Wednesday, June 25, 2014

Dental discussion - A more unusual dental extraction story

Today was an exciting day for me.  (Well, most days are usually exciting when I come into work, as I never know what is going to happen).
(graphic photo alert, and xrays too - technical stuff below).

Dr Liz's Dental Discussion
Last week, I saw Sienna, for her annual vet check up.  Sienna is a 9 yo very happy, very energetic, Labrador! At that vet visit, with me, I found her fractured tooth. The crown was swinging in the breeze, so an extraction was necessary.

 Today, she came in to have an anaesthetic to have her  mouth fully examined  the fractured tooth xrayed and then extracted.  It was broken, and couldn't be salvaged.

A routine "dental" and "extraction", I thought to myself. 

Something nice and easy, as it has been a very intense, very busy few weeks for us here.  I should've known better.  There is nothing routine about dentals and extractions!

Sienna's procedure was anything but routine. 

Everything went smoothly, but what we had expected to find, and what we actually did find, well.... made it exciting enough for me to write about it tonight.

For her, it started with her examination, her sedation and then on  intravenous fluids.  She is a 9 year old girl after all, and she would benefit from the extra fluid support! That went smoothly. No complications there at all.  All of the monitoring gear, plus our trained nurses means our pets are very well looked after!

Once she was asleep, we "charted" her mouth - this means that we go around each tooth, and with that we found that she had a growth on her gum over her canine, and her jaw shuddered when I probed her lower incisors.  OK, we weren't expecting that!  Will talk more about that later!

We saw the fractured tooth - the crown was swinging in the breeze!  It was her third premolar, which, generally speaking, is a fairly easy extraction - section the tooth, remove two roots - Bob's your uncle, so to speak!


We have flipped the fractured crown back, and you can just see
a little tooth root spike below my finger.

This is the tooth in its more normal position - it was only the
odd angle of the crown that gave it away during her
vet check the week before.

So we went to radiograph the area, and what I saw was a surprise.  This third premolar, which in over 98% of dogs and cats, usually has two roots, actually had an extra root.  In other words, Sienna had a three rooted premolar (which should've been a two rooted premolar).

This changed the "routine" to the "non routine".  We had to change our anticipated plan on how we were to extract this tooth.

The 3rd premolar has 3 roots, not the usual two.
The root labelled "3" is the "extra " one!
What a lucky, special girl she is!  Lucky that we have dental radiographs at Russell Vale Animal Clinic, and lucky that we used them, rather than "assumed" the tooth had  two roots, and lucky that two of the three roots were easy to spot - they were the ones that were poking through the gum. It was only the third root that we had to find.

What made it all the more exciting was that the distal root (the one closer to the back of the mouth), had a little curve at the end - we could see that on radiographs, so accounted for that in how we chose to extract the tooth.  We could also see that the root in the middle had a bit of twist on it (like a corkscrew), which again, made for a challenging extraction. We did this one last!

 We knew that her tooth was at high risk of fracturing during the extraction. The tooth was already dead, hence the reason why it broke in the first place.  A dead tooth is a friable tooth - more likely to snap or break, and we always aim to remove the entire tooth root - in one piece preferably!

It took time and patience, and of course, skill!  A thrill, and a little pat on my back for a job well done when I could count three roots on the swab, and the radiograph taken confirms three empty sockets!  

But the most important thing though, is that Sienna will now be pain free in her mouth, with all of the roots removed from her very special three rooted premolar tooth.

The "post extraction" radiograph - showing all tooth roots
are out!  Yeah!

It has now been 10 years since we have had dental radiology (we started in 2004), and we went digital in 2009.  It was a huge financial investment, as well as a huge learning curve, but we believe your pets deserve that. Don't you?

What if we didn't have dental radiographs? 

Well, we would've seen the two roots - they were visible easily.  We would've extracted two roots, and patted ourselves on the back for a job well done.  A root would've been left behind, enough to cause ongoing pain and suffering for Sienna.  She wouldn't have complained about it, as pets often don't complain about dental pain.

Sienna at the end of the day - Ready to go home!

What about the growth on her gum near her canine?

 We have excised that. It is in formalin.  We will speak to Sienna's parents about submitting that for histopathology.  As for the sensitivity between her lower incisors - well there was a wood chip in there, which we removed - she does love to chew sticks!  She has had periodontal therapy to salvage this area, and fingers crossed it works.

I am Dr Liz, the mad (and now cold thanks to the extreme winds in our area right  now) vet in Bellambi Lane. 

Did you know we offer free dental checks all year round?  No need to wait for Pet Dental Month here, as every  month is Pet Dental Month.  So if your pet has never had a complete dental check, why not book your pet in with us.  Call us on 42845988 or you can book online.