Wellness: Health Care
Orthodontics—braces—are actually the most gentle way of dealing with a malocclusion.
June 3 2013
Wilbur, a four-month-old Dachshund with a dash of Papillon or Chihuahua in the mix, was to be my first foster pup. A standout at the shelter, his irresistible face and personality sealed the deal. Once I got him home, I noticed that his lower jaw was considerably shorter than the upper one. Although he appeared to be almost chinless, it made his smile more pronounced. No big deal, I thought— he’s so adorable.
Two months later, I had him neutered, and when I picked him up, a handwritten note attached to his aftercare instructions suggested that he should be seen by an orthodontist immediately. My first response, like that of most people unfamiliar with this veterinary specialty, was one of disbelief. I thought perhaps it was some kind of joke. But no. According to my vet, Wilbur had a malocclusion that required treatment —the sooner the better.
Luckily, in nearby Pasadena, Calif., I found Jennifer Lynn, DVM, who has dedicated her practice exclusively to canine and feline dentistry for the past 15 years. Dr. Lynn explained Wilbur’s Type II, base-narrow malocclusion to me. His mandible (lower jaw) was much shorter than his maxilla (upper jaw), resulting in what most people refer to as an overbite. In growing pups, the jaws sometimes develop at different rates, but Wilbur’s situation was so extreme that there was no chance of the lower jaw ever catching up.
This was more than an issue of looks. His mandibular canines, which normally wing out in front of the maxillary canines, were not only behind them, but were linguoverted—that is, angled inward toward his tongue. Since his permanent teeth were still erupting, they hadn’t had time to do damage, but eventually, this misalignment could prevent him from closing his mouth, as well as injure his palate. The good news was that, treated early, the teeth could easily be shifted to give Wilbur a healthy, comfortable bite.
Why not just pull them? According to Dr. Lynn, canine teeth are important. Their roots are roughly double the length of their crowns, so removing them requires oral surgery and, sometimes, a bone graft. Lower canines make up a good portion of the chin, help hold the tongue in place and are used for grasping.
What about crown reductions? In cutting the crown, the tooth’s pulp is exposed. A small portion of the pulp is removed and the top of the tooth is shortened and reformed. Called a vital pulpotomy it’s not without potential complications, and needs to be monitored with annual dental X-rays.
Ball therapy is another option. Teeth can sometimes be moved into place in response to pressure generated by the dog chewing on an appropriately sized rubber ball for fifteen minutes three times a day. If, like Wilbur, the dog has no interest in anything that’s not stickor bone-shaped, then you don’t get to try that approach.
Orthodontics—braces—are actually the most gentle way of dealing with a malocclusion. Rather than surgically removing the teeth, they are carefully coaxed into position.
So, on to braces, and yes, they do come with rubber bands, or elastic chains, as they’re also called. With Wilbur under anesthesia, buttons were cemented to the lower canines and molars at the back of his mouth. Guided by composite extensions, pressure supplied by elastic chains attached to the buttons would gradually shift his teeth to the desired position.
Keeping the elastic chains intact proved to be the biggest challenge. Almost daily, Wilbur managed to dislodge one while chewing on found objects. I became an expert on reattaching them. Once, he managed to pop off a button, and had to be anesthetized so a new one could be put on. Thankfully, treatment is of short duration, two or three months on average. Wilbur didn’t require a retainer, though some dogs do. Once everything’s in place, it tends to stay that way because the dog’s normal bite acts as a natural retainer.
Others I spoke with have had equally positive experiences. Following the devastating loss of a beloved dog, and much searching, Brenda Lyum and her husband, Mark, of Simi Valley, Calif., brought home a Brittany Spaniel puppy, whom they named Abbey. During their first vet visit, the doctor took one look at Abbey’s mouth and commented that her severe overbite, a genetic defect, was reason to send her back to the breeder. But the Lyums were committed to caring for their new companion, and Brenda and Abbey made weekly visits to Dr. Lynn’s office, an hour-and-a-half drive each way.
During Abbey’s treatment, everyone, including those at the referring veterinarian’s office, marveled at the five-month-old puppy’s orthodontic appliances, which included a palatal expander with acrylic splints on both sides in addition to buttons, chains and composite extensions. They were amazed at what could be done. At a price not significantly different from the cost of extraction surgery, the Lyums were able to save Abbey’s teeth. Unlike rambunctious Wilbur, Abbey kept everything in place until her corrections were complete.
Dr. JP Gonzalez-Torres, a general dentist (for humans), was surprised to find that Piper, his 10-month-old female Wire Fox Terrier, could be treated for a malocclusion resulting from a retained primary, or persistent deciduous tooth. When his veterinarian recommended that he take Piper to Dr. Lynn, Dr. Gonzalez-Torres was intrigued. “As a dentist, I got really excited about the idea of a pet orthodontist. I didn’t know they existed. We were able to correct the issue in a relatively short period of time. Piper did great throughout treatment. For those who question it, the price can be steep, but the end result is amazing. If you can correct a dental issue that could affect the life of your pet, wouldn’t you do it?”
Board-certified veterinary dentists Dr. Anson Tsugawa and Dr. Kristin Walker, who specialize in oral surgery for trauma, fractures and conditions such as oral cancer at Dog and Cat Dentist, Inc. in Los Angeles, believe that every dog is entitled to a comfortable bite. On occasion, however, they have had to explain that veterinary orthodontic techniques are performed only to improve function, for comfort and to eliminate traumatic damage to the mouth, not for cosmetic reasons. In fact, the AKC does not allow dogs who’ve had “work” done on their inherited dentition to compete in confirmation trials.
Because older animals may take longer to treat, dogs should be evaluated as early as possible to prevent or correct dental problems. To avoid complications, multiple visits are required as treatment progresses, so proximity to the dentist is important. For those who must travel long distances and would appreciate fewer appointments, Dr. Tsugawa says some dogs can be fitted with an appliance that their guardian can tighten with a little wrench. Or sometimes, a mold of the dog’s teeth is sent to PetAlign, a New York company that fabricates a series of five or six progressive aligners that can be changed at home. Since each dog’s mouth is unique, a dental specialist or boardcertified veterinary dentist is the best judge of how to proceed.
While Wilbur’s treatment was successful, my fostering was not; he became a permanent part of the family the moment he first scampered through our door. And on our walks, his captivating smile continues to charm and start conversations with every person we meet.
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