I need to preface this story with the disclaimer that you "Do not try this at home."

Earlier this fall I was presented with a beautiful little wirehair that had some bite issues. She was an extremely nice looking pup with a great personality. She walked into my clinic to have her baby teeth examined. When I rolled back her lip I was shocked to find that her bottom teeth were actually growing into the roof of her mouth and had created holes that they were seated in. The pictures below were taken at that first visit. In this first picture you can see the lower canine, but it is difficult to tell exactly how much of that tooth is embedded in the roof of the mouth:

In this picture we've opened her mouth just slightly to show how much of the tooth is hidden:

The other side of the mouth wasn't in much better shape:

For those of you who have followed the website for some time you've probably picked up on the fact that I consult with specialists a lot, whether it is in dealing with my own dogs or in reference to client dogs. I'm sure that some probably want to ask, does this guy handle any of these hard cases? My answer is yes. What I think is one of my strengths is diagnosing problems and then finding the best route of treatment, which in some cases is to utilize the advanced knowledge of a specialist. This wirehair's mouth was one of those cases. I sent the pictures off to a dental specialist.

Her recommendation was to extract the baby canines as soon as possible. Although the owner had not reported pain she suspected the teeth being lodged in the roof of the mouth was actually causing a fair amount of discomfort and affecting the dog very adversely. We scheduled the procedure and got the dog back in and performed the extractions. We scheduled a recheck once the adult canines started to come in to see if the pattern would continue.

A little over a month later the pup returned for a look at the adult teeth. I was disheartened as I rolled back the gum only to find more of the same. In this front view you can see how deviated to the inside the bottom canines appear:

And in these two pictures from each side:

Another round of consultations with the specialist resulted in the recommendation of surgery. Essentially the object would be to remove some of the tissue from the roof of the mouth, above where the canines were contacting, in order to create a groove to force the growth of the tooth outward. The dog's own mouth would be used as an orthodontic device. After much discussion on the matter about the technique and the potential for multiple surgeries, neither of us at our practice felt comfortable jumping into this dog's mouth with a new procedure. I inquired to the specialist as to the cost if I referred the pup to her and was given a starting point of $2,500, which could end up higher if the first surgery didn't completely resolve the bite issues.

I've practiced in this neck of the woods long enough to know that I'd have trouble convincing a client to spend that money on a life-saving procedure, and it was pretty much not going to happen on a dental-correcting procedure. Somewhat off the cuff she mentioned there had been a study that indicated having dogs with this particluar issue chew on tennis balls may help force the teeth outward because the tennis balls were just the right width to help correct the problem. I filed that information way back in my brain as nothing more than a bit of trivia.

After the consultation I called and spoke with the owner about the surgery to correct the problem and the cost involved. He was open to the idea but not enthused to have it done just yet. We talked about the pros and cons of waiting, other options if we waited too long and the teeth fully erupted in the wrong place. As an afterthought I mentioned the tennis ball treatment. With the possiblity of needing multiple surgeries even if he headed to the specialist tomorrow, he elected to go the tennis ball route at least for a week. I stressed that we would need to keep a close eye on things and if it wasn't going well we'd need to do surgery sooner as opposed to later if we hoped to save the teeth.

At the first recheck I was shocked at the amount of progress we were making, the left side appeared to be on its way to normal and the right looked as if a more minor surgery, one without a referral, would be all that was needed. We continued the tennis ball treatement with another recheck in a week or two.

Two and a half months after the first appointment I rolled the lips back one last time and was in total amazement:

The canine issues had corrected. I joked with the owner we should have packaged the tennis balls up and sold them as a dental tool for a couple of grand. A complete afterthought of treatment ended up working. If I was a betting man I would have wagered a lot of money that this dog would have needed some type of surgery to correct these issues.

A couple of important points: The owner deserves a lot of credit for the success of this case. He came for the first visit from about an hour away specifically for me to evaluate the teeth. Once we got involved into the multi-step process it would have been easy for him to just take the wait and see approach or to miss a couple of the appointments. His deligence and willingness to stick with the multi-month process allowed this correction to take place. Secondly I think this illustrates how important multiple puppy exams are during that first year of life. This dog had no outward symptoms and had the mouth not been closely examined it may have been too late to correct the problem by the time the abnormality was detected.

Lastly, I can't emphasize enough the importance of specialists. Historically we as veterinarians have been a do-it-all profession, from working cattle in the morning, to canine surgeon, anesthesiologist, radiologist, zoo vet...you name it and we are expected to do it. For a vast majority of us that live in remote areas that is still the case. The profession, however, has continued to expand at an impressive rate and virtually any type of specialized treatment that is available to us is also available to our dogs.

The downside for many pet owners is that with this knowledge and level of care has also come an increase in veterinary costs. Certainly not everyone is going to be able to afford the expense of a specialist, or the ability to travel to these specialty practices. Thanks to modern technology we can still benefit from these advancements without having to leave the practice. In the last two weeks, as an example, we have had x-rays interpreted by a radiologist in Minnesota, received a chemotherapy protocol from an oncologist in Wisconsin, worked through a medicine case with an internist from New York, received laser surgery training from a surgeon from Illinois, and I am in the process of working with an orthotist in Nebraska. Some of these involved fees, while others were part of the diagnostic process, but in all the cases, our patients benefited from the input of a specialist without ever having traveled to meet them. In some cases, particularly those involving the brain, spinal cord, or advanced diagnostics like MRIs or CT scans, travel will be the only solution; however, with many cases a specialist may only be an email, phone call or fax away.

I'm always skeptical of people who are "experts" in every facet of this profession. There is just too much to know to be the best in all the fields of veterinary medicine. In my opinion it is the job of those of us in general practice to be the intermediary, taking the information generated by the experts and applying it to the needs of our patients. In this case that turned a $2,500 surgery into a $10 canister of tennis balls.