The Problem:
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 abscesses open for a while and drain and then seal over again. They never actually go away and they don’t seem to bother the dog much - they are bright, alert and happy. The owners often doubt me when I tell them that the actual problem is in the dog’s mouth. It is always due to an infection that has spread from an infected fourth upper premolar tooth. These teeth are not painful to the dog and the teeth are never loose. What they all have in common is a crack or fracture of the enamel that allows bacterial to migrate from the root of the tooth into the maxillary bone that forms the face and maxillary sinus. If I place these dogs on antibiotics the lesion seals over for a while but it returns once the antibiotics are discontinued. This particular tooth is the largest in the dog’s mouth. It is a massive three-rooted tooth with long roots that is used by the dog to crack bones. Chewing on a heavy bone 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 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.

The Treatment:
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.

Some years ago I was a contract veterinarian working for SeaWorld Parks. There I treated a similar condition in walruses that wore the ends of their tusks off on their swimming pool walls. Removal of their tusks was the only way to permanently cure the infection, which caused an abscess under the eye just like in dogs. Removing those tusks was an enormous task that required three veterinarians, custom made dental equipment and a day’s strenuous work. This problem is why so few walruses in captivity still have their tusks.

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