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DENTISTRY · February 19th, 2019

Counting Teeth the Easy Way

by Thomas Fatora, DVM

NVA DENTAL ADVISOR

1. Start client education early.

A puppy’s vaccination exam is the perfect time to start talking about their teeth with your clients. During these exams, I often show clients their puppy’s canines and request that they monitor their pet’s mouth for persistent primary teeth. I also look for malocclusions, explain the effects of teeth crowding in brachycephalics, discuss what happens when periodontal disease progresses unchecked, and recommend what type of chews to avoid. It’s also good to remind them that introducing brushing early means their pet is more likely to accept it as an adult.

2. Count teeth during spay/neuter appointments.

At the time of a puppy’s vaccine exam, adult teeth have yet to erupt. However, if you will be spaying or neutering a dog who’s 6 months or older, the adult incisors, canines and premolars should be in place and the molar teeth should be well on their way to complete eruption. This is perfect the time to look for missing teeth.

The Difference Between Missing and Impacted Teeth

Found a missing tooth? Take X-rays while the patient is under anesthesia for their spay or neuter surgery. Typically you will find one of three things:

  1. No tooth: Good news, no worries about monitoring the site for dentigerous cyst formation.
  2. The tooth is present but just under the gum surface: A minor operculation procedure will help the tooth break through the gum surface and allow it to move into proper position.
  3. The tooth is impacted; do you want to get it out or worry about it: If you don’t extract it, you will need to monitor the tooth with follow-up X-rays. How frequent depends on how lucky you are feeling. That tooth has the potential to develop into an expansile dentigerous cyst that can damage neighboring teeth before you catch it.

Calculating the Number of Teeth

Puppies have only three primary premolar teeth and no molars.

Deciduous teeth formula:
2 (Di3/3 Dc1/1 Dp3/3) = 28 teeth

Permanent teeth formula:
2 (I3/3 C1/1 P4/4 M2/3) = 42 teeth

3. Examine their mouth while your client is still in the room.

How often has your tech begun intubating a patient only to discover the patient has retained canine teeth? And it never ceases to be the case: If a client is less likely to approve an extraction of retained teeth, then you’re more likely to be unable to reach them while their pet is under anesthesia. And we all know it’s no picnic trying to explain on the phone why teeth are missing and why X-ray images are needed.

But this can all be avoided!

Take a look in the pet’s mouth before they are admitted for surgery, when the client is still present.

  • Doctors: If you don’t personally admit your patients, have your techs look in their mouth instead.
  • Hospital managers: If your CSRs admit the patients without looking at them; please rethink your admit routines.

A Quick and Easy Teeth Check

Use the maxillary and mandibular carnassial teeth as your landmarks.

  • 3 premolars in front of 108/208
  • 4 premolars in front of 309/409
  • 4 canines with no primary teeth
  • 6 incisors top & bottom with no primary teeth.
  • Open up; look in back for 2 teeth distal to the maxillary and mandibular carnassials.

My routine? I lift the lips on the right side, then check the front, then the left side, and finish with a quick open wide peak and count of the back teeth. I use a rapid focus camera and do my survey in less than 30 seconds. This way, if I find something I need to show the client; I do so with a photo rather than a squirming dog.

4. Take a look at their teeth during every exam.

During a recent exam, I took this photo of one of my patient’s teeth:

Not only was this dog missing tooth 106, but a look on the other side revealed they were missing 205, 206, 305, and 306. Another veterinarian who recently neutered the patient did not mention anything to the client about her pet’s missing teeth or taking X-rays. But by doing my dental due diligence, I earned her confidence and trust.

Sometimes you may find the patient is unwilling to let you look inside their mouth, but you still may be able to sneak a peek of the first premolars (a mandatory check for all Boxers!). The point is to always make an effort. Just by trying, you create a stronger awareness among clients that teeth can be impacted and must be addressed. And if you do find a problem during anesthesia, that phone conversation will be easier.

One last tip: Work on developing your routine with a Labrador before trying this on a Chihuahua.

For questions contact Dr. Thomas Fatora at Tfatora@nvanet.com.

Thomas Fatora, DVM

NVA DENTAL ADVISOR

NVA Hospitals | Frisco, CO

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