Tuesday, February 14, 2012

Case of the Week: Oz

Oz is a three-year-old flame point Siamese. When he came into the clinic for his six-month Wellness exam, I could see a small amount of gingival recession on his upper right canine tooth - his fang. He had mild dental tartar build-up and mild gingivitis but no other dental problems visible on his exam. He otherwise appeared to be a healthy young cat, so we scheduled him for a routine dental cleaning.

A few weeks later, Oz came into the clinic for his dental cleaning procedure. After a thorough cleaning of the teeth with the ultrasonic scaler, I performed an exam of his mouth. When cats are under anesthesia, I am able to perform a much better exam of their teeth. As you might imagine, probing a cat's gums with a sharp stick is not the easiest thing to do when he is wide awake. I look at all the surfaces of the teeth and probe the gum line for any defects in the enamel or gingival recession. At the upper right canine tooth, where I had seen the gum recession during his exam, there was a 6mm periodontal pocket. Basically, I could place the probe more than half way down along the tooth root. The upper right carnassal too
th, a three-root tooth towards the back of the mouth, also had a large periodontal pocket around both of its two front roots.

The lower teeth also had s
ome gum recession and periodontal pockets. The lower left first premolar had a 1mm pocket. The lower right first premolar and lower right molar each had a 4mm pocket, which is large for these small teeth.

After the cleaning and polishing of the teeth, I took radiographs (x-rays) of all the teeth. There was a larger amount of bone loss evident around many of the lower teeth. Bone loss occurs due to periodontitis, an inflammation of the tissues that hold the tooth in the bone. In Oz's case, two premolars showed substantial loss of bone and his lower right molar had lost so much of the bone that the roots were almost entirely exposed. Remember that at Oz's Wellness exam, all I could see were minor problems. It wasn't until he was sedated and had radiographs taken that I could diagnose the severity of his dental problems.

Oz's x-ray showing bone loss (on left) vs. a normal x-ray (on right)

I extracted four teeth - the upper right canine tooth, carnassal, lower f
irst premolar and molar. The large pockets around these teeth were allowing bacteria and plaque to extend down the roots leading to infection and pain. These teeth also would have eventually become loose in the mouth, causing more discomfort and even making it difficult for Oz to eat. After extraction of the teeth, I closed the gums over the empty sockets and the tissue healed very well.

Oz may have had more trouble on the right side due to the formation of his skull and teeth during development, or because of how he chewed his food. Sometimes, once a small problem starts and causes discomfort, the cat will chew more with the other side of his teeth allowing the plaque to develop even more. We will continue to monitor the rest of his teeth to watch for further problems.

Oz was not showing any symptoms of any mouth discomfort at home and his routine Wellness exam showed only the tip of the iceberg of his dental problems. In many cats, it is very difficult to see the extent of dental problems until we are able to probe the teeth and take radiographs under anesthesia. His case shows us the importance of routine exams and performing dental procedures whenever there is even a hint of dental disease on the exam.

-- Dr. Judy Karnia

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