Oral surgery for dogs and cats

Masses on the gums, palate or tongue can be inflammatory, benign or malignant. They can’t be reliably told apart by appearance, from a photo or on examination — histopathology of the tissue determines what the mass is.

So the plan includes a biopsy and dental radiographs to assess the bone beneath the mass. Depending on the situation, CT, chest radiographs or an oncology consultation may be needed. The extent of removal depends on the histopathology result: some masses require part of the adjacent bone to be removed as well.

It is better not to wait for a mass to grow: the smaller it is when diagnosed, the more treatment options there are.

An oronasal fistula is an abnormal opening between the oral and nasal cavities. In dogs it is often linked to severe periodontitis of the upper teeth, especially the canines, where only a thin plate of bone separates the root from the nasal cavity. Trauma or a complication after extraction can also be the cause.

Warning signs include sneezing, nasal discharge on one side, sometimes with blood, and fluid or food coming out through the nose while eating or drinking. These signs also occur with other nasal conditions, so an examination under anaesthesia and dental radiographs are needed.

An established fistula with epithelialised edges usually does not close on its own, and extracting the causative tooth does not always resolve it. I close the defect with a local tissue flap that has a good blood supply and lies without tension. After surgery, soft food, no hard objects and a healing check matter: in difficult local conditions the wound can break down and a repeat procedure may be needed.

If a permanent tooth is missing after the deciduous teeth have been shed, it doesn’t mean the tooth isn’t there. It may have stayed under the gum or in the bone — unerupted. This is often a first premolar, but a canine or another tooth can be unerupted too.

A dentigerous cyst can form around the crown of an unerupted tooth. It slowly enlarges, destroys jaw bone and may damage the roots of neighbouring teeth, often without obvious signs for a long time. Not every unerupted tooth develops a cyst, but only dental radiographs can show whether one is present.

If the tooth or cyst poses a risk, I remove the tooth together with the cyst lining, and when clinically indicated the lining is sent for histopathology. Piezosurgery can help near a thin plate of bone. Deciduous teeth that haven’t fallen out are a different situation, also assessed on radiographs.

Fractures of the lower or upper jaw after a fall, road accident or bite need a dedicated plan: the aim is not only to join the bone but also to restore a correct bite without damaging tooth roots. A fracture can also occur where periodontitis has already destroyed the bone. I describe diagnosis, stabilisation and splinting on a separate page.