Sweet four year old Rhoda belongs to one of the fabulous nurses at our veterinary clinic. She is well known for being an active young Spaniel, particularly partial to a ball and a game of fetch. Lately however, her zest for life seemed to done a 180... where she would usually play tug and tag with her little sister Bonnie all day long, she was now refusing to join in and seemed depressed. Her diligent owners had also noticed a sudden fussiness with certain harder treats and reported Rhoda was even turning down her favourite vegetable: carrots!
Because of these signs Rhoda's owners rightly concluded something might be wrong with her mouth, so took some pictures for me to look at. We were already aware that Rhoda was suffering from a significant amount of tooth wear as a result of her ball playing and balls had therefore been removed from her set of play things a while back. Tennis balls are the most common cause of this kind of abrasive wear, as their combination of fuzz and any sand that sticks to them acts as sandpaper, wearing teeth down quickly and effectively.
Picture 1 - Tooth wear (secondary to abrasion) in Rhoda
With abrasive trauma like this the enamel and underlying dentine are worn down, getting closer and closer to the pulp. In response to this 'tertiairy' (reparative) dentine is formed which keeps the pulp sealed off from the outside world. Tertiairy dentine is created very quickly and therefore laid down somewhat haphazardly. This means it is more porous than primary or secondary dentine. It easily becomes discoloured, which makes it easy to identify as a brownish spot where you'd expect the pulp to be. You can confirm you're dealing with tertiairy dentine by using a sharp explorer probe to check the tooth surface, as the probe should not enter the pulp cavity but glide over the discolouration as if sliding over glass.
Picture 2 - Examples of tertiairy dentine in Rhoda
Sadly this doesn't mean the tooth is definitely out of harms way! Because dentine is porous there is always a potential for bacteria to infiltrate the pulp cavity by working their way through the pores. This is yet another reason dental radiography is an unmissable part of dentistry as it is the only way to pick up signs of pulpitis associated with this kind of bacterial invasion. It's also the reason I will generally advise worn teeth to be checked with xrays regularly so any problems can be detected as soon as they occur.
If the wear happens too quickly for tertiairy dentine to be formed, the pulp cavity will become exposed and pulpitis and pulp necrosis will develop as bacteria from the mouth invade the soft tissue space. Open pulp cavities visually look different to tertiary dentine in that they are black and examination with a sharp explorer probe should confirm the open cavity (ie the explorer can be inserted into the hole or will 'snag' when run over the surface area).
Picture 3 - Pulp exposure and necrosis 107 secondary to rapid wear
As you can see from Rhoda's pictures there was at least one tooth (307) that seemed to be suffering from pulp necrosis. This tooth certainly needed assessing and treating. At the same time we evaluated all her other worn teeth both visually and radiographically, in particular 107 which was worn very close to the gingival margin. Our examination confirmed that 307 was not only suffering from pulp exposure and necrosis, but also from a tooth fracture beneath the gum line (this was evident on probing examination but sadly not as clear on the radiographs). This gave us enough reasons to extract this tooth. Further assessment also revealed that the significant wear of the 107 had led to pulp exposure and because there was little to no functional crown left this tooth was also extracted.
Picture 4 - Rhoda's preoperative intraoral radiographs
Luckily Rhoda's remaining teeth were found to be health despite the wear and she has made a stunning recovery! Not only is she happily munching her carrots again, she is back to playing day in day out with Bonnie and living her best Spaniel life!
Disclaimer - Permission was given by Rhoda's owners to share details of her case history and photo's on this blog.
Comments