Dysphagia in Dogs

 

Dysphagia, the medical term given to difficulty swallowing, can occur anatomically as oral dysphagia (in the mouth), pharyngeal dysphagia (in the pharynx itself), or cricopharyngeal dysphagia (at the far end of the pharynx entering the esophagus).

 

Symptoms and Types

 

Oral dysphagia can be caused by paralysis of the jaw, tongue paralysis, dental disease, swelling or wasting away of the chewing muscles, or by an inability to open the mouth. Animals with oral dysphagia often eat in an altered way, such as tilting the head to one side or throwing the head backward while eating. Food packed in the cheek folds of the mouth without saliva are also typical signs of oral dysphagia.

 

Pharyngeal dysphagia is when the dog can grab food, but must repeatedly attempt to swallow while flexing and extending the head and neck, chewing excessively and gagging. While food is retained in the cheek folds of the mouth, it is saliva-coated. There is a diminished gag reflex and there may be snotty discharge from the nose.

 

With cricopharyngeal dysphagia the dog may succeed at swallowing after several attempts, but afterward it gags, coughs and forcibly throws its food back up. Unlike pharyngeal dysphagia, the gag reflex is normal. Animals suffering from cricopharyngeal dysphagia are often very thin.

 

Causes

 

Anatomic/mechanical causes:

• Pharyngeal inflammation
• Due to abscess
• Inflammatory growths
• Tissue in the mouth filled with white cells and modified macrophages (the body cells that eat bacteria)
• Enlargement of the lymph nodes behind the pharynx
• Cancer
• Foreign body
• A pocket of saliva that is draining into the body
• Jaw joint disorders due to fracture or luxation (where the jaws slip out of joint)
• Lower jaw fracture
• Cleft palate – malformation in the roof of the mouth
• Lingual frenulum disorder – a small fold of tissue on the tongue
• Trauma/injury to the mouth

 

Dysphagia caused by pain:

• Dental disease(e.g., tooth fractures, abscess)
• Mandibular trauma
• Inflammation of the mouth
• Inflammation of the tongue
• Pharyngeal inflammation

 

Neuromuscular causes:

• Cranial nerve deficits
• Damage to trigeminal nerve (the nerve that stimulates the muscles for chewing)
• Paralyzed tongue – damage to the seventh nerve, the nerve that controls facial muscles
• Inflammation of the chewing muscles

 

Pharyngeal weakness or paralysis causes:

• Infectious polymyositis (e.g. Toxoplasmosis, Neosporosis)
• Immune-mediated polymyositis (hereditary muscle inflammation caused by an immune disease)
• Muscular dystrophy
• Polyneuropathies – problems with multiple nerves
• Myoneural junction disorders (when the nerves don’t receive the signal to trigger the muscles to act); i.e., Myasthenia gravis, tick paralysis, botulism)

 

Neurological causes:

• Rabies
• Other brain disorders

 

 

 

Diagnosis

 

You will need to give a thorough history of your dog’s health, onset of symptoms, and possible incidents that might have led to this condition, such as recent illnesses or injuries. Your veterinarian will order standard tests, including a chemical blood profile, a complete blood profile and a urinalysis. These tests will indicate if your pet has an infectious disease, kidney disease or a muscular injury. During the physical exam it is crucial that your veterinarian distinguish between vomiting and dysphagia. Vomiting involves abdominal contractions while dysphagia does not.

 

Your veterinarian may also draw blood to run laboratory tests for inflammatory disorders of the chewing muscles, like masticatory muscle myositis, as well as for myasthenia gravis, immune-mediated diseases, hyperadrenocorticism and hypothyroidism.

 

Your veterinarian will take X-ray and ultrasound images of your dog’s skull and neck to inspect for any abnormalities. An ultrasound of the pharynx will help your veterinarian to visualize masses and help take tissue samples if needed. If your veterinarian suspects that your dog has a brain tumor, a computed tomography (CT) scan and/or magnetic resonance imaging (MRI) will be used to locate the tumor and determine its severity.

 

Stained Tooth and Teeth in Dogs

 

Teeth discoloration is any variation from normal tooth color. However, the normal color of teeth varies, dependent on the shade, thickness, and translucency of the enamel covering the tooth.

 

Any variation from normal tooth color is discoloration. The normal color of teeth varies, dependent on the shade, thickness and translucency of the enamel covering the tooth. Extrinsic discoloration occurs when exogenous pigment accumulates on the surface of teeth. That is, the cause of the discoloration is from an external source, rather than from a physical condition. Intrinsic discoloration is characterized by secondary factors that are happening inside the tooth, discoloring the underlying dentin.

 

Symptoms and Types

 

Intrinsic discoloration is characterized by secondary factors that are happening inside the tooth, discoloring the underlying dentin. Extrinsic discoloration, meanwhile, occurs when exogenous pigment accumulates on the surface of teeth. That is, the cause of the discoloration is from an external source, rather than from a physical condition. Common symptoms associated with both discoloration types include:

 

• Abnormal coloration of one or more teeth
• Fractured tooth
• Pitted enamel (the glossy covering of the tooth) with staining
• Rings or lines of discoloration around one or more teeth

 

Causes 

 

Extrinsic discoloration

• Bacterial stains from plaque (mucin, debris, bacteria and a thin film of food) and calculus
• Foods
• Bleeding gums
• Dental restorative materials
• Medications
• Metal

 

Intrinsic discoloration

• Internal (trauma, injury)
• Localized red blood cell destruction in the tooth (trauma)
• Systemic infections
• Medications (tetracycline)
• Exposure to too much fluorine (ingestion of toothpaste containing fluoride)
• High levels of bilirubin in the blood (from bile, the liquid in the gallbladder that helps to dissolve food in the intestines)
• Amelogenesis imperfecta (a condition in which dental enamel does not calcify enough)
• Dentinogenesis imperfecta. (a condition in which the dentin does not develop correctly)

 

Diagnosis

 

A complete blood profile will be conducted, including a chemical blood profile, a complete blood count, and a urinalysis. You will need to give a thorough history of your dog’s health, onset of symptoms, and possible conditions that might have caused this condition, such as diet, injury, recent illnesses, etc. The history you provide may give your veterinarian clues to the origin of the dental condition.

 

An oral exam is part of a thorough physical exam. Your veterinarian will need to x-ray your dog’s teeth in order to identify internal or external resorption, and whether restorative materials or bacterial stain from bacteria are entering the crown of the teeth. Your veterinarian may also use a strong fiber optic light that is focused on the teeth to determine vital from dead dental pulp (the nerves and blood vessels in the tooth). If the tooth (or teeth) need to be removed, your veterinarian will most likely need to subdue your dog with general anesthetize in order to extract it.

 

 

 

Enamel Hypoplasia/Hypocalcification in Dogs

 

The outer coating of the tooth, the enamel, develops according to a specific set of physical and environmental circumstances. Normally developed enamel will have a smooth, white appearance. However, when conditions in the environment interfere with the development of tooth enamel, teeth can take on a discolored, pitted or otherwise unusual appearance.

 

Bodily influences, like canine distemper virus (in young puppies that are not vaccinated) or a fever over an extended period of time, may cause pitting and discolored enamel surfaces. Local influences, like injury (even from baby tooth extraction) over a short period of time can cause specific patterns or bands to appear on the developing teeth. These types of traumas can result in less than normal deposits of enamel, medically termed hypocalcification. The lack of sufficient enamel may cause the teeth to be more sensitive, with exposed dentin (which is normally hidden underneath the enamel), and occasionally fractures of severely compromised teeth. The teeth usually remain fully functional.

 

Symptoms and Types

 

• Irregular, pitted enamel tooth surface with discoloration of diseased enamel and potential exposure of underlying dentin (light brown appearance)
• Early or rapid accumulation of plaque (bacteria, food film, dead skin cells and mucin) and calculus (calcium phosphate and calcium carbonate mixed with organic matter) on roughened tooth surface
• Possible gingivitis and/or accelerated periodontal/gum disease

 

Causes

 

• Injury during enamel formation on the teeth
• Canine distemper virus, fever, trauma (e.g., accidents, excessive force used during deciduous/baby tooth extraction)

 

Diagnosis

 

Discolored teeth may be found by your veterinarian during a routine physical exam, which normally includes a complete oral exam. Intraoral radiographs (X-rays) can then be taken by your veterinarian to determine if the roots of the teeth are still alive.

 

 

Epulis in Dogs

 

Epulides are tumors or tumor-like masses on an animal’s gums, which do not come from the teeth. They appear early on as small masses sprouting from the gum, which seem to hang from a stalk, and often displace tooth structures as they expand. Most epulides stick to the bone, do not have a capsule, and have a smooth to slightly nodular surface. They do not spread but may deform the face.

 

Epulides are the fourth most common oral tumor in dogs (rare in cats) and occur most often in brachycephalic breeds. Boxers tend to have a greater incidence of fibromatous epuli than other breeds of dog.

  

Symptoms and Types

 

There are three categories of epulides: fibromatous, ossifying, and acanthomatous. Acanthomatous epuli, in particular, are highly invasive to the bone and are usually located on the front part of the lower jaw. On occasion your dog will display no visible outward signs. It is therefore important you look inside your pet’s mouth if you suspect a problem. Symptoms associated with epulides include:

 

• Excessive salivation
• Bad breath (halitosis)
• Trouble eating
• Blood from the mouth
• Weight loss
• Enlargement of the lymph nodes in the neck
• Asymmetric upper or lower jaw

 

Causes

 

None identified.

 

Diagnosis

 

After you give a complete medical history for the animal to the veterinarian, he or she will conduct a thorough oral examination, which should reveal an epulide. If present, X-rays will be taken to classify the type of epulis and check the health of the teeth around the epulis. A section of the epulis must also be cut out, down to the bone, to be sent to the laboratory for analysis. This is best done while your dog is anesthetized.

 

 

Gingivitis in Dogs

 

Gingivitis is a reversible inflammation of the gums and is considered the earliest stage of periodontal disease. In the early phases of gingivitis, some plaque is present and there is a mild redness of the gums, but the gingival surfaces are smooth.

 

The gingival sulcus, or gum pocket, is the narrow space between the inner wall of the gum and the tooth. As gingivitis develops, the bacteria present in these pockets changes for the worse, and the accumulation of more bacteria, which release toxins, destroy gums.

 

In advanced gingivitis there is plaque and calculus under the gums, moderate-to-severe redness of the gums, and the gum surfaces are irregular. Dental calculus is calcium phosphate and carbonate mixed with organic matter, while plaque is a collection of food, debris, bacteria, dead skin cells, and mucous that forms within 24 hours on clean tooth surfaces. The gum responds to plaque with an inflammation of blood vessels, swelling, and collagen loss.

 

More than 80 percent of pets three years or more of age have gingivitis. It develops earlier in life in toy breeds, and in general, affects dogs earlier in life than it does cats.

 

Symptoms and Types

 

• Red or swollen gums, especially on the side of the gum facing the inner cheeks
• Bad breath (halitosis)
• Variable amounts of plaque and calculus

 

Causes

 

Plaque accumulation is one of the main causes leading to gingivitis in dogs. Predisposing factors include:

 

• Old age
• Crowded teeth
• Soft food
• Open-mouth breathing
• Bad chewing habits
• Lack of oral health care
• Uremia and diabetes mellitus
• Automimmune diseases

 

 

Diagnosis

 

Your veterinarian will perform a thorough physical exam on your dog, taking into account the background history of symptoms and possible conditions that might have led to this condition. You will need to give a thorough history of your dog’s health and onset of symptoms, such as when the bad breath began, what your dog typically eats, whether your dog has had trouble eating/chewing, and whether your dog has had any previous health conditions. The routine you have been using to keep your dog’s teeth clean, if you have been using one, should be shared with your veterinarian as well, including the products you use.

 

Part of the physical exam involves closely examining your dog’s mouth to identify the condition. Your veterinarian will then make an appointment with you to bring your dog in for a dental exam. During the dental exam, your dog will be anesthetized. Your veterinarian will check the depth of the gum pockets, the amount of plaque and bacteria on the surface of the teeth, and will pull any teeth that are rotten or that are too crowded. All of the plaque and calculus will be removed using a scaling process that is done with special dental equipment, and if necessary, root planning. The tooth surfaces will be polished and the teeth will be reexamined after cleaning.

 

Oral Ulceration and Chronic Ulcerative Paradental Stomatitis in Dogs

 

Oral ulceration and chronic ulcerative paradental stomatitis (CUPS) is a disease of the mouth which causes painful ulcers on the gums and mucosal lining of the mouth cavity. The cause of this condition has been determined to be a hypersensitive immune response to bacteria and plaque on the tooth surfaces, and sometimes signs of CUPS will start subsequent to a dental cleaning, when these materials are loosened in the mouth.

 

While it appears that manipulation and antigenic stimulation (substances that stimulate the production of antibodies in the body) in the oral cavity may trigger stomatitis, it is also believed that such animals would probably have eventually developed the disease anyway. In some cases, the only resolution is to remove all of the teeth, so that the bacteria that is normally found on the surface of the teeth is no longer present in the mouth at all.

 

Certain breeds of dogs appear to be at higher risk for developing this disease. Maltese, cavalier king charles spaniels, cocker spaniels and Bouvier des Flandres have been found to have a higher incidence. One of the complications of CUPS is idiopathic osteomyelitis, inflammation of the bone and marrow, which cocker spaniels have been found to be predisposed to.

 

Symptoms and Types

 

• Bad breath (halitosis)
• Swollen gums (gingivitis)
• Faucitis (inflammation of the cavity at the back of the mouth – the fauces)
• Pharyngitis (inflammation of the back of the mouth, continuous into the larynx – the pharynx)
• Buccitis/buccal mucosal ulceration (tissue of the inner cheeks)
• Thick, ropey saliva (ptyalism)
• Pain
• Loss of appetite (anorexia)
• Mucosal ulceration on the gums that meet the lips – also called “kissing ulcers”
• Plaque on teeth
• Exposed, necrotic bone (alveolar osteitis and idiopathic osteomyelitis)
• Scar formation on lateral margins of the tongue from prolonged inflammation and ulceration

 

Causes

 

Metabolic

• Diabetes mellitus
• Hypoparathyroidism
• Hypothyroidism
• Uremia caused by renal disease

Nutritional

• Protein-calorie malnutrition
• Riboflavin deficiency

Neoplastic

Immune-mediated

Infectious

Traumatic

Chemical/Toxic

Idiopathic

 

 

Diagnosis

 

You will need to give a thorough history of your dog’s health, onset of symptoms, and possible incidents that might have precipitated/preceded this condition, such as chewing on cords or other inappropriate objects, recent illnesses, and the usual dental care that is provided. Your veterinarian will exam your dog’s oral cavity carefully to determine the extent of the inflammation, or whether any of the teeth are obviously in need of care. Standard tests will include a chemical blood profile, a complete blood count, a urinalysis and an electrolyte panel in order to detect an underlying disease. Diagnostic imaging is also standard in diagnosing dental conditions. X-rays will be taken to determine bone involvement and judge the extent of idiopathic osteomyelitis.

 

Often chronic antigenic stimulation (from a chronic disease condition) will predispose an animal to development of oral ulceration and stomatitis. (Antigens are substances that stimulate the production of antibodies in the body.)

 

Retained Deciduous Teeth in Dogs

 

A retained or persistent deciduous (baby) tooth is one that is still present despite the eruption of the permanent tooth (between three to seven months of age). This can cause the permanent teeth to erupt in abnormal positions, resulting in an incorrect bite pattern (or how the upper and lower teeth fit together when biting or chewing). Retained deciduous teeth may also cause overcrowding of teeth, accidental bites into the palate, or an abnormal jaw position.

 

As with most oral issues, early recognition and immediate dental care is essential to prevent permanent damage. Unfortunately, it often goes undiagnosed until later in life.

 

Retained deciduous teeth are more common in dogs, though it does occur in cats. It often affects smaller breeds of dog, including the Maltese, Poodles, Yorkshire Terriers, and Pomeranian.

 

Symptoms and Types

 

In addition to observing the deciduous (baby) teeth once the permanent teeth begin to erupt, the following signs may occur:

 

• Bad breath (halitosis)
• Abnormally-positioned permanent teeth
• Swollen, red, bleeding gums around baby teeth
• Local gingivitis and periodontal disease due to teeth overcrowding
• A permanent abnormal passageway between the mouth and nasal cavity (oronasal fistula)

 

Causes

 

None identified.

 

Diagnosis

 

Your veterinarian will perform a complete physical exam and inspect your dog’s mouth.  He or she will chart the teeth present in the mouth to and record the presence of deciduous teeth. X-rays of the inside of the mouth will also be taken to verify which teeth are permanent and which are deciduous, and whether baby teeth have permanent successors ready to replace them.

 

Maxillary and Mandibular Fractures in Dogs

 

The maxilla forms the upper jaw (maxilla) and holds the upper teeth in place, whereas, the mandible, also called the jawbone, forms the lower jaw and holds the lower teeth in place.

 

Fractures of the upper jaw and lower jaw (mandible) are mostly seen in dogs due to injury or trauma.

 

Symptoms and Types

 

Symptoms vary greatly depending upon the type, location, extent, and cause of injury. Some of the more common ones include:

 

• Facial deformity
• Oral or nasal bleeding
• Inability to open or close the jaw
• Fractured teeth
• Facial distortion

 

Causes

 

Although various types of injuries and trauma are typically responsible for fractures of the upper and lower jaw, certain risk factors may predispose a dog to the fractures, including oral infections (e.g., periodontal disease, osteomyelitis), certain metabolic diseases (e.g., hypoparathyroidism), and congenital or hereditary factors resulting in a weakened or deformed jaw.

 

Diagnosis

 

You will need first be asked for a thorough history of your dog’s health, including any injuries or traumas it may have sustained in the past. He or she will then perform a complete physical examination, closely examining the oral cavity, jaw bones, teeth, and other related structures. X-rays of the oral cavity are also used to determine the location and extent of the fracture.

 

Oral Melanocytic Tumors in Dogs

 

Melanocytic tumors of the oral cavity arise from a local invasion of neoplastic melanocytic cells, or melanin-producing cells found in multiple sites throughout the body, including the mouth and skin. These tumors arise from the gingival surface and are aggressive in nature. They are usually raised, irregular, ulcerated, have a dead surface, and are highly invasive to bone.

 

Melanocytic tumors are the most common oral malignant tumors in dogs, commonly affecting dogs over 10 years of age. Such tumors may cause death as these render animals unable to eat, lose weight, and metastasis to other body parts.

 

Symptoms and Types

 

 

Causes

 

The underlying cause for oral melanocytic tumors is currently unknown.

 

Diagnosis

 

You will need to give a thorough history of your dog’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform various laboratory tests, including a biochemistry profile, urinalysis, and complete blood count — the results of which are typically normal — as well as a physical examination, especially of the oral cavity.

 

Your veterinarian will also take a small deep tissue sample from the mass in the oral cavity, including a part of bone to be sent to a veterinary pathologist for further evaluation. Such biopsy samples are usually helpful in making a definitive diagnosis. In addition, X-rays of the oral cavity, skull, and lungs will help in the evaluation of the extent and location of metastasis.

 

 

Dilacerated Mandibular First Molar in Dogs

 

The abnormal development and formation of the mandibular tooth, a molar located three teeth away from the midline of the jaw, is an oral health issue seen primarily in small breed dogs. The mandibular tooth is one of the first permanent teeth to develop a calcified crown, and one of the largest.

 

There is no gender or particular breed predilection, but small breed dogs are at risk due to the small amount of space in the jaw for the molar to grow into. Therefore, it is generally recommended that small breed dogs be given a full evaluation of the mandibular first molars as they are growing in. 

 

Symptoms and Types

 

The defect will appear at the neck of the madibular tooth, often with gum evidence that the gum is receding. There may even be extensive bone loss near the root and possible exposure of pulp inside of the tooh. X-rays may reveal discontinuity between the roots and crown and/or presence of pulpal stones in the canal or chamber of the tooth.

 

Causes

 

One of the possible causes for this developmental problem is a mechanical challenge (lack of space) in the mouths of small dogs that impede proper crown-root development. Invagination, a folding in of the enamel and/or cement of the tooth, sometimes occurs at the neck of the tooth, often with some degree of gingival recession (receding of gums) at the site.

 

Diagnosis

 

Your veterinarian will perform a thorough physical and oral exam on your dog, taking into account the background history of symptoms, if there have been any. Dens-in-dente, an anomaly of development resulting from the deepening of enamel into the dental papilla (the cells involved in the developing tooth), typically begins at the crown and often extends to the root before the calcification of the dental tissues takes place. Traumatic damage to the tooth, possibly from aggressive deciduous tooth (i.e., baby tooth) extraction, may be linked to a loss of dental integrity.

 

If your veterinarian finds that the tooth is too damaged to remain, an assessment of the remaining mandibular bone will be an important prior to an extraction attempt. The diagnostic evaluation will include taking a dental X-ray to evaluate the extent of the changes, particularly at the roots.