VMDiva

Musings of a Veterinarian
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Oral Foreign Body

September 23, 2009 By: Dr. K Category: Case Review

[singlepic=29,300,,,left]A routine appointment recently presented for “something stuck in mouth.” The 5 year old rambunctious golden retriever jumped around the exam room but did give me a good enough look in her mouth to see some yellow/brown foreign material impacted into her gingiva along the outside of her fourth premolar and first molar on her left mandible. Oral exams are always a challenge in dogs because you never know when their patience will run out and they’ll snap their jaws closed on your fingers. Her owner noted the dog liked to chew on sticks and had also vomited up pieces of a toy that morning. The dog was pleasant enough that I decided to try to dislodge the material using a pair of hemostats. No luck. It barely budged and the mouth started bleeding.  One more try yielded the same results as the first and I decided to move on to plan B. I explained to her owner we would need to anesthetize her. We talked about how in instances like these, it was impossible to know how big the object was and how much damage had been inflicted. I thought we may be dealing with a deep pocket of tissue that would require closure with sutures.

Once under anesthesia, oral exam revealed semi-firm material lodged between the two aforementioned teeth as well as being impacted on the outside of her tooth. Some elbow grease and patience allowed removal of the material but revealed a bigger problem. The foreign body had worn away the alveolar bone, or the bone that sits around the teeth, so severely that the rostral (front) root of the first molar was nearly entirely exposed. The tooth had minor mobility. I made the decision to remove the molar because, with an exposed root, a tooth root abscess, fractured tooth, or food impaction could occur.

[singlepic=30,120,,,right]Removing a healthy multirooted tooth can be time consuming and arduous. I made a gingival flap on the buccal (cheek) aspect of the molar. This was done by running a #15 blade along the tooth to a depth of about 0.5cm. I then incised the periodontal ligament, which is a strong band of connective tissue between the tooth and socket and is responsible for keeping the tooth in place. A cutting disc was used to cut the molar in half transversely and the two halves were removed using dental elevators and root forceps. The two sections of tooth came out cleanly and the flap was then used to cover over the bone and socket left behind. Absorbable sutures were used to close the incision. Her prognosis for a full recovery is excellent.

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