Dear Christine,

I wonder if you could advise whether there is anything that I can do for my dog, Zac. A couple of days ago I noticed that one of his canines has turned a light shade of pink/grey. I went to see the vet I normally go to and he said that the dog was not in pain (because he did not flinch when the vet pressed his tooth), that there was no infection/abscess, that the gums looked nice and normal and that he probably has cut the blood supply to the tooth by banging it into something hard. When I asked whether root canal therapy would help, he said that he would not recommend it. However, I am concerned that the pulp and nerve will get infected at some point, if they
are dead.

We care about Zac and if, in the long term, root canal therapy would prevent the tooth from becoming infected, I would come with him to have it done. I would really appreciate your advice on Zac’s options and outcome if he has something done and if not.

Thanks,
Alison

DR. CHRISTINE’S REPLY:

Dear Alison,

Thanks for your email, this is something that I do get asked a bit so you’re not alone in your confusion.

Basically, if the tooth is discoloured from the inside, there is significant bruising of the highly sensitive pulp tissue inside the tooth.
If this is fairly widespread over the tooth, it is highly likely to be dead inside (a study published in Canada looking at these teeth found something like 93% were dead). This is because compression and swelling causes the pulp tissue to die (like a brain injury within the skull, the tissue can’t expand within the hard tooth, so the pressure builds up and the cells die).

The cases which MAY be still alive tend to be either in very young dogs where the root of the tooth is still growing (these have an open root so the pressure from swelling can be relieved more easily through the opening), or in teeth where there is a very localised patch of
discolouration (as the rest of the tissue may survive and repopulate the injured area).

If a tooth is dead and filled with dead tissue, this is like a sitting time bomb for infection. Bacteria from the body like to find their way to dead tissue (it is so tasty for them!!). Once they get into the tooth, antibiotics can’t reach them so they cause chronic infection.

It is impossible to predict when this happens by looking from the outside. Once the tooth is dead, the nerve dies so the tooth isn’t sensitive to touch. In humans, dead teeth are often painless as long as they don’t get infected (my 3 year old son has two black and grey front teeth from where he smashed them into a table while trying to fly like a superhero – they really hurt for a week or two, but now don’t hurt at all). However if they do get infected, he will let us know as they will hurt like crazy, and then we will know we need to see the dentist again.

The problem with dogs is that they don’t like to tell us when they have a sore tooth. As pack animals, they instinctively hide their pain, so they don’t appear weak or unable to pull their weight with hunting. This would lead them to being demoted in the pecking order, or thrown out to fend for themselves. I have seen teeth ripped in half by whipper snippers and chainsaws, with the nerve hanging out, that were intensely painful, yet the dog acted ‘normally’ and even ate dinner.

So without Zac telling you if/when it gets infected, you are really playing a waiting game, he will tell you when it is excruciating, but not until it becomes so sore that he cannot physically eat. The infection is deep in the jaw (for a canine the end of the root is about 2-3 teeth further back in the mouth) so you rarely even see any swelling.

Basically the two options come down to:

1. Wait and see – but as he may be infected without us knowing, I’d highly recommend monitoring it with dental xrays over time so we can detect deep infection in the jaw if it occurs. This requires an anaesthetic each time to take the xray. Xray changes in these things can also lag weeks to months behind, as you need to lose a fair amount of the bone due to infection before the xrays can detect the change in density. Therefore Zac may be sore for a period before we can tell.

2. Treat on the assumption that it is highly likely to be dead, and has a fair chance of getting infected at some stage. The options would be extraction or root canal, both procedures remove the dead tissue so the mouth can heal, obviously extraction means there is no tooth there, while root canal preserves the tooth. We can work out the best option for Zac when we see him.

Well, it’s that time of the year again, the Veterinary Dental Forum is on later this week in Boston and I am excited to head over for a hefty dose of dental immersion therapy.

I will be back (with all the latest dental information) at the Animal Referral Hospital on Thursday 17 November. Until then, if you have an enquiry please feel free to email me at christine@sydneypetdentistry.com.au. I will be checking my email regularly while away.

For urgent veterinary issues please contact the Animal Referral Hospital on (02) 9758 8666.

If you subscribe to Dogs NSW magazine, you might have already caught the feature in the November issue on Dental Care which Christine contributed to. If not, the exciting news is that, from this month, the magazine is available to all in digital format on the web. Like Sydney Pet Dentistry, Dogs NSW promotes the welfare of dogs, with an emphasis on responsible breeding. Many dental issues have a significant genetic component. So jump online, visit www.dogsnsw.org.au/resources/dogs-nsw-magazine.html and read all about it!

PDHM is a great opportunity to spread the word about the importance of dental care in our pets. This year’s pet dental health month received lots of media coverage. As Christine is the Pet Dental Health Month Coordinator for the Australian Veterinary Dental Society, she featured in many newpaper articles, and several radio interviews, discussing all matters dental.

The ‘bones’ controversy was a popular issue for discussion, as well as how to train dogs and cats to have their teeth brushed. Click here for more information on the drawbacks of bones, and here for our top tips for introducing toothbrushing to your dog or cat.

We won't be using these - they are not anatomically correct....

Sydney Pet Dentistry and the Animal Referral Hospital are excited to announce that we will be holding regular dental training programs for veterinarians wishing to improve their dental skills and knowledge. Topics we plan to cover over the next few months include surgical extractions, local anaesthetic nerve blocks for oral surgery, dental radiology and feline dentistry. We would love to know what you would like to learn more about, suggest a topic in the comments box below!

Christine recently attended the Australian Veterinary Association Conference in Adelaide. Aside from having fun catching up with other dentally-fixated vets from across Australia (and Canada!), she presented three talks, and was a tutor for both the beginner and intermediate dental workshop days. It was inspiring to see so many vets really getting into dentistry, improving their knowledge and skills for the benefit of pets across Australia.

Next year the conference will be in Canberra, and already the Australian Veterinary Dental Society has big plans to make the dental program even bigger!

Christine was recently invited to speak at the NSW Public Oral Health Conference in Wollongong on 11-12 May. For a change, her audience were ‘human’ dentists, rather than vets. She spoke about the world of veterinary dentistry, including some of the differences in treating animals compared with human patients. She also learnt a lot about what is new in human dentistry, including treatment of dental fractures, and reconstructive surgery of the face following trauma.

Christine’s favourite new tool is her rotary endodontic system, Lightspeed. Used for root canal therapy, this motorised system can speed up the procedure for your pet, meaning less time under anaesthesia. Christine was introduced to this system when in the USA recently, and cannot imagine living without it now!

Cleo

I went to see Dr Christine Hawke after she was highly recommended to me by our local vet who had been treating my dog Cleo with antibiotics for mouth problems.

Cleo was also being treated for a heart condition so the thought of an operation and anesthetic scared me greatly for this sweet old girl.

I went along to see Christine one Thursday morning, Christine could not have been more kind or thorough in her consultation.

Cleo will be 18 in December, she had suffered the problems in her mouth for too long now, I agreed that the operation was necessary so I left her with Christine to be operated on the same afternoon.

When I picked her up the next day she was happy to see me but I had a feeling it was going to take a couple of days to get her over the long operation and to get used to having no teeth!

It has been one week since the operation and I am thrilled to say that Cleo is looking wonderful, she is so much happier and brighter.

She has no problems at all eating, in fact I think she is enjoying food much more now!

Her mouth was slowly poisoning her system….now there is no more bad breath or sad eyes in fact I would even say there is a spring in her step that I haven’t seen for years.

I can highly recommend Dr Christine Hawke, she is an honest, down to earth and extremely clever lady whom I’m glad was recommended to my family.

Lucius

Our Bull Terrier, Lucius was referred to see Christine Hawke for assessment and management of a tooth root abscess.

During the initial consultation, Christine could not possibly have been more helpful and forthcoming. She spent the better part of an hour explaining every possible outcome as well as answering all of my questions. At all times, she made me feel completely at ease and I was elated to have her take Lucius on as her patient.

Lucius underwent surgery the following week and has recovered beautifully.

At every stage of my contact and dealings with Christine Hawke, she was professional, friendly and exceptionally thorough in all aspects of her
service. Her genuine affection and concern for our pet was unmistakable.

I would absolutely recommend her service to anyone and would be happy to give verbal reference at any time..

Gemma Smith

Eastlakes, NSW