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Flip the lip and count those teeth

Posted in Festival of All Things Dental @ Jul 30th 2015 - By Dr Liz Chmurycz, Russell Vale Animal Clinic
FatD Vetanswers Flip the Lip Pic 3

If there was a simple thing that was quick, easy and would improve your client’s perception of a vet visit you would do it, wouldn't you?

All of us “Flip the Lip” well, especially during Pet Dental Month, but how many of you start counting teeth …. out loud, at all vet visits?

Please share your tips if you are already doing this.  If you aren’t counting, thank you for starting it on the next pet you see.

Why is it so important? 

It is an opportunity to add value to what a dental check truly is – counting the teeth, assessing which teeth are broken, missing, or rotated (and more) –  it is a reminder that it is not just about gingivitis, tartar or periodontal disease  – it is for ALL pets who have teeth, whether they look normal or not.

Even if the teeth are pearly white, fractured or missing teeth are not normal! Perhaps there are fractured tooth roots causing pain, or an unerupted tooth with a developing dentigerous cyst?

 A pet owner deserves to know.

You all know how to count, and counting teeth is dead easy, so why not do it?

Start with the incisors - “1 2 3 4 5 6” -   add interesting tips about incisor function. Make it interesting with comments like  “Did you know that some dogs like Pugs or Boxers will have 8 incisors, not the usual six? That is why it is so important to do xrays in these guys, as you never know what you may find lurking under the gum.”

The canine tooth is the most common tooth that pet owners find disease on, and it is this tooth that they will base their pet’s overall dental health on.   In cats, a “long canine” can be also be a sign of resorptive lesions, and a clue that dental radiographs are needed.

As I move further back in the mouth,  I count  “ 1 2 3 and then the big one” (the first four upper premolars). It is not uncommon to find that the second premolar is missing, and if you look closely, you may notice in some breeds that it doesn't look like the typical premolar (usually because it is a retained deciduous one). Perhaps the third premolar is rotated causing crowding – this is often a site of periodontal disease, even in an otherwise normal looking mouth.

Do your best at checking the upper molars – in some dogs it's easy, in others not so.

On the lower jaw, start at the lower canine – I usually let owners know that this is a tooth I want to work hard to keep in the dog's head, as it takes up a huge chunk of the lower jaw, and yes, it keeps the tongue in the head.  I then go on to count “ 1 2 3 4 and then the big one”.

Common areas of missing teeth on the lower jaw is the first premolar (which is very commonly unerupted), second premolar (with some dogs having retained deciduous dentition instead), and a totally absent third molar.

Sharing is caring

During the counting process, I often share tidbits about the teeth of a pet, such as which teeth I really want to keep and protect, and which teeth the dog can happily live without.  In this way, we are  preparing the owner for the future if any veterinarian ever says “we need to extract xyz teeth”, with the owner knowing that yes, that their pet will be able to eat and function fine without them.

The first few times you do this, it may seem awkward, but please persist. It will become easier, and you will be amazed at the response you will get from your pet owner.

With your existing pet owners, the first time you do this on their pet they are likely to be impressed that you are trying to improve or do better and it can be encouraging for them to know this, as it's what they want to see in a pet care provider.

For your first time visitors, the usual response is “Well, my previous vet never picked that up”.  Some have been initially unsure but when you show them the dental model (and then their pet) with  xrays of broken teeth/dentigerous cysts, they then understand.

Of course, there are some pet owners who do not want to know anything, or are skeptical, even with the evidence in front of them, because it is different to what they know or believe.

It is important to focus on those pet owners who genuinely care about their pet, and trust in you to pursue further investigations, such as dental radiographs, and a complete dental chart.

Happy Counting!

Some images of what Dr Liz has found when she's 'flipped the lip'

All of you would recognize the retained upper canine, but what about the missing first premolar?

 

Radiographs confirmed an unerupted first premolar in which you could either extract or perform an operculectomy on. (In this case, I extracted the tooth).

 

“Milo“ a 1 year old Boxer with some “extra” teeth on his right upper side.

 

Milo with his normal looking left upper side of his mouth

 

A radiograph of the normal side, confirming that it was not “normal”.

 

A photo of the tooth hiding underneath the gum, which was successfully extracted.

 

Another picture of a dog with an obvious retained deciduous upper canine, and an otherwise looking mouth

 

Radiographs show the deciduous canine tooth with its long root, but also a retained deciduous second premolar, and the third premolar has three roots, not the usual two.

If you'd like to ask Dr Liz a question about 'flipping the lip' - just add it to the comments section below.

Dr Liz Chmurycz is a  companion animal veterinarian, based at Russell Vale Animal Clinic, in Wollongong, Australia. As a solo vet and business owner, she is also a mother of four children. She is passionate about the veterinary profession, and the animals she sees. 

You can read Dr Liz's Blog here: Dr Liz...the vet from Russell Vale Animal Clinic

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