Dental Crowns

For many pets, crowns are the only way to save a damaged or diseased tooth and maintain the pet’s ability to eat and function. Some categories of pets that often need crowns are show dogs, police dogs, guard dogs and agility dogs. These pets use their canines and other teeth in the day-to-day performance of their jobs, and a missing tooth would prevent the dog from carrying out its job.

But even dogs and cats that are family pets can and do need crowns on occasion. If the broken tooth is a canine, then a crown is often indicated. Canines form the corners of the dentition and stabilize the entire bite. Missing canines lower the dog or cat’s ability to grasp and rip meat, defend themselves and maintain proper occlusion.

Crowns protect the pet’s teeth from further breakage and damage. If the tooth has had a root canal, a crown is almost mandatory in many cases. Between the broken tooth that presented itself at the exam and the access opening drilled to get inside the tooth to do a root canal, the tooth can be severely compromised. The crown makes the tooth stronger.

Endodontics (Root Canal)

At I-20 Hospital, root canals for dogs and cats are routine procedures. The procedure is almost identical to root canals in humans. When a tooth is broken and the nerve inside the tooth is dead or dying, our veterinary dentists can perform a root canal to save the tooth.

During a root canal, we clean out the inside of the pet’s tooth that has infected tissue. Each root has a hollow chamber that goes from the tip of the root to the crown of the tooth. It is the tissue, blood vessels and nerves that live inside the root that get infected. Antibiotics don’t work on this issue since there is no longer blood supply to carry the antibiotic into the tooth where it is needed. Only by taking out all that infected material during a root canal can you restore the tooth to health.

Our veterinary dentists start by gaining access through a tiny hole in the crown of the pet’s tooth. Using a series of small to larger files, we can clean out the entire length of the root and reshape it more optimally for filling. We also use a solution that sterilizes the tooth and kills any remaining bacteria. After the cleaning process, we completely fill the tooth with an inert material to prevent reinfection.

On posterior teeth, we often put a filling in the access hole and finish off the procedure that way. On broken canines, however, we frequently opt for a crown. Crowns give the tooth back its original strength and protect it from future breakage. A strong crown will last for a decade or more in most cases.

Periodontal Disease Treatments

Diagnosing and Treating Pet Oronasal Fistulas

Oronasal fistulas occur when there is a hole or other communication between the oral cavity (mouth) and the sinuses. This fistula or hole then allows mucus from the sinuses to drain into the mouth. It also allows liquids (saliva, water) from the mouth to go up into the sinuses, which is often seen as drainage from a pet’s nose.

Pet patients with oronasal fistulas may present with a variety of symptoms. The owner may notice sporadic or chronic sneezing. There may be nasal discharge from one or both nostrils. Sometimes patients will present with no clinical signs, indicating the importance of thorough examinations and periodic teeth cleanings with the veterinary dentists at I-20 Animal Hospital.

Fistulas can occur in dogs and cats, and they should be treated because appropriate treatment can dramatically improve the quality of the pet patient’s life.

Causes of Oronasal Fistulas in Pets

Pets with oronasal fistulas may present with a variety of symptoms. The owner may notice sporadic or chronic sneezing. There may be a nasal discharge from one or both nostrils. Sometimes patients will present with no clinical signs indicating the importance of thorough examinations and periodic teeth cleanings.

Causes of Oronasal Fistulas in Pets

The most common cause of oronasal fistulas is advanced periodontal disease that has led to bone loss around the pet’s tooth, resulting in fistula development. Other causes of oronasal fistulas include complications from past extractions, foreign body penetration, bite wounds and neoplasia. They can also be caused by developmental clefts of the lip or palate.

Because periodontal disease in pets is the most common cause for oronasal fistulas, regular exams and teeth cleanings at I-20 Animal Medical Center can prevent them. Dachshunds are frequently affected, and in these cases, bone loss is often present adjacent to the upper canine teeth.

Treating Oronasal Fistulas in Pets

Treating oronasal fistulas requires extracting the tooth where the fistula is located. But merely extracting the pet’s tooth will not lead to closure and healing; instead, a hole will remain between the mouth and the sinuses if additional surgery is not performed to close the fistula.

After the tooth is extracted, the veterinary dental surgeon creates a mucogingival (tissue) flap so the defect can be covered and the fistula can heal.

Pet Jaw Fractures

Unfortunately, jaw fractures are very common in pets, and they are almost as frequent in cats as they are in dogs. And they aren’t only caused by major traumatic injuries! At I-20 Animal Hospital, we usually see them after a fight or a collision with an unmovable object (tree, fence, car, etc.), but that is not necessarily the “cause” of the fracture. Very often, when we treat a pet with a jaw fracture, they have advanced periodontal disease that has eaten away the underlying bone so that even a relatively minor accident produced catastrophic results.

We often hear from pet owners who were told by their veterinarians that their pet’s fractured jaw will resolve or heal on its own. But this is not true! In some cases, the bone will close, but it rarely does so in the correct place. The way teeth fit together is a very precise pattern, and once a fracture occurs, that pattern is no longer aligned. When a pet’s jaw fracture is allowed to heal on its own, we often see a granulation type of closure instead of bone to bone. This leaves the jaw weak and subject to refracture. It is also painful to the animal whenever they put pressure on the area in normal mastication (chewing).

Veterinary dentistry has come a long way in our ability to treat these cases. Thanks to veterinary ingenuity along with human dentistry’s advanced materials, at I-20 Animal Hosptial, we can now repair fractures with minimum trauma to the site.

At I-20 Animal Hospital, we have implemented a new, advanced material frequently used on the human side called Ribbond. It is used to make temporary bridges for missing teeth. When bonded properly, the material acts like Kevlar (bulletproof vest material) and holds pets’ teeth and jaws very rigidly. Now, we usually use wire only to put pieces back in alignment and then to hold them together like a cast using Ribbond. We get the strength of those old time metal plates but don’t have to screw anything into the bone, and this material is very lightweight and strong.

After bonding it into place, we coat the entire fractured area with a temporary resin material to keep the pet’s teeth apart and hold them in place. Pets are back to normal in only five to six weeks!

Oral Cancer Treatments

Oral cancer is very rare in humans but very common in dogs. It has been estimated that seven percent of all cancers in dogs are oral. As with all cancers, early detection and screenings are critical for treating oral cancers. As a pet owner, you should routinely check your dog or cat’s body for bumps, growths and swollen areas. You should also look in your pet’s mouth regularly and see if you find any area that is swollen, red, bleeding or ulcerated or any area that has a color change. These are the first signs of oral cancer.

Almost all oral cancers share the same symptoms:

Increased salivation

Swelling of the pet’s cheeks, tongue, lips or other oral tissues

Hesitation to eat hard food or chew on a favorite toy

Bleeding of the mouth

Bad breath

Weight loss

Pawing at mouth

Difficulty swallowing

Change in mood

Reluctance to play any game that requires using the mouth

Unfortunately, these can be the same symptoms as a broken or abscessed tooth, gum disease or oral trauma. A dog or cat exhibiting any of these symptoms should be checked out immediately at I-20 Animal Hosptial to find the cause of their change in behavior.

These oral cancers make up the majority of cases we see at I-20 Animal Hospital.

Fibrosarcoma in Pets

Fibrosarcomas are malignant tumors that have a tendency to grow to a large size, invade deeper structures such as tendons, fascia and muscles and ulcerate the epidermis. These tend to be like an octopus and grow tentacles into surrounding tissues. These typically show up as masses in the pet’s mouth and can range in size from the size of a pea to a golf ball. They can be in the cheek, on the tongue, on the palate or anywhere else in the mouth. These cancers are aggressive, so we treat them aggressively at I-20 Animal Hospital. If caught early, we can treat fibrosarcomas with surgery and radiation/chemotherapy.

Squamous Cell Carcinoma in Pets

Squamous cell carcinoma is not nearly as aggressive as the other cancers can be, but it is still a very serious cancer. If it occurs toward the front of the pet’s mouth, it is not as serious as when it is near the tonsils, throat or other lymph nodes. Treatment has a high success rate if we catch it early. This is by far the most common tumor in cats and the second most common in dogs.

Squamous cell carcinomas (SCCs) tend to look like sores in the mouth. Early on, they will show a change of color and/or texture and will often present as a small lesion or canker sore. Later, they can be very large and aggressive and will look like something is eating away the tissue.

Treatment at I-20 Animal Hosptial includes excisional removal, radiation therapy, chemotherapy and photodynamic therapy.

Melanoma in Pets

Melanomas can be very aggressive if they are not treated early. Oral melanoma and other oral cancers can present as pigmented or non-pigmented fleshy masses anywhere in the pet’s mouth. Melanomas have a very bad reputation for metastasizing early. This makes long-term survival poor. Early and aggressive treatment is very important. At I-20 Animal Hosptial, when we find melanomas, we take chest X-rays, dental X-rays (full mouth series) and blood work to make sure the cancer hasn’t metastasized to other areas like the pet’s jaw bone or lungs.

If caught early, melanomas can usually be surgically excised (cut out). Depending on the size and nature of the cancer, chemotherapy can also be part of the treatment modality as well as radiation treatment.

Osteosarcoma in Pets

Osteosarcoma is a cancer of the bone. While it is more common in the limbs, it can be found on occasion in the mouth (upper or lower jaw). Since it metastasizes, we typically take chest X-rays at I-20 Animal Hospital when a pet has osteosarcoma so we can make sure other areas are not highly involved. We do a simple biopsy of the tumor and then send it to the lab for verification.

Oral osteosarcoma is treated with greater success than osteosarcoma of the limbs or other bones. Surgical removal must be complete to prevent recurrence. We see it recur on occasion, but this is not common. Radiation and chemo have not proven to lower recurrence. Complete removal of all affected bone is the best treatment.

Epulis in Pets

Oral epulis has three subcategories: fibromatous, acanthomatous and ossifying. An epulis is the most common type of non-cancerous (benign) tumor in a dog’s mouth. We call these benign tumors because they do not spread to other parts of the body. However, an epulis can be “locally invasive,” which means that it can grow into the tissues surrounding its initial location. Gingival hyperplasia falls into this category.

Fibromatous Epulis

An odontogenic tumor arises from the tissue that is responsible for the formation of the pet’s teeth. Odontogenic tumors are of limited growth potential and do not recur if they are adequately excised.

The peripheral odontogenic fibroma in people is a rare condition, whereas the fibromatous epulis is common in dogs.

Acanthomatous Epulis

Acanthomatous epulis is now called canine peripheral ameloblastoma or canine acanthomatous ameloblastoma. They can be locally aggressive and should be surgically removed.

This tumor originates in the periodontal ligament, which is composed of thousands of tiny ligaments that hold a tooth in the bone. This epulis is a highly invasive one, therefore it is considered to be a type of cancer. Like a fibrosarcoma, the surgery is aggressive as we typically remove the growth and 1cm of tissue and bone surrounding it. Surgery, if done properly, is often curative. Radiation can also be used on larger lesions or on locations that are difficult to treat surgically if the veterinarian feels that it was not all excised during the operation.

Ossifying Epulis

These differentiate from a fibromatous epulis in that they have bone cells among the soft tissue. Ossifying and fibromatous epulis tend to grow slowly and do not invade bone. These tumors are odontogenic in nature and can involve the periodontal ligament, so we often have to take out the involved teeth. Since these tumors grow slowly and are not cancerous, per se, aggressive treatment, other than surgical removal, is not recommended or warranted.

Chronic Ulcerative Paradental Stomatitis (CUPS) Treatments

Chronic ulcerative paradental stomatitis, or CUPS, is a relatively common and frustrating condition seen in dogs, though it is not as common as stomatitis in cats. It is an extremely painful condition, so it is no wonder dogs with CUPS lose their appetites!

It is often called “the kissing disease” because it occurs where the dog’s cheeks meet the teeth, or “kiss up” against them. For some reason, the teeth become an irritant to the tender buccal mucosa (cheek tissue inside the mouth). The cause is not yet known. The sores can be small or as big as your thumb. Consider it like a canker sore times 10. That’s how miserable this disease really is.

CUPS and periodontal disease are separate conditions. Some dogs will present with CUPS alone, while others will have both conditions. The disease appears to be more common in Greyhounds and Labrador retrievers, but it has also been seen in Maltese, Miniature Schnauzers and other breeds.

Symptoms can include severe halitosis, difficulty swallowing and difficulty eating. Another common sign is excessive salivation.

Other diseases that can cause similar symptoms as CUPS include pemphigus, bullous pemphigoid (autoimmune diseases) and various oral cancers. These diseases need to be ruled out since the treatments for autoimmune diseases differ from treatments for CUPS. A biopsy of lesions can help rule out cancer in dogs.

It is unknown why CUPS lesions develop in dogs. We do know that affected dogs are incredibly intolerant to dental plaque. In these dogs, even just a small amount of plaque can potentially lead to an inflammatory reaction and lesion.

Treatment starts with a very thorough cleaning. Spotlessly clean teeth don’t seem to irritate nearly as much as dirty ones do. An initial regimen of antibiotics with steroids helps immensely. A longer-term use of steroids is often indicated. Obviously, medication can only be a short-term solution. Immaculate home care, including brushing, is the better solution. It takes a dedicated pet owner to handle the burden of CUPS.

You must clean the dog’s teeth daily and use a Chlorhexidene rinse or toothpaste to not only clean the surfaces of the teeth but also to kill bacteria. Daily home cleanings and routine professional cleanings at I-20 Animal Hosptial are crucial. Our veterinary dental care center is well equipped to handle these difficult cases that require advanced treatment and handling.

We take CUPS treatment very seriously at I-20 Animal Hospital. Any autoimmune disorder or antigen/antibody reaction is challenging to diagnose and even trickier to treat.

Stringent plaque control through professional cleaning (often every three to four months) and excellent home oral hygiene routines may resolve the problem. Supplemental antibacterial measures, like topical chlorhexidine rinses or gels, also help. In severe cases, topical anti-inflammatory preparations to modulate the inflammatory response may provide comfort. Discomfort caused by the ulcers complicates efforts to brush the dog’s teeth and give oral medications. In the worst cases, in which discomfort is severe and pet owners are unable or unwilling to brush the teeth, extraction of the adjacent teeth may be necessary to remove the contact surfaces on which plaque accumulates. Although this may aid in control of the lesions, it is not curative, as plaque grows on all mucosal surfaces in the dog’s mouth. In many cases, with complete extractions, animals continue to develop lesions due to hyperimmune response to the plaque.

These ulcers must be treated so your dog can have a better quality of life. We have numerous treatment options for CUPS at I-20 Animal Hosptial. 

Temporomandibular Joint Dysfunction (TMD) Treatments

Temporomandibular dysfunction is not a common condition in dogs especially, but we do see cases on occasion at I-20 Animal Hospital.

The main symptoms of Temporomandibular dysfunction are refusing to open or close the mouth, resisting eating anything hard or exhibiting tenderness around the jaw muscles or sides of the head. Your pet may paw at his face, whimper when eating or even hold his jaw in funny ways. In humans, TMD is often mistaken for an earache. The cause of TMD is a joint and disc that are not seating properly. When this occurs, the joint becomes inflamed and very tender.

The most common causes of TMD include trauma, infections, developmental problems, carrying around a heavy chew toy or object for extended periods of time, a tumor or cyst and, in very rare cases, tetanus.

At I-20 Animal Hospital, we often take detailed X-rays of the area or even an MRI when a pet presents with these symptoms. However, because X-rays and MRIs are taken in a stationary position, and TMD is visible when the disc on the head of the condyle is moving improperly during opening and closing, we typically diagnose by symptoms and the physical exam. Diagnosing and treating TMD should not be done by your regular veterinarian but by a veterinary dentistry specialist, like at I-20 Animal Hospital.

So if your dog or cat shows the above symptoms and they persist for more than two weeks, then it is a good idea to let a specialist take a look. In humans, TMD can be very painful, so we assume that animals experience the same level of discomfort.

Treatment can consist of simple solutions such as changing chew toys. Sometimes more complex treatments such as steroids, anti-inflammatories and muscle relaxants are needed. Occasionally, we even need to do bite equilibration if one or more teeth are preventing proper closure. If a cyst or tumor is present, it might have to be removed surgically. A good veterinary dentist will look at all these treatment options and pick the correct course of action once the proper diagnosis has been made.