later...

I never cease to be amazed at how useful this board is. So much of what I read turns out to come in handy.

 

Biko has just broken off one of her upper canines at the gum line. I have no idea how it happened. I remembered idly reading this thread a few days ago (but not much of the content) and immediately made an appt to have the rest of the tooth pulled to avoid possible infection down the line.

 

Then I came back and read this and the preceeding thread. That made me realize that:

 

1. There might be reasons not to pull the remaining tooth.

 

2. Breaking a tooth at the gumline might not be that common.

 

In fact, when I adopted this dog a year ago at the age of 8 months, she had no sign of an upper canine on the other side, just smooth gum. Now that the second upper canine is gone, I'm not sure what to think. The rest of the teeth look nice and white to me, but I'm no expert.

 

I'm looking for more insight on items 1 & 2 above. What other options are reasonable for a canine broken off at the gumline, and is this sort of tooth injury a red flag for something?

 

AK dog doc, I'm in SE AK or I'd hunt you down! Dog and I are headed to Fairbanks in two days, but just passing through the Anchorage airport, alas.

Link to comment
Share on other sites

With the canine, it's not so much the tooth (dogs can and do get by just fine without a canine) but the root. Teeth like incisors are easy to pull because the roots are relatively short and shallow and they can actually be pulled, as in pulled out from the socket. Canines can't be pulled. They are surgically removed.

 

The root of the upper canine is about twice as long as the tooth itself, and welded firmly into its socket with ligaments. To extract a canine requires flapping the gums back, gouging out the bone that lies over the root of the tooth, wrenching the tooth from the now-exposed trough (an article I read described this as grasping the tooth with the tool and twisting it back and forth forcefully until the ligaments were all broken and the root came free), packing the resulting empty space with a matrix to replace the lost bone, and sewing everything up. Frankly, in comparison a root canal seems like a pretty simple procedure.

 

In Solo's case, the way his tooth was broken if something hadn't been done it would have cracked and broken more (the part that was left was jagged), I didn't feel comfortable leaving it (losing the tip of a canine leaves a pretty horking huge hole for bacteria to enter, and the root provides a path for infection that basically goes straight up into the dog's sinuses), and I wanted Solo to retain the root. If you look at a dog skull, you'll see that the canine roots provide a really important part of its architecture. They basically buttress the front of the muzzle. The lower canines are even more important than the uppers in this respect (remove their roots and there's almost nothing holding the front "corners" of the mandible together), but the upper root is so huge that removing it is a pretty drastic change

 

The drawback to a root canal is that follow-up x-rays are required to ensure that no infection has actually taken hold. I suppose it would be possible to not do anything about a broken tooth and simply x-ray in the same manner, but I don't personally think it's a great idea. When you extract a tooth, once the recovery period is over, it's all over. In Solo's case he was x-rayed at his follow-up appointment while sedated rather than anesthetized, so this is an option (if it can be done with Solo, who is no vet's idea of an ideal patient, it can be done with pretty much any dog) if you don't want to put the dog under again.

 

Information on dental extraction in dogs and cats:

 

http://www.ivis.org/advances/Dentistry_Car...er_frm.asp?LA=1

 

I have a great chapter on root canals in dogs, but it's not available online. I'm pretty sure there's information on http://www.vin.com and I have it printed out somewhere, but I can't find it on the website right now.

Link to comment
Share on other sites

Melanie, thank you for that explanation. I had no idea that the canines were so essential to jaw integrity. That information will certainly make a difference in how I view a broken canine should one of my dogs have one in the future.

Link to comment
Share on other sites

photo3%20.jpg

 

Here's a view of the front of the dog skull that allows you to see, somewhat, where the roots of the canines go and how large they are. According to the article I linked to above, the lower canines form about 70% of the jaw at the anterior part of the mandible.

Link to comment
Share on other sites

Thanks a lot Melanie. Denise, I hope I'm not hijacking your thread, but I think Biko's story will be relevant to folks reading the thread, and maybe of use to you as well

 

I spent most of my evening reading about veterinary dentistry on the web. I tentatively came to the conclusion that a root canal was a better choice for a canine tooth. I read Denise's previous thread and found the photos useful, so I persuaded Biko to pose for one:

 

broken%20canine%2037.jpg

 

As you can see, the tooth was broken at the gum line, mechanism unknown

 

When I went to the vet's this morning, the photo was a great prop. You can see the exposed pulp (the dot in the center of the tooth). The root canal specialist took one look at it and said "There's not enough there to do a root canal on. And it does have to come out or she'll end up with an abcess." He too wouldn't do root canals on dogs under 18 months (Biko is about 22 months). He said that dog teeth are not mature (fully hardened) until about 3 yrs old, so it's not uncommon for them to break on young dogs. I asked about leaving a space where the canine root was and he said the bone just grows over. Not a problem. I asked if he put anything in the space left by the root and he said no.

 

Fast forward a few hours. The tooth came out really easily, much more easily than a canine usually does. It was small for a canine. They did have to cut the gum a bit, but they didn't have to remove any bone at all (which is usually required). Biko is doing great. The vet felt that the tooth probably had a defect in it to break so easily.

 

Earlier in the thread, I mentioned that Biko had no upper canine on the other side when I got her at 8 months, just smooth gum. The x-rays today showed that there actually is a tooth under that gum, a "huge" one, according to the vet. She said it would be a major project to extract it and was far better left in place. How interesting. The rest of the teeth looked normal and healthy.

 

Having previously read (and further researched) the thread about dog anaesthesia, I was prepared when the vet started reeling off the complicated series of anaesthetics that would be used. First there was a cocktail of three tranqulizer drugs given subQ (after which we got to go for a short walk as she slowed down), then ketamine and valium IV to actually knock her out, then isoflourane gas to keep her solidly down during the extraction, and then pain meds (and antibiotics) for a week afterwards. I'm glad that thread had prepared me for the subtleties of anaesthetizing dogs. The thread originally started out "isoflourane or ketamine?" but it's apparently much more complicated than that. I recommend that other folks read that thread (and beyond) if they're concerned about anaesthetizing their dog.

 

As if today (Nov 2) wasn't surreal enough in America, my one and only crown chose to fall off right while Biko was having her tooth pulled. I have no dentist of my own in this town, so I strolled across the street to one a friend had recommended. He saw me right away, took an x-ray, told me the crown was history and that I could choose between a gap and an implant (at some later date), ground down the bit of remaining tooth so it wouldn't poke a hole in my tongue, and sent me on my way at no charge since I didn't have dental insurance. Wow.

 

The original estimate for Biko's tooth extraction was $550-$800 (Alaska prices), which was a bit of a shock but begins to make more sense when you read what all's involved, plus the various drugs. However, the vet told me over the phone that the tooth came out so easily that the charge would actually be a lot less. I'll edit to post the actual charge when I get it.

 

Edit: It came to $380. The first $200 is what it costs for a normal tooth cleaning under anaesthesia at this clinic. The rest was x-rays, drugs, and the charge per minute for the actual extraction (only 9 minutes!). X-ray photos coming soon. I know you all will be fascinated, especially by the mystery "huge" right upper canine that never saw the light of day.

 

Here is the patient herself showing off her healthy lower canines (and no, she doesn't get to chew bones any more -- it was just a prop for the photo):

 

lower%20jaw.jpg

 

Now if the election will just turn out this well...

Link to comment
Share on other sites

Just take a look at these x-rays and then I'll go back to lurking. First, the broken upper right canine:

 

root%20of%20broken%20upper%20right%20canine.jpg

 

The canine that broke off at the gum line is the deeply rooted tooth between the premolars and incisors along the bottom of the x-ray. The break is at the lower end. You can see that even though the tooth broke at the gum line, there is still a LOT of root left.

 

Now for the missing upper left canine that's never been seen before:

 

unerupted%20upper%20left%20canine.jpg

 

See that whale-like shape below the premolars along the top of the x-ray? That's the upper left canine that never erupted! It looks like it wanted to though, doesn't it?

 

I asked if the unerupted canine was likely to be a problem down the line. The vet said the only way it might become a problem would be if one of the premolars got infected and the infection spread to the canine below (actually above) it. It would be a heck of a job to get that canine out of there.

 

Pretty interesting day. I wonder how the election went? Been so busy with teeth that I haven't even had a chance to check (but I did vote!).

Link to comment
Share on other sites

Hmmm. Kinda funky shape on the un-erupted canine. Interesting.

 

With the one that's broken at the gumline, you COULD try to see if a dentist could buid a crown on it, but that probably wouldn't be worth it to me, so long as the dog's function was acceptable with the tooth essentially absent. If it was me, I'd probably address the broken one in some way - partly because it's a possible infection risk, and partly for the comfort issues. That's a bit of a judgement call, though, depending on how long the tooth has been broken and what its condition is and so on. It sort of looks like the gingiva are trying to overgrow the remaining nub. Pepper did this to one of her teeth (an incisor). Not sure when she broke it, but at her first dental prophy I noted the tooth was absent. About three years later the BF had me look at her mouth for a broken tooth which was bothering her. I pulled it and when I looked at her dental chart it turned out to be the one I'd said was already missing - so evidently she'd broken it at or below the gum line and the gums had overgrown it prior to the first dental. And then some number of years later it became a problem, at which time I pulled it.

 

Sometimes over time the periodontal ligaments deteriorate to the point where you can pretty much just pluck the tooth out, even a canine. You DO still have to suture them back together, though, and on those ones that have almost fallen out on their own, you very often have only minimal tissue with which to work, and it's often in pretty poor condition. These can be a bit of a pain. So can extracting a canine tooth that's solidly rooted but has no crown to grasp to help with the extraction. So I guess the best course of action is to consult with your own vet and see what they think about it. Or else call up my dentist and see if he wants to fly to SE to do the root canal... :rolleyes:

 

(BTW, when you said you'd hunt me down, I hope you meant in a FRIENDLY way...!) :D

Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...