Maxillary fourth premolar tooth root abscesses are common in the dog. VESCONE owner, Dr. Amy Shroff's own dog, Bonnie, a 13 year old Scottish Terrier, was diagnosed with this condition last week and was treated here at the hosptial. Dr. MaryAnn Nieves, who performed Bonnie's surgery, talks to us about this medical condition and how it is treated.
What is Tooth Root Abscess?
All teeth have a central region called the pulp chamber, if bacteria gains access to this area, an infection of the tooth can occur. Bacterial can enter this region through the blood stream, because of a break in the tooth, or because of severe dental disease.
What are the symptoms?
Tooth root abscess can result in facial swelling, pain, and bad mouth odor. Some patients only present with a single region of swelling of the face, often just in front of the eye near the bridge of the nose. The area can later drain material onto the face.
What happened in Bonnie's case?
Bonnie had a break in her tooth which may have been the entrance point to the pulp chamber. Bonnie also had chemotherapy to treat lymphoma, the agents use suppress the immune system making it easier to have an infection. The combination of issues could have easily caused Bonnie to develop the abscess of left maxillary fourth premolar tooth.
Left: Bonnie's full x rays. Right: Cutout highlighting her tooth root abscess--it is the hook-like shadow above her tooth.
How do we know for sure it is tooth root abscess?
Confirmation of the diagnosis of a tooth root abscess is through the use of imaging of the skull (either CTscan or plain radiographs).
How do you treat it?
Antibiotic therapy in the initial phases can reduce facial swelling and pain, but are not a substitute for treating the dental disease. Some degree of surgery is always required, whether an extraction or an open root canal.
Dr. MaryAnn Nieves peforms Bonnie's root canal assisted by Bruce Leung, CVT.
How is Bonnie doing?
According to her Mom, Dr. Shroff: Bonnie has recovered very quickly. Her swelling has nearly completely resolved and her appetite has returned. Bonnie also has more energy despite her concurrent Lymphoma. We are so glad this was a separate issue and not a complication of her cancer. She is on a regimen of soft food, Tramadol and Simplicef. In the next day or two, we are starting her on a daily teeth brushing plan as well as daily chewing on rawhides to keep her teeth clean.
Oreo came to VESCONE's emergency room on Sunday, February 12th with a bleeding liver mass. This is a case where every department in our hospital was crucial to Oreo's treatment and recovery (Emergency, Surgery, Radiology and Oncology).
Picture: Oreo's mom, Peggy Koenig, visits her after surgery.
After our Emergency Veterinarian triaged Oreo, they called our radiologist, Dr. Marcia Whiteley, to do an emergency ultrasound. Dr. Whitely noticed a nodule on the spleen and was concerned about a larger than normal gallbladder.
Our surgeon, Dr. MaryAnn Neives, was consulted and performed surgery on Oreo to remove most of her liver and her entire spleen & gallbladder. Oreo also received 2 blood transfusions to after her surgery to help her recover. VESCONE has blood on hand for emergency transfusions 24 hours a day.
After 4 nights as an inpatient at VESCONE, Oreo was released to the care of her family. She is recovering from her surgery and her cancer will be treated by our oncology partner and adjoining neighbor, the New England Veterinary Oncology Group (NEVOG).
We are thrilled that Oreo is doing well and that all our departments (ER, Radiology, Surgery and Oncology) worked together quickly to provide the emergency care she needed.