The tooth has many layers. The enamel layer is the outermost layer of the tooth and is the strongest substance in the body protecting all other layers of the tooth. Inside the enamel layer is where the dentin is contained. This is a porous layer that surrounds the pulp which contains the blood vessels and nerves of the tooth. Every tooth is contained within bone and is connected to the bone with a periodontal ligament. Above the bone is the gum or gingival layer.
Dental surgery is required if there is injury (trauma or wear to the tooth) as well as if moderate to severe recession of the gingiva and periodontal ligament occurs. Our pet’s oral health is significantly controlled by genetics as well as wear and tear. Cats and dogs do vary in regards to conditions they are most prone to.
Feline odontoclastic resorptive lesions (FORL) are the most common dental lesions present in the cat. This disease process involves resorption of the enamel (outer tooth layer) of the teeth and progresses to resorption of the dentin (softer layer of the teeth under the enamel) and exposure of the pulp (the sensitive part of the tooth). The lesions can start at the root or the crown (visible portion) of the teeth involved. Cats with these lesions can show pain when the teeth are touched, and if many teeth are affected, increased salivation and excessive lip rubbing may be observed. Their appetite may decrease along with their activity level due to the oral pain they are experiencing. Most cats who present with lesions consistent with FORL also have periodontal disease (disease of the teeth and surrounding structures from the buildup of plaque and bacteria). The periodontal disease causes inflammation of the oral tissues, and in cats, it appears the tooth is more readily absorbed than the surrounding bone as in other species. This is why yearly oral exams, teeth cleaning, and good home oral care are so important to slow the progression of FORL. The only effective treatment at this time is extraction of all affected teeth and this is where dental surgery comes into play.
Dogs genetics as well as behavior play a role into their oral health. Smaller breed dogs are more susceptible to increased tartar (calculus) build up and may need to have dentals with extractions at a younger age. Due to the playful nature of our canine friends, stick chewing, rough playing with toys and munching on bones cause wear and tear and fractures of the enamel exposing dentin and pulp (the sensitive portion of the tooth).
Full mouth dental radiographs are vital and are done at every dental in order to assess the impact that any wear and tear that may have occurred. We can observe periapical abscessing (see circled picture) which indicates a separation of the periodontal ligament from surrounding bone. If this separation is already occurring the tooth is compromised and extraction is needed. In addition probing assesses whether or not there is gingival recession or pocketing or exposure of the pulp which can cause pain to our animals.
How is dental surgery done?
Dental surgery is a continuation of our dental prophylaxis and is only completed if a tooth is compromised. All of the same procedures are completed as our prophylaxis including anesthetizing the patient, obtaining full mouth radiographs and cleaning all of the teeth (see dental propylaxis information on our website). Again, because 60% of all dental pathology lies below the gumline, once our patients are fully assessed recommendations on treatment can be made. It is not uncommon to uncover more pathology (dental disease) than we expect
during an awake oral examination. Each tooth varies with its shape and number of roots, although the basic structure of teeth are the same. The procedure for each tooth varies slightly but the basic premise does not change. For dental surgical extraction, the gingiva is excised (cut away) revealing the alveolar bone which holds the tooth in place. The bone is then gently drilled exposing the roots of the affected tooth. Carefully the tooth is removed (if it only has 1 root) or is bisected (more than one root) and then removed. The resulting alveolar bone is then smoothed out with a drill. The gingiva is then sutured back together. The sutures will dissolve on their own and there is no worry about removing them.
Our patients are continued on pain medications after dental surgery. It is imperative soft food or moistened kibble are fed and no hard bones or toys are played with for the next 2 weeks to ensure healing. After 2 weeks normal feeding and behavior may be resumed. During this time returning to tooth brushing and using the Veterinary Oral Health Council (website: VOHC.org) approved dental chews and treats will aid in preventing further oral pathology.