Dental Disease and Oral Pain #3

The previous two brief studies described circumstances in which obvious oral pain secondary to dental disease was found on general physical exam. This case, however, demonstrates that even with very serious dental disease, some pets, especially tough little gals like this one, go about their business without showing a single sign or symptom.

Our lady was presented for what was expected to be a relatively routine dental cleaning and to evaluate the status of her upper right 4th pre-molar. An earlier physical exam raised suspicion of a fracture of this large, 3-rooted “crunching tooth”. Unlike other patients in the Dental Pain Case Study series, she did not have an uneven tartar pattern and was often observed aggressively gnawing and chewing on dental toys and dental bones using both sides of her mouth.

The dental procedure was revealing not only in confirming a slab fracture of the rostral (forward) crown of upper right P4, but also with finding a large, open pulp canal and an open hole in the buccal gingiva above the rostral root. Deeper inspection of this hole identified it to be the exit point of a deep tract from which purulent exudate (pus) would emanate on manipulation.

Dental radiography demonstrated severe alveolar (“root socket”) bone loss around not the forward root as anticipated, but instead surrounding the rear root. Further exam and probing found the tooth to be unsalvageable making extraction the necessary treatment.

The alveoli of both large, lateral roots were found to contain thick, nearly caseous pus and dense fibrotic material that appeared consistent with and was later confirmed by cytological exam to be fibrino-purulent reactive tissue. After thorough curettage and debridement, Consil mixed with the antibiotic Clindamycin was packed into each alveolus, a gingival flap created and sutured closed. Consil is a bio-glass product that becomes exceptionally hard once in the alveolus and provides a nice smooth surface and comfort when chewing.

This little girl also had two badly diseased right upper incisors which were also extracted and treated in similar fashion including Consil packing and gingival flap closure.