DENTAL AND ORAL CAVITY
C H A P T E R 3 5 
Many of the common dental conditions found in puppies
and kittens carry a favorable prognosis if addressed and
treated correctly. Providing a pain-free functional bite is the
primary goal of a dental treatment plan. It is important to
evaluate when treatment should be provided by a general
practitioner or if referral to a dental specialist is
appropriate.
NORMAL ANATOMY AND DEVELOPMENT
Knowledge of the normal deciduous dental formulas and
eruption times for the dog and cat will help determine
whether pathology exists (Table 35-1 and Box 35-1). The
deciduous dentition in the canine and feline contains no
molar teeth. In addition to no molar teeth, there is no decid-
uous counterpart to the first premolar tooth in the dog.
Mixed dentition is the term applied to the mouth when both
deciduous and permanent teeth are present. This is a normal
condition between 4 and 6 months of age.
The number of roots a particular tooth has is important
when an extraction is indicated or if a particular tooth has
an abnormal number of roots. Often teeth with abnormal
numbers of roots or shapes have other structural defects,
such as communication through the dentin and pulp to the
outside environment. This may lead to endodontic disease.
For normal tooth root numbers, see Box 35-2.
NOMENCLATURE
Use of the modified Triadan system of tooth numbering has
become common in veterinary nomenclature. A dental chart
should be used in the patient’s permanent record to docu-
ment any abnormalities and subsequent treatment per-
formed. There are numerous charts available from various
sources. For the general practitioner, the dental labels made
by DentaLabels (Kensington, CA) are useful as they are
user friendly and self-adhesive for easy placement in the
340
Andrea Van de Wetering
permanent record. The American Animal Hospital Associa-
tion provides a very complete dental chart for its members.
Most paperless computer programs have dental chart capa-
bility as well. See Figures 35-1 and 35-2 for sample dental
charts demonstrating the modified Triadan system of tooth
numbering.
NORMAL OCCLUSION
The cat and the dog have an anisognathic jaw relationship,
meaning the jaw lengths are not equal, with the lower jaw
slightly shorter than the upper jaw. The incisor relationship
in the canine is defined as a “scissor” bite. The upper incisors
overlap the lower incisors with 1 to 2 mm of space between
the upper and lower teeth, and the lower incisor cusps rest
on the cingula of the upper incisors. In the feline, the incisor
cusps may meet in a level bite. In both species the premolars
should interdigitate in a “pinking shears” type of relationship
with the lower premolars occluding rostrally to the upper
premolars. The large cusp tip of the lower fourth premolar
should be centered between the upper third and fourth pre-
molar. The upper premolars should occlude buccally (toward
the cheek) to the lower premolars and first molar.
CONGENITAL AND HEREDITARY PROBLEMS
Persistent Deciduous Teeth
When deciduous teeth exfoliate improperly or incompletely,
the deciduous tooth and the permanent tooth are present in
the mouth at the same time. No tooth of the same type
should be present in the mouth at the same time. If this
occurs, the deciduous tooth should be extracted immediately.
Persistent deciduous teeth are never normal and should be
extracted as soon as a diagnosis is made. Persistent deciduous
teeth are also a common cause of malocclusion because they
can cause the permanent teeth to erupt in an abnormal
Chapter 35   Dental and Oral Cavity 341

tooth to exfoliate. This abnormal mesioversion (the tooth is

TABLE 35-1 Approximate eruption times for angled toward the front of the mouth) of the canine tooth
the deciduous feline and has also been termed a “lance canine” tooth.
canine dentition Treatment for persistent deciduous teeth consists of com-
Tooth Deciduous dentition (wk) plete extraction of the deciduous tooth. Preoperative intra-
oral dental radiographs identify location and shape of the
Canine
tooth to be extracted. A gingival flap may be appropriate to
Incisors 3-5 allow adequate visualization and minimize chance of root
Canines 3-6 fracture. Extraction techniques are covered in detail in other
Premolars 4-10 texts (see Suggested Reading list); however, it is important
Molars Not present
to note that deciduous teeth have deceptively long roots
Feline compared with crown size, very thin enamel walls, and break
Incisors 2-3 easily with overzealous extraction technique (Figure 35-4).
Canines 3-4 It is essential to remove the entire deciduous tooth root
Premolars 3-6 when extraction is performed. Incomplete extraction may
Molars Not present lead to infection, pain, or malocclusion. Postoperative dental
radiographs should be obtained to ensure complete extrac-
tion. When performing deciduous tooth extractions, special
care should be exercised to avoid trauma to the permanent
tooth bud as this can cause damage to the permanent tooth
BOX 35-1 Dental formulas for the canine enamel (Figure 35-5).
and feline
Missing and Impacted Teeth
Canine Formula*
Normal tooth eruption occurs in two stages: the intraosseous
Deciduous: 2 (i 3/3, c 1/1, pm 3/3) = 28
Permanent: 2 (I 3/3, C 1/1, PM 4/4, M 2/3) = 42
stage and the supraosseous stage. In the first stage, the over-
lying bone and the deciduous tooth root (if present) are
Feline Formula* resorbed. In the second stage, the permanent tooth erupts
Deciduous: 2 (i 3/3, c 1/1, pm 3/2) = 26 through the soft tissues. This process can be delayed or inter-
Permanent: 2 (I 3/3, C 1/1, PM 3/2, M 1/1) = 30 rupted by a number of local and systemic causes, including
genetic and congenital problems, trauma, persistent decidu-
*Lowercase letters indicate deciduous or temporary teeth, whereas uppercase ous teeth, thickened fibrous tissue (operculum) covering the
letters indicate permanent dentition.
unerupted tooth, and failure of bone resorption. It is
important to note there are no deciduous precursors to the
permanent first premolar teeth in the canine or the molar
BOX 35-2 Tooth root numbers* teeth in both the canine and feline. Knowledge of normal
permanent tooth eruption times in addition to dental
Canine radiography can differentiate between congenital absence of
1 root: I1-3, C, PM1, Lower M3 teeth (oligodontia or anodontia) and impaction. Impaction
3 roots: Upper PM4, Upper M1-2 occurs when a tooth is covered by a tough gingival
2 roots: All others
tissue called the operculum that prevents eruption. When a
tooth is embedded, the tooth is not only covered by the
Feline*
1 root: I1-3, Upper PM2, Upper M1 operculum but also is covered by bone (Figures 35-6 and
3 roots: Upper PM 35-7). It is not uncommon to see lower first premolar
2 roots: All others teeth that are impacted or in an abnormal position,
particularly in brachycephalic breeds. Unerupted teeth are
*Compared with the canine, cats are missing the upper PM1 and M2 and the prone to developing destructive cystic lesions. These cysts
lower PM1-2 and M2-3.
Data from Holmstrom SE, Fitch PF, Eisner ER: Veterinary dental techniques for
can cause significant damage to the soft and hard tissues
the small animal practitioner, ed 3, Philadelphia, 2004, Saunders. surrounding them, including loss of surrounding permanent
teeth (Figure 35-8). Because impacted lower first premolar
teeth are often in an abnormal position, extraction is usually
location. The permanent premolar teeth generally erupt to appropriate.
the inside (lingually or palatally) of the deciduous counter- Breeders may request preeruption dental radiographs to
part. The exception to this is the upper canine teeth, which determine whether a particular dog has a full complement
erupt in front (mesial) of the deciduous teeth. Figure 35-3 of permanent teeth. In some breeds, such as the Doberman
shows an example of a dog with a persistent deciduous left Pinscher, Rottweiler, and German Shepherd Dog, absence
upper canine tooth. The permanent tooth has erupted in an of teeth may be grounds for elimination in the show ring
abnormal position because of the failure of the deciduous because of the hereditary component of this problem.
342 SECTION IV: SYSTEMATIC CLINICAL APPROACH TO DIAGNOSIS AND TREATMENT OF PEDIATRIC CONDITIONS

Clinic Name Doctor’s Name

Clinic Address
Telephone Number

Canine Dental Record

Dental Nerve Blocks (Bupivacaine)
Owner: Infraorbital (mg): L: R:
Patient: Maxillary (mg): L: R:
Breed: Age: Mental (mg): L: R:
Sex: Date: / / Mandibular (mg): L: R:

Pre-Treatment Pathology Treatment Procedures

Maxilla

100 4 4 200 100 4 4 200

9 9 9
9

9 9
9 9

Mandible

400 4 4 300 400 4 4 300

CANINE

R Maxilla L
110 109 108 107 106 105 104 103 102 101 201 202 203 204 205 206 207 208 209 210
G G

411 410 409 408 407 406 405 404 403 402 401 301 302 303 304 305 306 307 308 309 310 311
Mandible

Figure 35-1  Canine dental record. (Courtesy Allen Matson, Eastside Veterinary Dentistry, Woodinville, WA.)
Chapter 35   Dental and Oral Cavity 343

Clinic Name Doctor’s Name

Clinic Address
Telephone Number

Feline Dental Record

Dental Nerve Blocks (Bupivacaine)
Owner: Infraorbital (mg): L: R:
Patient: Maxillary (mg): L: R:
Breed: Age: Mental (mg): L: R:
Sex: Date: / / Mandibular (mg): L: R:

Pre-Treatment Pathology Treatment Procedures

Maxilla
100 200 100 200
4 4 4 4

8 8 8 8

9 9 9 9

4 4 4 4
Mandible
400 300 400 300

FELINE

R Maxilla L
109 108 107 106 104 103 102 101 201 202 203 204 206 207 208 209

G G

409 408 407 404 403 402 401 301 302 303 304 307 308 309
Mandible

Figure 35-2  Feline dental record. (Courtesy Allen Matson, Eastside Veterinary Dentistry, Woodinville, WA.)
344 SECTION IV: SYSTEMATIC CLINICAL APPROACH TO DIAGNOSIS AND TREATMENT OF PEDIATRIC CONDITIONS

Figure 35-3  Photos of the left upper arcade in a Beagle dog
showing a persistent deciduous canine that has caused the
permanent canine tooth to erupt mesially. This is also called a
lance canine tooth. Left untreated, these teeth develop severe
periodontal problems over time, which can result in oronasal
fistulas.
Figure 35-5  Enamel dysplasia of the permanent teeth after
extraction of the deciduous teeth in a dog. If the permanent
tooth bud is traumatized during the extraction procedure, dys-
plasia will occur. Dysplasia exposes the dentin tubules to the
environment and may weaken the tooth, possibly requiring com-
posite or crown restoration to avoid further damage to the teeth.
Enamel dysplasia may also result from a puppyhood illness or
facial trauma while the permanent tooth is still developing.

Figure 35-6  Intraoral photo of missing teeth in a 14-week-old

puppy. Dental radiographs must be obtained to ascertain
Figure 35-4  The crown length of a deciduous canine demon-
whether the teeth are truly missing or are impacted.
strates the deceptively short crown compared with root length.
The bracket is outlining the crown. The remainder of the tooth
is root. It is imperative to extract the root entirely. This may
require creating a gingival flap for increased exposure and
visualization. Complete extraction should always be verified
radiographically.

Preeruption radiographs are most diagnostic after 8 to 10

weeks of age.
It is simple to diagnose these abnormalities at the time
of routine well puppy exams or spay and neuter appoint-
ments. At this time, any missing teeth should be noted in
the medical record, and dental radiographs should be
obtained. Treatment of impacted or embedded teeth involves
making mesial and distal releasing incisions on both the
buccal and lingual or palatal surfaces, and then elevating a Figure 35-7  Intraoral radiographs of the puppy in Figure 35-6.
full-thickness mucoperiosteal flap on both surfaces. The This radiograph demonstrates that although the teeth are
fibrous tissue (operculum) covering the crown is excised with missing clinically, they are present under the gingiva. Left
a No. 15 blade, and any overlying bone is gently removed untreated, dentigerous cysts are likely to follow.
Chapter 35   Dental and Oral Cavity 345
Figure 35-8  Radiograph of a dentigerous cyst caused by an
impacted right lower first premolar in a 5-year-old Japanese
Chin. Timely diagnosis and treatment early in life could have
prevented the extensive damage and tooth loss caused by this
pathology. All puppies and kittens should be monitored for full
dentition by 6 months of age, and abnormalities should be
investigated radiographically.
with rongeurs. A high-speed dental bur should not be used
to remove bone as it may cause trauma to the underlying
tooth. The releasing incisions are closed using 4-0 or 5-0
absorbable suture, leaving the coronal aspect of the flap open.
Supernumerary, Fusion,
and Gemination Teeth
Abnormalities of the developing tooth bud can result in
abnormal numbers of roots or crowns or entire teeth in the
dog and the cat. Supernumerary teeth occur when two of
the same tooth are present in the mouth. It is not uncommon
to see supernumerary incisors in breeds such as the Boxer
and Mastiff. Supernumerary first premolar teeth are common
in many dog breeds as well. Cats can have supernumerary
premolars. These teeth should be extracted if they cause
crowding or impingement on adjacent teeth.
Fusion and gemination teeth are seen in many breeds of
dogs and cats. A fusion tooth typically has two fused crowns,
a common pulp chamber, and separate root canal systems.
In contrast, gemination teeth have two crowns and pulp
chambers but a single root canal system. Intraoral dental
radiographs can differentiate the two. These teeth are often
extracted because of the frequency of enamel, dentin, and
root canal system abnormalities that may lead to endodontic
disease.
Malocclusions
No controlled studies have been conducted to evaluate the
hereditary component of malocclusion; however, abnormal
bites are generally considered to have at least some genetic
component (see Box 35-3 for classes of malocclusions). The
use of an occlusal evaluation table (Table 35-2) is useful as
a means to help determine the genetic influence on a par-
ticular malocclusion. Each area of the mouth is assigned a
numeric value and then added together for a total point
score. The total point score helps determine whether a par-
ticular malocclusion is likely to be genetic in origin and aids
discussions with breeders.
Common malocclusions include anterior cross-bite, pos-
terior cross-bite, lance canine teeth, and base narrow canine
teeth. Jaw length discrepancies that lead to more severe
malocclusions can be noted very early in life. It is interesting
to note that the mandibles and maxillae grow at different
rates. That is, the right mandible may grow separately from
the left mandible, and discrepancies may or may not persist
once growth is complete. Traumatic malocclusions cause
extreme discomfort for the puppy or kitten and must be
addressed without delay. Puppies and kittens with painful
malocclusions may become head shy or have significant
behavior problems because of oral pain. Often the perma-
nent occlusion (or malocclusion) will be the same or very
similar to the deciduous.
Common Malocclusions
Anterior cross-bite (“reverse scissor bite”)
An anterior cross-bite exists when one or two of the upper
incisors are located to the inside of the lower incisor teeth.
This problem needs correction if the gingiva becomes trau-
matized, if the bite will excessively wear the opposing teeth,
or if overcrowding will cause periodontal disease in the
future. Correction involves selective extraction or referral to
a dental specialist for orthodontic movement (e.g., braces).
The benefit of orthodontic movement for any malocclusion
is retention of teeth. Retention of strategically important
teeth keeps normal tooth alignment, allows a nonpainful
bite, and in many cases gives good cosmetic results. If all the
lower incisors occlude mesially to the upper incisors, the
malocclusion is due to discrepancy in jaw lengths and is
termed a class III malocclusion.
Lance canine teeth (mesioversion of the upper
canine teeth)
Lance canine teeth are most common in the Shetland
Sheepdog, the Dachshund, and the Persian cat but can occur
in any breed (see Figure 35-3). This problem is often pre-
cipitated by persistent deciduous teeth; however, its origin
may also be idiopathic. Persistent deciduous teeth cause
mesioversion of the upper canine teeth. The lower canine
teeth are then prevented from erupting into normal position.
This is typically a bilateral problem. Neglecting to address
this malocclusion ensures severe problems later in life. If
untreated, painful occlusions, severe periodontal disease,
tooth loss, and oronasal fistulas may occur. Correction
involves referral for orthodontic movement to retain a stra-
tegically important tooth or extraction.
346 SECTION IV: SYSTEMATIC CLINICAL APPROACH TO DIAGNOSIS AND TREATMENT OF PEDIATRIC CONDITIONS
BOX 35-3 Classes of Malocclusion
Type 0: Normal Occlusion
The upper and lower canines and upper third incisors are
evenly spaced in a “scissor” relationship. The upper inci-
sors overlap the lower incisors with approximately 1 to 2
mm of space between them, and the lower incisor occlusal
cusps rest on the cingula of the upper incisors. The lower
canine teeth should occlude in the center of the space
(diastema) between the upper third incisor and the upper
canine tooth. The upper premolars interdigitate in a “pinking
shears” manner, with the lower first premolar occluding
rostral to the upper first premolar. The upper fourth premo-
lar and lower first molar teeth occlude to create a shearing
function, with the upper fourth premolar located buccally
to the lower first molar tooth. The crowns of the molar teeth
occlusal surfaces meet to allow a grinding action.
Class I Malocclusion
The overall dental relationship is normal with one or two
malpositioned teeth. Examples include but are not limited
to any single tooth in an abnormal position, such as rotated
or tipped, or an open bite.
Class II Malocclusion
The maxillary relationship to the mandible is such that
either the maxillae are too long or the mandibles are too
short. This is evident when evaluating either the relation-
ship between the incisors or the relationship between the
premolars. Often this is termed a “parrot” mouth, mandibu-
lar brachygnathism, or maxillary prognathism. A common
abnormality associated with a Class II malocclusion is base
narrow mandibular canine teeth. This may manifest as inter-
ference of the lower canine teeth with the upper canine
teeth or the palate. If the malocclusion is severe, the lower
canine teeth may occlude distally to the upper canine
teeth.
Class III Malocclusion
The maxillary relationship to the mandible is such that
either the maxillae are too short or the mandibles are too
long. This is often called an “underbite,” “sow mouth,”
maxillary brachygnathism, or mandibular prognathism,
depending on which jaw the abnormality is present. This
occlusal relationship may be considered normal for some
breeds.
Severe examples of this malocclusion may include lower
incisors and canines that occlude so rostrally to the upper
incisors that the cusp tips of the upper incisors cause
trauma to the lower mandibular soft tissues distal to the
incisors. It is not uncommon to see the lower canine teeth
interfering on the distal aspect of the upper third incisors,
necessitating extraction of the upper third incisors.
Class IV Malocclusion
This classification is reserved for the extremely severe mal-
occlusions, including wry bites or other severe skeletal
discrepancies as the etiology for the malocclusion.
Figure 35-9  Palatal trauma in a 12-week-old puppy as a result
of lower canine teeth that have erupted lingually. Treatment at
this point is extraction of both deciduous lower canine teeth.
This condition should be monitored closely as the permanent
dentition appears, and if the same condition occurs, referral to
a veterinary dentist or extraction is appropriate.
Mandibular canine tooth (linguoversion of
the lower canine teeth, with “base narrow
canine teeth” being the lay term)
Base narrow mandibular canine teeth are tipped or bodily
displaced lingually. Persistent deciduous teeth and mandibu-
lar brachygnathism (foreshortened mandible) are the most
common etiologies. When the lower canine teeth are base
narrow, trauma to the hard palate and gingival tissues occurs
(Figure 35-9). If left untreated, pain, infection, or oronasal
fistulas follow. Many treatment options are available for this
problem. When the deciduous teeth cause trauma to the
palate, they should be extracted. If the permanent dentition
erupts abnormally because of persistent deciduous teeth, the
deciduous teeth should be extracted immediately. No tooth
of the same kind can be in the mouth at the same time. If
the permanent dentition continues to be abnormal, treat-
ment consists of extraction or referral to a veterinary dentist
for crown height reduction and vital pulp therapy or orth-
odontic movement.
Breeders have been known to “clip” the crowns of the
offending deciduous teeth to prevent palatal trauma. This is
cruel to the puppy as the procedure leads to extreme pain,
severe pulpitis, infection, and potential damage to the per-
manent tooth bud.
Class II malocclusion (overbite or
“parrot mouth”)
Class II malocclusions are considered discrepancies of man-
dibular length when compared with the maxilla in which the
upper jaw exceeds the normal relationship with the lower
jaw, also called a parrot mouth. This is caused by either
mandibular brachygnathism (foreshortened mandible) or
maxillary prognathism (excessively long maxilla). This mal-
occlusion is not normal in any breed, is grounds for elimina-
tion in the show ring, and is thought to have a strong
hereditary component. This malocclusion causes severe
problems and is usually noted very early in life, as soon as
the deciduous teeth begin to erupt. As the teeth erupt they
become entrapped in the soft tissues of the palate or behind
Chapter 35   Dental and Oral Cavity 347

TABLE 35-2 Occlusal evaluation table

Point value

Incisor Relationship (5 Points Possible)

A. If lower incisors hit the cingula of the uppers (normal scissor bite) 5
B. If lower incisors hit the cusp tips of the uppers or hit the gingival tissue behind the uppers 4
C. If lower incisors are in front of the uppers or are behind the uppers with space between the upper and 3
lower incisors (in a rostral-caudal plane)
D. Marked space between the upper and lower incisors (rostral-caudal plane) 2
E. Extreme differences in jaw lengths 1

Canine Tooth Relationship (5 Points Possible)

A. Lower canines are centered between the upper third incisor and the upper canine tooth and not touching 5
either (normal)
B. The lower canine (one or both) is touching either upper premolar or upper canine 4
C. Canine teeth are causing wear on upper teeth or downward angulation of incisors so that the lower canine 3
tip touches upper canine and its base hits upper third incisor
D. The lower canine tooth is positioned inside (lingually) or outside (labially) of the upper canine tooth or upper 2
incisor
E. The lower canine tooth is behind the upper canine or ahead of the upper third incisor tooth 1

Lower Fourth Premolar Relationship (5 Points)

A. The large cusp is centered between the upper third and fourth premolar (normal) 5
B. Lower cusp tip shifts mesially (forward) to the small third developmental groove in the upper third premolar 4
or distally (backward) to the front edge of the upper fourth premolar
C. Lower cusp tip shifts mesially to the middle developmental groove in the upper third premolar or distally to 3
the mesial aspect of the upper fourth premolar
D. Lower cusp tip shifts mesially to the large first groove in the upper third premolar or distally half the 2
distance to cusp tip of the upper fourth premolar
E. Lower cusp tip shifts mesially or distally to meet the cusp tip of either the upper third or fourth premolar 1

Premolar Horizontal Alignment (5 Points)

A. Interdigitation with cusp tips as far forward as the lower second premolar with the upper second premolar 5
(normal)
B. Lower third premolar with the upper third 4
C. Lower fourth premolar with the upper third 3
D. Space between tips of lower fourth and upper third 2

Temporomandibular Angle of Mandible Relationship (5 Points)

A. Angle directly below posterior border of coronoid process or within 3 mm of that point 5
B. Angle displaced by 4-6 mm from point below posterior border of coronoid process 4
C. Angle displaced by 7-10 mm from point below posterior border of the coronoid process 3
D. More than 10-mm displacement from point below posterior border of the coronoid process 2

Head Symmetry (5 Points)

A. Perfect midline of head and dentition alignment 5
B. Subtract 1 point for: 4
1. Rotated teeth (either premolars or incisors)
2. Midline of upper and lower arches off center by less than width of upper incisor
3. Missing one tooth
C. Subtract two points for: 3
1. Rotated teeth in premolar and incisor areas
2. Midline off by width of one tooth
3. Missing two teeth
D. Subtract three points for: 2
1. Midline off by more than width of one tooth
2. More than two missing teeth
3. Noticeable deviation of muzzle to left or right of midline of rest of skull

Continued
348 SECTION IV: SYSTEMATIC CLINICAL APPROACH TO DIAGNOSIS AND TREATMENT OF PEDIATRIC CONDITIONS

TABLE 35-2 Occlusal evaluation table—cont’d

Point value

Area scores and reasons (30 points possible)

A. Incisors ____________________________________________
B. Canines ____________________________________________
C. Fourth premolar _____________________________________
D. Horizontal alignment _________________________________
E. Angle of mandible ___________________________________
F. Oral symmetry ______________________________________
Total points: __________

Grade Scale:
Excellent (27-30 points): No apparent genetic defects.
Near normal (21-26 points): Mild genetic problems; select mates with equal or better oral evaluation scores.
Genetic defect (16-20 points): Careful use if other body traits warrant use in breeding program.
Severe defect (0-15 points): Not suitable for breeding purposes.

Adapted from Ross DL: Orthodontics for the dog: bite evaluation, basic concepts, and equipment, Vet Clin North Am Small Anim Pract 16(5):955, 1986.

the upper teeth, creating a dental interlock that further

inhibits mandibular growth. When recognized early (by 6 to
8 weeks of age for best prognosis), extraction of the lower
deciduous incisors and canine teeth is indicated to remove
the dental interlock. This procedure eliminates the painful
condition for the puppy and possibly allows the lower jaw
to catch up in growth. If the jaw length discrepancy is not
severe, the growth of the mandible may catch up to the
maxilla; however, if the mandible is more than a few milli-
meters too short, it is very unlikely to normalize. Treatment
consists of extraction or referral.

Class III malocclusion (underbite, undershot

jaw, or “sow mouth”)
A Class III malocclusion presents as abnormal positioning
of the lower dentition in a more mesial (rostral) position in
relation to the upper dentition. This occurs either as a result
of maxillary brachygnathism or mandibular prognathism,
although the occlusion may be considered normal in some
breeds with brachycephalic anatomy such as the English
Bulldog. The common manifestation of this malocclusion is
interference of the lower canines with the palatal or distal
aspect of the upper third incisor teeth and trauma to the
lingual mucosa from the upper incisors (Figure 35-10). Pro-
viding a functional bite can be as simple as extraction of the
upper third incisor teeth.
Wry bite (Class IV malocclusions)
This classification involves wry bites in which one side of the
mandible and/or maxilla is displaced forward or backward
of its counterpart. These conditions are typically treated with
selective extractions to eliminate a painful bite.
Other Congenital and Hereditary Conditions
Crowded and Rotated Teeth
Crowded teeth are common problems in small breed dogs.
Rotated teeth seen frequently in brachycephalic breeds as a
Figure 35-10  Lower canine interference with the upper third
incisors caused by a Class III malocclusion. Treatment consists
of extraction of the involved incisor teeth to create space for
the lower canine teeth. This dog also has a reverse scissor bite
involving the right lower first and third incisor and the left lower
first and second incisor.
result of extreme crowding are prone to periodontal disease.
To maintain periodontal health, each tooth must have a
complete collar of attached gingiva. When teeth are crowded
or rotated, the normal gingival attachments are compro-
mised, thus predisposing the animal to periodontal disease.
Selective extraction is the treatment of choice.
Cleft Lip/Palate
Clefts may be classified as primary or secondary. Primary
clefts present as a cleft lip and are cosmetic only. These can
be repaired surgically as soon as the puppy or kitten is old
enough for surgery. Secondary clefts involve the hard and/
or the soft palate (Figure 35-11). Communication between
the oral and nasal cavity makes nursing impossible. Animals
with this condition have milk in the nasal passages during
nursing. Affected animals sneeze, gag, cough, have nasal
Chapter 35   Dental and Oral Cavity 349
Figure 35-11  Secondary cleft of the hard and soft palate in a
newborn English Bulldog.
discharge, and commonly develop aspiration pneumonia.
This condition is extremely rare in cats.
Tight Lip Syndrome
A genetic abnormality found primarily in the Shar-Pei dog
(but may occur in other breeds) presents with the lower lip
curled up over the lower incisors. This prevents forward
growth of the mandible, thus causing mandibular insuffi-
ciency, trauma to the lip from the upper incisors, and distoc-
clusion of the lower incisors. Surgical correction,
recommended at about 3 months of age, carries the best
prognosis. Surgical techniques are described elsewhere.
Craniomandibular Osteopathy (Lion Jaw, Westie
Jaw, Scottie Jaw)
This disease is most often recognized in West Highland
White Terrier puppies between 4 and 7 months of age;
however, it has been recognized rarely in other breeds.
A simple autosomal recessive mode of inheritance has
been identified in the West Highland White Terrier. Clini-
cally dogs present showing signs of pain on opening the
mouth, lethargy, and inappetence. Radiographically new
bone production and periosteal proliferation are noted on
the ramus of the mandible and occasionally extending to the
temporomandibular joint and other regions of the skull (see
Figure 42-3). This syndrome most commonly presents bilat-
erally. Treatment encompasses pain control, antiinflamma-
tory medications, and time. This disease usually regresses
spontaneously between 11 and 13 months of age when the
growth plates close. However, long-term sequela involving
fusion of the temporomandibular joint has been reported,
which, if it occurs, carries a very poor prognosis.
ACQUIRED PROBLEMS
Immune-Mediated and Viral Diseases
The common immune-mediated diseases in the dog and cat
often manifest with oral lesions. The most common viruses
include feline leukemia (FeLV), feline immunodeficiency
viruses (FIV), and calicivirus and rhinotracheitis virus. In
the dog, autoimmune disorders include pemphigus and
pemphigoid-like diseases.
Viral Papillomatosis
These benign oral wartlike lesions are caused by a papovavi-
rus. They typically spontaneously regress and require no
treatment. Transmission is thought to be horizontal from
animal to animal.
Feline Juvenile Gingivitis
Feline juvenile gingivitis is characterized by gingival hyper-
plasia. Treatment includes dental prophylaxis and gingivec-
tomy, followed by excellent home care during the first 2
years of life to prevent recurrence. Cats usually outgrow this
problem with good oral hygiene. Differential diagnosis
includes gingival fibropapillomatosis, which presents as
excessive gingival growth (proliferation) covering the crown
of the tooth. Treatment for this syndrome involves gingivec-
tomy and it does not usually recur.
Feline Juvenile-Onset Periodontitis
This syndrome is found typically in cats less than 9 months
of age. Clinical signs include weight loss, pain, halitosis, and
ptyalism. Abundant plaque and calculus formation causes
destruction of bone and soft tissues. Gingival recession, for-
mation of pockets, furcation (the space between tooth roots)
exposure, and severe gingivitis characterize the changes seen
with this disease. In extreme cases, the gingivitis can extend
to include the caudal buccal folds, fauces, and pharynx.
Various reports in the literature suggest that the more
common breeds affected include Siamese, Burmese, Maine
Coon, and Abyssinian cats; however, this syndrome has been
seen in other breeds as well. The etiology may be idiopathic
but can include FIV, FeLV, feline calicivirus, and other
underlying immune disorders. The role of Bartonella henselae
as an etiology has yet to be shown definitively. Treatment is
directed at combining frequent professional dental prophy-
laxis, analgesics, antibiotics, oral antiseptics, meticulous
home care, and selective extractions.
Enamel Defects
Enamel dysplasia can be caused by enamel hypoplasia (thin
enamel) or hypocalcification (inadequate mineralization).
Enamel hypocalcification presents as areas of the enamel
that are pitted, brown or yellow, and flake away easily. The
enamel usually appears roughened. Enamel defects may be
congenital abnormalities or result from puppy and kitten
illnesses or trauma. When the normal enamel covering of
the tooth is absent, the underlying dentin is exposed. Micro-
scopically, dentin appears porous. This can allow invasion of
bacteria into the pulp of the tooth and subsequent endodon-
tic disease. Severe defects should be treated with composite
restoration or crown therapy.
Discolored Teeth
Normal teeth are white or slightly yellow colored. Yellowed
permanent teeth in the juvenile animal are typically caused
350 SECTION IV: SYSTEMATIC CLINICAL APPROACH TO DIAGNOSIS AND TREATMENT OF PEDIATRIC CONDITIONS
by tetracycline staining. This occurs if tetracycline is given to
an animal during permanent tooth development and is a
cosmetic problem only. Teeth that are pink, purple, tan,
brown, or gray are abnormal, and trauma is the most common
cause of this discolorization. Acute trauma or bleeding dis-
orders such as von Willebrand disease (factor VIII defi-
ciency) will often cause hemorrhage into the dentin from
the pulp cavity, resulting in acute pulpitis (inflammation of
the dental pulp). Acute pulpitis is a very painful condition.
As the pulp of the tooth dies and the hemorrhagic areas
mature, the tooth will change to a dull gray, purple, or brown
coloration. Reports in the literature have shown that the
majority of discolored teeth have some degree of pulp necro-
sis. These teeth should be treated with extraction or referral
to a specialist for root canal therapy.
Oral Trauma
Craniofacial trauma is common in the young dog and cat
and usually is caused by vehicular accidents, falling from
heights (high-rise syndrome), aggression from other animals,
electrical and chemical burns, foreign bodies, and lacerations.
Mandibular symphyseal fracture and separation, lip avulsion,
maxillary and mandibular fractures, and temporomandibular
fractures occur frequently, as well as tooth injuries.
Repair of these problems must take occlusion into account
first and foremost. It is unimportant how well a fracture site
heals if the animal can no longer close its mouth, is left with
a painful occlusion, or sustains damage to the permanent
dentition. Although detailed discussion of fracture repair
techniques is beyond the scope of this text, oral fracture
repair techniques include tape muzzles for minor injuries,
external fixators, internal fixators, or, preferably, intraoral
acrylic splints. Internal fixators (pins and plates) often
damage vital tooth and anatomic structures and are not com-
monly recommended by the veterinary dental community.
Tooth Trauma
Fractures involving pulp exposure are one of the few true
dental emergencies. Pulp exposure of the primary teeth
should be treated with either extraction or referral to a dental
specialist for vital pulp therapy. Failure to treat fractured
deciduous teeth can lead to infection of the permanent tooth
bud.
Fractures of the permanent dentition involving pulp
exposure in the young dog and cat require treatment in the
form of extraction or referral to a dental specialist for vital
pulp or root canal therapy. Vital pulp therapy can only be
performed within 72 hours of tooth injury in dogs after 11
months of age. Prior to 11 months of age, the root apex has
not closed and vital pulp therapy can be performed up to 2
weeks after injury. Often the duration of tooth injury is
unknown and referral to a dental specialist should be offered.
In this case vital pulp therapy is not a treatment option.
Failure to treat fractures involving pulp exposure leads to
severe pain, root end infection, inflammation, root abscessa-
tion, resorption, and possibly osteomyelitis.
In the feline it is often difficult to determine whether
pulp exposure has occurred because of the small size of the
pulp chamber. Typically if more than 1 to 2 mm of crown
has fractured off the feline canine tooth, one can assume pulp
exposure. Treatment recommendations are the same as for
the dog.
Tooth Luxation/Avulsion
Luxation (partial displacement of a tooth from its alveolus)
and avulsion (the loss of a tooth from the alveolus) are con-
sidered dental emergencies. Both conditions carry a guarded
prognosis in terms of salvaging a vital tooth. If a tooth has
been avulsed, it should be packaged and transported in the
correct media, such as Hanks balanced salt solution, milk, or
saline (in that order of preference). If the owners desire
treatment to salvage the tooth, the animal should be referred
to a dental specialist immediately for treatment. Otherwise,
removal of the luxated or avulsed tooth and closure of the
soft tissues are appropriate.
SUGGESTED READINGS
DeForge DH, Colmery BH: An atlas of veterinary dental radiology, Ames,
Iowa, 2002, Iowa State University Press.
Hale FA: Juvenile veterinary dentistry, Vet Clin North Am Small Anim Pract
Dent 35(4):789-818, 2005.
Holmstrom SE, Fitch PF, Eisner ER: Veterinary dental techniques for the
small animal practitioner, ed 3, Philadelphia, 2004, Saunders.
McCoy DE: Surgical management of the tight lip syndrome in the Shar-
Pei dog, J Vet Dent 14(3):95-96, 1997.
Step by Step Compendium: Compilation of veterinary dental techniques.
Available through the Journal of Veterinary Dentistry, www.jvdonline.org/
step-by-step.html. (Last accessed March 2, 2009.)
Wiggs RB, Lobprise HB: Veterinary dentistry. Principles and practice, Phila-
delphia, 1997, Lippincott-Raven.