The Patient
Ruby, a 12 year old female spayed terrier mix, came to see me for an itchy skin lesion.
The Case
On examination, I diagnosed a "hotspot" which is a focal area of skin infection caused by an intense itch leading to chewing and self harm. I also found fleas on her body as the likely culprit. But, during her oral exam, I found a very suspicious red bubble in the gum tissue above the upper 4th premolar tooth on the right side. The tooth itself was completely covered in tartar and I could not even see the crown. When I touched the area she reacted in pain. She had mild to moderate dental disease throughout her mouth. I told the owner that I was very concerned about the tooth and I suspected that she had a tooth root abscess and this red bubble was actually a parulis which is a draining tract from an infected tooth.
The Treatment Plan
I recommended scheduling a complete oral health assessment and treatment, also known as COHAT, which is a full dentistry with dental xrays, scaling, and polishing of the teeth. The dental xrays would tell me if in fact the tooth was abscessed. Ruby returned the following week for her procedure. I induced general anesthesia and took full mouth dental xrays. Sure enough, the tooth was infected. This particular tooth has 3 roots and 2 of the roots had what is called a periapical lucency indicating bone loss and infection at the root tip. The tooth needed to be extracted. After getting the owner's permission, I performed an extraction of the tooth. This entails making an incision into the gum, elevating a gingival flap, dividing the tooth into 3 parts, elevating and removing each root intact, flushing the socket, and then closing the gum tissue over with absorbable sutures.
The Outcome
Ruby did great! Here are her before and after pictures. Her mouth cleaned up very nicely! Her mouth was healed in about 7 days. During this time the owner was instructed to feed a soft diet and I sent her home with pain medications. Ruby won't miss that tooth at all! Dogs have 42 teeth (people only have 32) and do remarkably well with missing teeth or sometimes no teeth at all. This case is a good example of why full physical exams are so important in veterinary medicine. Ruby came in for a skin lesion and we found a much more worrisome problem that I was able to address before she stopped eating or the infection spread through her body.
The Drake Center for Veterinary Care is an AAHA-accredited animal hospital located in Encinitas, CA. The Drake Center loves being a source of information for all pet owners across the country however if you have any questions regarding pet care and do not live in Encinitas, CA or surrounding cities, we encourage you to contact your local veterinarian. The Drake Center may use AI to assist in sharing knowledge; the Drake Center doctors verify any medical information shared in our blogs or website.
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