Conditions & Procedures

Just like humans, companion animals are affected by a wide range of oral conditions during their life stages, many of which are treatable. At Penn Vet’s Dentistry and Oral Surgery Service, our supportive team treats all conditions, including periodontal disease; stomatitis; endodontic disease in fractured, luxated, and avulsed teeth; oral tumors; malocclusions; and cleft palate defects.

Periodontal Disease
- Periodontal disease is one of the most common diseases found in dogs and cats, affecting 60-70 percent of these animal populations, beginning as early as three years of age. This disease is an inflammatory response to infection of the periodontal tissues caused by dental plaque.
- Periodontal disease occurs in two stages: (a) gingivitis and (b) periodontitis. Since gingivitis affects only the ginigiva – or gums -- it is the reversible form of periodontal disease. When left untreated, however, the dental plaque toxins increase, causing a more severe inflammation of gingival tissues. At that point, the gingiva detach from the tooth, creating a periodontal pocket. Bacterial toxins and enzymes from inflammatory cells further destroy the periodontal tissues that surround the tooth, changing the disease from gingivitis to periodontitis. This progression can result in alveolar bone loss (alveolar bone is the bone that surrounds the tooth). The loss of alveolar bone is typically irreversible, and with increasing bone loss, the tooth becomes mobile and is eventually lost.
- One of the most common signs of periodontal disease noted by pet owners is halitosis, or bad breath. Depending on the severity and progression of periodontitis, your animal may experience changes in eating habits, face rubbing, drooling, and weight loss.
- Diagnosing and treating periodontal disease typically requires an oral examination that is conducted under anesthesia. The exam can be followed by professional dental cleaning, along with capturing dental radiographs of the patient’s mouth.
Fractured and Worn Teeth

Found in both dogs and cats, fractured and worn teeth are not uncommon injuries. Teeth are worn down either by malocclusion, in which the tooth-to-tooth contact is misaligned, or – in the case of dogs – by excessive chewing of tennis balls. Tooth fractures result when excessive force causes a tooth to break.

Once there is a fracture in a tooth, bacteria can enter directly into the pulp cavity or through a worn crown. Left untreated, the pulp becomes inflamed and necrotic, and a periapical abscess (abscess at the base of the tooth) may develop. Treatment options vary, depending on whether the pulp is exposed. If it is, either an extraction or endodontic therapy would be recommended. Dental radiographs provide the opportunity for a complete diagnosis and confirmation of treatment.

While this is not a true dental emergency that needs immediate care, the tooth should be evaluated within a reasonable time.
Luxated and Avulsed Teeth
Tooth displacement injuries frequently occur after automobile accidents, falls from great heights, fighting with other animals, or when an animal gets a tooth caught in something like a fence.
- Luxation
- Avulsion
Oral Tumors
Oral tumors may be benign or malignant (having the potential to spread to distant sites). Even those that are benign may be locally invasive and may result in oral pain, bleeding, drooling, or difficulty eating. Unfortunately, dogs and cats often show no obvious clinical signs until the oral tumor is already very large. It is important to have your animal receive a thorough oral examination on a regular basis so that, if tumors occur, these can be diagnosed in the early stages. To determine tumor type and treatment options, an incisional biopsy of the tumor may be conducted prior to treatment. Treatment may include one or more of the following:
- Surgery: Removal of a portion of the lower (mandibulectomy) or upper jaw (maxillectomy) is generally very well tolerated, and in many cases, result in pets with good function and cosmetic appearance.
- Radiotherapy: Radiotherapy (radiation therapy) can be useful, either alone or in combination with surgery, depending on the tumor type, location, and the ability to remove the tumor surgically.
- Chemotherapy: Few oral tumors respond to chemotherapy alone, but chemotherapy may be prescribed to minimize spread to distant sites.
- Immunotherapy: Recent advances in vaccine technology offer a completely new treatment approach for certain tumor types.
Patients with rapidly growing oral tumors should receive immediate veterinary medical attention. Oral tumors are best treated before they have a chance to enlarge to the point where they are no longer surgically removable.

Procedures

Penn Vet Dentistry and Oral Surgery offers a wide rage of oral care to our patients.

Oral Examination

Comprehensive sedate oral examination is detrimental to aid in diagnosis and treatment. Some patients are aggressive, painful, or not cooperative with awake oral exams. Due to this an awake examination gives us an idea of what to expect and a good idea of what needs to be treated but a complete exam is best completed when anesthetized.
Anesthetized oral examination enables our clinicians to assess the severity of the disease. In addition to visually evaluating and feeling we use, and instrument called a periodontal probe that measures the space between the tooth and gingival tissue. Normal reading for a dog are 1mm-3mm and cats 0- 1mm any thing greater indicates changes in periodontal health.

Some patients are aggressive, painful, or uncooperative with oral exams when they are awake. But an 'awake' examination can give us an idea of what to expect and what needs to be treated.

That being said, a complete exam is best completed when the patient is anesthetized. In this instance, the examination enables our clinicians to assess the severity of the disease. In addition to visually evaluating and probing the area, we use a periodontal probe that measures the space between the tooth and gingival tissue. Normal readings for a dog are 1mm-3mm. For cats, a normal reading is between 0- 1mm. Anything greater indicates changes in periodontal health.

Dental Radiographs

An essential tool for dental and periodontal conditions, dental radiography is used to evaluate and examine tooth root fractures, determine the stage of periodontal disease, evaluate impacted or missing teeth, retained teeth, endodontic disease, and severity of oral tours.

Radiographs provide information such as the severity of periodontal disease, aids in the recommendation of treatment of oral condition, and helps monitor the stages of progression when combined with the intraoral and extraoral examination.
For new cat or dog patients, full-mouth dental radiographs are recommended. Specific radiographs can be helpful when taken during dental/medical emergencies while a patient is under anesthesia.
Radiographs of the head (skull) can help to gather additional and necessary information when dental films or digital sensors aren’t enough.

Computed Tomography Imaging

Penn Vet, dentistry, computed tomography Computed tomography (CT) imaging is a useful tool for the diagnosis of disease and treatment planning for various conditions of the head, including lesions of the nasal cavity and sinuses; disorders of the temporomandibular joint; fractures of the skull; and oral and maxillofacial tumors. CT imaging helps to explore a large volume of soft and hard tissue in a relatively short time. This is particularly important when a rapid diagnosis is needed for patients with head trauma or uncertain head pathology, as well as patients who are less than optimal anesthesia candidates. CT is very helpful in detecting lesions of hard tissues (bone and teeth) which is critical in defining tumor margins and planning radical surgical excision.

Dental and Periodontal Cleaning

Penn Vet, dentistry, periodontal cleaning Professional dental cleaning refers to removal of plaque and calculus (tartar). This is accomplished with hand instruments (scalers and curettes) and power instruments (various sonic and ultrasonic scalers).

In severe periodontal stages, procedures such as scaling and root planing (SCRP) and gingival curettage clean the root surface of the tooth to eliminate dental plaque and the inflammation of soft tissue lining within the periodontal space.
To enhance healing and connective tissue reattachment, perioceutic treatment involves the insertion of low-dose antimicrobial gel into cleaned periodontal pockets after root planing and curettage have been completed. Systemic antibiotic therapy should never be used as the sole treatment regimen.
Once all tooth surfaces have been cleaned and gingival tissues debrided, the teeth are polished with polishing paste and a rubber cup to aid in final removal of biofilm and smooth the tooth surface.

Periodontal Surgery

Penn Vet, dentistry, periodontal surgery The goals of periodontal surgery include eliminating plaque-retentive areas, reducing periodontal inflammation, and regeneration of periodontal tissues. The choice of periodontal surgery depends on the type and severity of periodontal disease. Surgical procedures include periodontal flaps to allow for tissue debridement (removal of diseased tissue), osseous surgery (eliminate infected bone and recontour), and placements of osteopromotive materials (bone graft that contributes to bone regeneration) and flaps to repositioned tissue at varying locations.

Some endodontic procedures with severe fractures that extend below the gumline may also need periodontal surgery. This procedure is called crown-lengthening and allows for placement of prosthodontic crowns in working dogs.

Finally, gingivectomy and gingivoplasty are used to eliminate pseudopockets (false pockets due to excessive gingival tissue).

Tooth Extraction

Penn Vet, dentistry, tooth extraction Tooth extraction is a surgical procedure completed under anesthesia. The most common indications for tooth extraction in dogs are periodontal disease and tooth fracture; in cats, this procedure is used when there is tooth resorption and stomatitis. Other conditions that can warrant extraction include tooth defects, injuries, cysts, traumatic malocclusions, and crowding. Whenever the disease process is too advanced for the teeth to be saved, extraction is necessary.

Techniques include closed and open extraction. In closed extraction, the gum tissue is not incised. Open extraction requires the creation of a periodontal flap and removal of alveolar bone in order to loosen the tooth from its attachments to the jaws. "Full-mouth" extractions are sometimes performed for treatment of severe oral inflammatory conditions such as stomatitis in cats.

Endodontic Therapy

Penn Vet, dentistry, endodontics

Endodontic therapy is used in treating dental traumas that cause exposure of the pulp (living internal portion of the tooth). When the pulp is exposed, bacteria can enter the tooth, resulting in pulpal inflammation and necrosis, and leading to periapical disease and abscess formation.

To determine whether or not endodontic therapy is required, patients need to undergo an anesthetized oral exam and dental radiography. In traumatized teeth, factors such as periodontal disease and root fractures can alter treatment options, and alternatively the tooth may need to be extracted.

Endodontic treatment options comprise:

Vital pulp therapy
Standard root canal therapy

Vital pulp therapy is primarily utilized for very “recent” tooth fractures (less than two days of duration), in young animals (less than two years of age), or after intentional surgical crown reduction for treatment of malocclusions or areas where the tooth is causing trauma to oral tissue. Vital pulp therapy can preserve pulp vitality and increase the strength of the tooth by allowing continued dentin formation. The procedure involves removing the infected portion of the pulp in the crown, placing a dressing in the pulp, and restoring the tooth. Dental radiographs are obtained four to six months after the procedure to monitor and confirm pulp vitality.

Standard root canal therapy can prevent the loss of the tooth. If the animal is older or the pulp is exposed for longer periods of time, standard root canal therapy is used to remove diseased or necrotic pulp tissue and provide a hermetic seal around the root(s). This approach aids in treatment of fractured teeth or luxated and avulsed teeth that need to be repositioned or stabilized, as well as reducing loss of blood supply to the pulp. The procedure consists of accessing the pulp cavity and debriding, shaping, disinfecting, and filling the root canal with an inert material, followed by access restoration.

Some fractures require multiple procedures to save the tooth. These procedures include two-stage root canal therapy, periodontal surgery, or a surgical root canal. Two-stage root canal is completed when the tooth is still vital and a treatment with inert material is placed to deaden the tooth. The patient will return in four to six weeks for final completion of the root canal. Fractures that extend under gums deep into the root must be treated with periodontal surgery prior to endodontic therapy. In addition, surgical root canal therapy is occasionally required and involves removal of the tip (apex) of the root. Antibiotic therapy is generally not required.

Restorative Dentistry and Prosthodontics

Penn Vet, dentistry, restorative dentistry Restorative and prosthodontic procedures aid in restoring a tooth and its function as close to its natural state prior to disease or trauma. Indications for restorative dentistry include fractured teeth, bonding for enamel hypoplasia and other defects, and management of dental caries. Just like in human dentistry, restorative materials such as composites, glass ionomers, and combination products (compomers) have replaced the use of amalgam. When necessary for working dogs or patients with aggressive chewing habits, a full metal crown composed of semi-precious metal is used to fully cover the tooth to aid in extra strength.

Orthodontics

Penn Vet, dentistry, orthodontics Just like in human dentistry, orthodontic treatment aids can be used to correct irregular tooth placement or skeletal malformation that might cause the oral cavity not to close in properly. The goal of orthodontics is to provide the patient with a pain-free and functional bite. There are two classifications of orthodontic treatment: Interceptive and Passive orthodontics.

Interceptive orthodontics is defined as extraction of deciduous or permanent teeth that cause malocclusion.
Passive orthodontic movement is achieved using dental materials to apply force to the tooth, causing it to move to proper placement within the oral cavity. Types of treatments include:
- Inclined plane: commonly utilized for treatment of lingually displaced lower canine teeth (base-narrow or in standing mandibular canine teeth)
- Buttons and elastic chains: typically utilized to actively move rostrally displaced upper canine teeth (lance teeth, spear teeth)

Neutering will help rule out the possibility of transferring genetic components of malocclusion to offspring.

Oral and Maxillofacial Trauma Management

Penn Vet, dentistry, oral and maxillofacial trauma Jaw fractures and oral and maxillofacial soft tissue injury may be a result of automobile trauma, falls, kicks, hits, gunshots, and fights with other animals. Pathologic jaw fractures frequently occur secondary to severe periodontal disease.

Several techniques are available to successfully repair jaw fracture. These include non-invasive and invasive techniques. Non-invasive techniques often make use of the teeth as anchor points for stabilization devices and include maxillomandibular fixation, circumferential wiring, and interdental wiring with intraoral splinting. Invasive techniques may sometimes be required and include external skeletal fixation, osseus wiring, and bone plating.

Temporomandibular Joint Surgery

Penn Vet, dentistry, temporomandibular joint surgery Patients with temporomandibular joint (TMJ) problems may have difficulty either opening or closing the mouth. Acute TMJ luxation is treated by manual joint reduction and tape muzzling to prevent recurrence of luxation.

Chronic luxation may require surgical removal of the mandibular condyle. Open-mouth jaw locking can occur when the mouth is opened wide, and the coronoid process of the mandible locks lateral to the zygomatic arch.This is commonly confused with TMJ luxation but warrants an entirely different treatment.
Acute treatment consists of opening the jaw further to release the coronoid process from the lateral aspect of the zygomatic arch, and then closing the mouth.
Definitive treatment involves partial resection of interfering bones. The latter surgery is also required in typically young patients with TMJ ankylosis (fusion of the bones that form a joint).

Oral and Maxillofacial Cancer Surgery

Penn Vet, dentistry, oral maxillofacial cancer surgery The oral cavity is the fourth most common site of malignant neoplasia in dogs and cats (predominately malignant melanoma, squamous cell carcinoma, fibrosarcoma, and osteosarcoma). By obtaining and examining a biopsy specimen, the clinician can establish a diagnosis, formulate a treatment regimen, and give the owner information regarding prognosis.

Describing the clinical extent (staging) of the malignancy is an essential prerequisite of rational treatment. This typically involves aspirating enlarged lymph nodes and obtaining thoracic radiographs. The treatment of choice for most oral and maxillofacial tumors (lip, cheek, tongue, tonsil, mandible, maxilla, palate, etc.) is wide surgical excision.

Most mandibulectomies, maxillectomies, and other radical surgeries can be performed without significant compromise of quality of life.

Facial Reconstruction

Penn Vet, dentistry, facial reconstruction There is a wide variety, of reconstructive surgery available, including palate defect surgery (see below), commissuroplasty (a forward advancement of the lip commissure to prevent the tongue from hanging out to the side of the mouth after mandibulectomy procedures), lip and cheek reconstruction (with axial pattern skin flaps that are harvested from the head or neck), jaw bone defect management (with osteoconductive, osteoinductive or osteogenetic grafts), etc. Principles of reconstructive surgery in humans are applied..

Palate Surgery

Congenital defects of the formation of lip and palatal structures may be inherited, or result from an insult during fetal development.
Palate defects acquired after birth result from severe periodontal disease, trauma, cancer, and surgical and radiation therapy.
Cleft lips rarely result in clinical signs beyond mild local rhinitis, and repair may be performed for aesthetic reasons.
Cleft hard and soft palate defects are best repaired in animals of three to four months of age. Preoperative management requires nursing care by the owner, which includes tube feeding to avoid aspiration pneumonia.
Palate defects acquired after birth are either repaired surgically or—if applicable—by placement of a silicone or acrylic obturator. Brachycephalic patients with respiratory problems may benefit from surgical expansion of nostrils (naroplasty) and shortening of the soft palate.

Salivary Gland Surgery

Penn Vet, dentistry, salivary gland surgery Swelling is the most common sign of salivary gland disease and is caused by firm swelling of the gland itself (inflammation, infection, necrosis, neoplasia) or by soft accumulation of saliva in an abnormal area (salivary mucocele).

The swelling may be on the side of the face, below the lower jaw, under the tongue, in the pharynx, or beneath the orbit causing the eye to bulge outwards.

Biopsy of the swollen gland will help determine benign or malignant pathology, requiring medical therapy or surgical resection. Injuries to the salivary glands and their ducts may result in formation of a mucocele.

Marsupialization is a procedure that creates a large opening into the mucocele through which saliva can drain into the mouth. However, this treatment has a tendency to fail and is therefore less successful than complete resection of the involved salivary gland(s).

Oral Medicine

Penn Vet, dentistry, oral medicine Some autoimmune diseases manifest along the lips or inside the mouth, others affect the muscles necessary for chewing. These and many other conditions of the head can be treated by means of medications. However, a surgical biopsy is often required for an accurate diagnosis.

Our team of specialized veterinary dentists and oral surgeons perform soft tissue and bone biopsies related to the mouth, throat, face and masticatory apparatus. The team also perform laser surgery for ablation of large oral ulcers as seen in cats and dogs with stomatitis.