Figure 1: Taz, an 11-year-old South African mastiff, was presented with severe oral bleeding due to endodontic disease. Deciding on appropriate chew products for a dog involves many considerations. Due to the strong forces that dogs can generate with their jaws and the tall height of their crowns, chewing on the wrong thing may result in fractured teeth, worn teeth or trauma to soft tissue of the oral cavity. Here are two stories of how chewing on the wrong thing can cause serious problems. Day Care Dilemma Doggie day care is a popular option for pets while mom and dad are at work. Day care centers provide environmental enrichment that might otherwise be lacking in a dog’s normal routine. Part of this enrichment involves exposure to chew toys. A colleague told me about a dog that was presented with severe soft tissue lacerations due to gnawing on an “indestructible” chew toy. The dog’s aggressive chewing resulted in erosion of the alveolar mucosa and the bone lateral to the mandibular carnassial teeth bilaterally. Some sleuth work revealed that the dog apparently had obtained the lesions after destroying a plastic ball well enough to create large holes with jagged edges. This story brings home important points: There is no such thing as an indestructible toy. Indestructible toys may inflict excessive trauma to the hard or soft tissues of the oral cavity. It is important to investigate which toys a pet is exposed to in day care or boarding situations. Oral pain rarely stops a dog from chewing, eating or working (police dogs). Case Study: Acute Bleeding in a Mastiff Taz, an 11-year-old neutered male South African mastiff, was presented through our emergency service for sudden and profuse bleeding from the mouth. The bleeding appeared to arise from the right mandible. There was no known history of trauma. Taz was adopted later in life, and his new owners knew he had bad teeth. The owners were reluctant to put Taz under anesthesia to have the dental problems treated due to concerns that his chronic hind limb paresis might get worse. When Taz presented to the ER, he was bleeding intermittently until a sudden and severe episode necessitated immediate anesthesia (Figure 1). Once Taz was placed under anesthesia, the source of the bleeding was isolated. A fenestration was present through the bone and mucosa lateral to a fractured right mandibular first molar tooth (Figure 2). Figure 2 (left): Gingiva and mucosa are raised to show a fenestration through the bone due to endodontic disease of the right mandibular first molar tooth (tooth 409). Figure 3 (right): Infection of the tooth caused bone erosion and inflammation in the area of the tooth roots and the adjacent inferior alveolar neurovascular bundle. Infection of the tooth caused bone erosion and inflammation in the area of the tooth roots and the adjacent inferior alveolar neurovascular bundle (Figure 3). A mucoperiosteal pedicle flap was raised and the tooth was extracted after sectioning into two pieces. Bleeding was controlled with placement of bone wax in the fenestration and the mesial alveolus. The periosteum was released from the underside of the flap to allow for tension-free closure. The flap was trimmed before closure so that the fenestrated mucosa could be excised. The mucosa ventral to the fenestration was utilized as the new edge of the rostral portion of the flap. The site was closed with 4-0 monofilament absorbable suture in a simple interrupted pattern. Taz was discharged the following day, and two days later the owner sent an email update: “I can’t thank you enough for saving Taz. He is doing amazing. He is just like a pup wagging his stump!” Lessons Learned Most practitioners know that endodontic disease can cause pain and infection, but life-threatening bleeding is a rare sequela of a pulp-exposed tooth. The fractured tooth is the third most common reason for dogs to be presented to our dentistry and oral surgery practice. One study found the prevalence of traumatic dentoalveolar injuries to be 26.2 percent. The most commonly injured teeth were the mandibular and maxillary canine teeth (35.5 percent).1 When a dog presents with a fractured tooth, I ask owners what the pet has been chewing. Common culprits include actual bones, nylon bones, antlers, cow hooves, rocks and ice cubes. Fraser Hale, a veterinary dentist in Canada, uses the kneecap rule. He tells pet owners that if a toy or treat looks like something they would not want to get hit in the kneecap with, they should avoid giving it to their dog. Words to live by. If you’ve ever had a toothache, you know how much this can mess up your day. Next month, we will share more stories of how relieving dental pain in pets can be transformative for the animal and its owners. Recommended Reading Soukup JW, Hetzel S, Paul A. “Classification and Epidemiology of Traumatic Dentoalveolar Injuries in Dogs and Cats: 959 Injuries in 660 Patient Visits (2004-2012).” J Vet Dent. 2015; 32(1):6-14. Dr. John Lewis practices veterinary dentistry and oral surgery at NorthStar VETS in Robbins-ville, N.J. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News. Originally published in the December 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
