617
49
Abnormal Numbers of Teeth and Enamel Defects
49.1 ­Introduction to Dentition
Cats and dogs have diphyodont dentition, meaning that
they have two sets of teeth in a lifetime. The first set
consists of deciduous teeth. Deciduous teeth are some‑
times referred to as “baby teeth” or “milk teeth.” These
develop during embryonic life and erupt in pediatric
patients. They are smaller than the permanent set of
incisors (I), canines (C), premolars (P), and molars (M)
that ultimately replace them [1, 2] (see Figures 49.1a, b).
There are fewer deciduous teeth in both the pediatric
dog and cat than in the adult [1–6].
49.1.1  Normal Canine Dentition
Puppies have 28 deciduous teeth as compared to a
permanent set of 42 [1–6].
The dental formula of an immature dog is [1–6]
●● 2 × (I3/3, C1/1, P3/3)
The dental formula of an adult dog is [1–6]
●● 2 × (I3/3, C1/1, P4/4, M2/3)
Eruption of deciduous incisors and canines occurs
between three and four weeks old; eruption of deciduous
premolars occurs between four and twelve weeks old
[1, 2, 7, 8] (see Figure 49.2).
Permanent incisors and canine teeth erupt between
three and four months old [1, 7, 8]. Permanent premolars
erupt between four and six months, and permanent
molars, between five and seven months [1, 7, 8].
Given the timeline above, it is not uncommon for
certain age groups of puppies to have both deciduous
and permanent teeth present in the mouth at the same
time [8]. This is considered age‐appropriate mixed denti‑
tion [1, 2, 8] (see Figures 49.3a–c).
49.1.2  Normal Feline Dentition
Cats have 26 deciduous teeth as compared to a perma‑
nent set of 30 [1, 4–6].
The dental formula of an immature cat is [1, 4–6]
Common Clinical Presentations in Dogs and Cats, First Edition. Ryane E. Englar.
© 2019 John Wiley & Sons, Inc. Published 2019 by John Wiley & Sons, Inc.
●● 2 × (I3/3, C1/1, P3/2)
The dental formula of an adult cat is [1, 4–6]
●● 2 × (I3/3, C1/1, P3/2, M1/1)
Deciduous incisors erupt between two and three weeks
of age, followed by the deciduous canines [1, 8]. Deciduous
premolars may erupt as late as six weeks of age [1, 8].
Eruption of permanent teeth begins with the perma‑
nent incisors between three and four months of age [1, 8]
and is complete by five to six months of age [1, 8, 9].
Typically‚ the molars are the last to erupt [5, 8, 10].
Given the timeline above, it is not uncommon for cer‑
tain age groups of kittens to have both deciduous and
permanent teeth present in the mouth at the same time.
This is considered age‐appropriate mixed dentition [1, 8]
(see Figures 49.4a, b).
49.1.3  Modified Triadan System
of Nomenclature for Dentition
During a sedated intraoral examination, each tooth is
inspected‚ and pertinent findings must be documented
in the medical record. Forty‐two teeth in a dog and thirty
teeth in a cat can be challenging to keep track of, without
a standard system of nomenclature [1].
The Modified Triadan System of nomenclature was
developed to facilitate the identification of individual
teeth in veterinary medicine [4, 6, 10, 11].
Each tooth is assigned a three‐digit identification
number.
The dental arcade determines the first digit in this
number [1, 4, 6, 10, 11]:
●● Every tooth in the right maxillary arcade has an identi‑
fication number that starts with one.
●● Every tooth in the left maxillary arcade has an identifi‑
cation number that starts with two.
●● Every tooth in the left mandibular arcade has an iden‑
tification number that starts with three.
●● Every tooth in the right mandibular arcade has an
identification number that starts with four.
618 49  Abnormal Numbers of Teeth and Enamel Defects
(a)
Figure 49.1  (a) Deciduous teeth in a puppy. Source: Courtesy of Shirley Yang, DVM. (b) Permanent teeth in an adult dog. Source: Courtesy
of Christiana and Kaylee Otterson.
Figure 49.2  Three‐week‐old puppy with eruption of the maxillary
deciduous incisors. Source: Courtesy of Lauren Bessert.
The teeth are then numbered beginning from
­midline. For instance, each arcade has three incisors.
So in the right maxillary arcade, the incisor nearest
the midline is given the identification number 101; the
middle incisor is 102; and the third incisor from the
midline is 103 [11].
Canine teeth are always numbered four [1, 4, 6, 10, 11]:
●● The canine tooth of the right maxillary arcade is
thereby numbered 104, 1 signifying the arcade and 4
signifying the tooth number.
(b)
●● The canine tooth of the left maxillary arcade is thereby
numbered 204, 2 signifying the arcade and 4 signifying
the tooth number.
●● The canine tooth of the left mandibular arcade is
thereby numbered 304, 3 signifying the arcade and 4
signifying the tooth number.
●● The canine tooth of the right mandibular arcade is
thereby numbered 404, 4 signifying the arcade and 4
signifying the tooth number.
49.1.3.1  The Dog
The last tooth in the maxillary arcade for the dog is
assigned the number 10 [1, 4, 6, 10, 11]:
●● The second of two molars that are associated with the
dog’s right maxillary arcade is thereby numbered 110,
the first “1” signifying the arcade and 10 signifying the
tooth number.
●● The second of two molars that are associated with the
dog’s left maxillary arcade is thereby numbered 210,
the 2 signifying the arcade and 10 signifying the tooth
number.
The last tooth in the mandibular arcade for the dog is
given the number 11 [1, 4, 6, 10, 11]:
●● The third of three molars that are associated with the
dog’s left mandibular arcade is thereby numbered 311,
the 3 signifying the arcade and 11 signifying the tooth
number.
●● The third of three molars that are associated with the
dog’s right mandibular arcade is thereby numbered
411, the 4 signifying the arcade and 11 signifying the
tooth number.
The remaining teeth (the premolars) are filled in
numerically, counting down from the last molar [1, 11]
(see Figures 49.5a, b).
 49.1  Introduction to Dentition 619

(a) (b) (c)

Figure 49.3  (a) Age‐appropriate mixed dentition. The permanent maxillary incisors are circled in blue. Source: Courtesy of Lauren Beren,
student veterinarian. (b) Age‐appropriate mixed dentition. The deciduous canine teeth are circled in dark blue. Source: Courtesy of Jule
Schweighoefer. (c) Age‐appropriate mixed dentition. The deciduous maxillary incisor that is circled in blue is loose and is about to become
dislodged. Source: Courtesy of Shirley Yang, DVM.

(a) (b)

Figure 49.4  (a) Head‐on view of age‐appropriate dentition in a kitten. Note that all four canine teeth are deciduous. Source: Courtesy of
Natalie J. Reeser. (b) Lateral view of age‐appropriate dentition in a kitten. Note that the canine teeth are deciduous. Source: Courtesy of
Natalie J. Reeser.

49.1.3.2  The Cat
The last tooth in the maxillary arcade for the cat is
assigned the number 9 [1, 4, 6, 10, 11]:
●● The one and only molar that is associated with the cat’s
right maxillary arcade is thereby numbered 109, the
●● The one and only molar that is associated with the cat’s
left maxillary arcade is thereby numbered 209, the first
“2” signifying the arcade and 9 signifying the tooth
number.
The one and only molar that is associated with the cat’s left
●●

mandibular arcade is thereby numbered 309, the first “1”

first “1” signifying the arcade and 9 signifying the tooth
signifying the arcade and 9 signifying the tooth number.
number.
620 49  Abnormal Numbers of Teeth and Enamel Defects
(a)
Figure 49.5  (a) Dental model showing adult dentition in the dog in the maxillary arcades only, with the teeth labeled using the Modified
Triadan System. (b). Dental model showing adult dentition in the dog in the mandibular arcades only, with the teeth labeled using the
Modified Triadan System.
●● The one and only molar that is associated with the cat’s
right mandibular arcade is thereby numbered 409,
the first “1” signifying the arcade and 9 signifying the
tooth number.
The remaining teeth (the premolars) are filled in
numerically, counting down from nine, when moving
caudal to the midline (see Figures 49.6a, b).
Because cats have fewer teeth than dogs, cats are
missing teeth #105, 205, 305, 306, 405, and 406 as
compared to dogs.
49.2 ­Supernumerary Teeth
When a patient has one or more extra teeth, the extras
are referred to as supernumerary teeth [2, 12–15].
Sometimes this condition is called hyperdontia or poly‑
odontia [12].
Any type of tooth  –  incisor, canine, premolar, or
molar  –  can be present as an extra. However, incisors
and premolars are most commonly implicated [2]. Boxer
dogs and Mastiffs are more likely to present with extra
incisors [13]. In cats, supernumerary teeth are most
often the fourth mandibular premolars [14].
(b)
One concern is that supernumerary teeth may cause
crowding. In dolichocephalic breeds, this is less of an
issue because there is sufficient space to accommodate
most extras. When crowding is not of concern, supernu‑
merary teeth can remain [15].
However, brachycephalic breeds already have fore‑
shortened skulls [2, 16–19]. Supernumerary teeth in
these breeds are likely to create spatial issues within
the oral cavity [14, 15]. Misalignment of teeth predis‑
poses the patient to premature periodontal disease [14,
15]. Surgical extraction of supernumerary teeth is
advisable when crowding becomes clinically relevant
[12, 13, 15].
Like brachycephalic breeds, cats often lack sufficient
space to accommodate extra teeth‚ and extraction of
supernumerary teeth is often indicated [12, 13].
49.3 ­Persistent or Retained
Deciduous Teeth
Dogs are more likely than cats to have one or more
deciduous teeth fail to fall out [8, 14]. These persis‑
tent or retained deciduous teeth linger as their

(a)
Figure 49.6  (a) Dental model showing adult dentition in the cat in the maxillary arcades only, with the teeth labeled using the Modified
Triadan System. (b) Dental model showing adult dentition in the cat in the mandibular arcades only, with the teeth labeled using the
Modified Triadan System.
permanent replacements erupt. In this clinical scenario,
both the deciduous and permanent teeth share the
same gingival collar [8]. This forces the permanent
tooth to be malpositioned [8, 20].
Retained deciduous canines are commonplace is clinical
practice. When the maxillary canine is involved, the
permanent tooth tends to erupt rostral to the deciduous
one [8]. When the mandibular canine is involved, the
deciduous tooth is often labial to the permanent one [8]
(see Figures 49.7a–d).
Most other permanent teeth will be deviated lingually
if their deciduous counterparts are retained [14].
Retained deciduous teeth should be extracted when
possible [8, 14]. Note that retained canine teeth have long,
thin roots that are easily fractured in the process of
removing them (see Figure 49.8).
Surgical excision is a delicate process, and care should
be taken to avoid inadvertently damaging the erupting
permanent canine tooth [8].
49.4 ­Hypodontia
Absence of teeth altogether, anodontia, is rare in the
canine and feline patient [21]. However, one or more
teeth may be congenitally absent [12]. This condition,
hypodontia, is more likely to be seen in clinical practice
[12, 21]. Kelly Blue Terriers and hairless breeds are over‑
represented [15, 22, 23].
Hypodontia may involve deciduous teeth, permanent
teeth, or both [15].
49.5  Resorptive Lesions 621
(b)
Incisors and premolars are more likely to be missing
than molars and canine teeth [15].
Note that hypodontia may also be acquired [15]. For
example, teeth may be missing secondary to trauma [15].
Dental radiographs are necessary to confirm hypo‑
dontia [15]. A differential diagnosis for hypodontia is
an impacted tooth, that is, one that fails to erupt
because of a physical barrier in its path [15].
Hypodontia is not a medical concern; it is an aesthetic
issue [12].
49.5 ­Resorptive Lesions
Tooth resorption (TR) is common in feline patients and
is sometimes referred to as feline odontoclastic resorp‑
tive lesion (FORL) [12, 24–27]. Other synonyms that
appear in the veterinary medical literature include neck
lesions, cervical line erosions, and external odontoclastic
resorptions [24].
Studies vary widely in terms of prevalence: 20–75% of
cats are affected by one or more lesion [15, 26–33].
Young Burmese and Siamese cats (<12 months of age)
appear to be at increased risk [30, 34]. Other breeds tend
to be predisposed when over six years of age [30, 34].
TR involves one or more teeth, the dentin of which
becomes eroded [24]. Note that this is a process [24, 27].
Over time, the following outcomes are possible [25, 27]:
●● The entire tooth may be consumed.
●● The root(s) undergo(es) complete resorption.
622 49  Abnormal Numbers of Teeth and Enamel Defects

(a) (c)

(b) (d)

Figure 49.7  (a) Dog with retained right maxillary deciduous canine tooth. Note that the permanent tooth is erupting rostral to the
deciduous one, which is typical. (b) Chihuahua with retained right maxillary deciduous canine tooth. Source: Courtesy of John A. Schwartz.
(c) Cat with bilaterally retained maxillary canine teeth. Because this photograph is a profile view, only the retained right maxillary
deciduous canine tooth is evident. Source: Courtesy of Hannah Butler. (d) Head‐on view of the same cat depicted in Figure 49.7c. Note that
both maxillary canine deciduous teeth have been retained. Source: Courtesy of Hannah Butler.

–– With nothing to anchor the crown to the jaw, the
crown falls out.
–– The patient is now said to have hypodontia.
●● The crown breaks off, leaving root remnants behind in
alveolar bone.
–– Root remnants act as a foreign body.
–– The periodontium becomes irritated and inflamed.
–– The patient’s mouth becomes painful to manipulate.
Classification of TR is complex [14]. Five stages of TR
have been described in the cat [14]. The details of these
stages are beyond the scope of this text; however, in gen‑
eral, they progress in terms of intensity [14]:
●● Stage 1 is least invasive: lesions are limited to the
enamel or cementum.
●● Stage 2 lesions involve the dentin.
●● Stage 3 involves exposure of the pulp.
●● Stage 4 lesions destabilize the structure of affected
teeth.
●● Stage 5 is most extensive: only tooth roots of affected
teeth remain.
A thorough intraoral exam under anesthesia and radi‑
ographic evaluation of all dental arcades are both neces‑
sary for staging to be accurate [14, 33] (see Figure 49.9).
Early and mid‐stage FORLs are likely to be underre‑
ported if the clinician is reliant upon gross observation
skills alone [25, 33].
Note that FORLs are not the same as dental caries or
cavities [24]. Caries develop when the acid by‐products
of bacterial fermentation of carbohydrates damage the
surface of one or more teeth [24]. Over time, a cavity
forms because acid‐induced demineralization of the
enamel and dentin allows bacteria to gain entry to and
 49.6  Enamel Defects 623

Conservation management may be appropriate for

lesions that are only evident radiographically in a patient
that has no overt pain or discomfort [33]. This is rarely
the case by the time the patient presents to the clinic for
evaluation [33].
Many patients with FORLs present with one or more
of the following clinical signs [24]:
●● Blood‑tinged saliva
●● Decreased appetite
●● Difficulty with prehension of food
●● Ptyalism

These clinical signs are suggestive of underlying oral

Figure 49.8  Extracted retained deciduous canine tooth from a
Yorkshire terrier dog. Note the long root. Source: Courtesy of Kelli
L. Crisfulli, RVT.
discomfort that is often secondary to TR [24].
Because most patients with TR are clinical at time
of presentation, extraction of affected teeth is per‑
formed more often than conservative management
[33, 36, 37].
When resorption is so extensive that it is impossible to
remove all tooth substance, coronal amputation is indi‑
cated [33]. This technique requires specialty training and
is beyond the scope of this text.

49.6 ­Enamel Defects
Odontogenesis is the process by which teeth form from
embryonic cells [38–41]. Tooth structure will be
impacted by any disruption in this process [38].
In dogs, enamel forms between two weeks of age and
three months [42]. Traumatic or systemic disturbances
that take place during this time frame can also alter the
anatomy of one or more teeth [38].
Severe fever and exposure to epitheliotropic viruses,
such as canine distemper virus (CDV), have been associ‑
ated with enamel defects [38, 43–45]. Specifically, these
have been linked to one particular type of defect, diffuse
enamel hypoplasia [38].
Figure 49.9  Radiographic evidence of FORL. Note how the crown Diffuse enamel hypoplasia is a condition in which a
appears to be dissolving. Source: Courtesy of Genevieve LaFerriere, patient’s enamel is thinner than it ought to be [38].
DVM. Defects may be linear or pit‐like, as is common for
human patients [38, 46] (see Figure 49.10).
In dogs, however, defects are more often circumferen‑
tial, meaning that they stretch around the entire crown
subsequently cause infection within the pulp [24, 35].
[38] (see Figure 49.11).
The pulp is the innermost layer of the tooth that houses
Dentin is exposed when patches of enamel are quite
blood vessels and nerve endings.
thin [38]. This leads to dental staining [38].
TR is a separate process by which dentin erodes.
Dental staining may also occur if tetracycline antibiot‑
Depending upon the stage, treatment for TR may involve
ics are prescribed during pregnancy or to pediatric
the following [33, 36, 37]:
patients <6 months of age [38, 43, 47–51]. Teeth will
●● Conservative management stain yellow‐brown [38]. This permanent stain is
●● Tooth extraction because tetracycline irreversibly binds to a certain min‑
●● Coronal amputation eral in teeth, calcium orthophosphate [38, 48, 52]. This
624 49  Abnormal Numbers of Teeth and Enamel Defects

Figure 49.11  Circumferential enamel defects in a canine patient.

Figure 49.10  Pit‐like enamel defects in a canine patient. Source: These defects occurred secondary to CDV. Source: Courtesy of
Courtesy of Adam Riley. Laura Polerecky, LVT.

creates a color change that darkens with exposure to

light.
Doxycycline and minocycline will also stain teeth,
although staining is less pronounced [51, 52].
Staining is aesthetically displeasing to the eye [38].
Dentin exposure may also lead to dentin sensitivity or
pulpitis [42].
Pulpitis is inflammation of the pulp. When pulp
becomes inflamed, it may experience minor hemor‑
rhage. Just as hemorrhage under the skin causes a
visible bruise, pulpitis causes the affected tooth to
discolor. The discoloration occurs from within the
tooth, which may appear pink‐purple to gray (see
Figure 49.12).
Note that pulpitis is not solely the result of dentin
exposure. It more commonly results from focal Figure 49.12  Pulpitis at the tip of the right maxillary canine tooth.
trauma. Source: Courtesy of Kimberly Wallitsch.

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