Case: Mochi is a 7 year old Corgi mix that develop facial swelling below her right eye. She had previously had a root canal performed at her previous vet on her right carnassial tooth. As you can see on the second photo that the tooth is fractured, but no swelling or redness is noted around the tooth. She was diagnosed with a tooth root abscess with dental x-rays (see the red arrows on third photo). Her owner elected for tooth extraction and this tooth was removed during a dental cleaning. The facial swelling resolved after treatment.
FUN FACT: Mochi 6 month prior had a similar presentation, diagnosis, and treatment on the left carnassial tooth. It is not uncommon for a dog to cause trauma to teeth on both sides of their mouth resulting in multiple diseased teeth.
What is a tooth root abscess?
An abscess of a tooth root is a severe infection that develops around the root of the affected tooth.
What is the most common location?
Any tooth can fracture; however, the upper carnassial tooth (fourth premolar) is the most commonly broken tooth that can develop a tooth root abscess. This tooth has three roots that can be up to ½ - ¾ inch long.
What causes a tooth root abscess?
A tooth root abscess is usually caused by a broken or traumatized tooth leading to an exposed root canal, or pulp. Bacteria enter the root canal leading to a severely painful infection. The most common causes of injury to a healthy tooth include a dog chewing on bone, antler, ice cubes, cow hoof, nylon bones, hard plastic toys, or sticks.
What is a slab fracture?
A slab fracture develops when a dog bites down with the carnassial teeth on a hard object at just the right angle. This pressure can lead to fracturing of a small flake or a slab of the outside of this tooth. This can occur on either side of the mouth. If a large enough piece is broken off, the sensitive dentin and often the nerve and pulp can be exposed. This can be painful and can set your pet up for a tooth root abscess in the near future if not corrected as soon as possible.
What are the signs of a tooth root abscess?
Dogs do not show pain like humans do. Many dogs will continue to eat even if their tooth is severely painful but may chew on the opposite side of the mouth, drop food when chewing, have excessive drooling, be reluctant to chew on toys, or be more sensitive when their mouth or face is touched. Some dogs may develop bad breath or even paw or rub at the affected side of their face. Since the roots of the upper fourth premolar lie just below the eye, this area can become swollen, painful, and even burst open as the infection spreads to surrounding tissues. This is commonly mistaken as an eye infection or a puncture wound. Redness or swelling may be noticed at the gumline of the affected tooth.
Your veterinarian may be able to make the diagnosis with a thorough oral examination or may need dental x-rays to confirm the diagnosis. X-rays will also determine whether the abscess has spread to surrounding teeth.
What is are the treatment options?
This is a very painful condition that must be treated as soon as possible. Antibiotics will be prescribed and likely pain medication to help with the symptoms until dental surgery can be scheduled. However, these medications will not treat the underlying tooth injury.
There are only two options for treatment for an abscessed tooth:
1. Root canal treatment
2. Extraction of the tooth
Root canal treatment may be able to save the tooth, but the success depends on the health of the surrounding tissues and the affected tooth. Many times, these complex cases are referred to a veterinary dental specialist.
Recovery is quick after extraction and an extraction will allow immediate pain relief from the tooth toot abscess. Soft food is recommended until the gums have healed. It is not recommended to allow these dogs to chew on hard objects in the future as there is still a risk to remaining teeth.