Tooth root abscesses are painful and need prompt treatment, but the signs can be easy to miss. Dogs don’t always show that their mouths hurt, and tooth abscesses can mimic other conditions.
 
Causes
Tooth root abscesses are pockets of pus caused by bacteria that invade the deep structures of the tooth. They often occur in teeth with severe periodontal disease or gingivitis (gum disease), especially if the gum has receded around the tooth.
 
Teeth that are cracked or fractured are also at risk for root abscesses. Teeth can fracture when a dog chews on something hard, like a bone, cow hoof, ice cube, hard nylon toy, or rock. Fractures that expose the pulp cavity (the inner part of the tooth) give bacteria a route to the tooth root.
 
Affected teeth
The upper fourth premolar—the large cheek tooth on each side of the upper jaw—is a common site of root abscess. This tooth, also called the carnassial tooth, is used to crush food. When a dog crunches something hard, a carnassial tooth can sustain a slab fracture (shearing off a slab from the side of the tooth) or can crack down the center. The roots of the carnassial tooth reach nearly to the eye, so an abscessed root causes swelling just below the eye.
 
Root abscesses can occur in any tooth. The large canine (fang) teeth are frequently broken and are also common sites of root abscesses.
 
Symptoms
Although tooth root abscesses are very painful, dogs’ signs of mouth pain can be subtle. Some dogs don’t show any symptoms at all. Signs of a tooth root abscess can include the following:

• Bad breath (usually worse than typical “doggie breath”)
• Pawing at the mouth
• Rubbing the face on the ground
• Reluctance to eat or to chew on toys
• Chewing on only 1 side of the mouth
• Lump on the face just below the eye
• Draining wound on the face
• Jaw swelling

 
A veterinarian may be able to find evidence of a tooth root abscess during examination of an awake patient. However, dogs with tooth root abscesses sometimes have too much mouth pain to allow much of an oral examination without sedation.
 
Diagnosis often requires dental radiographs (x-ray images) or at least a full oral examination with the patient under anesthesia. Dental radiographs sometimes reveal tooth root abscesses that can’t be seen any other way.
 
Treatment
Untreated tooth root abscesses cause prolonged pain and tooth loss. The infection can spread to other tooth roots and to the face, potentially even affecting the eye.
 
Dogs with tooth root abscesses need antibiotics and pain relief. The source of the infection must also be removed. There are 2 options for treating an abscessed tooth root:

• Tooth extraction
• Root canal therapy, which lets the dog keep the tooth

 
If you think your dog might have a tooth root abscess, make an appointment with your veterinarian as soon as possible. Your veterinarian will examine your dog and, if the signs indicate an abscess, will probably prescribe an antibiotic and an analgesic (pain reliever).
 
The next step will be either another appointment with your veterinarian for tooth extraction or referral to a dental specialist for possible root canal therapy. Both extraction and root canal therapy require general anesthesia.
 
If you would like your dog to keep his tooth, root canal treatment is the best option. Antibiotics alone are rarely enough to treat a root abscess. However, not all teeth are candidates for root canal therapy. The dental specialist will evaluate dental radiographs to see if root canal treatment is a good option and will extract the tooth if necessary.
 
Prevention
Sometimes tooth root abscesses are unavoidable. But you can take some measures to reduce your dog’s risk:

• Maintain good oral hygiene: brush your dog’s teeth regularly, have your veterinarian examine your dog’s teeth at least once a year, and have the teeth cleaned as advised by your veterinarian.
• Don’t give your dog hard toys, ice cubes, bones, or other hard objects that could fracture the teeth.

Are you tempted to skip your pets' heartworm and flea medicines during the winter? Dogs and cats actually need parasite prevention all year round. Year-round parasite control for pets helps keep the whole family safe from parasite-transmitted disease.
 
Warm spells during the winter are common in North Carolina, so we can’t count on cold temperatures to suppress insects that carry disease. Mosquitoes, fleas, and ticks can also live through the winter in areas that are protected from the cold.
 
Heartworms
Heartworms are transmitted by mosquitoes. Mosquitoes become active when the temperature rises above about 50°F (which happens routinely in North Carolina during the winter). But occasional warm winter days aren’t the only reason pets need year-round heartworm prevention.
 
Heartworm preventives work by killing tiny heartworm larvae that are already in an animal’s bloodstream. These larvae came from mosquitoes that bit the animal in the past month or more. Skipping a month of heartworm prevention could mean that your dog isn’t protected from heartworm larvae that he was exposed to when it was warmer. The American Heartworm Society recommends giving heartworm preventives all year round.
 
Intestinal parasites (worms)
Some heartworm preventives also control intestinal parasites like hookworms and roundworms. These parasites can infect humans too. Giving parasite prevention to your pets throughout the year is a sensible safety measure.
 
Fleas
Fleas don’t just causing itching. They also transmit diseases like cat scratch disease, tapeworms, and plague.
 
Fleas lay eggs that drop off the infested animal into the environment. This means that flea eggs are present everywhere the animal has been, including inside a home. After the eggs hatch, the larvae and pupae (intermediate stages) can stay dormant for weeks to months before becoming adult fleas.
 
Because fleas can go through their life cycle indoors, they don’t need to wait for warm weather to develop into adult fleas. Flea infestations are easier to prevent than to treat, so the best chance of avoiding a flea problem is to give your pets year-round flea prevention.
 
Ticks
Ticks carry many diseases that affect both pets and people. Some tick species, including the type that transmits Lyme disease, are active during the winter when the temperature is above freezing.
 
Ticks tend to live in leaf litter, crevices of buildings, and underbrush. When they’re ready to take a blood meal, they move to grassy areas or shrubbery near paths and latch onto a passing animal or person.
 
Ticks can be hard to see through fur, so you might not realize that your dog has picked up a tick. Because of the risk of serious disease, the safest approach is to limit tick exposure: control ticks around your home and give your pets tick preventives recommended by your veterinarian.
 
Photo by Justin Veenema