Better out than in

A diseased or damaged molar that is beyond repair is best removed, but how? Neil Townsend MRCVS explains

- Neil Townsend

DENTAL extraction can appear daunting to an owner. When performed by a suitably qualified and skilled clinician, however, with the correct equipment, it can be a routine procedure. The most common reason for removal of a molar tooth is infection of its roots, termed apical infection.

Signs of infection can vary. Generally, infection of mandibular (lower) cheek teeth creates a swelling on the bottom of the jaw, which may burst out into a draining tract (a surface wound). Apical infection of the front maxillary (upper) cheek teeth usually causes swelling in front of the facial crest – the bony ridge either side of the face. Because the back maxillary teeth have their roots within the sinuses, infection typically causes nasal discharge.

Teeth may become apically infected or require extraction as a result of fracture, advanced dental caries (decay), periodontal (gum) disease or a blood or lymphaticborne tooth infection. Signs may be subtle, ranging from quidding in the case of infection to tenderness over a facial swelling. Occasionally, a “dead” tooth with open pulps (the soft, central area) is only identified during routine dental examination.

A detailed oral exam under sedation can give clues as to which tooth is involved, by identifying fractures, open pulps, dental caries and periodontal disease. This will also provide information about the infected tooth, notably the integrity of its crown and whether the tooth is mobile.

Radiography (X-rays) are used to examine the roots of the cheek teeth and the surrounding structures. Advanced imaging such as computed tomography (CT) can be useful in cases where radiography and oral examination fails to reach a diagnosis.