Dr Liz Dental Discussion- The Unerupted Tooth - When things are not how they seem!

Did you know that our dogs should have 42 adult teeth? 

The problem lies in that in some breeds, like Boxers, you can't assume that what you see is what you have. You count 42 teeth, but they can have something totally different within their heads, that you wouldn't know unless you looked!

BE AWARE: This post includes surgery photos of pets under anaesthetic. We thank Milly's owners for allowing us to share these photos with you all.

Let me share with you a story about Milly, a 7 month old Boxer. (names have been changed, but not the breed).  Beautiful Milly is a very happy, beautiful and much loved little girl Boxer.  When she was six months old, she came in for her "six month of age" dental check at my vet hospital, Russell Vale Animal Clinic.

The reason we do this check is that we want to make sure that all of the baby teeth are gone, and that the adult teeth are through. We want to check that the teeth are sitting as they are supposed to be sitting, because if they aren't,  there are some simple things that we can try to help things. We also want to make sure that each and every pet has the right number of teeth that they are supposed to have.

Milly is a bit special. When we examined her mouth, on her left upper side, we counted the usual number of teeth.

This is Milly's "normal" left  side with four premolars and two molars. 

When we examined her right upper side, we realised how special she was. She didn't just have one first premolar, but she actually had THREE of them!

When we radiographed her right upper side, we confirmed the three single rooted first premolars, with the second, third and fourth premolars being normal shaped and sizes. But this then brought up a big question - could there be extra teeth on her left side, even though we do not see any?

So, Milly's owner booked her for a general anaesthetic and full mouth dental xrays!

And the big surprise on the left side was?

A dental xray solved that question - the left upper side wasn't normal.  In fact, it was abnormal in a way that if left untreated, could cause severe pain in Milly.

The surprise was that there was an unerupted tooth (labelled PM1 (1) , with the extra bonus of it being a supernumerary (extra) tooth to boot.  As a vet interested in dentistry, it is drummed into me to count the teeth in all of our pets and to radiograph those areas where the teeth are "missing".

And only a few experienced older veterinary dentists talk about radiographing "normal" areas in brachycephalic breeds, like Boxers, Pugs and Shih Tzu's.  They, like me, know that even in these "normal" looking mouths, we can see abnormalities.

In fact, when I recently shared this case on VIN (Veterinary Information Network), the vet dental specialists commented that they see this "all the time", and one had seen five that week! 

Why is identifying unerupted teeth important? 

Indi's Dentigerous cyst

Do you remember my story about Indi and her dentigerous cyst a few years ago? A Dentigerous cyst is a bone eating cyst that forms around an unerupted tooth.

Dentigerous cysts can be prevented.

Read more here.

It can be prevented by identifying all unerupted teeth and either exposing them (through an operculectomy if possible), or through extraction.

If not identified early, then it can lead to severe bone loss, teeth loss, and even a fractured jaw.

Indi's dentigerous cyst meant a loss of three teeth, including her canine, but she didn't get a fractured jaw!

We wanted to prevent that with Milly.

Her problem was that despite her normal side looking normal, it was anything but. 

So what to do? 

Look at the "Extra" tooth

This unerupted tooth needed to be removed.  Using needles, we identified its exact location. A surgical flap was created, and the tooth was seen.

An empty socket!

Once the tooth is identified, gently undermined and extracted, the socket is curetted and lavaged thoroughly.  The gum is undermined to ensure a closure with no tension, and the area is stitched over.

 Any other issues with the mouth were addressed (and with Milly, there were a few),  and she was allowed to wake up from her anaesthetic.

Happy Milly, Happy Milly's parents, and of course, a happy vet.

We work very hard to prevent disease, and in Milly's case, we prevented a dentigerous cyst and ongoing pain for her.  In amongst the sad moments of being a vet, identifying, treating and preventing disease  is one of the many many joys. 

I am Dr Liz, the vet from Russell Vale Animal Clinic.  One of the most important aspects of being a veterinarian is the prevention of disease.  With the work that I do, thanks to the loving pet owners of dogs like Milly, I am able to use my skills, knowledge and equipment to identify abnormalities BEFORE they create irreversible damage.

Thank you for being part of the bellambivet blog.