Pediatric Dentistry- Identification of Abnormalities
Stephen Juriga DVM, DAVDC
Small Animal Track
2012 ISVMA Annual Conference Proceedings
Teeth play an important role in the overall health, lifestyle and activity of our pets. Teeth
are used to catch, hold, grasp, shear and crush objects. Moreover, they are used in
play, for protection, and most importantly assist in nourishment. Young patients may
suffer from orthodontic abnormalities, missing teeth, fractured teeth, gingivitis, and even
periodontal bone loss. If these conditions are recognized they are treatable with similar
techniques and materials as used in human dentistry.
Puppies benefit from regular examinations of their teeth as they grow. Fortunately,
puppies require vaccinations and surgical neutering at 6 months or age: during the
critical months of tooth eruption and jaw growth. Early recognition and treatment of
abnormalities will prevent unnecessary discomfort and more serious conditions later in
life. Ultimately an early diagnosis allows better and, in many instances, simpler
treatment options. Veterinarians need to perform an oral examination at each visit,
communicate to pet owners any abnormalities found on the examination and be
prepared to perform or refer the patient for any needed treatment.
First, we consider pets from birth to 1 year of age as our pediatric patients. Puppies are
born without visible teeth. Puppies should have 28 primary teeth, which normally begin
erupting between the 3rd and 6th week. Permanent teeth are visible on radiographs by 8
weeks of age as small tooth buds. As these teeth mature and grow they will compress
the blood supply of the primary tooth causing it to be lost. Therefore, the deciduous
tooth should become discolored, mobile and will be lost prior to the permanent tooth
appearing.
Deciduous teeth are replaced by permanent teeth between 4-7 months of age (typically
later in small breeds). The central incisors are the first permanent teeth to erupt,
followed by the second incisor, then the lateral incisor. Finally, the canine teeth and
molars erupt by 5-7 months of age. If the deciduous teeth are not lost at the time of
eruption of the counterpart permanent tooth a malocclusion will occur.
Conditions affecting puppies from birth to 6 months of age:
 Cleft palate
 Delayed eruption of deciduous
teeth
 Fractured deciduous tooth
 Persistent deciduous teeth
 Malocclusion - Class 1, 2, 3
A cleft palate may involve the lip and primary palate. These defects are small and
maybe repaired when the pet is mature. A cleft of the secondary palate and soft palate
is diagnosed in our young patients due to milk leakage from the nostrils while nursing.
These patients are tube fed or nursed with large baby nipple until they are 8 weeks of
age. One cannot wait too long as these defects will become relatively large. Repair of
palate defects can be challenging as the surgical flaps typically are under some tension,
there is constant motion/irritation from the tongue and changes in air pressure while a
pet breaths.
Primary teeth are long and thin teeth. A fractured deciduous tooth is painful and quickly
becomes infected. This infection will may cause a draining tract, osteomyelitis, or
damage to the permanent tooth. Treatment for any fractured primary tooth with pulp
exposure is immediate and careful extraction. Pre-extraction x-rays are essential to
identify the location of the permanent tooth.
Malocclusions are relatively common in the dog and may affect the periodontal health,
comfort, and well being of our pets. Class 1 malocclusions are when both jaws are a
proper length and an individual tooth or multiple teeth are misaligned, crowded or
rotated. Class 2 malocclusions or “overbite” is a condition in which the maxillary teeth
are markedly in front of the mandibular counterparts. A class 2 malocclusion is
commonly diagnosed at the puppy’s first or second visit. These young patients benefit
from interceptive orthodontics. Interceptive orthodontics involves the selective extraction
of the lower incisors and/or canine teeth to alleviate pain and allow the jaw (mandible) to
grow to its genetic potential. Class 3 malocclusions or “underbite” is when some or all of
the maxillary teeth are located behind the mandibular incisors or canine teeth. This
malocclusion can result in gum trauma and tooth-to-tooth contact. Fortunately, few of
these pets require therapy however some require an extraction of the less functionally
important tooth. In brachycephalic breeds (Boxer, Shih tzu, Pug…), a Class 3
malocclusion is called a reverse scissor bite and is considered normal for these breeds.
Deciduous teeth should be visible in the oral cavity by 12 weeks of age. Delayed
eruption occurs in toy breeds more frequently. The teeth are commonly found under a
dense fibrous gingival tissue. Treatment involves dental radiographs to identify the
shape and position of the deciduous and permanent tooth. The tissue is then excised
over the impacted tooth and the patient is monitored to confirm the tooth fully erupts.
Persistent deciduous teeth are very common. The “Two Tooth Rule” states that if the
crown of the permanent tooth is visible above the gum line, the primary tooth should be
gone. If the primary tooth is still present then it should be extracted as soon as possible.
If left untreated, the primary tooth commonly directs the permanent tooth into an
abnormal position. Timely extractions are important to allow for the permanent teeth to
erupt into a normal position. Radiographic assessment is vital to successful extraction
therapy. Root resportion is only visible on dental radiographs and will direct either
cimple (closed) or surgical (open-flap) extraction herapy.
Conditions affecting our patients from 6-12 months include:
 Malocclusion - Class 1, 2, 3
 Base narrow permanent canine
teeth
 Missing teeth/Impacted teeth
 Deformed teeth
 Dentigerous cyst
 Fractured immature tooth
 Enamel hyperplasia
 Spear tooth
 Crowding & supernumerary teeth
Malocculsions of the permanent teeth again require individual evaluation and treatment.
Our goal is to provide our patients with a comfortable and functional bite.
Remember dogs have 42 permanent teeth. If a pet over 6 months of age is missing 1 or
more teeth, a dental x-ray of the area should be taken. Impacted teeth must be treated.
Therapy ranges from a gingival incision, which allows the tooth to erupt, to extraction or
oral surgery.
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Dentigerous cysts occur due to an unerupted tooth. The key is to notice that a tooth is
missing. These cysts are painful, benign structures that will expand and destroy bone.
There are reports of these cysts undergoing a malignant transformation. Treatment
involves extraction of the tooth, removal of the cystic lining, histopathologic submission
and wound closure.
Enamel hypoplasia/Hypocalcification is a developmental condition in which the teeth are
covered with abnormal or pitted enamel. This will appear as a rough and yellow stained
surface of the affected tooth. Restorative therapy maybe performed to protect the tooth
while they develop. Regular brushing of these teeth is important to control plaque and
tartar that easily accumulates on them.
Spear tooth is a rostrally deviated maxillary canine tooth that can occur in any breed of dog,
although it is more common in the Shetland Sheepdog. These teeth are prone to developing
advanced periodontal disease and many patients will have tooth-to-tooth contact which is
painful. These patients benefit from orthodontic therapy.
Small breed and brachycephalic dogs (Pug, Boston Terrier, Boxer) may have severe crowding
and rotation of teeth. The shortened upper jaw (maxilla) does not allow proper positioning of
teeth. This crowding leads to food impaction and early onset of gingivitis. Selective extraction
of the less significant tooth can prevent premature periodontal disease and encourage overall
improved oral health. Similarly, extra teeth (supernumerary teeth) may lead to crowding or
result in tooth-to-tooth contact. These teeth should be x-rayed to assess their root structure.
In some instances extraction therapy is necessary.
Base narrow mandibular canine teeth result in a painful condition in which the lower canine
tooth or teeth strike the roof of the mouth (palate). Many patients with a class 2 malocculsion
will develop this condition. Therapy depends on the age of the pet and severity of the
malocclusion. Orthodontic therapy such as incline capping, acrylic incline plane or crown
reduction therapy is recommended for patients with this condition.
Deformed teeth occur more commonly in small or toy breed pets. Although, deciduous teeth
involved in trauma or adjacent to a maxillary or mandibular fracture can become deformed as
they undergo abnormal development. The crown of the pet’s teeth must be examined to
ensure there is a complete covering of enamel and there are not any fissures in the crown.
The large lower molar of toy breeds may have this defect as well as root convergence. These
teeth are prone to infection that can result in a bone infection that weakens the jaw of the pet.
Gemination is a disorder in which the developing tooth bud attempts to split but fails to do so
completely, resulting in duplication of part of the tooth but not complete twinning. Gemination
teeth commonly have two crowns, each with a separate pulp chamber merging into a common
root canal system.
A fractured (immature) tooth with pulp exposure in a pet under 1 year of age must be treated
within 48 hours of the trauma. The pulp is the inner-most part of the tooth and will appear as
a red dot/tissue in the center of the tooth. When exposed it is painful and will become
infected. This tooth root in a young pet is not fully formed. Pulp capping or vital pulpotomy
procedure (< 12 months) may be performed to allow root-end closure and secondary dentin
deposition to strengthen the tooth and retain its function. In teeth of less functional
importance, surgical extraction therapy should be performed in a timely manner based on
dental radiographs of the tin walled immature root structure.
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Until our patients learn to “speak up”, it is our responsibility to keep a watchful eye on the
primary and permanent teeth in our young patients’ mouths. Our goal is to identify any
abnormality as early as possible, assess how it may affect the pet, and select the best course
of therapy to correct the condition. Moreover, take these oral examination opportunities
(vaccination series or surgical neutering) to educate you clients on the VALUE of these visits
and when oral pathology is noted you will look brilliant!