Pictured below is the X-ray of 3 year old, female Boxer taken during a dental evaluation. She sometimes bled from her gums, especially after chewing on hard objects. Her physical examination was normal except for one problem – she was missing two of her lower incisors. Incisors are the small teeth between the large fangs or canine teeth. Normally, there are 6 incisors on the upper and lower jaws – 3 on the rights side and 3 on the left. Her family thought they fell out awhile ago. Study the image and then answer the following questions: 1) Identify the abnormalities found on this film? 2) Did the missing incisors fall out? 3) How is this condition treated?
Diagnosis: Fractured Incisors. Crowns (Part of teeth above gum line) are missing but roots are still present.
Fractured teeth are a common problem in dogs and cats. The crown of the tooth breaks off leaving the root still embedded in the periosteal bone. Anesthesia and dental X-rays are required to find this condition. These painful roots would have been missed if an anesthesia free dental was performed.
Broken roots are extremely painful. They were removed, the bone was curetted to get rid of infection and the gingiva was sutured closed. Note on the post op film that the entire root has been extracted. It is important to remove the entire root, tip and all, to prevent infection and pain.
This dog did very well after her procedure. She is backing to eating well, without any blood.
Tear staining is a common problem in dogs. Tears spill over the lower lid and run down the face causing a condition called epiphora. The moist environment creates a perfect home for bacteria to grow. The combination of moisture and bacteria stain the fur making the dog look like a football player with black patches under their eyes.
The two general causes of epiphora are either excessive tear production that overwhelms the drainage system or a problem with the drainage system such that it does not capture the tears.
Excessive Tear Production: In my experience, excessive tear production is usually caused by irritation. Hair growing in the wrong place and rubbing on the cornea is often the cause. Eyelashes that grow in the wrong direction (distichiasis) and lids that roll inward (entropion) are common. Since plucking the eyelash only provides temporary relief, offending lashes are removed with traditional or cryosurgery. Entropion can be caused by too much skin or an instability in the attachment of the corners of the lids. Both require surgical correction. In dogs with a lot of fur, trichiasis or excessive hair growth can cause epiphora. Long strands of facial hair touch the lids and eyes. Tears wick down the hair following the path of least resistance. A trip to the groomer will usually solve the problem.
2. Abnormal Drainage System: Problems with the drainage of tears is common in small dogs with large eyes. Normally, tears are collected in the lacrimal lake. It is a sac-like area created by the lower eyelid. The tears then exit through the nasalacrimal duct. There are many problems that can occur in this system including:
Large eyeballs with tight eyelids. This condition takes all the slack out of the lower lid destroying the lacrimal lake.
Imperforate puncta. The opening of the tear duct is called a puncta. Some dogs are born with a membrane over the opening. I see this most commonly in golden retrievers and cocker spaniels although it is reported in other breeds as well. The membrane is removed with surgery.
Blocked nasolacrimal ducts. Dogs can have all kinds of problems with their nasolacrimal or tear ducts. Some are born with problems while others develop them. Small stones or debris can block the system. To remove, the duct is flushed with saline. I have also seen the duct blocked or narrowed from infections in the nose or tooth roots. The condition may or may not resolve when the infection is treated.
There are many products sold over-the-counter for the treatment of epiphora. Some contain bleach which burns the skin and eyes! Please do not use these. Others contain antibiotics but those can lead to bacterial resistance and superbugs. Others, do not provide a complete ingredient list making it impossible to tell if the product is safe and effective. Therefore, I do not recommend any over-the-counter tear staining products. If the cause of the tear staining cannot be corrected, then daily cleaning is the best therapy. Clean the skin to remove debris and then pat dry with a cotton ball.
Morgan, R. ‘Epiphora’. Associate Database, VIN, last updated 11/7/2007.
On a recent trip through the San Diego Airport, I was surprised to see a dog wheeling around the airport. He was dressed for the holidays wearing a Santa hat, elf collar and a vest that read, ‘Pet me’ in big bold letters. People surrounded him like presents around a Christmas tree. Young and old, travelers, airport staff, pilots and crew all stopped to pet the adorable ball of fur.
When the crowds parted, I got my chance to meet this wonderful canine ambassador. Champion Brother Bear is a 12 year old Siberian Husky who lives with 7 other huskies in California. His nickname is Koda. He takes turns with the other dogs coming to the airport to de-stress the travelers. Research conducted by Dr. Karen Allen verified what pet people already know – spending time with animals lowers our blood pressure and heart rate. People who live with pets also get more exercise, visit their physicians few times each year and have lower levels of cholesterol and triglycerides. I hope more airports will follow the San Diego Airport’s lead and embrace animal assisted therapy!
Sources: -Allen, K., Shykoff, B. E., Izzo, Jr. J. L. Hypertension, 2001;38:815-820. -Friedmann, E. et al, Social Interaction & Blood Pressure: Influence of Animal Companions. J of Nervous and Mental Disease 17 (8): 461-465. -Seigel J.M., Stressful Life Events and Use of Physician Services Among the Elderly: The Moderating Role of Pet Ownership. J. Person Soc Psych 1990; 1081-1086. -Serpell, J.A. Evidence for long term effects of pet ownership on human health, Pets, Benefits and Practice, Waltham Symposium 20, April 19, 1990.
Many of you know I had cancer and it was a cat who diagnosed me. That cat was Tigre. He was amazing! I am sad to say we lost him right before Christmas. After a long battle with gastrointestinal disease, Tigs went into renal failure. I miss him terribly.
Like so many wonderful pets, Tigre arrived in our home from the Arizona Humane Society. Someone stabbed him and left him to die on the streets. When Steve and I met him at the shelter, he put on a great show. We would later come to know it was all genuine. He was great friends with his fellow orange cat Kalani, but more than anything in the world – Tigre loved people. With both animals and people, he had a wonderful and loving spirit.
Tigs alerted me to cancer by hissing at my abdomen followed by trying to cover it with a bed sheet. He also, never left my side during the four months of chemo. I was home every other week during that time and we were inseparable. During those moments which were particularly bad, he somehow knew. Tigre gently placed his paw on my face and purred. He was the best therapy I could have had.
Truth be told, Tigre was Steve’s cat. If given a choice, Tigre always took Steve’s lap over mine. At night, he would lie on Steve’s chest purring loudly. In the morning, he would sit on the bathroom counter watching Steve shave.
For me, a veterinarian, animals are so therapeutic. Of course, they each have their own gifts and bring their distinct joy into our lives, but Tigre was very special. I thank God for the gift of him in my life. He was a cat who saved a life and changed lives. I am certain there is a special place in heaven for Tigre. Rest well my friend. I look forward to embracing you again someday.