Animal Dentistry & Oral Surgery Specialists LLC


Dale Kressin DVM, FAVD, Dipl AVDC 
Steve Honzelka DVM, Resident
Joey Buhta DVM, Intern

Serving Oshkosh-Green Bay-Milwaukee-Minneapolis & Metropolitan areas
920-233-8409  888-598-6684

 







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Member of:
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American Veterinary Dental College

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American Veterinary Dental Society

Minnesota Veterinary Medical Association


Wisconsin Veterinary Medical Association

 since 1983
Dr. Kressin previously on WVMA Executive Board

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Milwaukee Veterinary Medical Association

Northeast Wisconsin Veterinary Medical Association

Dental (tooth) extraction in cats, dogs, rabbits and other species

"Pulling teeth" or dental extraction?

Sometimes anaolgies are made with reference to "pulling teeth".  People might say getting their childern to eat vegetables is like "pulling teeth".  We believe the reason is that "pulling teeth" is never fun or easy.

Dr. Kressin never uses the phrase "pulling teeth" with reference to dental or oral surgical procedures.  This phrase is far from an accurate description of procedures requiring skill and attention to detail.  Serious complications can and unfortunately do arise from attempts to (literally) pull teeth.

Dental extraction is an important and beneficial dental procedure when performed correctly! 

Tooth extraction is a common dental procedure performed in most veterinary practices.  In Wisconsin, certified veterinary technicians or veterinarians may perform dental extractions provided they have appropriate equipment, instruments, training and have developed skill from clinical case experience.  Dr. Kressin teaches dental procedures to veterinarians and dental radiology for veterinary technicians.

Some dental extractions are "awfully simple while others can become simply awful".  Some teeth are particularly difficult to extract.  Well informed veterinarians prefer to refer their clients to Dr. Kressin for these more involved cases.  Dental radiographs are tremendously important for the evaluation of teeth before, during and after extraction to avoid patient injury.  The "risks" associated with dental extraction are significant.  Tooth fracture, failure to remove roots, excessive bleeding and jaw fracture are complications assocoated with dental extractions (see images below).

We have performed full mouth dental extraction on cats and dogs.  Full mouth extraction means removing all of the teeth.  This is an extensive procedure however it is tremendously beneficial for patients with specific condidions. 

Cats with lymphocytic, plasmacytic, gingivitis stomatitis are in tremendous pain.  They have a life threatening condition and the optimal treatment is full mouth dental extraction.  We perform between one and five full mouth dental extractions on cats per month and clients continued to be very impressed with the value of this service!  The earlier we treat these cats, their long-term prognosis seems to be substantially improved.  A step by step procedure illustrates the extraction of the right upper fourth premolar in a cat; at this link.

Dogs with "CUPS" or chronic ulcerative paradental stomatitis also live with chronic pain.  It is a tremendous shame to see these animals suffer.  They have swollen and ulcerated gums, lips and tongues.  Selective tooth extraction or full mouth dental extraction has been very rewarding for these dogs. 

We consider teeth as functional "assest" or non-functional "liabilities" for our patients.  All teeth serve a function however some teeth are functionally more important than others.  The most important teeth are sometimes called "strategic teeth".  These are the canine and carnasial teeth.  The carnasial teeth are the upper fourth premolar and the lower first molar teeth.  In viewing the mouth from the side, these are the largest teeth used for shearing food items.  Non-strategic teeth may be as important to the owner as the strategic teeth.  We make every effort to clarify the client's treatment preferences before performing dental extraction.

Our goal is to transform nonfunctional teeth to functional teeth if we can.  Painful teeth are nonfunctional.  A build up of calculus on one side of the mouth and substantially less calculus on the other side may be an indicator of pain. 

Painful teeth may have enamel defects, may be fractured (with dentin or pulp exposure), severely affected by periodontal disease, have pulpitis (inflammed pulp), pulp infection, root abscess or be associated with a jaw fracture.  The treatment options would be to repair any jaw fracture and either treat the tooth by endodontic (root canal or vital pulpotomy) therapy or by tooth extraction.  Traumatic malocclusion can be uncomfortable.  With orthodontic therapy, teeth can be saved and the occlusion can be transformed for improved comfort and function.  One clinical case of traumatic malocclusion (shown here) was treated by dental extraction.  The owner lived too far from our facility to return for the needed re-evaluations of the occlusion.  In this case, dental extraction was more logical and practical.

For some teeth extraction is the only option.  There may be no reasonable way to transform a particular tooth to a functional tooth.  Some owners prefer to extract teeth to avoid further complications or expense.  Others want to better understand all treatment options.  Some teeth require extraction because they result in malocclusion, dental crowding or even result in teeth grinding.  Supernumerary or persistent deciduous (baby) teeth typically are extracted to avoid crowding and accumulation of debris.

For some pets, the strategic extraction of deciduous (primary or baby) teeth can allow for normal jaw development.  This procedure can immediately eliminate a painful traumatic occlusion and allow for a normal occlusion of the secondary (adult) dentition.  This extraction procedure is often referred to as "interceptive" orthodontics

Our initial consultation allows full disclosure and discussion of benefits, potential procedural risks, prognosis and cost influences of each treatment option.



This dog has persistent deciduous
incisor teeth of little functional value
to this dog.

Surgical or nonsurgical extractions? 

Dental extractions are classified as "simple" (non-surgical) or surgical.  Dr. Hale, a friend, collegue and fellow veterinary dental consultant has stated; "dental extraction can be awfully simple or simply awful".  We find with appropriate training, equipment, instruments and skill, there are far fewer "awful" extraction experiences. 

Taking dental radiographs and carefully evaluating them is the mandatory first step in our practice for every dental procedure.  This helps identify potential problems that may occur especially with dental extractions.  Problems such as tooth ankylosis, tooth resorption or root dilaceration (curved roots) create unique challanges and may require special surgical technique.

Nonsurgical extraction 

If teeth are severely affected by periodontal disease, the gingival attachments can be incised and a dental elevator is used to separate tooth from the alveolus (tooth socket).  This is accomplished by tearing the remaining periodontal ligament using a gentle twist and hold technique with a dental elevator.  The tooth then "simply" lifts out of the alveolus.  The extraction site is ALWAYS sutured closed to avoid infection and to minimize patient discomfort.

Surgical extraction (step by step photos below)

Surgical extraction techniques are particularly beneficial when normal healthy teeth, supernumary teeth (many photos using this link) or abnormal teeth require extraction.  Teeth with fractured roots must be removed surgically or a root tip will be left in the alveolus.  Some multi-rooted teeth can be severely affected by periodontal disease of a single root.  The non-surgical technique will not be appropriate for such a tooth.  Surgical extraction is usually our preferred technique for most teeth. 

A surgical flap is created to allow access to the alveolar bone.  High speed drills are used to expose the roots.  Multi-rooted teeth can easily be sectioned to allow for safe tooth root removal.  Dental luxators, elevators and extraction forceps may be helpful.

If difficulties arise during dental extraction, dental radiographs help diagnose and resolve these problems.  After the tooth roots have been removed, the tooth alveolus (socket) is meticulously cleaned free of debris.  The mucogingival flap is carefully prepared for a tension free closure.  The alveolus is ALWAYS sutured closed to avoid infection and to provide optimal patient comfort.  A dental radiograph is taken to confirm that the entire tooth has been extracted and the alveolus is free of bone, root remnants or debris.

What complications may occur from dental extraction?

Dental extraction can be awfully simple, however they can be very difficult as well.  We provide step by step images on this website to help veterinarian collegues avoid complications.  These are some of the potential complications associated with dental extractions that have been presented to us;

Abnormal secondary teeth
Discolored teeth
Draining tracks
Facial swelling
Jaw fracture
Tooth fracture
Excessive bleeding
Instruments fractured
Perforation of canals, eyes or sinuses
Inadequate healing (infection and oronasal fistulation)


Dental radiographs, dental extractions and complications

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Pre-operative dental radiograph allows
diagnosis.  This tooth has endodontic
"halo lesions" at the root apices (ends),
periodontal disease (bone loss) and a serious
root defect.  Careful dental extraction technique
is needed to avoid root fracture.

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Severe "perio-endo" disease is shown
above and required dental extraction.
The gingiva appeared normal however
the periodontal probe picked up the
deep defects confirmed with this
dental radiograph.

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Dental radiograph demonstrates
complete extraction.



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14 month dog, fractured canine tooth
extracted.  Post extraction radiograph.
Gentle technique avoids damage to
the thin alveolar bone (tooth socket).

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11 yr cat; tooth fracture complication
during dental extraction.  Cat was not
eating (see dental radiograph below).

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11 year cat; extensive tooth resorption.
This is a post extraction radiograph of
the tooth root remnant shown above.
Meticulous technique prevents alveolar
bone (tooth socket) injury and jaw fracture.

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Dog; tooth fracture complication from
dental extraction.  Premolar tooth with
booth roots fractured.

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Root fragments were removed.

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5 yr. dog; jaw fracture complication, 
both mandibles fractured during the
extraction procedure. No dental radiographs
were available to the operator.

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Closer view of the mandibular fracture.
Alveolar bone (tooth socket) is shattered.
Bilateral rostral mandibulectomy performed.

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Cat 6 yr.; mandibular fracture during canine
tooth extraction.  A wire was placed that
resulted in misalignment of the jaw.  The
cat was unwilling to eat (see below).

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Oblique view shows fracture extended
back to the fourth premolar tooth.

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Cat; mandibular fracture close up view.
These jaws are extremely fragile.  If we
perform root canal therapy we can avoid
this serious complication.  Rostral
mandibulectomy was performed.  Cat 
returned to eating.

         

The advantage of the dental radiograph                       A post dental radiograph confirms complete dental
prior to surgical extraction helps plan the                      extraction and mandibular bone integrity.
procedure.       

       
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Dog; 7 months developed facial swelling
abruptly.

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Dog (image above); halo lesion observed.
To the right of this tooth see abnormal
dental structure unerupted.

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Periodontal probe penetrated 10 mm
into the gingival sulcus.

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The above tooth was extracted as well as the
adjacent premolar tooth (see below).

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This adjacent premolar was deformed.

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Premolar extracted (see above).


Surgical extraction; lower fourth premolar! (step by step)
This is a tooth with 2 roots!

The following images were put together to illustrate important procedural techniques used in dental extraction.  The images are very graphic.  They are intended to help my fellow veterinarian collegues.  I encourage veterinarians to purchase the best equipment and instruments to perform surgical extractions meticulously.  Many complications occur from error in technique as well as from inadequate equipment and instrumentation.  Dental extraction procedures require focussed attention and time to perform flawlessly.  Dental radiographs are extremely important.  Every veterinarian that provides teeth cleaning or oral surgery needs dental radiography capability.

I will help any veterinarian interested in formal dental or oral surgery training.  I will travel to your hospital or clinic.  Efforts to avoid dental extraction complication are well worthwhile.  Complications can and do occur.  If you recognize complications 
while performing dental extraction or oral surgery, please feel free to contact me.


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This premolar was fractured and had
pulp exposure (see pink nerve exposed).
This is a painful condition!

It is critically important to take pre-operative dental radiographs prior to tooth extraction.  These radiographs allow for a diagnosis and treatment plan.  It helps determine if the tooth could be or should be saved or wether extraction is the best treatment option.  This is extremely valuable in avoiding extraction complications (shown with above images).

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This dental radiograph shown the crown
fracture and notice the two "halos"
around both roots.  This is a severe
tooth infection.

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Surgical extraction involves initial gum
incisions.

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The gums are reflected back to view
the underlying alveolar bone (tooth
socket).

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The roots are exposed using a high
speed drill.

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A special bur is used to section the tooth
to allow for elevation of each root.  This
step helps avoid tooth fracture and
leaving root tips.

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The appropriately sized dental luxator and
dental elevator are chosen to gently tear the
periodontal ligament that holds the roots
to the alveolar bone (tooth socket).

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Instruments are used 360 degrees around
the tooth root to release the periodontal
ligament.  A wide selection of instruments
are needed for the variety of teeth (shape
and sizes) we extract.

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The tooth root is lefted out of the alveolus
(tooth socket) with an extraction forcepts.

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Each root tip must be carefully examined
to ensure there is no root fracture.

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The remaining root is carefully removed
using the exact same technique.

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This photo demonstrates removal of the
final root.  Notice the was sectioned.

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The roots are again carefully examined
to ensure no root or crown remnants
have been left within the alveolus
(tooth socket).

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A pediatric high speed drill mounted with a
diamond bur is used to smooth alveolar
(tooth socket) edges.  This provides
patient comfort after the surgery.

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The alveolar bone (tooth socket) is
carefully examined for bone fragments,
debris and smoothness.

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The alveolvus (tooth socket) is curetted
and further evaluated for unwanted
debris.

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The edges of the gingival flaps are
carefully prepared for closure of the
surgical extraction site.

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The gingival flap is contoured and "released"
to provide a tension free closure.

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We prefer to "position the flap" prior to
suture closure to ensure it covers the
alveoli (tooth sockets) perfectly and
to ensure it will be tension free.

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Monocryl is Dr. Kressin's preferred
suture.  Sutures are tied gently to
avoid post operative discomfort.

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Post operative dental radiographs are
taken to ensure there are no tooth
remnants left.

Surgical extraction; upper fourth premolar (step by step tooth sectioning)
This is a tooth with three roots!

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Slab fracture of right upper fourth
premolar tooth.

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Periodontal probe demonstrates that this 
crown fracture extends into the root.

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Dental radiograph used to diagnose the
problem and to determine if dental extraction
or root canal therapy should be performed.

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Tooth extraction was the best treatment
option for this tooth.  Flap made to expose
the roots and to section the tooth.

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Tooth sectioned into three separate roots. 
Tooth sectioning minimizes complications
with dental extraction of multi-rooted teeth.

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Two roots have been removed and
the palatal root is being elevated.

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Post extraction radiograph is very important
to verify extraction was complete and no
root remnants remain.

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Extracted roots should be carefully examined. 
The root tips should be smooth.

Surgical extraction of upper fourth premolar tooth in a "brachycephalic" breed is a little different than the case above due to dental crowding.

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This dog was referred for root canal therapy.

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Dental extraction was necessary due to the
severity of the fracture into the pulp chamber.

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Dental crowding in this case required
extraction of the adjacent rotated
third premolar tooth.

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The alveoli (tooth sockets) were curreted
free of debris prior to suturing the defect
closed.

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4-0 Monocryl sutures were placed for
a tension free closure of the surgical
defect.

Surgical extraction; upper first molar (step by step tooth sectioning)
This is a tooth with three roots!

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Pets are often presented for facial swelling.

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Veterinarians know not to guess at the
cause of facial swellings.  Dental
radiographs are always taken to make
the correct diagnosis.  The left upper
first molar tooth was the cause of this
dogs' facial swelling.  One cannot assume 
the swelling was  was due to the upper
fourth premolar tooth.

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A mucogingival flap was created to expose
the molar alveolar bone for tooth root access.
The salivary duct near this tooth must be
recognized and avoided.

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The tooth is sectioned to separate the
roots.  First section completed.

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This image demonstrates the second section
to divide this tooth into three separate roots.
Dental radiographs are needed.

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Dr. Kressin sutures all extraction sites
closed to prevent food entrapment,
infection and pain.

Oronasal fistula formation is a common complication with dental extraction.

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Oronasal fistula; dental extraction complication
from traumatic extraction with the development
of osteomeylitis (bone infection).

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These bony fragments of incisive bone
were removed to allow normal healing.

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The remaining incisors were extracted.
Infected and necrotic (dead) bone was
removed (see above photo) and the
oronasal fistula was closed using
4-0 Monocryl suture.

Surgical extraction for treatment of a traumatic malocclusion.

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This photo was taken to demonstrate
"interceptive orthodontics" performed to
remove the primary (baby) teeth from
the shorter lower jaw.  This allow for
normal jaw length development.

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Notice the fragile root tips.  It is
important to ensure the entire root
is removed during dental extractions.

Additional cases of surgical extraction for traumatic occlusion are shown in the dental occlusion webpage.

Surgical extraction of right upper canine.

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Right upper canine exposed for surgical extraction.

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Dental elevator being used to gently
lift this canine tooth out of the alveolus
(tooth socket).  Great care is taken to
avoid puncture into the nose.

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Canine tooth has been removed.  The
alveolus (tooth socket) is curretted and
gently flushed.

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The flap is sutured closed with 4-0 Monocryl
suture.

Surgical extraction for treatment of patient with severe periodontal disease.

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Cat; severe periodontal disease is
a good reason for dental extraction.

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Cat; dental extraction performed.
Dental radiographs are used to verify
the extractions were complete .

Dental extraction complications.

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Cat; this lower canine tooth fractured
during dental extraction.

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The root tip was removed surgically
with great care to avoid mandibular
(jaw) fracture.

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This jaw fracture was a serious complication
from the extraction of the lower canine tooth
in a cat.  The original operator attempted to
repair the fracture.  The cat was pawing at the
face due to extreme discomfort.

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Blackie suffered severe chronic respiray
track infection after dental extraction
was performed.

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Oronasal fistula; extraction complication!
Blackie developed a hole that allowed
food and oral fluids to enter the nose.

Surgical extraction of the upper fourth premolar; anatomy, step by step procedure and special considerations.

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