Animal Pediatric Dentistry
Our puppies and kittens benefit from regular examinations of their teeth as they grow. Fortunately, puppies and kittens require vaccinations during the critical months of tooth eruption and jaw growth. Which allows your veterinarian to closely watch for any dental abnormalities. We feel that every pet deserves a functional and comfortable bite. Early recognition and treatment of abnormalities prevents unnecessary discomfort and more serious conditions later in life. Ultimately an early diagnosis allows better and, in many instances, simpler treatment options.
It is my goal to teach you how to recognize the common dental conditions affecting our young pets, their significance to the pet, and what treatment options are available. First, we consider pets from birth to 1 year of age as our pediatric patients. Puppies’ and kittens’ primary or deciduous teeth will erupt between 3-8 weeks of age. At the time of their first visit to the veterinarian puppies will have 28 teeth and kittens will have 26 teeth.
These teeth are replaced by permanent teeth between 4-6 months of age. At 4 months of age the first permanent teeth to erupt are the central incisors (blue arrows). These are followed by each incisor laterally (green arrows) with the canine or fang teeth being last to erupt.
Conditions affecting our patients from birth to 6 months of age include:
A cleft palate may involve the lip and primary palate. These defects are small and maybe repaired when the pet is mature. A cleft of the secondary palate and soft palate is diagnosed in our young patients due to milk leakage from the nostrils while nursing. These patients are tube fed or nursed with large baby nipple until they are 8 weeks of age. One can not wait too long as these defects will become relatively large. Repair of palate defects can be challenging as the surgical flaps typically are under some tension as well as the constant motion/irritation from the tongue and changes in air pressure while a pet breaths.
Primary teeth are long and thin teeth. A fractured deciduous tooth is painful and quickly becomes infected. This infection will cause a draining tract (blue arrow), osteomyelitis, or damage to the permanent tooth. Treatment for any fractured primary tooth with pulp exposure is immediate and careful extraction. Pre-extraction x-rays are essential to identify the location of the permanent tooth.
Malocclusions are relatively common in the dog and may affect the periodontal health, comfort, and well being of our pets. Class 1 malocclusions are when both jaws are a proper length and do not result in any over or underbite. Individual or multiple teeth maybe crowded, rotated, or misaligned.
Class 2 malocclusions or “overbite” is a condition in which the maxillary (upper) teeth are markedly in front of the mandibular (lower) counterparts. An overbite (class 2 malocclusion) is commonly diagnosed at the puppy’s first or second visit. These young patients benefit from selective extraction therapy. The lower incisors and/or canine teeth are carefully extracted to alleviate pain and allow the jaw (mandible) to grow to its genetic potential.
Class 3 malocclusions or “underbite” is when some or all of the maxillary teeth are located behind the mandibular incisors or canine teeth. This malocclusion can result in gum trauma and tooth-to-tooth contact. Fortunately, few of these pets require therapy. In brachycephalic breeds (Boxer, Shih tzu, Pug…), a Class 3 malocclusion is called a reverse scissor bite and is considered normal for these breeds.
Deciduous teeth should be visible in the oral cavity by 12 weeks of age. Delayed eruption occurs in toy breeds more frequently. The teeth are commonly found under a dense fibrous gingival tissue. Treatment involves dental radiographs to identify the shape and position of the deciduous and permanent tooth. The tissue is then excised over the impacted tooth or the tooth is surgically extracted.
Retained or persistent deciduous teeth are very common. The “Two Tooth Rule” states that if the crown of the permanent tooth is visible above the gum line, the primary tooth should be gone. If the primary tooth is still present then it should be extracted as soon as possible. If left untreated, the primary tooth may direct the permanent tooth into an abnormal position. Timely extractions are important to allow for the permanent teeth to erupt into a normal position.
Conditions affecting our patients from 6-12 months include:
Malocculsions (Class 1, 2, 3 below) of the permanent teeth again require individual evaluation and treatment. Our goal is to provide our pets with a comfortable and functional bite.
Remember dogs have 42 teeth and cats have 30 teeth. If a pet over 6 months of age is missing 1 or more teeth, a dental x-ray of the area should be taken (see red arrows). Impacted teeth must be treated. Therapy ranges from a gingival incision, which allows the tooth to erupt, to extraction or oral surgery.
Dentigerous cysts occur due to an unerupted tooth. The key is to notice that a tooth is missing. These cysts are painful, benign structures that will expand and destroy bone ( blue arrow). There are reports of these cysts undergoing a malignant transformation. Treatment involves extraction of the tooth and removal of the cystic lining.
Enamel hypoplasia is a developmental condition in pets. These pets’ teeth are covered with abnormal or pitted enamel. This will appear as a rough and yellow stained surface of the affected tooth. Restorative therapy will protect the tooth while they develop. Regular brushing of these teeth is important to control plaque and tartar that easily accumulates on them.
Spear tooth or an abnormally directed maxillary canine tooth can occur in any breed of dog, although it is more common in the Shetland Sheepdog. These teeth are prone to developing gingivitis and the tooth-to-tooth contact is painful. These pets benefit from orthodontic therapy.
Many small breed and brachycephalic dogs (pug, boston terrier) have severe crowding and rotation of teeth (blue arrow). The shortened upper jaw (maxilla) does not allow proper positioning of teeth. This crowding leads to food impaction and early onset of gingivitis. Selective extraction of the less significant tooth can prevent premature periodontal disease and encourage overall improved oral health. Extra teeth (supernumerary teeth) should be x-rayed to assess their root structure. These teeth may lead to crowding or result in tooth-to-tooth contact. In some instances extraction therapy is necessary.
Base narrow mandibular canine teeth result in a painful condition in which the lower canine strikes the roof of the mouth (palate). Therapy depends on the age of the pet and severity of the malocclusion. Orthodontic therapy is recommended for these patients (refer to Orthodontics section). We recommend incline capping, acrylic incline plane, and crown reduction therapy for pets with this condition.
Deformed teeth (blue arrow) occur infrequently in pets. The crown of the pet’s teeth must be examined to ensure there is a complete covering of enamel and there are not any fissures in the crown. The large lower molar of toy breeds may have this defect as well as root convergence. These teeth are prone to infection that can result in a bone infection that weakens the jaw of the pet.
A fractured (immature) tooth with pulp exposure in a pet under 1 year of age must be treated within 48 hours of the trauma. The pulp is the inner-most part of the tooth and will appear as a red dot/tissue in the center of the tooth. When exposed it is painful and will become infected. This tooth in a young pet is not fully formed and will benefit from a pulp capping or vital pulpotomy procedure.
Until our pets learn to “speak up”, it is our responsibility to keep a watchful eye on the rapidly growing teeth in our young patients’ mouths. Our goal is to identify any abnormality as early as possible, assess how it may affect the pet, and select the best course of therapy to correct the condition.