What You See May NOT Be What You Get

Sandra L. Waugh VMD, MS Windsor Pet Dental When a dog or cat is brought in for an awake examination, I always warn the owner that we often find more dental disease once we have our dental x-rays. Why is this? Dogs and especially cats are often not very compliant for an awake exam. Even if they are willing to hold still, we get to look but rarely get to touch much less use any instruments on the teeth. And teeth are like ice bergs - the crown is 1/3 of the entire tooth, the remainder is in the jawbone. The only way to see the roots is to take dental x-rays. And dental x-rays can only be taken on a pet under general anesthesia.

In my experience both dogs and cats can have hidden disease, but it seems much more likely in cats. I have an example to show you. “Oscar” was only 4.5 years old and under general anesthesia when the photographs and x-rays were taken. There are some problems visible in the photographs, indicated by the green and blue arrows. The green arrows point to areas where the gum tissue is growing up on the side of the tooth. This happens when there is a tooth resorption underneath. The blue arrow points to an area of very rough tartar with pink tissue underneath. All of this could be seen during the awake examination, but the examiner needs to be able to spot these areas very quickly!

Upper Incisors

The other teeth in the photographs look normal as do the canine (fang) teeth in the photograph of the front of his mouth. After an awake oral examination it would appear that 4 teeth would need to be extracted.

As the saying goes “Don’t count your extractions before x-rays have been hatched” (well, taken).

Lower Incisors

Here are the x-rays of Oscar’s upper right, lower right and left and upper left canine teeth.

For comparison this is a normal canine tooth. It has a consistent white density in the entire tooth. The darker area in the middle of the tooth is normal and is the pulp chamber in the crown and the root canal in the root. Oscar’s teeth are undergoing root resorption, meaning that the structure of the roots is being removed (by Oscar’s cells). This process starts at the bottom of the roots and in this case it has reached the crown. These teeth are likely to break off at the crown root junction (red arrow) if not extracted. They can be a source of intense pain once the resorption enters the crown, as it exposes the inside of the tooth to the bacteria that are present in the mouth.

This much resorption in a 4.5 year old cat is very unusual and was a totally unexpected finding from the outward appearance of beautiful white teeth.

The blue arrow above points to the same tooth in the photographs with a blue arrow. That tooth had the very rough tartar, but now you can see that most of the tooth is gone! This tooth has three roots and it is easy to imagine that in the near future the crown of this tooth will be gone and the roots may very well be left behind. The red arrow points to a tooth root left behind (retained) from the similar tooth on the other side of the mouth. The other teeth in these x-rays are also undergoing tooth resorption but it is not as obvious.

And here we have the lower jaw teeth with the green arrows matched to the photographs. The destruction occurring these teeth is easy to see, as well as the tooth with the yellow arrow. The other two teeth are also undergoing resorption but it is not as obvious. Tooth resorptions can also be found using a dental explorer. I always examine all of the teeth in a cat’s mouth with an explorer because tooth resorptions are so common in cats.

At the end of the day Oscar had all of his remaining teeth and retained root extracted except for the upper incisors! This added up to 21 teeth and 1 retained root extracted. Cats without any teeth do well because they have loving owners to provide them with easy to eat foods during recovery. Once the mouth has healed in 14 days, they can eat whatever food they like. Cats that like dry food will usually go back to eating dry food, even if all of the teeth are gone. Oscar’s teeth were no longer functioning as teeth. Instead they had become a source of pain and a reason to find eating difficult or unpleasant. Dr. Waugh is a graduate of the University of Pennsylvania School of Medicine. She also holds a Masters Degree from Washington State University of Veterinary

Medicine and is owner of Windsor Pet Dental, PLC.