Extractions
Dental extractions will always be carried out by a Veterinary Surgeon. They must be always carried out with care and using the right equipment. Fracturing teeth and leaving root tips in the jaw can cause severe problems. Radiographic back-up can prove invaluable for difficult cases.
Sometimes teeth affected by severe periodontal disease can be relatively easy to extract – the difficulty then is in sorting out the infection and preventing recurrence.
The following images illustrate some of the more advanced techniques that sometimes have to be employed.
Extraction of a Lance or Dagger Tooth
The normal position of the canine tooth is shown below.
However in "Dagger Tooth" the canine tooth erupts in an abnormal position – pointing forwards. This can be seen in the picture below (the ET - anaesthetic tube can also be seen).
In this case the Dagger Tooth has caused the little incisor tooth next to it to be pushed inwards. Also plaque and debris is starting to build up between the two teeth and periodontal disease will follow.
The options for this tooth are orthodontic correction, shortening the crown of the tooth, or extraction. This dog’s owner opted for extraction. This can be a difficult tooth to extract as its attachment to the jaw is quite healthy and the root of the tooth lies just next to the nose and it would be easy to penetrate through.
The first stage is to disinfect the mouth to provide a clean operating field. A gingival flap is then prepared by making a surgical incision into the gum to expose the bone covering the tooth root.
A high speed dental drill with water cooling, is then used to carefully bur away the bone
Special dental luxators are then used to cut the ligament that holds the tooth in the jaw.
The tooth is gently rocked backwards and forwards and the ligament is cut, stretched and torn.
Eventually the tooth is loose enough to allow the tooth to be carefully extracted.
It is important to note that the inner bone wall of the tooth socket is completely intact. There is no penetration into the nasal chamber.
The socket can then be filled with a bone graft, or with special materials such as Consil which encourages bone to grow back into the socket.
The gums are then carefully sutured back in place using fine dissolving sutures, without any tension on the wound.
Over the next few days and weeks the area heals. Pain relief is an important part of the post operative care.
Multi-Rooted Teeth
Many of our pets' teeth have more than one root. This makes them much more stable and therefore difficult to extract. To try this for your self compare how stable you are when standing on both legs – then ask a friend to try and push you over when you are standing on only one leg!
This is why it is normally essential to split a tooth into single root portions prior to extraction.
This tooth had severe periodontal disease which had produced a deep pocket around a root and had in fact killed the tooth by allowing infection to enter the tooth from the root end.
Here you can see how the dental probe can pass all the way down. A radiograph is very useful to see how far the infection has spread – is the jaw itself fractured?
The first step is to gently push back the gums to expose the upper part of the tooth's roots.
The junction between the roots (the furcation) is located and a high speed water-cooled dental drill is used to cur the tooth in half.
The dental luxators (as in the previous case) are used to cut the periodontal ligaments which attach the roots to the jaw bone.
The roots are carefully extracted and checked and radiographs confirm the extraction and no damage to the jaw.
The root sockets in the jaw bone are carefully inspected.
Sometimes the edges of the sockets may need to be smoothed down.
Here we have used Consil granules (a bio-glass designed to encourage bone to grow in) to fill the sockets in the hope that we will get a stronger jaw bone more quickly.
Whether or not Consil or bone grafts are used, or the sockets are simply filled with a blood clot, it is important that the gums are carefully sutured over. Without this suturing the sockets can become filled with food material, the bone is exposed to the air and infection is more likely. Not to mention the fact that suturing reduces bleeding and post-operative pain.
An absorbable suture material is used to carefully, gently close the wound without putting the area under tension.
Did You Know?
Calculus
The rough surface provides increased surface area which encourages further plaque accumulation - in turn this produces more calculus.
