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.

Astonishing Secrets - Ear Mites, itchy ears, puppies and kittens

Welcome to the Astonishing Secrets series of Dr Liz.  Through this series, we hope to offer information and help you help your pet until you are able to get them into your regular vet.

"I see a mite in there"

 When you have a relationship with your vet, then they, like us, will do all that they can to help you and pet at any time.

When ears get itchy, our pets can do things like scratch at them, or head flap from side to side.  Ears should never have any discharge (or at the very least, a small amount of waxy material).  Anything that looks liquidy, black, gooey with or without blood, is not normal, and needs immediate attention.

There are many pets who are often so stoic that we do not see any of these signs, and it is only when the discharge from the ears is obvious that a pet owner is aware. 

How often do you check your pet's ears?  We recommend each week at the very minimum.

How often should you clean your pet's ears?  This can differ from pet to pet, but can be weekly, or after a bath or swim.

A dog's ear is shaped like an "L", and an otoscope
is needed to see the horizontal component.

Many pet owners are not even aware that their pet has a problem, until they visit their groomer, who may diagnose "ear mites" or an "ear infection".

Ear mites are common in young animals, and in those animals who have had contact with young ones.  However, the discharge and signs they produce can look exactly the same as a yeast infection, and to confuse things further, many pets often have both yeast (malassezia) and ear mites at the same time.  This means that many owners often go to the pet shop to pick up ear mite drops but find they are disappointed when their pet continues to suffer.

Malassezia yeasts look like purple coloured peanuts microscopically.
They produce a black waxy discharge often confused as
Ear Mites, but can occur concurrently

To diagnose both types of infections does require a veterinary visit, as we perform a microscopic examination of the ear discharge (to see the mites), and cytology also - to look for bacteria and yeasts.

The ear drops needed to treat Malassezia (yeast infections)  is a prescription medication only.  The treatment for ear mites is available over the counter.

What do you need to do

1. Your pet's ears need to be cleaned.  We recommend the use of PAW Gentle Ear Cleaner.  Syringe in the ear cleaner, massage for a minute, the remove the debris.  Allow the ears to dry for 15 minutes.

2. Make sure you give your pet a lot of yummy treats doing this - you need to pay them well

3.  Apply Revolution spot on (the cat one for cats, the dog one for dogs) onto the back of the neck.  Repeat each 2 weeks for three doses.

Revolution Spot On by Pfizer.

4. At some point during this six weeks, your pet will need to have the ears tested to check that the Revolution has killed the ear mites, as well as stopping reinfection (from the eggs that are laid), and to make sure that any other underlying ear infection is identified.

5. If a yeast infection is identified, then your vet will dispense effective prescription medication.

A little tip:  To treat mild yeast infections in the ear, or to prevent recurrence, you can use Otoflush ear cleaner by Dermcare.

Some interesting facts about Ear Mites:

Technical Name:  Otodectes Cynotis
Loves:  Puppies and kittens, but can also infect people
Is Spread by:  Direct contact from animal to animal
Lives:  Usually in the ear canal, but lays the eggs in the discharge, and also on the hair around the ears.
Life Cycle:  Eggs hatch within 21 days of being laid, hence re-infection is common if treatment is not of sufficient duration.
How it irritates the ears:  They have long hairs on the end of the legs, and this causes a "tickle" as they burrow through.
Other:  They are white, and are visible to the naked eye.  If you place a bit of ear discharge on a glass slide, and then shine a light on it, you may see the ear mites moving away from the light

Picture Reference from: http://vetnetwork.net/ext_clients/anasazi/pca.php?article_id=108 Accessed 4th January 2015.


Treatments include:  Revolution (Pfizer) and Advocate (Bayer).

I am Dr Liz, the vet from Russell Vale Animal Clinic, in Wollongong.  Do you have any questions about your pet or their ears?  Feel free to add  comment or question below.

2015 New Years Resolutions for Dr Liz and her crew

As I write this on the eve of New Years 2015, I have to admit to myself that I, like many others, did not keep half of the resolutions I had set into place for 2014.

Whilst I could come up with a million and one excuses or reasons, the truth of the matter is.... I am human.  Things happened which challenged me as a person, which turned me cynical, made me reactive,  and overall, a person I never thought I was. 

I want to be happy, like a Lab!

Whilst the majority of you would never have noticed as you would not have seen me at my weak moments, I know for a fact some did.

I didn't return calls in a timely fashion, I wasn't available at short notice to speak with you, and sometimes, the clinic was closed for family, for conference leave or for other reasons. I felt like I had failed some pet owners this past year, and it was an awful awful feeling for me. If I do not or cannot provide you with the animal care service you need and deserve, then you will, understandably, go elsewhere.  You are all lucky in Wollongong, as we have the best vets in the world living and working right here (IMHO).

We thank you all for being part of the animalclinic family.

I am thankful for those who have chosen, and will continue to choose Russell Vale Animal Clinic as your pet care provider.  You are amazing, and I endeavour to work harder to be deserving of your trust in us.

For 2015..... my resolutions -

I hope  to continue

- working on kindness and compassion
- to be true to myself and my family
- to give my family a hug every day, and make sure they know that they are the most important thing
- to be kind to myself
- to love all animals
- to love the pet owners of the animals that we see

I am not going to resolve to lose weight, drink or eat less or exercise more, as whilst I don't intend to fail those, given my work/life balance, that is not going to happen.

I want to continue to be there for all of my animals in 2015 and beyond!

And yes, there's more ...
Bellambivets blog is going to start posting regularly, each Tuesday and Friday. (or if you prefer another night, let me know, I can be flexible too), starting from Tuesday, 6th of January 2015.

To make sure you don't miss a post, you can always subscribe (go to the right).

- Astonishing Secrets - the help you need to help your pet until you can get them to a vet. 

The Astonishing Secrets Dudes!

- Behaviour Bytes - exploring our pet's inner demons - helping our animals with their mental illness of depression, anxiety, fear and extreme phobias.

- Dr Liz's Dental Discussion - As a practice which offers "First Class" Dental services, including dental radiography, we explore the routine, and not so routine side of veterinary dentistry.

Our Dental Discussion Dudes!

- Gratitude Project - My 2014 project kept me sane, when the world seemed to be caving in around me and my practice, so it is continuing into 2015.  It is all about being grateful for what we have.

- Musings of Dr Liz - aaahhh... otherwise known as the ramblings of a mad vet.

and a new section, which is
- Dear Dr Liz - as a vet who offers online veterinary consults, designed to help pet owners help their pet, we are sharing these questions with all of you - as it is likely you will have a similar question at some point.


I am Dr Liz, from Russell Vale Animal Clinic, otherwise known as the vet on Bellambi Lane. 

Take care, and Happy New Year!