Category Archives: Case Studies

Punkin’s Teeth

Punkin is a very nice 9 ½ year old spayed female Domestic Shorthair Cat. She was presented to us for a routine wellness exam and was seen to have moderate tartar accumulation. A dental hygiene procedure was recommended so Punkin was brought in for this.

Punkin’s pre-anesthetic labwork and exam were unremarkable. After cleaning all the way around every tooth, above and below the gumline, performing a thorough magnified dental exam, and taking full mouth radiographs, one problem was discovered.

Can you see the bulging at her lower left k9 tooth?

This is caused by boney remodeling in response to a periodontal infection. You can see the difference between the right and left sides on this dental x-ray.

This is a problem for the future hygiene of this tooth because the boney lip is creating a pocket for bacteria to live. Without any treatment this tooth is doomed and will most likely need extracted in the next year or two.

To improve the hygiene of this tooth, the gingiva was elevated off the bone around this tooth, and the boney lip was removed.

The gingiva was placed back against the tooth and sutured in place with very small sutures.

This delicate but simple procedure has hopefully saved this tooth from rapidly progressing periodontal disease and this super sweet cat will get to keep this tooth for years to come with proper at-home care. This is yet another example of how a routine wellness exam resulted in catching a disease process early and being able to treat the condition.

Zoe’s Teeth

Zoe is a 3 1/3-year-old, spayed female, shorthaired barn cat that was presented for her annual vaccines and wellness exam. Upon examining her mouth, we noticed unusually severe periodontal disease considering her young age. Zoe ended up coming back for a COHAT (comprehensive oral health assessment and treatment) and the following pictures and radiographs were obtained.

Note the excessive amount of tartar and gingivitis. Considering this cat’s age this is atypical and made us suspicious of feline juvenile periodontitis.

This photo demonstrates the excessive bleeding upon gentle probing and the complete loss of periodontal attachment and bone between the roots allowing us to pass the explorer under the crown and between the roots. 90% of Zoe’s teeth were in the end-stage of periodontal disease at the time of her dental procedure.

To demonstrate the rapid rate at which periodontal disease can progress, Zoe had a COHAT about 2 years ago and radiographs were obtained at that time. The following are radiographs from 2 years ago, followed by radiographs from now for comparison.

Unfortunately, nearly all of Zoe’s teeth exhibited advanced stages of resorptive disease or periodontal disease, or both. At this stage of disease the only logical treatment is to remove the affected teeth to eliminate pain and infection that cannot otherwise be realistically managed. This would leave Zoe with only a small number of teeth that do not oppose other teeth so are ineffective, and have a high chance of developing these same dental diseases. Considering these facts, we removed all of Zoe’s teeth so she will never need to suffer from dental pain or infection again.

Full-mouth nerve blocks were performed prior to surgery with the addition of a narcotic agent that may provide pain relief for up to 4 days. Very gentle surgical technique was emphasized and very small absorbable sutures were placed to close all dental extraction sites. Post-op radiographs were also taken to ensure complete removal of all dental hard tissues. Zoe was given a long acting antibiotic injection and was sent home with pain medication and a soft diet for 2 weeks. The o reported back the next day that Zoe was eating well and seemed very happy.

This is a great example of how a “routine wellness exam” can drastically change an animal’s quality of life!

Distichiasis

Nico is the world’s nicest 3-year and 9-month-old Greater Swiss Mountain Dog that was presented for a wellness exam and vaccines. Upon examining his eyes we noticed something that shouldn’t be there. Can you see it?

Upon discussing this with the owner it was reported that Nico’s eyes have always been a bit “goopy”. Look closely and you can see eyelashes growing the wrong direction out of the margin of his eyelids (green arrows).

This is a common finding in dogs known as “Distichiasis” where eye lashes are growing from the oil secreting glands in the eyelid. The oil gland opening points toward the cornea, and this is why the eyelash ends up pointing that way. Small thin hairs with no clinical signs (goopy eyes) don’t need treatment, but large stiff lashes like this need to be removed to prevent damage to the cornea and chronic irritation. This is a procedure best performed by an eye specialist, so Nico was referred to a Board Certified Veterinary Ophthalmologist for treatment. This involved very low intensity electrocautery of the hair follicle followed by removal of the hair. Although Nico may grow more of these, he will be much more comfortable now that they have been removed. **You never know what a “routine” wellness exam may discover in your dog!**

Florida Spots

Bailey is an incredibly sweet, 9 ½ year old, spayed female, color point domestic shorthair cat who was presented for a wellness exam. We immediately noticed her eyes looked a bit different. Bailey is very healthy and happy and has no idea her eyes look this way. Her owner reports that the eyes suddenly appeared this way many years ago while living in the Virgin Islands and the condition has never progressed or seemed painful.

This is condition we never see in this area known as “Florida Spots”. It is a condition seen around Florida and the Virgin Islands with no known cause. Some have speculated that fire ants are the cause; others suspect a local lizard. Regardless, the condition does affect vision but does not need any treatment since it doesn’t get worse and is not painful. Leave it to cats to keep things interesting!

Max’s Eyes

Max is a 6-year-old, neutered male German Shepherd Dog that presented for a routine wellness exam. Max’s owner had no concerns but thought his vision was declining. Upon examining Max’s eyes, the following was seen:

Can you see the black pigmented areas of the cornea?

There is also fluid in the cornea (corneal edema) and there are blood vessels that have grown within the normally clear cornea?

These changes have reduced Max’s visual field by about 40%.

The left eye has much more pigmentation affecting his entire visual field.

This means that Max’s pupil is completely covered by pigment and he cannot actually see out of this eye. This is a “functional” blindness meaning the rest of the eye works just fine but it is as if you were sitting in a car and someone painted black paint over the windshield.

This is a case of a common inflammatory corneal disease called “Pannus” which is seen frequently here in Colorado especially in German Shepherds. This can be a devastating disease because the pigment is permanent and cannot be removed meaning Max will have limited vision from now on. The condition is usually managed successfully with topical immunosuppressant eye medications but catching the disease early before the development of pigment is critical. Many dogs with this condition do not show obvious symptoms of discomfort and if they have darkly colored skin and hair around their eyes it is easy to overlook these changes.

This is a good example of how “routine” wellness exam can greatly improve a pets quality of life.

Murry’s Teeth

Murry is a 5-½ yr old, neutered male, domestic medium haired cat. His owner is the best cat owner in the world! He is indoor only and is up to date on all vaccines, and he eats a diet of canned and dry commercial cat foods. Murray has no known health issues and he was presented for a routine COHAT (comprehensive oral health assessment and treatment). Murry has had previous dental extractions so several of his teeth are already missing.

This is what his teeth looked like prior to cleaning:

There is very mild tartar on most teeth and mild to moderate gingivitis especially around the k9 teeth.  Look closely at his lower k9 teeth (right).

They look perfectly good to me! They are clean and have very mild gingivitis around them. But, upon closer inspection with magnification and a very thin dental explorer, 1 very small bleeding hole was discovered at the inside of the base of each crown.

Then, his dental radiographs were performed and we discovered this:

These teeth are in the advanced stage of tooth resorption and are very painful. The only treatment option to alleviate Murray’s pain is to extract the teeth. This just goes to show you that even with a very dedicated and vigilant owner, and visibly clean teeth, a significant and painful dental disease can lurk beneath the gum line and is only visible with dental radiographs. This is why we always radiograph every tooth every time.

**This also demonstrates why, unfortunately, we cannot estimate the entire cost of a comprehensive dental procedure prior to cleaning and radiographing the entire mouth. Likewise, we cannot estimate the cost of extracting teeth or performing other treatments prior to cleaning and radiographing the entire mouth. In this case, the extractions were relatively simple as only the crowns of the teeth and a small amount of root needed to be removed. In other cases, these 2 teeth may have taken an hour to remove, drastically changing the cost of the procedure.