The foremost dental decision made daily is whether to leave teeth with suspected pathology to follow up in the future, treat the teeth or extract them. For some teeth the decision is easy, especially if they are mobile. In other situations, having a goal of creating a pain-free mouth that is functional will help you make correct choices. This is the first installment of a series to help you decide how to deliver the best in dental care by extracting teeth. The next installment will cover how to treat what you see, and after that we’ll discuss when it’s best to do nothing and follow up in the future.
We need to be our patients’ advocates when extraction is indicated. Most clients will not realize their pets are in pain because that pain is masked. In essence, we are doing harm when we do not urge our clients to let us care for painful dental problems. When a client asks, “How will my dog eat after its teeth are extracted?” it’s best to respond, “Better than before because we are removing the oral pain.” Most clients see a great improvement in their pets’ lives within weeks of extractions.
Is the patient’s bite functional or poorly functional?
A scissors bite where the maxillary incisors lie just in front of the mandibular incisors and the premolars interdigitate allows the teeth to work in an efficient, or a functional, manner. When teeth are in abnormal locations due to inherited defects or previous trauma, often an inefficient, or a poorly functional, bite results.
Generally, any time there is a problem with a deciduous tooth, it should be extracted. This includes retention next to the adult tooth, malposition and fracture exposing the pulp (Figures 1A, 1B and 1C).
When the adult mandibular canines and incisors impinge or penetrate the maxillary gingiva, extraction or crown reduction and restoration relieves discomfort and creates a functional bite (Figures 2A, 2B and 2C).
Conversely, when the maxillary incisors impinge or penetrate the mandibular gingiva, extraction of the maxillary incisors creates a comfortable occlusion (Figures 3A and 3B).
When teeth are too close together or extra teeth are present, creating crowding, extraction will often relieve or prevent periodontal inflammation and pain (Figures 4A and 4B).
Should I extract or leave fractured teeth and teeth affected by advanced periodontal disease?
Visible signs. How do you decide if you do not have intraoral radiography? Look for obvious signs of pathology caused by endodontic disease, including pulpal exposure with clinical focal swelling of the face or the alveolar mucosa above the mucogingival line. If the client will not accept referral to a veterinary dentist for advanced endodontic care, extraction is indicated (Figures 5A and 5B).
Probing abnormalities. The dental probe is a valuable instrument that can be used in every oral assessment performed under anesthesia. Small dogs and cats should not have probing depths greater than 2 mm, while larger dogs normally display 4-mm depths around the canines and 1- to 2-mm depths around the incisors, premolars and molars. When the probing depths are greater than 5 mm, surgery is indicated in the form of either open root planing or extraction (Figure 6).
Tooth mobility. Fractured teeth that are significantly mobile due to advanced periodontal disease or root fracture need to be extracted. But these extractions may be a challenge without intraoral radiographs.
How do intraoral radiographs help?
Intraoral radiographs aid the decision-making process whether to leave, treat or extract an endodontically affected tooth. When referral to a veterinary dentist is not in the cards, those teeth affected by internal resorption where the root canal is not only enlarged but nonuniform compared with the contralateral tooth should be extracted along with those teeth that have marked periapical lucency (Figures 7A and 7B).
When should I extract resorbing teeth?
In cats and dogs, resorbing teeth with pathology extending into the oral cavity should be extracted together with those with marked loss of dental hard tissue. When the tooth resorption extends into the oral cavity, bacteria will gain access into the tooth, causing inflammation necessitating extraction (Figures 8A, 8B, 8C and 8D).
When should all the teeth be extracted?
Marked chronic stomatitis is thought to be caused by a hyperimmune response to plaque. Full-mouth extraction eliminates the dental plaque-retentive surfaces, eliminating or at least decreasing inflammation (Figures 9A, 9B and 9C).
Comfort vs. pain
Fortunately, the dogs and cats we see in companion animal practice do not need their teeth to survive. They do not have to depend on their teeth to kill prey. For them kibbled, canned or soft human food is delivered to a bowl once or twice a day. Our dental goal is to provide a healthy, functional and pain-free mouth. Often and for good reasons extraction is the treatment of choice.
Dr. Jan Bellows owns All Pets Dental in Weston, Florida. He is a diplomate of the American Veterinary Dental College and the American Board of Veterinary Practitioners. He can be reached at (954) 349-5800; email: [email protected]