Carnassial Tooth Abscess In Dogs
The Fourth Upper Premolar Tooth

Ron Hines DVM PhD..

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  .Click here for a larger Image and the typical facial look of a pet with this problem

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Two or three times a year clients come to my office perplexed about a small draining pustule or abscess that forms just under their pet’s eye.

Sometimes the bone beneath this lesion has a lump on it. These spots open for a while and drain and then they seal over again. The spot never actually goes away but it doesn't seem to bother the dog much - they are still bright, alert and happy. Often clients just bring it up in passing when their pet is being examined for something else.

The owners often doubt me when I tell them that the actual problem is in the dog’s mouth. What has happened is that an infection has spread from an infected fourth upper premolar tooth.

The tooth that is responsible is usually not painful to the dog and the tooth is never loose. What they all cases have in common is a crack or fracture of the enamel of the tooth that allows bacterial to migrate from the root into the maxillary bone that forms the face and maxillary sinus.

If I place these dogs on antibiotics, the infection seals over for a while - but it returns once the antibiotics are discontinued.

This particular tooth, the 4th Upper Premolar Tooth, is the largest in the dog’s mouth. It is also called the carnassial tooth. It is a massive three-rooted tooth with long roots that is used by the dog to shear and crack. Chewing on a heavy leg bones or stone was probably what cracked the tooth in the first place. The roots are so long that they reach into the maxillary sinuses upon which the abscess later forms. I have read that occasionally peridontal disease surrounding the carnassial tooth is severe enough to cause this infection but I have never seen this occur.

What Needs To Be Done?

The treatment of choice is to remove the tooth. This is easier said than done. This is a procedure that must be done under general anesthetic. To remove the tooth I must first split it into two sections. I do this with a glass-cutting file or hacksaw blade and dental shears. Once the tooth is removed I probe the abscess to establish good drainage to the sinus and loosely sew the defect in the gums. I place the dog on antibiotics for one week. I have never had a case that did not heal excellently. As soon as the tooth is removed the abscess beneath the eye heals too Since dogs no longer need to gnaw heavy bones they do quite well without this tooth. Irrigating the abscess with hydrogen peroxide using a 23-gauge catheter on a 3ml syringe also speeds healing. For a week after surgery feed the dog only soft foods. Try to keep the dog from chewing on bones, rawhide or other toys for three weeks subsequent to surgery. The chromic gut sutures I place in the gums dissolve on their own.

There are veterinarians who specialize in endodontics who can perform a root canal on the tooth and save it. You might also find a dentist willing to work with your veterinarian in this procedure. However, not having this tooth will cause absolutely no problems for your average pet. It would only be a problem if your pet relied on crushing meat bones or slab portions of raw meat for food.