JUNE 2007: GRACIE

Gracie is a 15-pound, 3½-year-old spayed female Shih Tzu presented for a dental cleaning and extraction of a persistent, deciduous maxillary right canine tooth (#504). A moderate swelling of the rostral, left mandible was noticed at the time of the initial examination. Preanesthetic bloodwork was done, an intravenous catheter was placed, and Gracie was placed under anesthesia for the procedure.

During the anesthetized oral examination, it was observed that the left mandibular canine (#304) had a partially visible crown due to crowding from the 3rd incisor (#303). The first premolar (#305) was missing. The right mandibular canine (#404) was fully erupted, but the first premolar (#405) was also missing and the crown of the 2nd deciduous premolar #806 was just breaking through the gingiva and was mobile. Permanent tooth #406 was present.

Radiographs showed that #305 and #405 were impacted with a developing dentigerous cyst apparent surrounding the crown of #405. #806 showed root resorption with the crown attached to the gingival tissues. Other findings were a remaining left mandibular deciduous canine root (#704), along with the above-mentioned deciduous maxillary canine (#504). The maxillary left 2nd molar (#210) and mandibular right 3rd molar (#411) were missing.

The first radiograph shows the mandibular left impacted first premolar (#305) and retained canine tooth root (#704); the second radiograph shows the mandibular right impacted first premolar (#405) and deciduous "floating" crown of #806. Observe the speckles present on both radiographs; these artifacts are due to fluoride granules radiographically visible from the prophy paste; it would be better to use a fine flour pumice slurry to polish teeth when radiographs are to be taken since the pumice has no radiopaque materials to complicate the interpretation of the film

The deciduous canine tooth (#504) and root (#704) were extracted by simple elevation, as was the mobile crown of #806. The prophylaxis was performed, and Gracie was recovered. Since communication with the client was not available during the anesthesia episode, Gracie would be referred to a veterinary dentist to remove the impacted teeth during a second procedure.

The referral report indicated that teeth #305 and #405 were surgically extracted along with #406 due to involvement of the dentigerous cyst developing around #405. The cyst lining was gently removed with a small bone curette and Consil synthetic bone grafting material was applied. Both flap sites were closed with 4.0 Monocryl. Gracie went home with an oral antibiotic and pain medication for 1 week. Her follow up recheck with us after 7 days showed progressive healing with only mild inflammation of the gingiva. The rostral swelling of the mandible had subsided. Gracie was scheduled to return in 6 months to be rechecked.