Piper’s Premolar Problems

Piper is an 11 year old Cocker-Bichon mix belonging to a veterinarian who specializes in chiropractics and acupuncture.  Over Christmas, Piper received a bully stick and enjoyed chewing on it.  One day, however, Piper’s human brothers noticed that she had bad breath.  On closer inspection, her owner noticed a fractured upper fourth premolar (also known as a Carnassial tooth).

Piper was brought to Four Lakes Veterinary Clinic so we could see if the fracture was bad (had an exposed pulp cavity, which could lead to a tooth root abscess) and needed extraction or if it was just loss of enamel.  Sadly, it was definitely a slab fracture–a chunk of the tooth was fractured off and there was exposure of the root canal.  Piper was scheduled to have the tooth extracted.

Once Piper was anesthetized, Allison used a probe to look for other diseased teeth–if the probe goes under the gumline more than about 3 mm, there is bone loss and the tooth may need to be extracted.  The probe found some pockets under the gumline, but none over 2 mm in depth.  Dental x-rays were then taken to assess the health of the roots and look for problems under the gum line.

Since the probing didn’t show any obvious areas of disease, we were a little surprised when we saw the x-rays of Piper’s lower first and second premolars on the left side.

piperbadrootsThe x-ray of the same teeth on the right side showed a little dark area under the first premolar (the small, one root tooth), but since the left side showed lucency around 2 roots, the owner opted for extraction.  All of Piper’s teeth showed some “horizontal” bone loss, which is common in older dogs, especially small breed dogs.  Once there is sufficient bone loss and the bifurcation of the root is exposed, then the tooth needs extracting.

Now poor Piper had 3 teeth that needed to be extracted.  Local lidocaine nerve blocks were given to help with post-op pain.

SAMSUNG CAMERA PICTURESI extracted the lower two premolars first.  The gum over the outside of the tooth is cut and elevated off the bone, then a bur is used to remove some of the bone.  There is a dental tool called an elevator that is inserted alongside the tooth to help break down the ligament holding the tooth in the socket. Once the tooth is loosened, it can be removed.  Then the gum is sutured closed over the holes.

Next I tackled the fractured Carnassial tooth.

SAMSUNG CAMERA PICTURES

SAMSUNG CAMERA PICTURES

First a flap of gum was made over the outside surface, then bone was removed.  The tooth was then sectioned, leaving 2 roots in the front and one in the back, to make elevating and extraction a little easier.

SAMSUNG CAMERA PICTURES

I thought I had extracted all 3 roots, so we took an x-ray to verify.  Much to my consternation, there was a root remaining!

piperretainedroot

After scrutinizing the x-ray and the extraction site, Allison and I finally found where this root was and extracted it.  I was very glad we took a second x-ray!  I made sure the bone was all smooth, then sutured the gum closed.  Piper recovered nicely!

SAMSUNG CAMERA PICTURES