Carnassial Tooth Abscess

“Stephanie, I need to bring my dog, Sprint, in to see Dr. Randolph for an abscess on his face. We are visiting here from Iowa, thinking of buying a vacation home on the Mississippi Coast, but we’re headed back to Iowa in three days and I don’t want Sprint to have any complications on the trip.”

“Yes, ma’am, we can see you at 2:50 this afternoon and get Sprint all safe for the trip.”

Sprint arrived with some history. It turns out that he has had an abscess in this same place on his face before.

And, he has Cushing’s disease.

As you know, or just read, Cushing’s disease results in high levels of cortisol, a naturally-produced corticosteroid that comes from the adrenal gland. High levels of cortisol can suppress the immune system and result in wounds and infections that won’t heal.

Enter Sprint, whose Cushing’s disease is not yet fully regulated, having only recently been diagnosed back home in Iowa. The swelling he has today is in the same location as a previous lesion, indicating a strong likelihood that this is an unresolved, recurrent problem.

After thorough examination we discovered that Sport has moderate dental calculus, but that’s not exactly the source of today’s problem.

Sprint’s problem is, in fact, dental, but not visible from the outside. He has an infection of one of the roots of the right carnassial tooth, the fourth upper premolar. You can most easily recognize it as a big, obvious crushing tooth.

A three-rooted tooth, the carnassial possesses one root that terminates just under the facial bone, immediately in front of the eye. Pet owners commonly think that draining wounds in this area have been caused by the bite of another animal. Infection of the tooth root is a fairly common problem.

Treatment can be conservative or aggressive.

Conservative therapy includes dental scaling and polishing to remove dental calculus, which may harbor bacteria that are in the source for infection, along with long-term antibiotic therapy of at least four weeks duration. Six to eight week durations of antibiotic therapy are sometimes needed.

Even with extended antimicrobials pockets of infection often persist, necessitating more aggressive treatment.

Aggressive treatment usually translates to surgical extraction of the tooth. Having three roots, the tooth must be sectioned, dividing each crown and root from the others. Each portion is then removed individually and the resulting defect is sutured closed. Post-operative pain medication will be dispensed so that your pet will not be uncomfortable. He will soon be eating normally, even on the affected side, though hard food will have to be crushed on the opposite side.

If the tooth is to be saved, referral to a board-certified veterinary dentist can be scheduled for a root canal procedure.

We elected to treat Sprint with a Convenia injection, and made plans for him to have two more Convenia injections at two-week intervals after he gets home. These injections will be performed in conjunction with dental prophylaxis.

Sprint’s mom and I had an interesting conversation after we finished with his medical care. She said, “I can’t get over the devastation from Hurricane Katrina. According to the news reports we got, we didn’t even know the storm hit here. All we heard about was New Orleans this and New Orleans that.”

“Sadly, we were ignored by the press to a great extent. In fact, the eye of the storm went immediately west of our home. Another reason you didn’t hear much about us, though, is the nature of Mississippians. As Governor Barbour put it, ‘Our people hitched up their britches and went to work.’ We had tremendous help from church groups all over the country. We will never be able to thank people enough for all they did for us.

“Some people fretted over the lack of publicity, but many of us took the Conestoga wagon approach.”

Sport’s mom cast a questioning look at me.

“When people were crossing the plains in Conestoga wagons in the 1800s, if an axle broke, they didn’t wait for the government to come fix it for them, Pa just said to Ma, ‘Hon, when I pick up the wagon, you slide the wheel on.’ And she did. And they went on across the prairie. People took responsibility for their own welfare, and that’s what we did.

“August, 2010, will be our five-year point after Katrina. We’re very proud of how far we’ve come, but, thanks to the weak economy and the outrageous cost of insurance, many homes and businesses have not been rebuilt, and some never will be. Nagasaki wasn’t rebuilt in five years, and no one should be surprised that we aren’t.”

Sprint’s mom glowed. “We love it here, and we hope our bid is accepted on the house we like so that we can spend half of our year here.”

“Have a safe trip Saturday,” Stephanie and I said as Sprint and mom exited.

See you tomorrow, Dr. Randolph.

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