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CopyrightAll contents copyright (c) 2011 by Sydney Pet Dentistry. All rights reserved. No SDUW�RI � WKLV�GRFXPHQW�RU� WKH� UHODWHG�ÀOHV�PD\�EH� UHSURGXFHG�RU� WUDQVPLWWHG�in any form, by any means (electronic, photocopying, recording, or otherwise) without the prior written permission of the publisher.

Limit of Liability and Disclaimer of WarrantyThe publisher has used its best efforts in preparing this book, and the information provided herein is provided “as is.” Sydney Pet Dentistry makes no representation or warranties with respect to the accuracy or completeness RI �WKH�FRQWHQWV�RI �WKLV�ERRN�DQG�VSHFLÀFDOO\�GLVFODLPV�DQ\�LPSOLHG�ZDUUDQWLHV�RI �PHUFKDQWDELOLW\�RU�ÀWQHVV�IRU�DQ\�SDUWLFXODU�SXUSRVH�DQG�VKDOO�LQ�QR�HYHQW�EH�OLDEOH�IRU�DQ\�ORVV�RI �SURÀW�RU�DQ\�RWKHU�FRPPHUFLDO�GDPDJH��LQFOXGLQJ�EXW�QRW�limited to special, incidental, consequential, or other damages.

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In addition, terms suspected of being trademarks, registered trademarks, or service marks have been appropriately capitalized, although Sydney Pet Dentistry cannot attest to the accuracy of this information. Use of a term in this book should not be regarded as affecting the validity of any trademark, registered trademark, or service mark. Sydney Pet Dentistry is not associated with any product or vendor mentioned in this book.

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Table of Contents

INTRODUCTION 1THE NORMAL MOUTH 3

What is a normal bite? 4What is the normal structure of a tooth and its socket? 5

BITE ABNORMALITIES IN PUPPIES 6What is a malocclusion? 6What causes a malocclusion to develop? 10My dog has a malocclusion. Do we need to treat it? 13What are our treatment options? 14What are some of the ethical considerations... 19

OTHER COMMON PROBLEMS WITH PUPPY TEETH 21Does it matter if teeth are missing or delayed in erupting? 21Does it matter if my puppy doesn’t lose its deciduous teeth? 23Do we need to worry about broken deciduous teeth 24

SO HOW DO I MAKE SURE MY PUP HAS A COMFORTABLE MOUTH? 25

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INTRODUCTIONHello and thanks for downloading my book on Common Dental Problems for Competition Dogs – Puppy Problems. Although all puppies can be affected by oral problems, there are some which can be devastating for puppies involved in showing or competitive sports.

Orthodontic issues can be very painful for individual pups, and, as many have a genetic basis, they have enormous implications on breeding programs. Traumatic dental issues can also severely impact sporting performance as well as quality of life.

Early assessment and treatment of dental problems in puppies is critical in minimising long-term complications, giving your pup the very best chance at a happy and healthy life, both in and out of the show ring.

My name is Christine Hawke, and I am a veterinarian with almost 20 years experience in small animal practice. After many years in general practice, I developed a passion for all things dental, and have been running a small animal dentistry-only practice in Sydney since 2007. I am a Member of the Australian College of Veterinary Scientists LQ�WKH�ÀHOG�RI �9HWHULQDU\�'HQWLVWU\��WKLV�FDQ�only be attained through examination), and am currently undertaking advanced training under the mentorship of Dr David Clarke in Melbourne.

,�DP�RIWHQ�VXUSULVHG�DW�VRPH�RI �WKH�P\WKV�,�FRPH�DFURVV�LQ�WKH�ÀHOG�RI �GRJ�dentistry. These range from the types of treatment that can or should be performed, through to whether dental problems need treating at all. This misunderstanding means that many dogs do not get the standard of dental treatment they deserve.

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Imagine having a toothache or sore mouth and not being able to tell anyone!One of the biggest misconceptions is that dental problems don’t need the same treatment in animals as they do in humans. Nothing could be further from the truth! Dogs’ teeth have the same type of nerve supply in their teeth as we do, so anything that hurts us will hurt them as well. All dogs, whether they are performance dogs or pets, deserve to have a healthy, pain-free mouth.

Oral and dental issues frequently go undiagnosed in dogs, partly because the disease is hidden deep inside the mouth, and partly because dogs are so adept at hiding any signs of pain. As a pack animal, they don’t want to let the rest of the pack (including us!) know they have a problem, as anything that limits their usefulness to the pack may be grounds for exclusion. This is a survival instinct.

Dogs will suffer in silence for as long as they can, and they only stop eating when they cannot bear the pain any longer.

How to get the most out of this bookThis book has been written to help you understand how oral and dental problems develop in puppies, what the implications of these issues are, and what options are available to you and your pup to achieve the best outcomes in terms of overall health, comfort and performance.

You don’t need to read it from cover to cover, as your dog would need to be pretty unlucky to need all the advice included here! However, I do recommend that you look through the information on what a ‘normal’ mouth is, as this will help you to understand how each problem can arise.

If you would like to speak to me for advice on your dog, please feel very welcome to call me on 0408 782 611, or you can email me on christine@sydneypetdentistry.com.au.

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THE NORMAL MOUTH,Q�RUGHU�WR�GHWHFW�DQG�XQGHUVWDQG�GHQWDO�SUREOHPV��ÀUVW�ZH�QHHG�WR�NQRZ�ZKDW�is NORMAL.

Puppies have 28 deciduous (primary, milk or baby) teeth which erupt between 3-8 weeks of age. These are replaced by the adult (permanent) teeth between 4-7 months of age. Adult dogs should have a total of 42 teeth. The difference in the number of deciduous and adult teeth arises because some adult teeth (the PRODUV�DQG�WKH�ÀUVW�SUHPRODUV��GRQ·W�KDYH�D�GHFLGXRXV�YHUVLRQ��

There are four types of teeth which are shaped to perform different functions:

�� incisors (smaller front teeth which are used to nibble, cut and groom)

�� canines (large fangs used for hunting, piercing, holding objects and protection)

�� premolars and molars (cheek teeth used for holding, shearing, and grinding)

NORMAL DECIDUOUS DENTITION IN THE PUPPY

NORMAL ADULT DENTITION IN THE DOG

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The ‘carnassial’ teeth are the large specialised pair of teeth towards the back of the mouth on each side, which work together like the blades of a pair of scissors. The upper carnassial is the fourth premolar, while the lower one is the ÀUVW�PRODU�

The upper jaw is the maxilla, and the lower jaw is the mandible.

What is a normal bite?The way the teeth align with each other is referred to as the ‘occlusion’. Normally the upper incisors sit just in front of the lower incisors, this is called a ‘scissor bite’. The lower canines sit in the gap between the upper canines and corner (third) incisors, without rubbing against either of these teeth.

NORMAL OCCLUSION IN THE ADULT DOG (COPYRIGHT AVDC, USED WITH PERMISSION)

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Although a scissor bite is standard for most breeds, in some breeds with a short, wide muzzle (brachycephalic skull type), a reverse scissor bite is accepted as the breed standard, where the upper incisors are behind the lower ones, and the lower canines are shifted forward. A level bite (where the upper and lower incisors are in line with each other) is also acceptable in some breeds.

The points of the smaller lower premolars should point to the spaces between WKH�XSSHU�SUHPRODUV��ZLWK�WKH�ORZHU�ÀUVW�SUHPRODU�EHLQJ�WKH�ÀUVW�IURP�WKH�IURQW��The upper carnassial tooth should sit outside the lower carnassial tooth.

What is the normal structure of a tooth and its socket?While the precise shape and size of a dog’s teeth looks quite different to ours, the basic structure of a dog tooth is similar to a human tooth.

�� The portion of the tooth we can see above the gumline is called the crown, and that below the gumline is the root.

�� The bulk of the tooth is made up of dentine (or dentin), a hard bony-like material with tiny dentinal tubules (pores) running from the inside to the outside. In puppies, the dentine is relatively thin, making the tooth more fragile than in an older dog. The dentine thickens as the tooth matures throughout life.

�� The crown is covered in enamel, which is the hardest material in the body (even harder than bone!). This is only made prior to eruption, and cannot be regenerated if damaged.

�� Inside the tooth is the pulp, which is living tissue containing blood vessels, nerves and immune cells. The nerves have processes which extend through the dentinal tubules, and if these are exposed or stimulated they can cause sensitivity or intense pain.

�� The root of the tooth is covered in FHPHQWXP�� DQG� ÀUPO\� DWWDFKHG� WR�the bony socket by the periodontal ligament.

�� The gingiva (gums) attach to the tooth at the junction between the crown and root. STRUCTURE OF THE TOOTH AND

PERIODONTAL (SUPPORTING) TISSUES

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BITE ABNORMALITIES IN PUPPIES

What is a malocclusion?Malocclusion is the termed used for an abnormal bite. This can arise when there are abnormalities in tooth position, jaw length, or both. The simplest form of malocclusion is when there are rotated or crowded teeth. These are most frequently seen in breeds with shortened muzzles, where 42 teeth need to be squeezed into their relatively smaller jaws. Affected teeth are prone to SHULRGRQWDO�GLVHDVH��LQÁDPPDWLRQ�RI �WKH�WLVVXHV�VXSSRUWLQJ�WKH�WHHWK��LQFOXGLQJ�the gums and jawbone) and early tooth loss.

CROWDED UPPER INCISOR TEETH IN AN ENGLISH BULLDOG, WITH

TRAPPING OF FOOD AND DEBRIS. THERE IS AN EXTRA INCISOR PRESENT WHICH IS EXACERBATING THE PROBLEM.

ADVANCED PERIODONTAL DISEASE DUE TO PLAQUE ACCUMULATION BETWEEN CROWDED INCISORS.

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0DORFFOXVLRQV�FDQ�EH�FODVVLÀHG�DFFRUGLQJ�WR�WKH�UHODWLRQVKLS�EHWZHHQ�WKH�XSSHU�and lower jaws.

Class I malocclusions occur when the jaws are normal lengths, but one or more teeth are rotated or misaligned. The most common ones we see in our practice include:

�� Anterior (rostral) crossbite occurs when one or more upper incisors are positioned behind their lower counterparts. Constant striking of the lower incisors and oral tissues by the upper teeth may result in periodontal GLVHDVH��SXOSLWLV��LQÁDPPDWLRQ�RI �WKH�VHQVLWLYH�OLYLQJ�SXOS�WLVVXH�LQVLGH�WKH�teeth), and early tooth loss.

�� ‘Base narrow’ canines (Linguoverted or ‘inverted’ canines) are a relatively common and painful problem in Australian dogs. The lower canines erupt more vertically or ‘straight’ than normal (instead of being tilted outwards), and strike the roof of the mouth. This causes pain whenever the dog chews or closes its mouth, and can result in deep punctures through the palatal tissues (sometimes the teeth even penetrate into the nasal cavity!). In our practice in Sydney, we see this most commonly in Staffordshire Bull Terriers and Labrador Retrievers.

ANTERIOR CROSSBITE

BASE NARROW CANINE TOOTH STRIKING THE UPPER JAW

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�� Lance’ canines (Mesioverted or ‘spear’ canines) occur when an upper canine erupts so it is pointing forward, like a tusk. This is seen most commonly in Shetland Sheepdogs, and can lead to lip trauma and displacement of the lower canine tooth (which cannot erupt to sit in its normal position in front of the upper canine).

Class II malocclusions (‘overshot’) arise when the lower jaw is relatively short compared with the upper jaw. This type of occlusion is NEVER considered QRUPDO��DQG�FDQ�UHVXOW�LQ�VLJQLÀFDQW�DQG�SDLQIXO�WUDXPD�WR�WKH�XSSHU�JXPV��KDUG�palate and teeth from the lower canines and incisors.

LANCE CANINE IN A SHETLAND SHEEPDOG

CLASS II MALOCCLUSION IN A PUPPY. THE LOWER CANINES ARE DAMAGING THE HARD PALATE EVERY TIME

THE PUPPY CLOSES ITS MOUTH.

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Class III malocclusions (‘undershot’, ‘prognathism’) occur when the lower jaw is relatively long compared with the upper jaw. The upper incisors may either meet the lower ones (level bite), or sit behind them (reverse scissor bite). While this is very common, and considered normal for some breeds, it can cause SUREOHPV�LI �WKH�XSSHU�LQFLVRUV�DUH�KLWWLQJ�WKH�ÁRRU�RI �WKH�PRXWK�RU�WKH�ORZHU�teeth (similar problems to rostral crossbite). If the lower canines are striking the upper incisors, the accelerated dental wear often results in dead or broken teeth.

CHRONIC HARD PALATE DAMAGE AND TRAUMATIC WEAR OF THE UPPER CANINE AND THIRD INCISOR TEETH IN

AN ADULT DOG WITH AN OVERSHOT JAW.

CLASS III MALOCCLUSION IN A PUPPY (LEFT) AND AN ADULT BOXER (RIGHT)

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Class IV malocclusions (‘wry bite’) occur when there is deviation of one or both jaws in any direction (up and down / side to side / front to back). These may be associated with mild to severe problems with chewing, damage to teeth and oral tissues, and chronic pain.

What causes a malocclusion to develop?Normal development of the teeth and jaws is largely under genetic control, however environmental forces such as nutrition, trauma, dental interlock and RWKHU�PHFKDQLFDO�IRUFHV�FDQ�DOVR�DIIHFW�WKH�ÀQDO�RXWFRPH���

As the interaction between these factors can be quite complex, it is recommended that you have your pup individually assessed – feel welcome to call me for advice.

What role does genetics play in malocclusions?

Most malocclusions involving jaw length (skeletal) abnormalities are genetic in origin. We need to recognise this as it has enormous implications if you are planning to breed, as once a malocclusion is established in a line, it can be heartbreaking work to try and breed it back out.

The exact genes involved in jaw development are not yet well understood. We do know that the upper and lower jaws grow at different rates, at different times, and are under separate genetic control. In fact, the growth of one only affects the growth of the other if there is physical contact between them via the teeth. This contact is called ‘dental interlock’.

When the upper and lower teeth are locked against each other, the independent growth of either jaw is severely limited. This can occasionally work in the dog’s favour, for example if the lower jaw is slightly long compared with the upper jaw, the corner incisors may lock the lower canines in position behind them, limiting any further growth spurts of the lower jaw.

WRYBITE IN A YOUNG PUPPY

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However, in many cases, dental interlock interferes with jaw development in a negative way. A classic example we see regularly in our practice is when a young puppy has a class II malocclusion (relatively short lower jaw) and the lower deciduous canines are locked behind the upper deciduous canines, or trapped in the tissues of the hard palate. In these cases, even if the lower jaw was genetically programmed to catch up to the upper jaw, it cannot physically do so.

Early removal of the lower canines (and often the lower incisors as well) to relieve this problem is strongly recommended. This procedure is called ‘interceptive orthodontics’ as we are ‘intercepting’ the developing problem before growth is completed and it is too late.

Extraction of these teeth will not stimulate jaw growth, but will allow it to occur if nature (ie genetic potential) permits. It also relieves the painful trauma caused by the teeth to the hard palate whenever the pup closes its mouth (and we all know how sharp those baby teeth are!!). More information on interceptive orthodontics can be found later in this book.

DENTAL INTERLOCK IN A YOUNG PUPPY – THE GROWTH OF THE LOWER JAW IS LIMITED BECAUSE THE LOWER CANINE TOOTH IS TRAPPED

BEHIND THE UPPER CANINE TOOTH.

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Some tooth position abnormalities also have a genetic basis, the ones we see most commonly include:

�� rotated premolars in brachycephalic (short muzzled) breeds

�� base narrow canines in Staffordshire Bull Terriers

�� lance canines in Shetland Sheepdogs

In some breeds, a genetic tendency for retained deciduous teeth can also contribute to the development of problems, such as anterior crossbite seen in several of the toy breeds.

It is crucial to remember that genetic malocclusions are not usually seen in all puppies in an affected litter as they are not dominant traits. Puppies can carry the genes contributing to genetic faults without showing any physical signs at all. If an affected puppy is noted, extreme caution should be exerted when planning future breeding from the parents and siblings, and neutering of the affected puppy is strongly recommended.

Again, if you are concerned you may have a genetic issue, please feel welcome to contact me anytime for advice.

Does overnutrition or undernutrition affect the development of malocclusions?

Although diet often gets the blame for development of malocclusions, the role of nutrition is actually much OHVV�VLJQLÀFDQW�WKDQ� LV�RIWHQ�EHOLHYHG��2EYLRXVO\� JURVV� GLHWDU\� GHÀFLHQFLHV�will affect bone and tooth development, for example severe dietary calcium GHÀFLHQF\� FDQ� OHDG� WR� ¶UXEEHU� MDZ·��However, the vast majority of puppies are on balanced, complete diets and have adequate nutrient intake for normal bone and tooth development.

One myth I have heard repeated by several owners is that strict limitation of a puppy’s dietary intake can be used to correct an undershot jaw. This is simply NOT true. Limiting calories will NOT slow the growth of the lower jaw relative to the upper jaw (both jaws receive the same nutrient supply). Such a practice is not only ineffective, it can be detrimental for the puppy’s overall growth and development.

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What about other causes of malocclusions?

Trauma, infection and other mechanical forces may affect growth and development of the jaws and teeth. Developing tooth buds are highly sensitive WR�LQÁDPPDWLRQ�DQG�LQIHFWLRQ��DQG�PDOIRUPHG�WHHWK�PD\�HUXSW�LQWR�DEQRUPDO�positions (or not erupt at all!). Damage to developing teeth can also occur if the jaw is fractured.

Retained or persistent deciduous (puppy) teeth can also cause malocclusions by forcing the erupting adult teeth into an abnormal position. As previously mentioned, this may be a genetic trait, but can also occur sporadically in any breed of dog.

While games such as tug-of-war are often blamed for orthodontic issues, this is not a common cause of problems.

A full bite assessment can help differentiate between malocclusions which are due to shifting of teeth alone, and those which have an underlying genetic basis. Contact me if you would like to arrange a bite assessment for your puppy.

My dog has a malocclusion. Do we need to treat it?Not all malocclusions need to be treated. Many dogs have ‘abnormal’ bites (in fact, these may be part of the breed standard!), yet live happy, comfortable lives. However, others suffer chronic problems. These may include:

��'LIÀFXOW\�SLFNLQJ�XS�DQG�FKHZLQJ�IRRG��Trauma to the oral soft tissues (gums, cheeks, lips, tongue)

��Trauma to the hard palate, including RURQDVDO� ÀVWXOD� IRUPDWLRQ� �SXQFWXUH�holes extending through the hard palate into the nasal cavity)

��Dental trauma, with abnormal wear, pulp death and dental fractures

�� Temporomandibular joint pain and disease

CHRONIC WEARING OF TEETH AGAINST EACH OTHER, DUE TO A

MALOCCLUSION, CAN LEAD TO PULP EXPOSURE AND DENTAL FRACTURES.

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The basic rule is that every dog deserves a pain-free, functional mouth. If there is damage occurring to teeth, or oral tissues, we need to alleviate this, to allow the dog to live happily and healthily. If there is no functional problem and no trauma occurring, then treatment is simply not required.

Sometimes the hardest part is determining whether the problem is in fact causing pain. As we know, dogs are very adept at masking signs of oral pain, and will FRQWLQXH�WR�HDW�GHVSLWH�VLJQLÀFDQW�GLVFRPIRUW��3XSSLHV��LQ�SDUWLFXODU��GRQ·W�NQRZ�DQ\�EHWWHU�LI �WKH\�KDYH�KDG�SDLQ�VLQFH�WKHLU�WHHWK�ÀUVW�HUXSWHG�YHU\�HDUO\�LQ�OLIH��

Early assessment to determine whether intervention is required is critical in puppies with any signs of occlusal problems. Not only does this allow us to relieve their pain promptly, it can allow for easier correction of problems than if we wait until the permanent teeth have fully erupted and settled into place.

If you think your puppy (or adult dog) has a malocclusion that may be causing any of the above problems, the sooner we start treatment, the better.

What are our treatment options? The best option for your dog will depend on several factors, including:

�� the type and severity of the malocclusion

�� the temperament of the dog

�� the ability to provide appropriate oral care during treatment

�� the desired outcome

�� personal preference

�� cost of care

The overriding aim is always to give the dog a healthy, pain-free and functional mouth. Sometimes this will result in a ‘normal’ mouth, whereas in other cases, this might not be realistically achievable.

While some basic advantages and disadvantages of the different treatment RSWLRQV�DUH�RXWOLQHG�KHUH��LW�LV�YHU\�LPSRUWDQW�WR�VHHN�VSHFLÀF�DGYLFH�IRU�\RXU�individual dog, as no two mouths are completely the same, and an individual bite assessment will help us determine the best course of action together. You can contact us anytime.

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Corrective orthodontic treatment may involve:

��movement of teeth

�� changing the shape of teeth (eg reducing the height of teeth)

�� selective extractions

�� any combination of the above

Movement of teeth - malpositioned teeth may be moved into a more appropriate position using orthodontic appliances such as braces (yes, braces), wires, elastic (masel) chains or plates (similar to those used in humans!). In some cases, this may be a multi-step procedure which means repeated general anaesthetics.

The advantage is that the dog gets to keep functional teeth, avoiding some of the complications associated with major extractions. For example:

�� Extraction of lower canine teeth - the roots of these teeth make up about 70% of the front of the jaw, and so there is a potential risk of jaw fracture associated with their removal. Some dogs also use these teeth to keep the tongue in position, so the tongue may hang out after extraction.

�� Extraction of the upper canine teeth – sometimes the upper lips will droop inwards and start to catch on the lower canine teeth.

�� Extraction of teeth may severely limit an animal’s success in the show ring, especially in breeds where the correct number of teeth is emphasised in the breed standard.

�� Loss of teeth may affect the ability to retrieve, carry objects etc.

ORTHODONTIC MOVEMENT OF THE LOWER INCISORS USING A MASEL CHAIN (IN BLUE).

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Orthodontic movement of teeth is a complicated science, and, while some procedures appear quite straightforward, permanent damage to teeth and the VXUURXQGLQJ�VWUXFWXUHV�FDQ�UHVXOW�IURP�LQDSSURSULDWH�SURFHGXUHV��SRRUO\�ÀWWHG�appliances, or excessive pressures.

The outdated practice of using rubber bands to move the teeth is not recommended, as they slip down between the tooth and the gum, causing GDPDJH� WR� WKH� VHQVLWLYH� WLVVXH� KHUH�� 7KH� IRUFHV� DSSOLHG� DUH� DOVR� GLIÀFXOW� WR�regulate, which can cause damage to the ligaments around the teeth, as well as the tooth roots. Much safer and more effective methods are now available.

Altering the shape of teeth VR� WKH\� ¶ÀW� EHWWHU·� LQ� WKH� PRXWK� FDQ� DOVR�be performed. This may vary from removal of small amounts of enamel (odontoplasty) to create space between teeth, right through to shortening the crown of a tooth to prevent it from causing trauma (crown reduction).

Crown reduction is commonly performed to treat base narrow canines, or class II malocclusions, where the lower canines are puncturing the hard palate. Part of the tooth is surgically amputated, a dressing inside the tooth to promote KHDOLQJ��DQG�WKH�WRRWK� LV�VHDOHG�ZLWK�D�ZKLWH�ÀOOLQJ��MXVW� OLNH�WKH�RQHV�KXPDQ�dentists use). This procedure MUST be performed under controlled conditions as it exposes the highly sensitive pulp tissue. If performed incorrectly, the pulp will become infected and extremely painful for the rest of the dog’s life.

THIS PUP HAS TRAUMA TO THE ROOF OF HER MOUTH DUE TO HER LEFT LOWER CANINE. A CROWN REDUCTION PROCEDURE RELIEVES THE TRAUMA WHILE MAINTAINING SOME FUNCTIONALITY AND AVOIDING EXTRACTION.

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Even the less invasive odontoplasty (enamel shaping) can result in exposure of the sensitive dentine or pulp tissue if taken too far, and must be performed with extreme care to avoid permanent problems. Xrays are recommended prior to surgery so we can measure how far we can go before we get into the ‘danger zone’.

Although sometimes practised, clipping the tips of the teeth of puppies is NOT a humane procedure, and not only causes intense pain (imagine how it would feel if your own tooth was cut in half), but the resulting pulp infection can cause irreversible damage to the adult tooth buds which are developing underneath.

Extraction of teeth is sometimes performed, alone or in combination with other orthodontic treatments. This may be the preferred treatment in cases where:

�� the teeth are crowded or rotated

�� one tooth is blocking the potential movement of another tooth into a better position

��more complicated, multistep procedures are not desired.

While the dog may lose some function, this is far preferable to doing nothing (this condemns the dog to a life of pain). Indeed, unless released into the wild, dogs do well even if we need to extract major teeth (canines and carnassials), as they have the humans in their pack to do all the hunting and protecting for them.

Interceptive orthodontic treatment is the term we use when we remove deciduous teeth to alter the development of a malocclusion. The most common form of this is when we relieve dental interlock that is restricting normal jaw development. Such intervention does not make the jaw grow faster, but will allow it to develop to its genetic potential by removing the mechanical obstruction.

EXTRACTION OF DECIDUOUS LOWER CANINES AND INCISORS IN A PUPPY WITH AN OVERBITE RELEASES THE DENTAL INTERLOCK AND GIVES THE LOWER JAW THE

FREEDOM TO DO SOME ‘CATCHING UP’ (IF GENETICALLY POSSIBLE).

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$V�MDZ�JURZWK�LV�UDSLG�LQ�WKH�ÀUVW�IHZ�PRQWKV�RI �OLIH��LW�LV�FULWLFDO�WR�KDYH�DQ\�issues assessed and addressed as soon as they are noticed, to give the most time for any potential corrective growth to occur before the adult teeth erupt and dental interlock potentially redevelops. Ideally treatment is performed from eight weeks of age.

Extraction of deciduous teeth is not necessarily as easy as many people imagine. These teeth are very thin-walled and fragile, with long narrow roots extending deep into the jaw. The developing adult tooth bud is sitting right near the root, and can be easily damaged. High detail intraoral (dental) xrays can help us locate these tooth buds, so we can reduce the risk of permanent trauma to them. Under no circumstances should these teeth be snapped or clipped off as this is not only inhumane, but likely to cause serious infection and ongoing problems below the surface.

THE EXTRACTED DECIDUOUS CANINE AND INCISOR TEETH ARE THIN AND FRAGILE, WITH VERY LONG ROOTS.

DENTAL XRAY OF A PUPPY SHOWING HOW CLOSE THE DEVELOPING ADULT TOOTH BUDS ARE TO THE ROOTS OF THE BABY TEETH.

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What are some of the ethical considerations in treating malocclusions?The aim of any veterinary procedure should always be to improve the welfare of the patient, so the invasiveness of any treatment needs to be weighed up against WKH�OLNHO\�EHQHÀWV�WR�WKH�GRJ��(YHU\�DQLPDO�GHVHUYHV�D�IXQFWLRQDO��FRPIRUWDEOH�bite, but not necessarily a perfect one. Indeed, some malocclusions (particularly WKRVH�LQYROYLQJ�VNHOHWDO�DEQRUPDOLWLHV��FDQ�EH�GLIÀFXOW�WR�FRUUHFW�HQWLUHO\��

In addition to the welfare of the individual dog, both veterinarians and breeders need to consider the overall genetic health of the breed. Both the Australian National Kennel Club and (in New South Wales where our practice is situated) the Veterinary Practitioners’ Board stress that alteration of animals to conceal genetic defects for the purpose of improving their value for showing (and breeding) is not ethical.

Vets and responsible breeders work together to improve the conformation of breeds, which can sometimes mean some tough decisions when genetic problems are discovered.

PERMANENT ENAMEL DAMAGE ON ADULT TEETH FOLLOWING EXTRACTION OF DECIDUOUS TEETH. THE RISK OF THIS CAN BE MINIMISED BY USE OF DENTAL

XRAYS, AND EXTREMELY GENTLE SURGICAL TECHNIQUE.

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For animals with malocclusions, very strong consideration needs to be paid to whether or not breeding from the affected animal is in the interests of improving the breed. If there is a genetic component, then neutering or selective breeding is recommended. As the vast majority of orthodontic abnormalities are not dominant in their inheritance (not all pups carrying the ‘bad’ genes will have visible problems), a ‘small’ issue seen sporadically can easily become widespread within a line.

This not only means many pups will have physical problems requiring correction for their own individual welfare, but breeding the problem out again can be H[WUHPHO\�GLIÀFXOW�

The bottom line is that, while all dogs will have multiple treatment options available, and in some cases the occlusion can be corrected to the point of EHLQJ�¶JRRG�IRU�VKRZ·��DGYLFH�VKRXOG�GHÀQLWHO\�EH�VRXJKW�DERXW�WKH�OLNHOLKRRG�of a genetic component prior to embarking upon this, as the consequences for the breed can be devastating if such animals (or their close relatives) become popular sires or dams.

,I �\RX�QHHG�IXUWKHU��FRQÀGHQWLDO�DGYLFH�RQ�VXFK�LVVXHV��SOHDVH�IHHO�IUHH�WR�FRQWDFW�me for more information.

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OTHER COMMON PROBLEMS WITH PUPPY TEETH

Does it matter if teeth are missing or delayed in erupting?Sometimes a puppy may be missing one or more teeth. In the absence of trauma (which is usually apparent for other reasons!), there are a couple of things that may be going on.

Sometimes a tooth is congenitally missing, that is it has never developed. While dogs can physically cope well with missing teeth, in some breeds this is considered a serious fault, and will severely affect the chances of the dog being successful in the show ring.

Alternatively, a ‘missing’ tooth may be unerupted below the gumline. This can only be diagnosed using xrays. In some cases, the tooth may be trapped under a thickened layer of gum tissue, and surgery to relieve the obstruction (an operculectomy) may allow the tooth to erupt smoothly into the correct position if performed early enough.

MISSING LEFT LOWER SECOND PREMOLAR TOOTH – XRAY CONFIRMS THAT TOOTH IS CONGENITALLY ABSENT.

IMPACTED LOWER CANINES TRAPPED UNDER THICK GUM TISSUE. THEY ARE ALSO IN A BASE NARROW POSITION. THESE TEETH WERE ABLE TO ERUPT WHEN THE

TISSUE WAS SURGICALLY RELEASED (OPERCULECTOMY).

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Sometimes, the tooth will be in a favourable position but caught behind a small rim of jawbone – again early surgical intervention may be successful in relieving this obstruction. If the tooth is in an abnormal position or deformed, it may be unable to erupt even with timely surgery.

Impacted or embedded teeth should be removed if they are unable to erupt with assistance. If left in the jaw, a dentigerous cyst may form around the tooth. These can be very destructive as they expand and destroy the jawbone and surrounding teeth. Occasionally these cysts may also undergo malignant transformation (ie develop into cancer).

ALL missing teeth should be assessed with xrays to avoid the severe damage and deformity which can result from cyst formation.

SWELLING IN AREA OF MISSING CANINE TOOTH

XRAY OF IMPACTED CANINE TOOTH INSIDE CYST

DEFORMED CANINE TOOTH AFTER SURGICAL EXTRACTION

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Does it matter if my puppy doesn’t lose its deciduous teeth?Retained deciduous teeth are bad news for dogs for two main reasons.

1. If there are two teeth in one socket (deciduous and adult), the surrounding gum cannot form a proper seal between these teeth, leaving a leaky pathway for oral bacteria to spread straight down the roots of the teeth into the jawbone. Trapping of plaque, food and debris between the teeth also promotes accelerated periodontal disease. This not only causes discomfort and puts the adult tooth at risk of early loss, but allows infection to enter the bloodstream and affect the rest of the body.

2. ,I � WKH� GHFLGXRXV� WRRWK� LV� VWLOO� ÀUPO\� LQ� SRVLWLRQ� DV� WKH� DGXOW� WRRWK� LV�erupting, it forces the adult tooth into an abnormal position which can FDXVH� D� VLJQLÀFDQW� PDORFFOXVLRQ�� )RU� H[DPSOH�� WKH� ORZHU� DGXOW� FDQLQHV�normally erupt on the inside of the deciduous teeth, so if they are forced to erupt alongside them, a painful base narrow malocclusion can result.

RETAINED DECIDUOUS UPPER CANINE PREDISPOSES THE ADULT TOOTH TO PERIODONTAL DISEASE.

RETAINED LOWER BABY CANINES FORCE THE ADULT CANINES TO ERUPT IN A NARROW POSITION.

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The upper adult canines normally erupt in front of the deciduous ones, so forcing them further forward can result in ‘lance’ canines. Finally, the upper adult incisors usually erupt behind their deciduous versions, so if these are retained a rostral crossbite may develop.

Do we need to worry about broken deciduous teeth (as they will fall out soon anyway)?Puppies play rough, chew whatever they can get hold of, and have tiny teeth with very thin walls. Therefore fractures will sometimes occur. A common misconception is that broken deciduous teeth can be left until they fall out. Unfortunately this is NOT true. From the puppy’s point of view, broken teeth HURT, just as they do in children. Anyone who has had a bad toothache would agree that even a few weeks is a long time to wait for relief!

Broken teeth also become infected, with bacteria from the mouth gaining free passage through the exposed pulp chamber inside the tooth, deep into the underlying jawbone. This is not only painful, but can lead to irreversible damage to the developing adult tooth bud, which may range from defects in the enamel (discoloured patches on the tooth) through to arrested development and inability to erupt. The infection can also spread through the bloodstream to the rest of the body. Waiting for the teeth to fall out is NOT a good option!

RETAINED UPPER BABY CANINES FORCE THE ADULT CANINES TO ERUPT IN A MORE FORWARD POSITION. THIS CAN CLOSE THE GAP WHERE THE LOWER CANINE

USUALLY SITS, FORCING IT INTO A TRAUMATIC POSITION.

PUP WITH A TOOTH ROOT ABSCESS DUE TO A FRACTURED BABY CANINE

TOOTH

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SO HOW DO I MAKE SURE MY PUP HAS A COMFORTABLE MOUTH?We cannot rely on dogs to tell us when they have oral pain. It is up to us to be vigilant and watch for signs of developing problems. Train your pup to allow handling and examination of the mouth from an early age. We will be posting some videos of oral examination tips shortly, watch out in your email inbox for this.

Things can change quickly - check their teeth and bite formation frequently as they grow. Here is a checklist of things to look for:

�� Check the number, position and structure of the teeth

�� &KHFN�WKH�MDZ�OHQJWK�DQG�WKH�ZD\�WKH�WHHWK�ÀW�WRJHWKHU��Watch closely for any broken or damaged teeth

�� Look for any redness, swelling or signs of pain

��Note any problems eating, chewing or playing

Seek veterinary care as soon as a potential problem is noticed – you can call me on 0408 782 611 or email me anytime on christine@sydneypetdentistry.com.au for advice or assistance.

Remember, early recognition and treatment is crucial if we want to keep your dog happy and healthy in and out of the show ring. The sooner we treat dental problems, the higher the chance of getting the best possible results with the least invasive treatment.