Carnassial Tooth Abscess

Today I had one of my more rewarding moments in practice.  BUT FIRST… the back-story.

The carnassial tooth is the dog’s fourth pre-molar tooth.  It’s pretty much the biggest tooth they’ve got.  Sure, the canine tooth (the big fang) may look more impressive, and it’s got a root that’s bigger than the fang you can see.  The carnassial tooth is way back in the back, with only the two little molars behind it.  It looks like half of a big pair of shears, which it is.  This is the tooth that can cut your finger off (or your wrist if it’s a big enough dog).  It’s got three roots in a tripod arrangment so that it’s very stable in the mouth, great for cutting through your luckless prey. 

This is pretty important, as dog’s don’t really grind their food up into pulp the way we do when we chew.  Their teeth function to catch prey and tear them into pieces small enough to gulp down.  The bigger the piece, the longer it stays in the stomach.  Processed dog food just turns into mush when it gets wet, so dogs don’t really need to chew it to eat it.  They just crunch it up for fun.

Even though dogs may not actually need their teeth to eat that kibble (to say nothing of the bits), they feel a lot better when their teeth are healthy.  If you have an abscessed tooth, it really hurts.  In fact, it’s hard to think about anything else, much less enjoy life.   Every now and then, a dog develops an abscess (a pocket of pus that is destroying the tissue around it, creating pressure and pain) around one of the roots of the carnassial tooth.  If it goes on for a long time, it may burst and drain.

Abscesstooth_2 Sometimes it bursts and drains inside the mouth, as in this drawing .  That would give most people a clue that it’s an abscessed tooth. 

Abscessface_2 Sometimes it eats through the bone and bursts out through the skin under the eye, as in this drawing.  This is not so intuitively obvious as a tooth problem.  It’s common enough that these little pictures are in my handy-dandy illustration book that sits on the exam room counter, but it could be something else, like a tumor or foreign-body.

Tinkerbelle is a cute little Rat Terrier.  When we saw her in November, both sides of her face had been draining through holes like the one in drawing number two…for more than three months. Ouch!  Of course, if the holes had been draining for three months, the teeth must have been abscessed for a while before that.  Tinkerbelle had seen another doctor three times for this problem and been treated with antibiotics to no avail.  It’s not suprising that antibiotics alone did not help. You need to either do a root-canal (which takes a pretty good specialist and about $500 per tooth, not counting anesthesia, antibiotics, etcetera), or extract the tooth.  While I can’t really know what the other doctor was thinking, I know that sometimes we sell people short, thinking that they just can’t or won’t pay for what the dog needs.  The thing is, you don’t know what’s in the client’s heart or wallet.  My job is to offer my best.

"These teeth need to be extracted.  They are huge teeth with three roots.  Only one root will be bad, so the other two will be solid as a brick.  We will have to cut and peel back her gums, grind away the outside of the tooth socket, cut the tooth into three pieces, and extract each root.  Then we’ll sew the gums back together.  It’s major oral surgery, on both sides.  She’ll need I.V. fluids for the procedure because she is old and she will be under anesthesia for quite a while.  This is what it will cost." [$400]  "Do it!", they said, and we did.

Today, Tinkerbelle came in for a checkup.  As her owners were leaving, they said, "Since her surgery she has had a complete personality change."  [I thought, "Great, they are going to tell me the anesthetic has made her crazy."]  "She is so loving now.  We can pet her and she doesn’t try to bite us.  She likes for us to hold her and love on her now."

Amazing how getting rid of constant pain can make you feel better and act nicer.  It makes me feel better, too.

276 thoughts on “Carnassial Tooth Abscess

  1. Georgia says:

    How old was tinkerbelle when she had this surgery? My pomeranian is 14 years old and it is the second time the abscess has come back but the docter is apprehensive to do the surgery becuase she is a senior dog. Is it still safe to do this surgery to a 14 year old (very heathly otherwise) pomeranian?

    Any advice would be helpful! Thanks!

    • Patricia A Ibarra says:

      Hi! I’m Tricia and read yor story. Im sorry it happened. Im in the same shoes. My Chihuahua is almost 14
      I feel so bad and guilty. I should have been more mindful to her dental h! All I can find is $2000. Im retired on SSA. I’ve been told to put her down! I said if your kid had it and you couldn’t pay, you’d kill him? Nice guys

      • Doc says:

        Hello, Patricia,
        I’m sorry that you’ve had such a bad experience. I don’t know what kind of treatment your dog needed. I don’t know what kind of costs the hospital has where you were seen. It’s hard to have to give a client less than the best you would like to, but I can only give away so much. If I didn’t pay myself a dime, it costs me over $50,000 each month to keep my clinic running, pay the bills and staff. I can’t do it for nothing, even if I didn’t need to pay myself.

        • Mary Ellen Zenzie says:

          I wrote Aug 6 about 16.5 yo rat terrier who had 14 teeth extr due to carnassial tooth abscess burst under eye. Draining before surgery and continues to drain pus which is also coming out her eye when pressing under eye. Vet seen 4 or more times post op. Culture report due tomorrow but we guess may never heal. I think possible tumor behind all this. He said zygoma area on that side looks different than other. Wondering if xrays would show a tumor? I’m hearing her air coming from nostrils sounds just different. He said preop xrays wouldn’t have shown tumor up that high.

          • Doc says:

            Hello, Mary Ellen,
            I had some bugs with my comments, so just now seeing this. To radiograph that area, you need the patient anesthetized with the film in the mouth, whether using a regular X-ray machine, or a dental X-ray (probably better for this area). A C-T scan would be best, as soft tissue masses won’t show up very well on regular X-rays. I hope she is doing better.

        • Patricia Ann Ibarra says:

          I’m writing back it’s been months and I have had no luck, I saved some money but my life is so painful and full of grief ????, sadness, guilt I feel suicidal. My daughter came to visit me and she stopped breathing and died, All my belongings are gone, I rented a room from people their dog attacked me I had to have emergency surgery and then 2 weeks in a SNF so they sold all my furniture washer car was totaled kept rent and deposits and a energy bill so I was homeless no car to stay In and in a wheelchair my daughter’s patient let me rent a room but he died in 2 months. They gave him 2 yes. He has a reverse motage and we don’t know when we have to move out. I spent all the money I saved for Marleys surgery for her cessation and church service she was religious where I am not I lost all Faith. I’m a good hearted caring person who helps those in need but I need help I don’t care about the beautiful car and furniture that is material. But I want help for my dog she loves me with all that she is and I can’t help her my daughter called me and I didn’t go right away and it was to late I gave her CPR until the ambulance came and failed again. So if you could direct me to get help I can pay payments. I have a bill from the vet itemizing her surgery my story is all true as unbelievable as it sounds.
          Thank you if you read all
          Patricia Ann Ibarra
          916 628-1113 or 916⁷30-5108

          • Doc says:

            Hello, Ms. Ibarra,
            Sorry I’ve gotten behind in answering questions. I really don’t know any resources in your area. I am so sorry to her of your incredible combinations of loss and trauma.

      • Jay says:

        I don’t know what state you are in, but in Colorado there is Veterinary services (clinic, surgery, hospital) for low income people, you only need to show proof, such as Medicaid, Food stamps card and your income. After the Dr sees your dog they will tell you what’s needed and the cost. Next, you have to apply for Care Credit and 1 or 2 others. If you get turned down, which you have to show proof of, they will give you “credit” that you must pay back. In Colorado it uaed to be called Harrison and then Pet Aid, I believe. I have heard it changed names again. I’m thinking that you could call Dumb Friends and ask them about any clinics in town that have a sliding scale (what you pay is based on how much you earn). Why Dumb Friends? Pet Aid is right next door to the Dumb Friends free cat spay and neuter clinic and the canine spay and neuter clinic is through Pet Aid. Look online and call Dumb Friends league, although I hope your baby has already been and is feeling good! ????

    • Darlene says:

      My dog has sever chf and she has rotten teeth and tooth abscess she can’t be laid to sleep to pull are clean them any idea what to do .

      • Doc says:

        Hello, Darlene,
        When I run into a situation like this, I usually get a consultation with the anesthesia specialists at the veterinary college. Sometimes they can suggest an anesthetic plan that will work, despite the patient’s illness. In the meantime, I often prescribe clindamycin. It is one of the antibiotics that can penetrate bone. It won’t eliminate an abscess, but will frequently calm them down for a while.

        • Mary Ellen Zenzie says:

          Our 16.5 yr old rat terrier just had this carnassial tooth and 13 others removed a week ago and did very well. Shes left with a seepage from the abscess that came thru her right cheek. On clindamycin, meloxicam, probiotic. Wondering how long to expect this wound to drain?

          • Doc says:

            Hello, Mary Ellen,
            I would expect this to get better very soon. If the drainage is not improving, you should certainly let your veterinarian know.

  2. Doc says:

    Tinkerbelle was almost 14 when she had the procedure. The safety of anesthesia for any dog must be assessed individually. If anesthetic were good for you, you wouldn’t lose consciousness.

    Pre-operative assessment of liver and kidney function, blood sugar, electrolytes, electrocardiogram, chest X-ray and blood pressure give you a better idea of what you can expect during anesthesia. Support with I.V. fluids and patient warming are both helpful. Have a good monitoring set-up so that you can adjust things as soon as they take a downward turn, rather than several minutes later.

    Anything you do like this requires a “risk versus benefit decision”.

    Sorry I was so late responding. I’ve been out of town for a few days.

    Thanks for reading and writing.

  3. Sarah says:

    I have a 7 year old Catahoula who gets puffy faced right in the spot above her carnassial tooth and under her eye, as seen in the figures above. The funny thing is that the puffyness comes and goes, she can be normal for weeks and then suddenly the sides of her cheeks swell up, it’s not hard, and it’s not soft, and over the course of a few hours it will subside. I don’t see anything leaking inside of her gums or onto her fur as if an abscess had ruptured, and I haven’t been able to link the occurrence to any food allergies, or anything else. For a while I wondered if she has a clogged or inflamed salivary gland. Often it will happen on both sides at the same time, but not always. And she can go weeks without any occurrence and then she’ll get 3 or 4 in a week, or just one, it is very sporadic and random. Her mood or behavior doesn’t change and she even lets me push on them and stick my fingers into her cheeks to look inside.
    She crunches on her food, will spend hours devouring a bone when I give her one to chew. Her symptoms don’t sound like a tooth abscess to me. But the puffy region is just like shown on the figures you provided. This has been happening for over a year, she doesn’t seem to suffer for it. Any ideas on what it could be?

  4. Doc says:

    Your dog needs to have dental X-rays performed, with a dental X-ray machine and dental film, NOT a big X-ray machine and “whole-head” pictures. Despite the fact that your dog continues to eat and function, there may still be pain. What is the alternative to eating? Starving? I really don’t think you should ignore this.

    Thanks for reading and writing.

  5. Jacque says:

    I have a 9 year old Lhaso Apso that has had a chronic ear infection for about 9 months. Dr.’s thought it was due to dust mite allergy. I took her to a Dermatologist who treated the infection so she could see into the ear, but then the dog developed yeast infection, then this abscess under the eye. There is no bacteria growing in the culture that was taken last week, however this abscess has continued to drain for a week. Could the abscess be related to the ear infection or the ear infection and abscess be related to Carnassial Tooth Abscess? The Dr. thinks that a saline solution injected into the abscess to see if it comes out the ear may explain. So far I have 3 vets that are baffled by this.

  6. Doc says:

    Hello, Jacque,

    The doctors seeing the case are in a better position to evaluate it than I am. In addition to the saline injection, they may be considering a fistulogram. This is where a dye that will show up on X-ray is mixed with saline and injected in the abscess tract to see where it goes. Certainly good dental X-rays would be helpful in evaluating whether this is a tooth problem or not. In fact, they are the only way to evaluate WHICH tooth is involved, if it IS a tooth.

    Your dog’s case sounds complex and frustrating. I hope that your doctors are able to resolve it speedily. It sounds as though a C-T scan or MRI might be necessary.

    Good luck, and thanks for reading and writing.

  7. Jacque says:

    I took my Lhaso Apso in to a surgeon and he came to the conclusion that it was an ear problem – so she had a Total Ear Canal Ablation and bulla Osteotomy on Tuesday. The abscess is still draining from her face. Dr. said the abscess was draining out from way below the ear. Hopefully this will solve her chronic ear problems.

  8. Doc says:


    That is one major surgery. It will take a while before your dog is recovered just from the surgery, so don’t expect immediate relief from all the problems. Where the deep ear structures are irreversibly damaged, this is certainly the best course, and the only way to eliminate the dog’s pain

  9. Nicole says:

    Dear Doc,
    My almost 1 year old Belgian Sheepdog has an abscess around his carnassial tooth and it goes partially across his mouth. He is behaving normally though- and I was just wondering how you can tell if it is a carnassial tooth abscess or if he just chewed something sharp and poked his gum there. He eats EVERYTHING! If it isn’t hurting him do I still need to get it looked at? And how soon? I can’t really afford to take him to the vet but now I’m worried and need advice.

  10. Doc says:

    Hello, Nicole,

    I am glad that your dog still has a good appetite. However, this does not rule out pain — his alternative is to painfully starve to death or painfully keep eating. If he has a big hole in his mouth, it hurts.

    There are times when the only way for me to assess a dog’s pain (or lack thereof) is to put him on pain meds for a few days and see how his behavior does or doesn’t change (Use human meds with care: for instance, some dogs have developed bleeding ulcers with a single dose of ibuprofen. Consult your veterinarian). A big hole in his mouth is not so mysterious.

    I know finances can be a problem, but you need to figure out a way to help this guy.

    Thanks for reading and writing.

  11. Tiffany says:

    My 8 year old collie mix came up with a swelling yesterday sometime I noticed it last night similar to the second picture – It’s obviously extremely painful he’s always a very mild mannered dog who likes gum massages but when I tried to very gently lift the swollen lip to see if it was draining he tried to take my hand off without any warning, obviously he needs to see a vet asap but I live in a small town and the vets here don’t have dental x-ray machines, only one out of 5 even has an x-ray machine, they don’t believe in using IV’s for dogs or any animal under any circumstances… in short I’m seriously worried that when I take my dog in to have the tooth extracted the vet will kill him – we’ve lost a young dog and a cat to this vet’s incompetence already. It’s a heartbreaking situation because this dog is my absolute best friend he grew up with me and I know he’ll suffer and eventually die without treatment but a 100 mile trip is out of the question – what can we do to minimise his risk, what procedures should we insist on before/when he goes in for surgery? I have reason to believe he has kidney problems AND possibly diabetes but the vets here all refuse to do bloodwork because they say it isn’t needed.

  12. Doc says:

    Hello, Tiffany,

    I am sorry that you do not have a relationship with your veterinarian where you have confidence in one another.

    Even though your veterinarian may not offer pre-op blood work routinely, I am surprised that they wouldn’t be interested in doing it for a client who wants it.

    With the information you have given me, I would suggest seeing your regular veterinarian so that you can possibly get a different diagnosis. If the tooth problem still is at the top of the list, then perhaps they could get some pain medication and antibiotics started, and help you with a referral to someone who will do the type of work you want.

    Good luck

  13. Trina Johnston says:

    Hi Doc, I have a 8mth old GSD just noticed today he has a large round lump exactly the place you show on pic but it seems to be more in the cheek than in the gums. if it’s an abscess at that age should it be extracted?

  14. Doc says:

    Hello, Trina,

    If the tooth is abscessed, it needs either extraction or root canal therapy. If there is an undiagnosed lump, then we would start by trying to aspirate it (use a needle to suck out some of the insides) to see what it is. YOu might have to X-ray the upper jaw, which would take dental films and general anesthesia.

    Your veterinarian needs to take a look at this.

    Thanks for reading and writing.

  15. Trina Johnston says:

    Thanks for answering so quickly, I took Ozzy to my vet this morn she thinks it’s a foreign body like wood chip as she can feel the whole lump on the cheek more than the gum I pray to God that’s all it is. Thanks again Doc I really appreciate your response.

  16. A HENDERSON says:

    My dog has carnassial abscess like tinkerbell. My vet took the tooth out but pus in still coming out. The operation took place in Sept, I went back after a couple wks coz it was still leaking and they put her on long course antibiotics, they have just finished and it is still leaking !! What would u suggest 2 do nx ???

  17. Everett Mobley says:

    Hello, Arleen,

    The main thing right now is to let your veterinarian know that things are not going well. They are best equipped to advise you.

    Fore me, the next step would be to re-X-ray the mouth and see if there is another tooth involved, or a pocket of infected bone (with or without another tooth involved).

    Another bad tooth would need extraction, a bony pocket would need to be scraped out.

    A complicated case may need to be referred to a veterinary dental specialist. (I wish that I had one closer to me than 200 miles).

    Thanks for reading and writing.

  18. ARLEEN says:

    Thanks for your help especially since I’m in Scotland !! Took her to vet yest. for check up and she went in today for x-ray,they saw tooth was badly decayed the the flesh eaten away so she had tooth out and they flushed through where the pus was draining out, hopefully that should be it , she’s like a different dog already !!!!
    Thanks again.

  19. Heide says:

    Can a dog have these same symtoms in othere areas of the teeth and can a dog form an abcess if they have punctured an area of the gum and it may still be lodged in there.

  20. Doc says:

    Hello, Heide,

    Yes, to all your questions. The carnassial tooth (4th upper premolar, or #108 and #208) just happens to be the most commonly affected.

    This is why dental X-rays are so helpful.

    Thanks for reading and writing.

  21. Dee says:

    Our 12 yr old golden retriever just had his
    carnassial tooth extracted today by a highly respected veterinarian. Our dog had broken it and a large lump under his eye appeared. We thought it was due to a spider bite or allergic reaction. But the vet took one look at his face, opened his mouth and “aha” there was the evidence. We were able to take him home today with a course of antibiotics. A couple of hours ago, we noticed some blood coming out of the nostril that is on the same side of his face as the lump. Not alot but dripping.
    I called the emergency vet and they said unless it is bleeding profusely, it is probably nothing to worry about.
    Just thought I would see what you think and then others who go through this can be aware.

  22. Iris says:

    My beloved, elderly, arthritic, deaf pit bull at age 15 puffed up under her eye on one side of her face a six months ago. The vet put her on antibiotics and also Rimadyl, for her arthritis. The swelling went down immediately and she responded wonderfully to the Rimadyl. However, now, 6 months later, she stopped tolerating the Rimadyl, and she puffs up on one side or the other of her face in the Carnassial abscess spot, every day or two, then it mostly goes back down. I’ve taken her to the vet twice and he’s mentioned that it might be an abscessed tooth, each time. There is no draining pus, inside or out. He’s given her two rounds of antibiotics and she did seem to feel better at first with this one.

    But, only tonight did she show signs of being off her appetite. I always soften her food for her with warm water and wait a few minutes, but tonight she only wanted to eat if I fed her soft kibbles by hand. Of course that could be something else, but I worry it could be pain from this tooth, or teeth (both sides seem problematic).

    The vet said each time, “We could put her under and go in and explore it, or you could take her to have a dental x-ray done… here, let’s try her on antibiotics and see what happens.”

    Because he wasn’t actively recommending either course of action, just saying we “could” do that, I just went with the antibiotics. She is losing muscle mass and has ever weaker hindquarters. Do you think he hasn’t recommended action more strongly because he worries she might not tolerate or recover from surgery? How can I better understand the risks?

    My fear is that, as I have heard happens to some older dogs, she simply wouldn’t recover any kind of tolerable quality of life post-surgery, and then might have to be put down after suffering the injury of surgery (in which case it would seem to have been wrong to put her under the knife). But I am able to pay for any treatment, I only want to do what’s best for her. (She also gets extremely extremely anxious and tense at the vet’s, though the vet himself is gentle and I think very good.)

    Would an x-ray be better, i.e. less invasive and adequately accurate, compared to putting her under and going in to explore?

    Thank you for answering! Thank you so much for all this information!

    • Mary says:

      Hi Iris, 15 is pretty old for a pitty. I had my 14 year old girl put down last summer. We found a vet who came to the house to do it. We were all there, showering her with love and feeding her canned cat food (her favorite!) It was the kindest, most peaceful passing. I had a painful surgery last year and I decided I would not subject any of my older pets to something like that. A little too soon is definitely better than too late.

  23. Mary says:


    I just adopted a 4 yr old dog rescued from a puppy mill. I did not know she had problems w teeth, since were told they were in good shape. Her breath was so bad and when I investigated her mouth, the carnassial teeth are obvuously the cause of the odor. The teeth have holes in them w pulpy material which probably means they are absessed. I will take her to the vet next week but am trying to educate myself first. What is the reason they pull these teeth vs root canals? Is it the difference in cost? I hate to see her lose these teeth. Are they still able to eat dry dog food without these teeth?
    Thank you!

  24. Doc says:

    Hello, Dee,

    I would not say that it is expected or customary to have a nose-bleed after an extraction. However, if there were an abscess, it could have easily broken through the thin bony wall into the sinuses. This would explain the discharge from the nostril

    The odds are good that with the abscess opened, and the tooth removed, that things will heal while taking the antibiotics.

    Good luck.

    • Diane I says:

      Hi my dog does need a dental and now has puffiness in the area you mention. He is on antibiotics. Can the dental surgery wait a few days? He us still eating and drinking normally. Running around and playing.

      • Doc says:

        Hello, Diane I,

        If he is eating and drinking normally and running around playing, then I’d say his pain is not too bad. I’d get it handled as soon as you can, though.

  25. Doc says:

    Hello, Iris,

    It sounds as though your dog may be developing some other health problems in addition to the arthritis and the probably abscessed tooth.

    With recurrences after repeated antibiotics, I think it unlikely that the tooth will get better. A dental X-ray will make sure whether an abscess is the problem AND (important) which tooth is involved.

    Dental X-ray does require light anesthesia. The dog won’t hold still with a dental film in its mouth while it is awake.

    If your veterinarian is not comfortable with treating your dog more aggressively, ask him/her to refer you to a dental specialist. At this dog’s age, I would certainly want to do pre-surgical risk factor assessment, i.e. ECG, blood chemistry panel, chest X-rays.

    I can certainly understand being reluctant to anesthetize an aged animal for a potentially major procedure. There ARE risks involved. On the other hand, it sounds like your dog’s quality of life is deteriorating. It sounds as though the condition may be painful.

    Ask your veterinarian if he/she knows of a dental or surgical specialist within driving distance. Also, you might ask for another type of pain medication, since your dog doesn’t tolerate the Rimadyl now.

    Your veterinarian is really the best person to advise you, but they may be reluctant to push you, considering the age of the dog. Just let them know that you are ready to jump in with both feet and guns blazing.

    Thanks for reading and writing.

  26. Doc says:

    Hello, Mary,

    Yes, they will still be able to eat dry dog food without these teeth. They can gulp it down whole with no problems as a general rule.

    They might not be able to take down a goat and rip it to pieces, but how often is that going to be a problem?

    As far as root canal versus extraction, there are several considerations. First, as you mentioned, cost: a root canal will cost a lot more than an extraction, several hundred dollars per tooth.

    Second, it takes a veterinary dentist with special expertise and tools. Many veterinarians (such as myself) can do a fine job extracting the damaged tooth and suturing the gums and getting it to heal, yet have absolutely no way of doing a root canal.

    Third, a root canal may not be an option is there is extensive bony damage from the abscesses. Again, it may take a good veterinary dental specialist to make that evaluation. It will certainly take good dental X-rays taken under anesthesia.

    I hope this gives you some help. It sounds like you need to have a little more discussion with your regular veterinarian. They can see the dog and I cannot. If you are interested in saving the teeth, then let them know that.

    I hope this is helpful.

  27. gena says:

    Hi I have an 8 1/2 yr old shepherd mix who has always had slight bumps on his cheeks if you will. About a month ago I noticed that the right side is now much larger. It almost looks like he has a marble under his skin. My vet said he does not believe it is and abscessed tooth or an infection. It is hard and it doesn’t seem to hurt him. He lets me touch it and push on it. He is acting normal..eating, drinking, sleeping. Any ideas?

    Thank You

  28. Doc says:

    Hello, Gena,

    We often refer to that sort of nondescript lump as a “growth”. Why that’s better than lump, I don’t know. A “growth” suggests that it’s something that “grew there”, which it apparently has.

    Differential diagnoses would be some sort of tumor (whether benign or malignant), some sort of tooth problem, a reaction to some foreign body penetration (the body trying to wall off a sliver of something).

    Diagnostically, the first thing I do is try sticking a needle into it to withdraw some cells for microscopic examination. This can often help you differentiate between an infection and a tumor, though it is unlikely to tell you what kind of a tumor it is.

    Taking an X-ray of the area would also be helpful, to let you know if bone is involved, or if the mass is confined to the soft tissues.

    To really know for sure, you would have to remove a piece of the mass (a biopsy) and let the pathologist examine the whole section under the microscope. This allows them to see not only the cell types, but the structural relationships. This is what it takes to make a definitive diagnosis in many cases.

    There are many cases where older dogs grow little lumps that just sit there for years and cause no problems at all. There are others that don’t look like much, but are the early stages of bad cancer.

    As in people, you look for lumps that are growing or changing, lumps that bleed, sores that won’t heal, etc.

    At the very least, I would measure the lump weekly and record its size on your calendar. That way you’ve got some objective measure of whether or not it’s growing, and how fast.

    You might ask your veterinarian about getting a fine-needle-aspirate cytology. He/she can make the preparations for microscopic exam and look at them, or send them out to a pathology lab for evaluation (which will certainly cost more). Most dogs will allow this procedure without sedation, but it is certainly a little trickier on the face.

    I recommend that you talk to your veterinarian about your concerns. Since I cannot see the patient, I am in a poor situation to make recommendations. It is possible that he/she has very good reasons for not being terribly concerned at this point. Sometimes we don’t do as good a job explaining as we might.

    Good luck.

  29. vicki alberti says:

    My dog has two cracked teeth. One tooth abscessed and was removed 2 months ago. In hindsight, both teeth probably should have been removed, but were not. For almost two weeks now my dog has had lameness in her right front and rear paw. The vet did blood work for tick disease, all normal. Last night I noticed her face swollen. I believe her other tooth is abscessed. Is it possible that the infection in her mouth has spread to her paws?

  30. Doc says:

    Hello, Vicki,

    It is extremely unlikely that the tooth problem is causing the lameness. Despite what you hear in the song “Old Dan Tucker” (“combed his hair with a wagon wheel and died of a toothache in his heel”), it just isn’t likely at all.

    You should re-visit your veterinarian. He/she may want to take X-rays, do additional blood-work, or try some anti-inflammatory medication. You also need to get that tooth handled.

    Good luck.

  31. Lana Washburn says:

    Dear Doc,
    My 7 year old mixed rotty and golden retreiver has been ‘sick’ for 2 weeks already. He won’t eat anything (turkey…roast beef…hot dogs…sausage…) and he is very subdued. My vet has done blood work,a urine test, a fecal test, 2 chest x-rays, and every thing looks normal. She put him on Baytril and we can’t tell if that is doing any good or not. I have to go to her to have her give him his pills because I can’t open his mouth like that, and he won’t eat anything, so I can’t just hide the pill in a piece of good food.
    Just tonight she was wondering if possibly he has an abcessed tooth in the back because when she opened his mouth wide he made a whimper. I have no idea what could be wrong with him. I am of course very worried that it might be a cancer inside somewhere. He WILL go for a walk, and he trots right along, but seems to get tired easily. He’s usually a very happy boy. Lately he doesn’t even stretch when he wakes up, and he has been sleeping way more than normal.
    I don’t know what to do.
    He sometimes has this little sort of blowing type quiet cough too. Like when he wakes up to just stand up and change his sleep position.
    Do you have any ideas???
    Thank you so much.

  32. Lana Washburn says:

    I forgot to tell you that my dog also has been having a temperature. Initially it was 105 when we first saw my vet, then it went to 103 the next morning, and then back to 104.3.
    Today she did not take his temperature as I had to see her on her ‘day off’ in order to have her give my boy his pills.
    Thanks again.
    Lana Washburn.

  33. Doc says:

    Hello, Lana,

    Seven years old is a lot older for a Rottweiler than for some other breeds. The Golden has a higher incidence of cancer than many other breeds, but not generally short-lived, like Rotts. That’s the worst thing I have to say. So, quit fixating on the worst-case scenario, and let’s go on to what we need to do here.

    Some dogs develop an abscess behind their eye: “Retro-bulbar abscess”. The jawbone (mandible) is L-shaped. When you open the front of the mouth, the “sticky-up” part of the “L” cranks forward and puts pressure on that area behind the eye. If you’re normal, it doesn’t hurt. If you have an abscess there, it REALLY hurts. Treatment consists of short anesthesia and lancing the abscess from inside the mouth. Antibiotics are needed to follow up, but usually won’t relieve the problem.

    At this dog’s age, there are certainly a lot of other things that could be going on. Your veterinarian has assembled a good database with the previous testing. The dog wasn’t showing the pain when the mouth was opened before, so there was no particular reason for him/her to consider this.

    Your veterinarian may want to take dental X-rays at this point. This does require anesthesia (though not deep, and your lab tests are good, so probably that will go well). Sometimes when you anesthetize the dog and open the mouth, you can see an obvious bulge. Unfortunately, many times with the retro-bulbar abscess, I could see nothing. I just lanced “where it’s supposed to be” and followed up with antibiotics. Sometimes pus runs out, sometimes nothing appears to happen, but you’ve given the pressure an escape-route and the dog gets better.

    Your best bet is to stay in touch with your veterinarian, giving good feedback on what the dog is doing. This way you and he/she can look at the case in a new unit of time.

    Good luck.

  34. Jackrabbit says:

    Dear Doc,
    I have an almost-12-year-old black lab with a carnassial tooth abscess that didn’t slowly appear at all (meaning, Wednesday, there was nothing visible; Thursday I woke up and it was the size of a golf ball). I rushed him to the vet the very day he woke up with it, and the vet put him on Clavamox and scheduled him for surgery (tooth extraction) next week.

    Some questions:

    1) Is an antibiotic sufficient to make this abscess shrink or does it only kill the infection? If the abscess should shrink on the medication, how many days/doses should my dog be on antibiotics before I see improvement?
    2) I read that the abscess should be gone before they do any dental surgery. If it’s not, what does that mean, and what’s the next step?
    3) Since the abscess is so big, does this mean it’s been causing him pain for a long time prior to it showing up, or do they develop rapidly?
    4) Do I have to worry that the infection has spread to other parts of his body? And will it affect his eye (the eye it’s under can’t fully open because of its size)?
    5) Is there something I can do to relieve the swelling? The vet mentioned a warm compress, but what does that mean, exactly? Is a warm towel and mild pressure sufficient?

    I’m so worried about him because of his age, but he is very healthy and just had a full blood work-up done a month ago that came back immaculate. I’m hoping this means he’ll tolerate surgery well. I guess my fear is that I keep reading all the problems that can happen if left untreated, and I have no idea how long this thing’s been festering before showing up.

    Thank you in advance for any help you can give me.


  35. Doc says:

    Hello, JR,

    I strongly suggest that you ask these questions of your regular veterinarian. He/she is probably thinking that everything has been explained so well, and would appreciate the opportunity to address your questions.

    1. Clavamox is an antibiotic with a good record of effectiveness at killing the bacteria that usually live in the mouth. It is not so great at penetrating bone. We hope that it will slow down the infection, keep it from getting worse, and maybe help the dog to feel better. An abscess is a pocket of pus and it won’t totally go away without being drained and cleaned out.

    From your description, I would expect two to three days before seeing much improvement with the antibiotics.

    2. If the infection could be largely cleared up, then we would have less complications in recovery from the oral surgery. It is very unlikely that the infection can be completely eliminated with medicine alone. If the infection is still pretty bad before the surgery, the healing may be slower. It is possible that a second surgery would be necessary. The first would remove the tooth and allow drainage,after which it should be easier to clear the infection. Then a second surgery might be needed to close the area.

    3. The dog may have had low grade pain for a long time that has suddenly gotten worse, as the abscess enlarged. I have had low-grade aches that came and went for a while before getting bad enough that I absolutely HAD to get to the dentist.

    Dogs are pretty stoic about these things. It is quite possible that after his tooth problem is handled, he will be much more playful and “acting younger”. That will let you know that he has had some pain for a long time.

    4. The infection is unlikely to spread to other parts of the body, though this is possible. The Clavamox should prevent that from happening. It is unlikely to damage his eye, but it can be painful when the mouth opens. The back part of his jaw-bone comes forward when opened and can put pressure on the whole area.

    5. Heat causes capillaries (microscopic blood vessels) to open. This brings more circulation to the area: more oxygen, more nutrition, more antibiotic, more infection-fighting cells.

    I usually run a pan of water about as hot as I can stand to put my own hand in. Then I wring out a dish-towel and use it to apply heat. When the towel cools off, I re-soak and wring it. Ten to fifteen minutes, three times daily is optimum.

    It sounds to me like your veterinarian is doing everything right and has you on track to get this problem handled. The only other thing I’d be doing would be to ask about some pain medicine. I’m sure they will send you some after the surgery, but your dog could probably use some pain relief right now.

    Please talk with your veterinarian about this. Do not use over-the-counter human pain meds.

    Good luck.
    Everett Mobley, D.V.M

  36. Jackrabbit says:

    Dear Dr. Mobley,

    I can’t thank you enough for your quick response — it really put my mind at ease. I actually ended up doing exactly what you described (regarding a warm compress) for lack of any other ideas immediately after I wrote you, and the swelling really seemed to go down a bit. My dog is more alert, playful, and relieved today after 2 full doses of the antibiotic, too, and I’m sure he’ll be even better after the surgery and healing.

    So often in searching online for answers, I read things that just don’t get to the heart of my questions, and/or are answered by people with opinions instead of facts backed up by experience. I have done extensive research into every aspect of my dog’s care, which is why I take him to holistic vets, monitor his nutrition (by giving him the highest quality food (Abady) and herbals/supplements), and ask a million questions to make sure I’m doing the best I can for him! It means a lot that you care so much about animals (and their owners) to take the time to write such thorough responses to animal lovers searching for clarity. Thank you so much for doing what you do.

    Warm regards,

  37. cosmetic dentistry beverly hills says:

    Abscessation at the root of the carnassial tooth may give rise to an inflammatory reaction, then a fistula on the face, below the eye. Called also carnassial abscess, facial abscess, facial sinus. Less often, abscessation of the roots of the lower carnassial tooth can drain through the skin over the mandible or into the mouth.


  38. mary says:

    my pekingese is only 3 but she has that problem. I am torn because she had a neurological problem when she was just a baby that made her twitch a little so the vets felt that she couldnt go through surgeries coz if they put anestesia on her she wouldn’t ever wake up. So not, I do not know if it still applies now that she’s older. I really don’t know what to do. She hasn’t played coz it hurts so much and been moody n distant. any advice?

  39. Doc says:

    Hello, Mary,

    The tooth really needs to be fixed. It’s really not okay to let her continue in constant pain.

    It is time to re-evaluate your puppy’s risk factors for anesthesia. Talk to your veterinarian about getting blood-work, chest X-rays, and an electrocardiogram. Then they can get a consultation with a veterinary anesthesia specialist, if needed.

    Your veterinarian can help you with this. Talk to him/her.

    Good luck.

  40. Heather Taylor says:

    My 7 yr.old St. Bernard(150lb.) needs Help.. I took for his 1st dental cleaning in July. 3 weeks later his Jaw seemed dislocated. It came on instantly within an hour. I called our vet, not in, took him to animal hospital. They said it’s a Retrobulbular Abscess. They xrayed, put him under and lanced it to drain and sent us home with 10days worth of Clavamox (1000mg.) On the 12 day, jaw pain again, our vet was in, they perscribed Chlorampenicol (500mg.) 3 timed a day, for 7 days. By the 8th day his jaw was sore again, Called vet, they perscribed, Metronidazole(500mg) and SM2 TMP, twice a day. It’s now day 4 and he seems to be getting worse. I’m not sure where to go with this. He’s an inside dog and is again in pain and not wanting to take his meds this morning because of jaw pain. He is not swollen at all.. We just held him down and took a look in his mouth and his gums look great along with the back of his mouth which was huge when the onset had occured.
    We need help, not sure what to do, or where to go.. Do I keep seeing my Vet or go back to animal ER.
    If anyone has dealt with anything similiar or if anyone has any idea concerning the treatment he has received of why he’s not getting better.. Can You Please Help Me???
    Thank You, Heather

  41. Doc says:

    Hello, Heather,

    Retro-bulbar abscesses usually cause pain when the mouth is opened. The wider the mouth is opened, the more pain there is.

    This is an abscess below and behind the eyeball. The jawbone (mandible) is L-shaped. When the front of the jaw goes down, the upper part of the “L” goes forward, pushing on this area behind the eye. Thus, the pain when the mouth is opened.

    If this is truly the problem, it may have to be re-lanced and drained again. The fact that there was a lot of swelling in that area before strongly suggests that retro-bulbar abscess was the problem. They frequently do NOT appear swollen in the mouth, even when they are pretty bad.

    There may be an abscessed tooth in the area that is causing the problem. If in doubt, I would consider asking your veterinarian for a referral to a veterinary dental specialist.

    It is difficult for us general practitioners to get great dental X-rays unless we are doing a lot of it. You need to rule out tooth problems.

    Good luck.

  42. Heather Taylor says:

    Dearest Doc,
    I can’t Thank You enough for the reply, it’s just nice to know when someone cares because Doc, I feel so bad for him because I can’t get him any Better. We have a relative out in the West and Im going to hopefully get a referral from him for a Dental Doctor here on the east coast and maybe we can begin the steps to ending this.
    When I decided to take him for a teeth cleaning, it was only because all my friends and family have begun to take their dogs for cleanings. I thought, well, he’s a bigger dog, I’ve done everything I could to keep him healthy and want to continue making sure nothing is ever getting overlooked and he gets to live a real long time. He has always been in completely perfect shape, maintains 145lbs., perfect bm, and the biggest baby you could ever imagine BUT Smart…. He knew this morning that he needed help and tried to get me in the car but it’s the holiday, anything open is only the ER. He’s still taking Metronidazole(500mg) and SM2 TMP, twice a day and was perscribed that as of this past Friday(almost 4 days treatment)and he’s hurting more. He hasn’t been taking pain meds but I did give him 1 Dermaxx and it calmed him so he’s not sitting here panting but in the meantime, I just don’t know what course of action to take…. He will need to be seen tomorrow, at this point his face isn’t swollen, looks perfect and while he was panting, we were able to get below him and look inside his mouth with a spotlight and there is no lump in the back(as when it 1st occured)and all the coloring seems even but hurts him when he pants and lets his jaw go open furthur, he’ll jump and do a squell as if he got shocked. I made him burger for breakfast, hopeing to give him iron and I just wish I knew HOW TO GET HIM BETTER… I feel so bad for him but he’s laying comfortable now, but Dr., Thank You so much for your time… Have a Wonderful day.. Cheers, Heather

  43. michael says:

    Our dog Roxy had an absessed tooth extracted today and after bringing her home her hind legs are slouching quite a bit. She walks okay, but the whole rear of her body seems to lag behind and sway like an intoxicated person would. My wife called our vet and she seems to think it’s just the anesthesia in her system. Although it’s early, I wonder if these are normal symptoms for this type of thing. She was put under for her dental cleaning a year ago and had none of these symptoms then. Any thoughts?

  44. Doc says:

    Hello, Michael,

    It does seem odd that your dog has had difficulty after anesthesia this year when she did not on the previous occasion.

    However, some time of anesthetic after-effect does sound like the most likely situation.

    If your dog is not making continuous improvement over the next 24 hours, your veterinarian will want to know and follow up.

    Stay in communication with your doctor.

    Good luck.

  45. Heather Taylor says:

    Dearest Doc, We went to a dental doctor for Herbie(he has now been seen by his reg. vet, 2 trips to the Animal ER where they put in a drain for a retrobular abscess, and another local vet to just get labs, to make sure his HCT was within rage because at ER it was at 22% and I needed to follow up with that level and hoped he might also notice something that no one else had because Herbie wasn’t getting better.) There are only a few certified Dental Doctors in America and Dr. Velese took the intiative to do in depth blood work and Herbie has LYME DISEASE.. I’m from Pa and it’s common in our area but it isn’t looked at as the 1st type of treatment unless you see a specialist. My Dental Doctor said he sees many cases of Lyme Disease symptoms in the jaw for pets. I do hope this is read by many and people realize that any form of discomfort can easily be Lyme Disease. Herbie showed no signifigent lameness besides jaw pain, no weight loss, tiredness, or stiffness in other joints. This has been a costly experience between a surgery(which wasn’t necessary), many types of meds with exams and an ultrasound. Who would have thought……. Thank You for your time Doc… Have a great day because mine finally looks Sunny !!

  46. Doc says:

    Hello, Heather,

    I’m so glad to hear that Herbie is now doing well. That is certainly a dramatic and unusual story. Thanks for the follow-up.

  47. Dehaluyi says:

    I am amazed by your estimate of doing TWO extractions!
    Maybe I can fly my little 9-year-old Chihuahua-Pekingese mix up to you for the surgery I know is coming? For now the Clindamycin has cleared the infection & the swelling & lesion are gone, but we know we’ll eventually face surgery.

    Just wonder why ONE extraction here would be $950.00 PLUS anesthesia & overnight stay.

  48. Doc says:

    Hello, Dehaluyi,

    I’m not sure what your veterinarian is including in his/her cost estimate. Also, I don’t know what their cost of operations may be. It is certainly different in different parts of the country.

    If I were in a metropolitan area, I know I would have to charge a great deal more to cover my overhead just for the same things I am doing now. If I were including additional services or personnel, I would have to factor that in, as well.

    It’s really an “apples and oranges” kind of thing.

  49. Tony says:

    I have a 10 y/o Chihuahua and she has some swelling under the right eye on her snout. This just appeared this morning but has grown throughout the day. She doesn’t want to eat hard food, and isn’t really chewing anything. She is also shying away from anything that is too cold to drink. I am certain this is an abscess and normally I would have no problem taking her in to get it taken care of. Here is the complication this time. We are on the road for a cross-country journey which will culminate in leaving the country to work in Dominican Republic (DR). We are taking our dog with us, and literally ALL of our money is committed to the trip, so a $500 root canal is out of the question. What other options do I have? We have a vet in the DR, and we will have more money to provide better care for her. Is it safe to just let this run its course and treat her later as needed? The only other option I have is to put her down… We love this dog like family and I really don’t want to do that for something so small. Please help!

    • Amber says:

      Call around to different veterinary offices in ur area and ask if they will do a payment plan..It took me 2 weeks to find a compassionate veterinarian who understands that I am on a fixed income and I care about my furbaby.Soon she’ll be seen and then surgery for her tooth..

  50. Doc says:

    Hello, Tony,

    Long distance diagnosis is always tricky. It certainly sounds like an abscess. An extraction would certainly be cheaper than a root canal, and may be needed anyway.

    Starting the dog on antibiotics and pain medication in the meantime would be a possible option.

    You would still need to see a veterinarian for this. I’m guessing clindamycin and possibly some type of narcotic for pain. You really need to get her in to a veterinarian.

    Good luck.

  51. Heather Taylor says:

    Dearest Doc,
    I have previously written concerning my St. Bernard (Herbie) who began mouth issues back in august. He had taken Doxycycline for 6 1/2 weeks as of last weekend. We wern’t sure when he would have a long enough dose to put the Lyme into remission but felt this was a longer than normal cycle of it. We have kept a Deramaxx 1000mgs. also in him daily. (His jaw has been irritated and I’m assumeing permanetly from the flare up that initialy made him go lame in the 1st place.) Within 2 days of no doxycycline he began doing a whine, holding his jaw funny, limping and panting and this whole lameness again occured suddenly, like within 2 hours… We called the vet and he said start the doxycycline 400mgs. BID. We also continued the Deramaxx 1 daily. In 2 days, his jaw was feeling terrific and his leg isn’t any better and now holding it up. We then felt it thouroughly and noticed above the joint, going into the tibia, he is swollen and hard as a rock. I called the vet and he set up an x-ray for Monday and it’s now Saturday. Doc, I’m fearing the worst… He is uncomfortable and I’m now giving him 1 1/2 Deramaxx Daily until Monday. Please tell me there is something other than Osteosarcoma that can cause a bone to be this deformadly swollen and rock solid, suddenly ??.. He has had a distemper shot, so I’m not thinking Paget’s.. So my biggest question is that I need an educated opinion on, goes as follows, If this is Bone Cancer and we elected to begin a pain free healing process such as amputation, Would the Lyme Disease that’s in his system inhibit the healing process of his amputation ?? Doc, any response is welcome, I may be looking way to deep but if I’m going to be told that we need to make decisions on Monday for my Very Loved Herbie, I absolutely have to be educated in every avenue of treatment that could possible present itself here both Medically and Humanely… Thank You very Much for all your time..
    My Regards, Heather

  52. Doc says:

    Hello, Heather,

    I’m a little out of my depth when trying to answer your question.

    The first test would usually be an X-ray of the leg, looking to see if this looks like a tumor. Sometimes osteomyelitis (infection in the bone) can have a similar appearance and confuse the issue.

    A biopsy may be required to make the diagnosis. While waiting for results (or if you feel that it IS cancer), you proceed to stage the disease.

    “Staging” the cancer means looking to see how much of the body is affected. Typically we do chest X-rays and abdominal ultrasound to look for obvious tumor spread. If those are clear, you would also get current bloodwork.

    If there are already tumors in other body parts, it’s not going to help very much to amputate the leg. In a case where the tumor has already spread, you would be looking at using more potent pain-killers, like narcotics, to keep the dog comfortable for as long as possible.

    If there is no indication that the cancer has spread, then amputation would certainly be reasonable. Dogs do really well on three legs, even big dogs. Removal of the affected limb relieves the pain that is caused when the tumor destroys the bone.

    As to the difficulty with a relapse of the Lyme Disease, your veterinarian will need to consult with an internal medicine or infectious disease specialist (and I am neither).

    I am sorry I cannot be of more help.

  53. Heather Taylor says:

    Dearest Doc,
    I need to Thank You because for the most part you opened the door of hope for me and my family(osteomyelitis). Keep in mind that as of July, he was in perfect health or at least seemed to be and then all of the sudden these illnesses keep on snowballing. It’s been a sad process and we just want him to be comfortable. The mass above his ankle joint is encompassing almost half way up his tibia and is rock solid and waiting to see the vet is making my mind go crazy. His overall body is loving gentle rub downs and you won’t believe this one, I was just rubbing him down, and he was sitting between my legs and I would go up and down his back then go to his neck and when I put my hand under his rt ear(he never has had any infection or other ailment with his ears) and the flap seemed heavy so i pushed on it and it’s swollen. I didn’t poke or probe it but there is no doubt that it’s heavier and swollen, looks perfect and the underside has normal coloring ?? Again Doc, Thank You for all your information and if I’m faced with decisions on monday, I need to know what’s all involved. I love all my pets and my Herbie is very special to me and trying to work with him during this process has been pretty sad when we keep having a new ailment appear. My poor baby….
    Thank You Doc,

  54. Heather Taylor says:

    Dearest Doc,
    You put our minds at ease many times throughout Herbie’s ordeal over the past few months and We want to express sincere Thank You’s and want to let you know that we did put Herbie down today. Since last Tuesday(3 days after stopping Doxy) he began failing and each day there after it, he was getting worse. We immediately thought that we hadn’t treated him long enough for the Lyme(6 1/2weeks) and began the treatment again but Herbie was certainly getting more tired and in pain. By this morning, he wanted to lay in the yard and keep his head down. His breathing over the past few days starting to sound obstructed. I read many articles concerning Doxycycline suppressing tumors and I wondered if there were any effect on his, while we were treating him with high doses for the Lyme. Our vet did confirm the Osteosarcoma, we had sad hopes that he’d say “Oh. he has a broken leg”, but luck wasn’t there for us today. He was in much pain, and lost more weight than we even realized since all of this begun…..RIP…. Thank You again for all your responses, you’ve been a life saver when we have been racking our confused heads on what could be wrong with him, he’s finally in peace and painfree…
    My regards,

  55. Doc says:

    Hello, Heather,

    I am sorry to hear about Herbie. Sometimes the body can no longer support the spirit. Francis Bacon once wrote, “A healthy body is a guest-chamber for the soul, and a sick one is a prison.”

    It is hard to lose a friend, but harder still to see one imprisoned in a broken body.

    Best wishes.

  56. Monqique says:

    To whom it may concern: I took my dog to the vet today, and she definately has a carnassial tooth abscess. They sent me home with antibiotics and an oral rinse. I have a 14yr old female chihuahua. They estimated the price to be anywhere between $1,300-1,800. Is that a decent price for such a procedure?

    • Amber says:

      Hi, that’s the exact same price my veterinarian gave me for my fur baby tooth.My vet gave me the estimate sheet and yeah that’s a costly procedure but worth it..And my veterinarian is letting me do payment plans.

  57. Doc says:

    Hello, Monqique,

    I really cannot speak to prices here. That sounds like a lot, but I don’t know what all is included, what the general cost of operations are where you live, etc.

    With a dog that age, I am sure the figure include some pre-anesthetic diagnostic testing, and a lot of support during the procedure, plus pain control afterwards, and so forth.

    I am sorry that I cannot give a meaningful answer to your question.

  58. Dan says:

    Hi Doc,

    I have a 8yr old herding dog who has an active tooth abscess of either the upper left canine or adjacent first molar. She is a strong chewer and has essentially flattened out all her teeth chewing/playing with rope and kongs. Other teeth show root canal darkening and pitting. What is the prognosis and your suggestions?

    In the story above you said it was $400 to take out the 2 teeth, did that include x-rays and lab work? I am struggling with the delicate balance of costs and overall health(ok except for mouth)and age.
    Thanks for your work on this site.

  59. Doc says:

    Hello, Dan,

    It’s been quite a while since I wrote that, and I can’t really remember what cost what. I don’t think there were X-rays, but there was labwork and I.V. Fluids, I’m pretty sure. The dog was pretty old at the time.

    If you can put a probe into the pulp chamber, then it’s a matter of “when, not if” on the development of an abscess. You either get a root canal (bigger bucks), extract the tooth, or live with constant pain.

    Did you ever watch “Cast Away” with Tom Hanks? He uses a rock and an ice skate to punch out his abscessed tooth because he can’t stand the pain.

    You need to do something about that tooth.

    Good luck.

  60. Amy says:

    My dog, age 11, has carnasal tooth absess on one side and the vet said the tooth needs to come out. My dog has Cushings Disease and the vet did a CBC and just about everything looked okay with the exception of his kidney results – everything regarding kidney output was elevated. He said that indicates renal failure due to Cushings. He also noted that my dog does not seem to have a heart murmur but did say that his heartbeat was irregular. He said that the surgery was risky and that “quality of life” needed to be the main consideration at this point because the swelling on the side of his face had to be causing him pain. He said that before the surgery a catheter would be inserted and fluids would be pushed during and after surgery in an attempt to keep the anesthesia from harming his kidneys. He said he would do all he could to help my dog come through surgery with as little damage as possible, but that I needed to understand that the most likely scenerio is that he would suffer some damage and his life would most likely be shortened due to the surgery, if he survived the surgery. He did prescribe an antibiotic (Clindamycin 150 mg 1x daily for 14 days) and pain medication. He has been on the antibiotic two days now and the swelling has gone down a bit and he seems to be feeling better. Is there a chance that the antibiotic will take care of the problem with the absess?

    Thank you.


  61. Doc says:

    Hello, Amy,

    I am glad that the clindamycin is making your dog feel better. However, it is unlikely to provide lasting benefit. The infection will be reduced in severity, but there will still be a pocket of pus and dead tissue to re=start things when you stop the medicine.

    Your veterinarian is familiar with your dog and his medical conditions and his current labwork. He/she is in the best position to advise you. I do agree that letting the dog live with constant pain of an abscessed tooth is not really a good way to avoid the risk of anesthesia. Everything we do in life requires some evaluation of risk versus benefits.

    If your veterinarian is uncomfortable with the risk levels, thus making YOU uncomfortable with the risk levels, then you might consider asking for referral to a specialist. A veterinary dental specialist in a specialty clinic may have more support for anesthetic monitoring. More importantly, he/she will probably do the procedure more rapidly, thus having less time under anesthesia.

    Good luck.

  62. Carmrn says:

    I have a 12 year old pit bull female, I took her to the emergency room last night because the left side of her face looked droopy, her left eye was swollen shut she was drooling and has not been eating. They said she has an ear infection, sinus infection possible abscess and possible parasites. I’m not sure what to do. Although I love my dog dearly my financial situation is tought, however if this is the only things wrong I may be able to borrow money for her. My question is at this age is it worth putting her through all the exams and trial/error meds, could this the beginning of her started to fall apart and should I put her down. Very Very confused.

  63. Doc says:

    Hello, Carmrn,

    I wish I had a simple answer for you.

    Ear infections often require both topical therapy (treating the ear directly) and systemic therapy, such as cortisone injections or tablets to shrink the swelling (and open up the ear canal, and relieve pain), plus antibiotics for deeper infections.

    An abscessed tooth really should be extracted. Antibiotics may help temporarily, but only temporarily.

    It is certainly possible that at this age, you may go from one crisis to the next. Unfortunately, the only way to deal with multiple problems is to treat them all.

    If this is not financially doable, then you may have to consider euthanasia. You may be able to “buy some time” by treating with antibiotics and pain medicine and seeing how much improvement you get.

    Only you can make the decision as to whether or not your dog has an acceptable quality of life. If she is going to have more bad days than good days, or no good days, then it may be “time”.

    Sometimes it does come down to money, and sometimes it doesn’t matter how much money you could spend: not all problems are fixable.

    Sorry I don’t have easy answers for you.

  64. Kelly Hall says:

    Hello Doc,
    We have a 8-9 yr old Weimerraner (sp?). We were given the dog so are unsure of his exact age. He does appear to have hip issues, and takes awhile to get moving in the mornings. A few days ago, he developed swelling under his left eye. I automatically assumed an infected or abscessed tooth. My husband thought a spider bite, or other kind of bite. But, after a few days he was yelping slightly while trying to eat. I did soften the food the first day, and he didn’t have any trouble. Today, he ate it all, but did yelp somewhat. We too are unable to spend any or alot of money on this dog that we love, which is sad! We are wondering if a human antiobiotic would work just as well until we can get him to the vet for an extraction if that is the problem. What do you suggest. Thanks sooo much, this forum is so great!! Kelly

  65. Ella Jane says:

    dear doc,
    this morning my nine year old miniature dachshund suddenly had a large swelling under her right eye, just above the 4th premolar. She has been having problems with her teeth for two or three years now. I know the tooth probably needs to be extracted at this point (I need a root canal myself and can’t afford it, I don’t think we’ll be able to do it for Snickers), but here’s my question: my paycheck doesn’t drop until tomorrow. Is this an issue that we can wait overnight for, or should I put it on the credit card today? She seems about like usual, happy to play and run around outside, she just doesn’t want the swelling to be touched.

    Thanks so much for all your advice.

  66. Doc says:

    Hello,Ella Jane,

    This is not life-threatening. The sooner it gets handled, the sooner your dog’s pain will be handled. Can it wait until tomorrow? Have you ever had a toothache and waited until tomorrow? It’s hard to say how much it hurts.
    I’ve treated patients who had been suffering with draining lesions for months. They feel a lot better when it’s taken care of.

    Do it soon.

    Good luck,
    Everett Mobley, D.V.M.

  67. richy says:

    i have a 17 yr old male jack russell which is still fit and healthy, recently he got a carnassial tooth absess which the vet treted with antibiotics, but know its back and really smells. the vet says he wouldnt advise surgery because of his age so can you advise any medication to control problem. thanks

  68. Doc says:

    Hello, Richy,

    Re-treating with antibiotics (like clindamycin) may get things quieted down again, but the only way to really handle it effectively is to extract the tooth.

    I can appreciate your veterinarian’s concern about anesthetizing such an old dog. However, if he is otherwise fit and healthy, it should be feasible.

    If your regular veterinarian is not comfortable with this, you might ask him for a referral to a veterinary dentist, or even a specialty practice (not necessarily a dentist) that has more sophisticated monitoring and anesthetic capabilities.

    Good luck.

  69. richy says:

    i have a very lively 11 yr old jack russell bitch, while playing with my other dogs she stopped and looked like she was going to pass out. this was 3 days ago and she now hardly moves and has stopped eating but still drinks water. any advice would be great. thanks, richy

  70. Kim says:

    Dear Doc,

    We are fostering an 8-year-old Chihuahua who was rescued from the local shelter with bilateral facial abscesses. The rescue league treated them with antibiotics to no avail, finally got her to a vet with dental x-rays, and one week ago she had both carnassials removed. One side of her face is still steadily draining fluid, and neither opening has really started to heal. Should we be patient, or should we get her back in for further diagnosis?
    Thank you!

  71. Doc says:

    Hello, Kim,

    While one might not expect complete healing by this time, neither should you have continuous fluid drainage at this point. I would certainly get her back in to your veterinarian for a follow-up. When we don’t hear anything, we just assume things are going great. They aren’t, so let him/her know.

    Thanks for reading and writing.

  72. Karen says:

    Dear Dr. We have an 14 yr old lab mix and he has gum disease and has lost a bunch of teeth. HE WENT TO THE VET FOR A TEETH CLEANIN, the vet said he wouldn’t advise putting him under any more cause of his age. Lately we have notice a swelling type abcsess looking thing above his rt. canine. Were both unemployed and freakin out. This evening I knowtest that he was bleeding where the abcess was. now it’s not swelled jusst a dark purpleish color. My Question is should we scrap up (TRY)MONEY FOR AN EXTRACTION OR WOULD ANTIBOTIC MAYBE WORK???

  73. Doc says:

    Hello, Karen,

    Antibiotics like Clindamycin may help give temporary relief, but they won’t get rid of the abscess.

    I wish there were a simple answer for this, but if your description is what it sounds like it is, you have an abscess and the tooth needs to be extracted. It is bound to be painful.

    If the nerve to the tooth is blocked with local anesthesia, then you can use a lighter degree of anesthesia, and this lessens the risk.

    Good luck.

  74. grant taylor says:

    dear doc,
    my dog is a 14 year old full blood boxer. her face is swollen on the left side but there are no drain holes but her eye is swollen and pink and she doesnt like to eat either what could this be?

  75. Doc says:

    Hello, Grant,

    “Steak & Shake — famous for steak-burgers”
    Boxers — famous for cancer.

    Your dog could certainly be having tooth problems, or a retro-bulbar (behind the eyeball) abscess (which isn’t a tooth problem). Both of these could cause pain and swelling in this area.

    With an aged Boxer, I would also be concerned about cancerous growths in the area.

    Your dog needs good examination, maybe x-rays, maybe even a CT-scan for diagnosis. Sometimes one can insert a needle into the swelling and get enough cells for a diagnosis. This is called “Fine Needle Aspirate Cytology”.

    She needs to go see her veterinarian.

    Good luck.

  76. Kayla says:

    Hi Doc,

    I have a 8 month old Cairn terrier and he developed a very hard lump right under his eye. The size seems to be increasing, and it’ll soon be hard for him to see out of it. It’s not pussy or leaking anything at all, so I’m not sure if it’s his tooth or not. I thought it was a bee sting at first, but it’s not going away. I thought only older dogs got tooth problems. =/

    I have an appointment for him Saturday morning. I hope he’s okay until then. He seems to be his happy self, running around playing and eating. What do you think this could be? If he does need his tooth pulled about how much will this whole procedure cost? When I called the vet they didn’t sound like they would even need to do an xray, so this confused me..

    Thank you. :]

  77. Doc says:

    As long as he feels good, I think you’re okay until Saturday. It would be unusual to have such a bad tooth problem at this age. Your veterinarian may put a needle in to the lump to get a better idea what’s going on, possibly X-ray as well.

    I really cannot speak to the cost without knowing what the problem actually is. This is one of those things where it’s going to take the “hands on” approach. Good for you for already scheduling your appointment.

    Good luck.

  78. J Bo says:

    Hi Doc, my 4 year old dog in otherwise excellent health broke the tops off both her upper carnassials about 6 months ago chewing on compact hide bones.

    Why she would do such a thing I can’t imagaine!

    There’s seemingly no pain or discomfort, but the teeth don’t look good – and the broken ends are going brown and the teeth obviously starting to go bad. I think there is a hole into the pulp chamber on both.

    My main question is – what is the risk of anaesthetic in a dog like this. Is it essentially routine with very minor risk. I’m thinking it is probably best to get them removed now while she is younger, though I have been really fretting about it.

    Is removal a straight forward process that will be ‘clean’ so to speak (in terms of being able to remove all nerves). I pretty certain there is no absess or anything at present.

    Also, just in last couple of weeks on one of her pendant ears, she has developed a little sort of spot (a couple of mm wide) that keeps just scabing over, because it is leaking very slightly.

    I’ve been wondering if the two might be connected – or if she has just had an insect bite or thorn type injury there, etc.

    Many thanks in advance,

  79. Doc says:

    Hello, J-Bo,
    Sorry to be so late on this. We have been changing over our practice management computer software in the last week and it has been killing me.

    A four-years old dog in good health otherwise would not be expected to have any unusual anesthetic risk. Nothing is guaranteed, but I would not expect a problem.

    These teeth have three roots, which are usually solid in a situation like this. Thus the gum tissue has to be lifted up, some bone removed, and the tooth cut into three pieces. Then each root is extracted individually. It’s pretty major.

    Then the gums are sutured shut. You go home with antibiotics and pain medication. Prognosis is good.

    I would think the ear thing is a separate problem.

    Good luck.

  80. Carrie says:

    Hi Doc-
    I have a 9 year old Chihuahua with bad teeth. By “bad” I mean he’s had many pulled (12?) over the years and what’s left have an unbelievable amount of tartar on them. Unfortunately, this has been a problem since he was very young. During his last dental cleaning, in 2008, my vet told me that once she cleaned some of the teeth, she discovered that tartar was all that was holding them in and pulled them.

    To complicate matters, Chili started having seizures in November of 2008. During the first couple of seizures, he lost 2 large teeth (molars?). Shortly after, I broached the subject of having more of his teeth pulled with our vet. I don’t want him to be toothless, but I am terrified these teeth are or will cause more severe problems. At that time, and at subsequent times since, my vet has maintained that putting him under anethestic to do the procedure is too risky given his age and history of seizures. He is currently taking phenobarbital daily, twice per day which has reduced the seizures to 1-2 per month. He is otherwise healthy, no abnormalities in his bloodwork, etc.

    I recently moved cross-country and plan to have this discussion with our new vet once I am employed again (soon, hopefully) but wanted to get your opinion on the matter. Are there alternatives to anesthesia?

  81. Doc says:

    Hello, Carrie,

    I do not believe that your dog’s dental problems can be handled without anesthesia.

    The good news is that you should be able to find a doctor who can successfully anesthetize your dog. Dogs with seizure problems can be anesthetized and have surgery. If the rest of your blood-work is okay, this should be doable.

    I would suppose that when your new veterinarian examines your dog and his bloodwork that he/she can advise you on this. If I were to do it, I would probably get a consultation with an anesthesia specialist first, if I were uncomfortable with the dog’s situation.

    These problems do need to be handled. Being toothless is really of no consequence to a dog who eats commercially prepared dog food. They don’t really need to chew it, as it turns into mush when it gets wet.

    Dog teeth are pretty much all sharp cutters for catching prey and slicing it into chunks small enough to gulp down whole. They don’t really have much in the way of grinding surfaces, like a person’s molars. The dog food is already in small chunks, so teeth are not needed.

    With no teeth, your dog will quit having gum disease. His tongue may hang out a little, but you can live with that.

    I urge you to pursue care for your dog’s dental problems.

  82. louise says:

    Hi we have a 1.5yr old samoyed called meiko, he cracked his fang tooth in half with slight pulp showing, we have been refered to dental specialist 150 miles away from us who has put him on painrelief and antibiotics for 2 months apparantly untill the tissue around the tooth dies so that they can do root canal. This doesnt seem right and is costing a fortune! what do u think?

  83. Doc says:

    Hello, Louise,

    I am no dental expert and I have not seen your dog. Having said that…

    If the canine tooth (fang) has exposed pulp, then you really have three alternatives:

    1. Do nothing, let the tooth abscess. The dog could be in pain for years. Bad idea. Imagine your tooth is broken and the nerve is exposed. Now imagine that you can’t do anything about it… for weeks. Now imagine that it doesn’t hurt. Good luck with that, huh?

    2. Extract the tooth. The root is about twice the size of the exposed fang – huge, not all that easy to extract. This is oral surgery, and it isn’t cheap, but it sounds cheap when you compare it to the cost of the root canal.

    3. Root canal therapy. Saves the tooth (probably) and eliminates the dog’s pain. Costs a lot, as it requires specialized equipment and specialized knowledge. Believe, as someone whose family dentist performed a root canal that should have been done by an endodontic specialist the FIRST time, you don’t want a “bargain” root canal.

    In the immortal words of Charley Allnut in “The African Queen”, “you pays your money and you takes your choice.

    Good luck.

  84. Jeremy says:

    Hi Doc, I have sort of a lengthy question here. My 8 year old Corgie/Mix has been having some nasal problems and he has a couple of bad teeth. I took him into the vet and they told me that yes the teeth were bad and rotted and cracked but they did not think the bleeding was from that. My dog started out bleeding a little bit at night in may and it never got worse, but we brought him to the vet in late June to figure it out. Anyways, the vet didn’t want to mess with the teeth which is what I though the problem was and I still think it is. The vet did a nasal aspirate and sent the cells to be examined but did not find any sort of cancer cells or anything. Abouth two weeks ago he got a bump on his face that is right below his eye that is real squishy, but give hime no pain when I touch it. He has been on Prednisone for the last 4 weeks and ever since the vet put him on that he has not been able to breathe out of his nose. My dog has always had some allergies and has had chronic ear infections for the last 4 years on and off with treatment. Anyways, to make a long story short I have spent nearly a thousand dollars trying to figure this out and the vets refuse to believe that it all may be linked to teeth and want to blame cancer, but have not really found any evidance of cancer. They would like me to get an endoscopy done, but that would cost me another $1000 and I am pretty broke as of right now. If you have any ideas I would greatly appreciate it and if you know if Prednisone can cause a dogs nose to plug? Thanks you in advance.

  85. Doc says:

    Hello, Jeremy,

    I wish that I had a simple answer for you. The only thing I can think of that would worsen with prednisone and stop up the nose would be some type of infectious problem.

    In other words, if you had granulomatous inflammation (where the body’s reaction to the problem is producing a growth of tissue), and this was due to an infection, then the prednisone could slow down the body’s defenses. Thus, the infection could get worse, and the tissue growth would get bigger, and the nose would stop up.

    You could have tooth problems, cancer, fungal granulomas, a lot of things. Certainly endoscopy of the nasal passages would be the most direct approach. The other things one might do would include X-rays of the tooth roots and nasal passages.

    Unfortunately, X-raying those areas requires anesthesia, as you have to place the X-ray film inside the dog’s mouth and hold it still. That is not happening in an awake dog. Same thing for scoping the nasal passages, which also requires a tiny endoscope, which many practices do not have (including mine).

    I am sorry that I don’t have a quick fix for you.

    Good luck

  86. Angie Crowder says:

    Hi. I have a 13 year old Shepherd mix. He developed a golf-ball size lump in the same exact spot in the photo you have posted. It’s like it appeared overnight. I didn’t know if it was a bugbite or beesting, so I’ve been giving it a few days before taking him to the vet. I came home tonight (he’s had this for three days now) and it has been bleeding. No pus is coming out, but it has been steadily bleeding all day. Do you think this is related to an absess with his teeth? He’s still eating and drinking and acting normal. I plan to take him to the vet tomorrow.

  87. Sharon Adams says:

    I have a golden retriever, collie mix from the shelter 4 yrs. ago, I think he is about 6 or 7 now. About 6 months ago I noticed that this back upper cheek on the right side was a little bigger than the other side, I pressed on it and it felt like the rest of his gums just a little more raised. I didn’t think that much as about it as I guess it was gradual, he didn’t favor it when he ate, he didn’t have a temperature and acted playful like he normally does. About 1 1/2 years ago the vet said he had two cracked teeth, one would need to be pulled, but they said the other cracked one wasn’t that bad so they would leave it. I had changed vets and a few days ago I had him in for his annual exam. I really hadn’t thought that much about his mouth but showed the vet, I said I found a very little red round spot at the top of his gum in the back where his cheek meets his gum, she looked at it and told me it was very serious and his tooth would have to come out, it would be major surgery for him as they would need to scrape the bone also, that they would put him on antibiotics right after ( although I read they usually also put them on ahead of the surgery which they didn’t) his surgery is scheduled in 2 days (11/2) they want to also clean his teeth while he is out, is that a good idea? I was also told it would be expensive, about $600.00, I’m on unemployment but my family is going to help me with the cost. The vet said they would take an x-ray before the surgery. Does this sound right to you? He is my best friend and I would do anything to see he got the best treatment and I have only been to this vet for shots on two visits. Should I get a second opinion as she told me it would be very painful for him. I only have tomorrow to find out with the surgery in 2 days, I don’t know how long you take to reply. I’m glad I found you website, sounds like you really help a lot of people concerned about their their pet as well.

  88. Doc says:

    Hello, Sharon,

    I know that $600 is a lot of money. However, just anesthetizing and cleaning the teeth is usually going to run in the $150 to $200 range in a low-income area like the one I practice in.

    The X-rays help you be sure you are removing the correct tooth or teeth.

    Those back teeth are very big, and have three roots. You have to peel back the gums, remove some bone, and then cut the tooth into three pieces so that you can remove each root individually. This is a LOT of work.

    Then we usually suture the gums shut, and you have to use special small suture, which costs more.

    It also sounds like you will need antibiotics and pain medicine for a few days.

    Teeth that are cracked into the pulp chamber will eventually abscess. If you have ever known someone with an abscessed tooth, it really hurts a lot.

    I have had several patients who “came back to life” after these painful teeth were removed.

    It sounds to me like your veterinarian is trying to do the best for you and your dog.

    Good luck.

  89. Doc says:

    Hello, Angie,

    That could certainly be an abscessed tooth. In a dog that age, I would also be concerned about a tumor or cyst.

    Your plan to take him to your veterinarian is the best recommendation I could give you.

    Good luck.

  90. Angie Crowder says:

    I am so thankful I found your blog. I took Shiloh to the vet today and it is an abscessed tooth – 4th pre-molar. He is scheduled for surgery in the morning. Thank you for your blog.

  91. Barb says:

    Hi I am not sure what to do my dog Bambi is 3 pounds full grown chihuahua. Just this year in March she suffered a bad concussion to her head, about 3 months after she had a grand mal seizure. I had noticed before the head trauma in March she had bad smelling breath and was rubbing the sides of her muzzle with her paws. She still eats twice a day and I have been brushing her teeth although she struggles really bad and hates it. I was trying to wait awhile after her head trauma before putting her under the stress of a dental procedure. She did not have any more seizures until yesterday morning I woke up an she was having another grand mal seizure in my bed while sleeping. I did call me vet and let him know what happened but they said if she is not having more than one a month then it should be ok. What I am curious about is could tooth pain cause a seizure like this? My vet also told me that he would do a dental procedure but there were more risks involved when a dog has had head trauma in the past. So that is why I put off doing dental work to see if she had more seizures, which she has now had another. I feel like I am in between a rock and a hard place. I did a full blood work after the first seizure in March and she had some elevated liver enzymes which the doctor said he could still do the dental work because it was not elevated high enough, and could have been higher due to the stress on the liver from the first seizure. Anyways sorry for so much info I just do not know what to do.

  92. Doc says:

    Hello, Barb,

    Your veterinarian who knows your dog is the best person to advise you on this. Without seeing your dog and having a relationship, I really cannot prescribe for you.

    That being said, it sounds to me like it is time to go ahead and get that mouth problem taken care of. While it is true that there are additional risks in anesthesia with a seizure patient, I fear that your dog is living with constant pain in her mouth.

    This may not be provoking seizures, but it’s really not a good situation. Seizure management usually becomes a life-long situation, but the dental problem should be something that can be handled and finished with.

    The seizures are unlikely to go away, and most seizure disorders are progressive, meaning that over time she will have seizures that last longer, come more frequently, and are more severe.

    Generally speaking, it would be better to get your other problem handled earlier, rather than later.

    Talk to your veterinarian about this.

    Good luck.

  93. katy says:

    Hello Dr,

    My 14 year old pit bull, who is generally in great health has carnassial infection and swelling. I took her to the vet today, he gave her an antibiotic shot and take home antibiotics for two weeks (although he said they usually don’t work). He is testing her blood to see if she has strong enough liver function etc to perform extractive surgery. He also wants to xray her when she is under if she is fit for surgery to rule out cancer. I’m very upset because I hate to think of the trauma/risk of the surgery for her and the pain she may currently be in.
    If she is not fit for surgery, does this mean she will suffer with this endlessly if it can’t be cleared with antibiotics? Are there any other options? I would love a second opinion. Thanks so much

  94. Doc says:

    Hello, Katy,

    The doctor who is seeing your dog is in a much better position to advise you than I am.

    If your dog’s lab-work and X-rays should indicate a higher than normal risk for anesthesia, and your veterinarian does not feel good about doing the surgery, then you might ask for a referral to a dental specialist.

    These folks can get the job done much faster, therefore you have less time under anesthesia. Typically they have a good support staff, as well.

    There are very few dogs that just cannot be anesthetized at all, so the odds are good that this painful condition can be handled.

    Go ahead and let your regular veterinarian proceed with the risk-factor assessment that has been recommended, and then you can go to the next step.

    Good luck.

  95. teresa mccrary says:

    I have a 16 year old femaile rat terrier. A few weeks ago she all her teeth removed expect maybe 3. She was fine but now she started having nose bleeds. Last night was a bad one to. How long will these continue? I guess they are from the sockett. SHes not on anything for her mouth. She does take a heart pill and a congestion pill. Thanks Teresa

  96. Doc says:

    Hello, Teresa,

    Have you asked your veterinarian about this? This is not supposed to be happening.

    The canine teeth (the fangs) have enormous long roots. If these have been diseased, there is a VERY tiny amount of bone between their sockets and the nasal passages. It could easily have been destroyed by infection.

    There could be a communication between the mouth and the nose, you could have bone-infection in the nasal passages, even a tumor.

    You really should let your veterinarian know about this. He/she will have a better idea whether this is related to the previous problem, or you need to have the mouth and nose X-rayed, or what.

    I would not ignore this or just “hope it gets better”. It is also possible that your dog is having blood-clotting problems and could have a serious, life-threatening hemorrhage.

    Do call your veterinarian, please.

    Best wishes.

  97. Tammy in AR says:

    I have read your entire blog on abscessed teeth this evening.

    I freaked out last night when the swelling occurred in my Katie girl’s cheek. Didn’t know what it was – called my vet immediately. Spoke with the vet on duty and she said it sounded very much like an abscessed tooth or allergic reaction to a bug bite and to bring her in first thing in the morning. Which, I happily did. However, I wish I had read this blog prior to my 8am appt. It sounds like the only way to FULLY treat this is extraction/root canal. My vet this morning only prescribed anitbiotics and pain meds. Which, I was grateful for this morning and thought was the best course of action. It sounds like we should have done more than meds this morning. So, now I’ve spent the $200 today – which really should’ve been spent on extraction expenses. The vet even said, lets see if the antibiotics work. Would you say that eventually, regardless of the anitbiotics – she’s going to need that tooth extracted?

    I appreciate what you’re doing with this blog. Very helpful.

  98. Doc says:

    Hello, Tammy,

    I always feel that the doctor who is seeing the pet is best qualified to judge what is needed. That doctor not only sees the condition, but is acquainted with the rest of the pet’s health status, and can factor that into the treatment plan.

    If your dog truly has an abscessed tooth, then it is not very likely that antibiotics will resolve the situation permanently. This is according to the dental specialists (and I certainly do NOT claim to be one of them).

    Having said that, putting the dog on antibiotics may give some rapid relief of the swelling and pressure, and make the extraction process less prone to complications with the healing. So, not a bad thing.

    I recommend that you share your concerns with your veterinarian. Just ask what he/she feels the odds are of this really giving you a long-term handling. Let him/her know that you would really rather get things taken care of and resolved than deal with a recurring situation. Ask if there are there reasons NOT to go ahead do an extraction.

    Communication is the universal solvent, so apply some communication to this situation.

    Good luck.

  99. Sandy says:

    It is interesting that I am trying to learn about dental problems that my shitz tsu seems to be having. Not much out there on the internet. In my former life, I was a dental hygienist for many years, so I am looking for detail. BUT, the gem I found was the last line of the Dec 18 post, “Communication is the universal solvent”. I have posted that above my desk. Very poetic and true. Thank you.
    Sandy Lewis

  100. Doc says:


    I should have given credit where credit is due, as it is not original with me. That gem is from L. Ron Hubbard;.

    Thanks for reading and writing.

  101. Terri Shannon says:

    I have been reading all of these stories but haven’t found the answer I am looking for. My 9yr old Rhodesian Ridgeback/Lab mix had a runny eye and then the golf ball sized lump. We did blood work (all ok) and xrays. Saw a very small spot so we extracted a tooth. There was a pocket of pus. They put him on pain med, and antibiotics. It has been 7 days and the lump has not decreased. His eye is totally bloodshot. They told me the lump is Osteomyelitis and the anitbiotics should make it go away. Do you have any idea how long it will take? Can’t they put a needle in to drain something? Is there anything else I can do?? Thank you!!

  102. Doc says:

    Hello, Terri,

    Osteomyelitis is infection in the hard structure of the bone itself. Even when culture has identified the correct antibiotic, and you have selected an antibiotic that DOES get into bone (many do not), it will take a long time (weeks) for the bone to get back to normal. After the infection is controlled, the bone will have to remodel, which is a slow process.

    It is not like an abscess in soft tissue. Here you have sort of a “balloon” full of pus that can be drained. The bone is a different situation.

    Keep your veterinarian informed of your dog’s progress. I suspect that they will want to recheck every couple of weeks, and I would recommend that.

    Good luck.

  103. Kelly says:

    my tea cup pom ; has had teeth pulled and after wards started sneeezing blood and all stuffed up and wouldnt eat ; I have to feed her thru a syringe..the vet knocked her back out and xrayed and said no infection nothing wrong seems to be a little fluid but she hasnt eated in two weeks I feed her and everytime after she eats her nose bleeds ..I bought her to another vet and htey gave her antihistamines to try and dry her nose up..she cant smell so she wont eat …I have no idea what to do with her..she doesnt seem to be in pain all off a sudden she sneezes like a machine gun and spews blood …I am at a loss …help

  104. Doc says:

    Hello, Kelly,

    It sounds like you need to see a veterinarian who is a dental specialist. They can usually take better X-rays of the mouth and nasal cavities.

    I would be worried about a communication between the mouth and the nasal passages. I would also be worried about some type of problem that started in the nasal passages, like a foreign object, or a tumor.

    If the upper canine teeth (fangs) were removed, their root goes almost into the nasal passages in a normal dog. A diseased tooth frequently has a communication there.

    This can require cleaning out the socket and filling it with synthetic bone-graft material like Consil, before closing with a gum flap.

    Talk with your veterinarian about this and ask if there is a veterinary dental specialist that he/she can refer you to.

    Good luck.

  105. pamela zimmerman says:

    thanks so much for posting this. I am struggling with my 10yo Chessie mix’s obviously abscessed teeth. the information you gave made me feel more informed and encouraged me to call my vet again and talk more. We are scheduled for surgery in a few days…and though i am still scared and quite upset about it, i feel at peace with my decision. I am hopeful again. thank you

  106. Julia says:

    I just want to tell you THANK YOU for posting this article and for so graciously answering everyone’s many questions. My Jack Russell is in surgery right now to extract an abcessed carnassial tooth. She had developed a small hard bump below her eye. I had no idea what it was so I did what I usually do to find information… google it! I came across your article which described her symptoms exactly. I took her straight to the vet and yes… an abcess. Thanks again for sharing your knowledge and expertise!

  107. JuliB says:

    My 7 y.o. miniature pinscher Penni has something that looks like this. However the vet said he didn’t see any abscess when he looked, and that her teeth looked fine.

    They took fluid from the swelling, sent it out, and the white blood count was only slightly elevated. So, they said that it’s probably a cyst.

    Should I still be concerned? Could there be an abscess without it being seen? Should I go elsewhere and get dental xrays?

    Thanks so much!

  108. Doc says:

    Hello, JuliB,

    If this is a benign cyst, it may not require treatment (other than to have a better cosmetic appearance). If the dog is painful, then it probably does need more attention.

    If things get worse, you certainly need to let your doctor know about it.

    Dental X-rays would certainly give you more information, but your veterinarian may have information that lets us know it is not necessary at this time.

    Even if it just looks bad, you may want to have surgery done to improve the appearance. If surgery is done, be sure that a biopsy is sent to the pathologist to be sure of what you have removed: Did you get it all? What was it? Will it come back?

    Share your concerns with your veterinarian. When they don’t hear from you, they believe that everything is okay and that they have done a good job explaining things and answering your questions. If you need more information, let them know.

    Best wishes.

  109. Lester says:

    have a question if someone could help answer it? It will be very much appriciated.
    okay so i have a pomaranian and she is 11 yrs old and she has been having very bad teeth problems. I can tell that when i pet her around the face and mouth area, i see her take her pawns and smake at her mouth as if she is trying to put her far back teeth in place, like her teeth move around in the back of her mouth, and she has the worst of breath you cant even stand be around, and i also can tell she bleeds a lot in her mouth, like i know i need to do something about this pronto, but i honestly cant afford it but i cant keep watching her suffer, because even though she doesnt yelp i know she is still in pain. So i would really like to know if i can remove her teeth my self.? if so i would also like to know if i can step to step how too. please help. thanks

  110. Doc says:

    This is a tough situation. Even though the teeth are probably very loose, extracting them from an awake dog would be very difficult. They are already painful, and the dog will not appreciate you fiddling with them. I really don’t know how you could do very much good without sedating the dog for proper extractions. I wish I had a good answer for you, but I do not.

    I would contact my veterinarian for an estimate of what it would cost, and try to start setting aside a little each week to save up. It may not be as much as you are thinking.

    Good luck.

  111. Jackie says:

    Man, I wish you could see my dog…. I love you logical and common sense approach. My best friend Max mini white schnauzer has recently got some black stuff on the side of his lower jaw towards the back.. I thought it was dirt. 2 nights ago when he was pretty much calling it a night, he looked up and his lower jaw kind of made a clicking sound and it was shakey…. next day he was fine eat fine seem to drink extra water (might have been my imagination on the water) barked hello to people as we walked so I thought he was ok… then he started again last night same thing as the night before… tonight it really didn’t happen, but he is extra tired. I am on unemployment and it is not the $1000 a week unemployment… I just want to see someone that wont try to take advantage… I will come up with the $ to save his life and have him out of pain but if he need to he can eat soft food… I can only afford for him to be healthy and pain free no extra…. Do you have any advice for me possibly and are you in the state of WA by chance 🙂

    Thank you
    sorry I didn’t proof this

  112. Doc says:

    Hello, Jackie,

    I’m in southeast Missouri.

    I’m not really visualizing your problem very well. “Black stuff” on the side of his jaw is not giving me much definite to go on. Some dogs have black spots on their gums and it is normal. A melanoma (a type of malignant tumor) is usually black.

    It sounds like this is not an emergency, but something that does need to be looked at.

    Wish I could help more. See your veterinarian.

    Good luck.

  113. Catherine says:

    Hi Doctor, We have a female Cairn Terrier that we addopted as a rescue from a hoarders house. She suffers from dry eye which we have been treating with medications. However, it is not improving her tear production. Our vet has suggested tooth extraction as a way to improve her dry eye condition. Have you ever heard of this working for dry eye? Thanks, Catherine

  114. Doc says:

    Inflammation in the area could be contributing to the problem. If there is a diseased tooth, it needs to come out anyway.
    There is not generally a direct relationship between the teeth and tear production.
    I would suspect that you will still need to provide tear replacement therapy and continue the other dry-eye treatments, i.e. cyclosporine or tacrolimus, or even possibly pilocarpine.

    Good luck.

  115. Heather D. says:

    Ugh, now I feel just awful. I just got a call from our vet who was doing a dental on my 15 year old Bichon with breath that could peel wallpaper. One of his carnassials was cracked in half and abcessed. I don’t know how long it had been abcessed but I hate the thought of him hurting so much. This dog has been through the wringer. His first owner shot him full of buckshot (we’ve seen it on x-ray, including one lodged in the muscle of his heart), he has a collapsing trachea,and in the last 4 years he has had both ACLs repaired and two other dentals.
    If they are so good at hiding pain (which he was, for sure), then how can I tell earlier that there is a problem? It was his breath that made me take him in this time, even though his teeth looked pretty good overall.

  116. Doc says:

    Hello, Heather,
    I understand that you feel bad about missing the dog’s painful condition. On the other hand, you have taken care of many problems for this poor boy, and now you’ve taken care of this one, too.
    We just have to do the best we can, and that’s what you have been doing.
    Thanks for reading and writing.

  117. Adam says:

    My 19 years old Pomeranian has recently been diagnosed with a carnassial tooth abscess. It will require a surgery (that costs at least $800) to remove one or all the bad teeth and the vet thinks the success rate is only 50% because of his age. He is already blind and he usually sleeps the entire day, so I worry that he may not has an acceptable quality of life after the surgery and he may just go from one crisis to the next.

    Should I consider euthanasia instead of surgery?


    Shun Yuk

  118. Doc says:

    Hello, Adam,

    This is a terribly difficult question to answer, even when I have the patient in front of me… which I don’t.

    I can’t really assess your dog’s quality of life, much less what it would be if the tooth problem were resolved.

    I have seen painful dogs “come back to life” when the painful teeth were removed.

    On the other hand, at nineteen we have to realize that there can be lots of other problems coming on.

    The best we can hope for is to improve the quality of the life that remains to your friend. We know we are not going to add another 19 years.

    Discuss this further with your veterinarian. If your veterinarian is pessimistic about the outcome, you might also consider asking him/her to refer you to a dental specialist for further evaluation.

    Good luck.

  119. Sharon Pippin says:

    One of my older chihuahuas had this several months ago and just completed her 4th antibotic. Her eye looks whitish and has a lot of mucus in it,will it cause her to lose her eye? We have an appointment again next week. I keep mentioning the eye to my vet but he don’t seem concerned about it.

  120. Doc says:

    Hello, Sharon,

    It is very hard for me to tell you what is going on with your dog, since I cannot see it.

    I am concerned about your description, though.
    A “whitish eye with lots of mucus” sounds like it could be a dry eye. Tears have a watery part and a mucus part. If there isn’t enough of the watery part to keep the mucus dissolved, it globs up on the eye. A dry eye suffers damage to the cornea, because half the cornea’s nutrition must come from the tear film.

    This may or may not be related to the tooth problem, but it should be looked at just in and of itself.

    Also, if you have a tooth with a recurring abscess, it is very unlikely to heal with antibiotics. We always worry about anesthetizing older animals, but an abscessed tooth hurts all the time.

    If you veterinarian is not comfortable with performing the procedure, you might ask him/her for a referral to a dental specialist.

    Again, I could be completely misinterpreting what is going on. Long distance diagnosis is not very accurate sometimes.

    Share your concerns with your veterinarian again.

    Good luck.

  121. Nancy Step says:

    Hi Dr.
    I’m hoping you can help me. My 9 Y/O female lab who is in excellent health had a small growth removed from under her chin as well as a tooth cleaning. The vet informed me that one of her teeth (upper right)was broken and he removed it. At the time her right tear duct was draining. She was put on an antibiotic for the skin post op. The tear duct continued to drain after surgery and I was given antibiotic eye ointment to use which I did. After bringing her back numerous times, I was told that she may have a deep infection from the tooth that was broken and extracted and it is putting pressure on her tear duct. She was put under anesthesia to drain her tear duct and put on Clindamycin for 10 days. After that was finished her tear duct was still draining. I was told to use the antibiotic ointment but woke up one morning to my dog with a very swollen snout on the right side. I took her to the emergency vet and they told me that she has a huge abcess inside her gum (by the tooth that was extracted) and it is possible that a small fragment of tooth was still inside. I then took her to a dental specialist and he took an xray and he said her jaw is mottled and it does not look good. He is taking a biopsy and it may be oral cancer. Help! I am so upset at all of this and have no idea how this happened? Can this all be from an infection in her jaw?

  122. Doc says:

    Hello, Nancy,

    I think our best bet is to rely on the advice of the dental specialist.

    By “mottled”, I am assuming the specialist means that the appearance of the bone in the area is abnormal.

    If it is indeed cancer, I fear that we usually do not know the cause. I would doubt that it was related to the broken tooth. I cannot imagine how, really.

    The biopsy should tell you if this something treatable with medicine, or whether surgery or radiation therapy would be required.

    When the biopsy results come back, your dental specialist should be able to advise you as to your best options. He may refer you to an internist or oncologist (cancer specialist) if the biopsy shows cancer growth.

    Good luck.

  123. alice bastyr says:

    My dog has an abscess I think on his gum, we have no full time vet & they say only call if its an emergency. He has had a fever of 103 for 2 days. He is eating, not as much as normal, drinking, not throwing up & pooping fine, but not very active, he just turned 1 & weighs 75 lbs. Will it be OK until Monday or is it an emergency?

  124. Doc says:

    Hello, Alice,

    It’s pretty easy to make a mistake without seeing the dog. However, from your description, it sounds like Monday will be okay.

    If he is really painful, you could (short term only) give him regular strength Tylenol two or three times daily.

    If he has no other health problems, that should be safe for the two days.

    NO ibuprofen, NO Aleve. Serious risk of ulcers. Don’t pick random human meds without consulting your veterinarian, and the Tylenol is NOT for long term.

    Good luck.

  125. Karen Clark says:

    Hello, I am looking for some advice. I have an 11yr old shepard mix who about 6 months ago had his carnassial tooth removed after a massive overnight swelling appeared. Now, 6 months later, the same area under his eye has swollen once again. My vet says he has NEVER had to remove the other tooth in that area and being that my dog is almost 12, he really doesn’t want to put him under to take it out. We treated with Keflex but a week after the complete course of antiobiotics, the swelling is returning. He had a perfect full panel blood workup a few months ago and besides being moderately overweight, he is in great health. Your advice? I appreciate your time, thank you.

  126. tammy levanger says:

    Dear Doc,
    22 months ago, our chihuahua developed a small abcess under his right eye. His doc checked him out, was no obvious tooth infection and he was put on antibiotics. It took two courses, but the abcess healed…….for about 4 months. The doc xrayed his face on the right and saw something that warranted an exray on the left side of his face. The area appeared to be bilateral and since only the right eye has the abcess, a tooth was determined to not be the isse. The wound was flushed to remove any minute piece of debris that may have been lodged, and he was again put on antibiotics (stronger than before) and after two full rounds, the abcess cleared up…….for about 4 months. Additionally, a small abcess appeared under his left eye while the right side abcess grew until he is now oozing from two different areas, the biggest about 1/2 long. It no longer responds to an antibiotic, but the doc still does not think it is tooth related, wants to to a culture sensitivity test to see what bacteria we are up against and give a new type antibiotic. I told the doc that I really think it is teeth related, and wasnt it possible that both sides were infected, just the one side had not abcessed yet when the xray was done back when. Having 7 pets, I know my doc very well and we “verbally sparred” a little on this issue – she said in her 17 years she has never seen bilateral abcesses and suggested we consider a specialist. We have agreed to do the culture test, take a new antibiotic and the doc has finally agreed to xray him again in two weeks. I am so sure they will finally find the “root” of the problem. I’ll keep you posted, thank you so much for this article. It sounds exactly like poor Rico.

  127. Doc says:

    Hello, Karen,

    Sorry about the late reply. I was out of the country for two weeks visiting my daughter who is a Peace Corps volunteer in Zambia. We had not seen her for 17 months.

    It sounds to me like you need to see either a dental specialist, or a veterinarian who has dental X-ray capabilities. It certainly could be the other tooth. It could also be a different type of problem, even a tumor.

    Regardless, dental X-rays will probably be the best way to tell what is going on.

  128. Doc says:

    Hello, Tammy,

    Sorry to be so late in replying, but I have been out of the country for two weeks visiting my daughter. She is a Peace Corps Volunteer in Zambia, and we had not seen her for 17 months.

    I think that a culture and sensitivity is a great idea. If you continue to have problems, I think that the referral to a dental specialist would be the next best step. These doctors just have more experience with unusual problem cases, and often have a better insight into how to handle them.

    It is certainly possible to have bilateral tooth abscesses, so having both sides involved doesn’t rule out the teeth.

    It sounds like your doctor is being very thorough, but some cases are tough enough that they really benefit from a specialist’s expertise and equipment.

    Good luck.

  129. Lynda says:

    We have an 8 yr.old 130 lb GS
    who began yelping in pain when he would turn his head a certain way, or just lying on the floor, he would yelp.Doesn’t seem to bother him eating, drinking, etc. This is the third day for Rimdyl and Amoxie. He wouldn’t let the vet look in his mouth but when he pressed on the upper gum area and the dog yelped he told my husband that it probably was a tooth. Husband couldn’t remember which tooth. Said if the antibiotics didn’t help would probably be major surgery.Sound like the carnassial tooth?There’s no outer swelling showing.He doesn’t feel well.Any ideas?

  130. Doc says:

    Hello, Lynda,

    I hope that when the pain gets under control your dog will allow a better examination of his mouth.

    If not, I would certainly consider letting your veterinarian sedate him for a better exam.

    Also, there can be problems with the neck, a disc problem for instance. This is not so common in the GS, but still possible.

    I have seen one dog (in 33 years) that turned out to have meningitis. He didn’t want to move his head up, held it down, didn’t want to turn his head.

    Ideally, if the better examination does not reveal an obvious diagnosis, one would x-ray the mouth before removing that tooth. It is a fairly major procedure to remove that 3-rooted big tooth.

    It is often hard to nail down the area that is actually causing the pain.

    Keep your veterinarian informed about your dog’s response (or lack of response) to treatment. When we don’t hear from you, we assume it’s going great.

    Good luck.

  131. Carissa says:

    I took my chihuahua to the vet this morning and she has an abscess tooth. Her face was all swollen and once we got home it busted. Should I be really concerned as to how big the spot the puss is draining from is?

  132. Doc says:

    Hello, Carissa,

    You should call your veterinarian about this and let him/her know what happened.

    Until the tooth can be extracted, I would usually have the patient on antibiotics, and would be applying a hot compress for 10 to 15 minutes three times daily. I usually just run a pan of water as hot as I can stand to put my own hand in it. Then I soak a small towel and use that to apply the heat.

    Please let your veterinarian know what has happened. Since he/she has actually examined your dog, he/she is in a much better position to advise you.

    Good luck.

  133. Patricia says:

    I have a 7 yr old Golden Retriever who had a carnassial tooth extraction, right side in April. When the tooth was extracted the doctor told me he could only find 2 roots even though it has 3 roots. Since then i have noticed Simba has been rubbing his face on the right side and snores horribly at night. At night i also notice him breathing short rapid breaths and panting. The only relief i have found is putting him outside in the cold air, which seems to help open up the nasal passages. The vet has taken an x-ray of the chest and heart which came back normal. Could there be any link between the tooth extraction and the nasal congestion/ breathing/ panting. We have scheduled to see a internist next week, with hopes to find some answers.

  134. Doc says:

    Hello, Patricia,

    I hope you get some good info from the internist. I know that the dental specialists all tell me that if I cannot get good dental X-rays, it is possible that I am leaving something in there that will cause a problem.

    What you are describing sounds like more than I would expect from a root fragment still there, though.

    I’m glad you have the opportunity to see a specialist.

    Good luck.

  135. Lynette says:


    My 14 year old lab has an abcess. We took him to the vet yesterday at the first signs of swelling. We have him on 5 days of amoxicillin before his extraction. Is there anything I can do to ease his discomfort until then? His eye is almost swollen shut and he won’t stop panting. Poor guy is so miserable. Help!!

  136. Doc says:

    Hello, Lynette,

    Please let your veterinarian know what is going on. I am sure that he/she would be glad to prescribe pain medicine for your buddy. It sounds like he needs it.

    We often use NSAIDs like Rimadyl, but we also use other types of pain medicine, such as Tramadol, and even stronger opioids, if needed.

    Let your veterinarian know your concerns.

  137. Samantha says:

    Hi, my 11 year old malamute wouldn’t eat starting about a week ago. She’d approach the food interested & then turn away. I finally tried bread, which she did eat, but dropped several times out I’d what appeared to be pain. She the experienced a pretty severe round of diahrrea. Other food we got her to eat caused vomiting, while there is still some food like rice that she has kept down just fine. We took her to the vet & the only thing they could find was an abcessed carnnasial, but they are discounting that it could be the cause. She otherwise has good energy (especially for not eating) and is perky. The root is exposed & the gum slightly red & slightly swollen, but not horribly. I have been rather emotional in response to this and she has always been sensitive to my state, so my vet suspects some of this could be from that. Labs only reflected that she isn’t eating, otherwise pretty normal. Have you seen much vomiting & diarrhea with these infections? No fever either. Thanks!

  138. Doc says:

    Hello, Samantha,

    I would not expect vomiting and diarrhea with a bad tooth. The labwork makes it unlikely that this is a metabolic problem (bad kidneys, liver).

    There is a specific test for pancreatitis which can certainly cause these symptoms. Your veterinarian may already have checked this.

    With all those things being normal, I would think that the next step would be some imaging, X-rays and ultrasound.

    Dogs sometimes eat things that they can’t digest or pass, causing blockages or other types of intestinal or stomach damage.

    At eleven years of age, you could also be dealing with some type of tumor or perhaps an inflammatory bowel disease problem.

    Antibiotics and pain medications should help if it’s the tooth, but they might contribute to nausea if the problem is elsewhere.

    This is a difficult case, so be sure to let your veterinarian know what is happening with your dog, and discuss your concerns with him/her.

    Good luck.

  139. Nick says:

    Hi Dr,
    I have a quick question. I just got a dog last Friday (6 year old French Bulldog) and I noticed he had awful breath so I took him to my local vet today. They diagnosed him as having 3-4 abscessed teeth. Their recommendation was an overall cleaning and extraction of the bad teeth. His breath is just so awful so the diagnosis is believable, and she showed me how she could actually move one of this teeth back and forth. I have one question though that doesn’t make sense to me.

    He has no problem, that I see, eating dog biscuits or bones. He finishes them and seems to enjoy himself. Is it possible for him to have abscessed teeth but not be in obvious discomfort?

    At this point I’m planning on trusting my local vet as they have an extremely good local reputation but it doesn’t make sense to me from what I’ve read that abscessed teeth are supposed to be painful. Thanks

  140. Doc says:

    Hello, Nick,
    I absolutely get what you are saying. Think Tom Hanks in “Castaway” knocking his tooth out with an ice skate.

    Be that as it may, I have seen numerous dogs make a significant improvement in their overall attitude after getting rid of bad teeth.

    They may not clutch their mouth in pain, but that doesn’t mean they don’t feel it. As for not eating, their other choice is starving to death, so they eat.

    You will be glad you took care of your buddy.

    Best wishes.

  141. Andrea says:

    My dog is a 15 year old staffordshire bull terrier. She already had surgery on the lump on her upper gums. She had chewed it and it bled. The dr supposedly removed it, but it came back. She was on steroids and antibiotics to help make it get smaller, which hasn’t happened. What are my next options

  142. Doc says:

    Hello, Andrea,

    Ask your doctor if he/she is able to take good dental X-rays. If not, ask if there is a dental specialist they can refer you to.

    I am worried about a possible cancerous growth from your description.

    Your veterinarian is better able to advise you than I am, as he/she is actually seeing your dog.

    However, general practitioners like myself often need the services of a specialist when our treatments are not working as well as we would like.

    Good luck.

  143. Bobbi Casper says:

    My 7 year-old male cat had two teeth pulled two days ago. One of them was the Carnassial molar. Right after the molar was pulled, he started sneezing and his right eye (on the same side as the extraction)teared. Could he have developed an after-the-fact infection after the surgery or some kind of root possible still left in his gum is causing further problems? Thank anyone who may have an answer?

  144. Andrea says:

    HI dr,

    Youwereo n the money about my dog Trouble. She has malanoma. The vet said she would possible need surgery and it would involve removing bone. Possible radiation. We don;t know if it has hit other organs though. 2 vets said to me that she has a lot of lfe left in her as in years, but that was before the cancer. What are your sugestions. Will radiation be too much on a 15 year old dog and the surgery? It takes her 3 days to seriosuly be back to normal. She has had many surgeries in her life for mass cells tumors since 2000, but I am guessing this is a different cancer. If you were tosee her, you would not know she is 15.

    thanks for your earlier response too, as you were right on the money.

  145. Doc says:

    Hello, Bobbi Casper,

    If you have not yet informed your veterinarian of this complication, please do so as soon as practical. If you don’t tell him/her, they think everything is okay.

    If the signs do not improve rapidly with treatment, good dental x-rays may be necessary to determine the source of the problem.

    Good luck.

  146. Doc says:

    Hello again, Andrea,

    I am sorry to hear that I was right about this being a cancerous growth.

    I am no cancer specialist, but oral melanomas are bad news. I could not speculate as to possibility of cure, but my own limited experience has been poor.

    This is a case where consulting with a veterinary oncologist (cancer specialist) would be really important.

  147. Andrea says:

    HI Dr,

    We talked 2x recently about my dog Trouble with malanoma. On Wednesday my best freind and companion had to go to doggie heaven. My vet agreed that it was time. Everything you said was correct and I am at peace with letting my TROUBLE go. Thank you hor helping others on the internet. Your responses were always expedient. Keep helping others. Thank you again.

  148. Doc says:

    Hello, Andrea,

    I am sorry to hear about your loss. Melanoma is bad news. I hope that the memories of good times with your buddy will eventually fill the void of the loss.

    Best wishes.

  149. rebecca says:

    my 13 year old Yorkie had a swollen eye on Sunday. I took her to the vet last night. he says she has abscessed tooth and wants to extract it. otherwise she is very healthy little dog. I’m worried about her having surgery at 13 years old. I’m also concerned how the extraction will impact her after words. any words of advice?

  150. Staci says:

    We just found out our seven year old Llasa mix broke tooth #108. We were given the option to root canal or to pull the tooth depending on what the x-rays reveal. What are questions we can ask the anestesiologist to inform ourselves that she has the best treatment since this is the most dangerous part of the procedure? Thank You

  151. Doc says:

    Hello, Rebecca,

    If she is otherwise healthy, then we would hope that her risk factors would be small. Certainly we worry about her age, but we also would worry about her being in constant pain.

    If she has an abscessed tooth that is making her eye swell, then I can assure you that she is in constant pain.

    Your veterinarian can do some pre-op testing to check to see if there are any unusual risk factors for anesthesia. When these area detected ahead of time, one can often do things to compensate for them, and reduce the overall risk.

    As far as after-effects, she won’t miss the tooth, and she certainly won’t miss the pain.

    Recovery is usually rapid.

    Good luck.

  152. Doc says:

    Hello, Staci,

    I think that the anesthesia would be similar for either procedure. Extraction would require a gingival flap (lifting the gums away from the tooth) and cutting the tooth into sections for removal of the three individual root sections.

    Root canal therapy requires some time in placing the files and repeating the x-rays. It is more expensive, but of course, it saves the tooth.

    I would ask the anesthesiologist about pre-operative testing for anesthetic risk factors, such as bloodwork, chest-x-rays, electrocardiogram, and so forth. If an unsuspected problem is found, it can often be compensated for.

    Good luck.

  153. Patricia says:

    I am babysitting a dog right now and within the hour I noticed probably a quarter shaped bump under her right eye. Seems to be ok just sleeping like normal and lets me touch it. About an hour later it wasn’t sticking out as high but seemed to go down but bigger. The owner is picking her up in the morning like scheduled just wanted to make sure I shouldn’t call her now or anything I can do now.

  154. Doc says:

    Hello, Patricia,

    This doesn’t sound like an emergency if the is not apparently in pain.

    Have you looked in the mouth to see if something is just stuck between her cheek and gum?

    Good luck.

  155. Simone Anne says:

    Hello! Just wondering if it’s necessary to pull the tooth if the dog isn’t in pain. Does this lead to other health risks? What about the risk to a small dog who is thirteen for going under anesthesia? We are worried that the wrong dosage/a bad day/the recovery time could hurt her worse. Is that crazy? Thanks for all of your help! 😀

  156. Doc says:

    Hello, Simone Anne,

    We always are more concerned about anesthesia with older pets. It is a good idea to do some pre-anesthetic risk factor testing: blood chemistries, chest X-ray, possibly an electrocardiogram.

    Most dogs can be safely anesthetized, even those that are old and sick. There are always risks, though. If anesthesia were good for you, you wouldn’t lose consciousness.

    If your veterinarian isn’t comfortable with it, ask for referral to a dental specialist.

    It’s pretty hard for you to tell how much pain the dog is in. If there is an abscessed tooth, I guarantee that it hurts all the time. Ask any person who has ever had one.

    What we frequently see after tooth extraction is a client who finds the dog playing more, “acting younger”, etc. They aren’t hurting now.

    You have to weigh anesthetic risks (which may not be that bad – find out with the tests) against constant pain for the rest of the dog’s life.

    Tough call, but did you ever see the Tom Hanks movie “Castaway”? His tooth hurts so badly that he knocks it out with an ice skate.

    Good luck.

  157. dentist says:

    I guess I wouldn’t be cranky either, if a constant cause of pain is taken out by the dentist! My pet Daschund has a sore tooth I can’t get near to because he always snarls me out of the way.

  158. Sally says:

    Hi Dr.,
    I have a 2 year old mixed breed who recently developed a marble-sized bump underneath his left eye. I initially assumed it was just a bruise or a “goose egg” type thing, but after playing outside with the tennis ball a couple of times, the bump would swell in size, become less round and even droop a little. Despite the swelling it never felt soft to touch and always went away by the end of the day, but went back to the initial size.
    After taking him to the vet a few days ago, she said said it was most likely an abscess tooth because it is painful (he yelped when she examined him but always seemed fine with me touching the bump!) and the swelling seems to go up with activity. She prescribed 2 weeks worth of Chlemycidin and Tremodol and we’re trying to avoid the tennis ball for a while to see if that will reduce some of the irritation and swelling.
    His mood and energy level are normal even though his is generally low-energy for a young dog, he eats dry food with no problem, and I am sure he would continue to play with the ball if I let him.
    He is due back to the vet in two weeks, but the bump seems to be slowly getting bigger. I am worried by the fact that he has an abscess tooth at such a young age and that it might be indicative of more underlying dental issues. If the swelling continues despite antiobiotics should I seek a specialist before taking him back to the regular vet before then end of two weeks?

  159. Doc says:

    Hello, Sally,

    If the antibiotics are not working, then we would suspect either an abscessed tooth, or some type of foreign object causing the infection.

    Ideally, the next step would be dental X-rays under anesthesia. This determines for sure whether it is a tooth (as well as which tooth it is).

    I suspect that this will need either surgical tooth extraction, or surgical exploration and drainage (if a foreign body).

    The fact that he continues to eat does not mean that he has no pain. It means he doesn’t want to starve to death.

    Share your concerns with your veterinarian. If she feels that your dog should be seen by a specialist, then ask her to recommend one that she trusts.

    Good luck.

  160. Gauge says:

    I wonder if anyone can give me any insight into my dog. I have a 5 year old min pin who, last August, developed a minor swelling under his eye. We went through several therapies, including eye drops and several rounds of antibiotics before it was decided his 4th premolar root was abscessed. That was removed in December of last year. The swelling never went away. We switched vets and in January the new vet found 3 pieces of root the original vet did not get removed.

    Finally the swelling went away after that surgery. For about 2 weeks, anyway. 2nd vet did yet another surgery and found no reason for the continued swelling except that only 2 of the 3 root channels had healed over. Again, after draining, the swelling subsided for a good while.

    But yet again, the swelling is back. My dog doesn’t seem to be in any kind of discomfort, but I know it cannot feel good to have a marble sized lump under his eye.

    What the heck is going on? Everything I’ve read says that removing that tooth should have taken care of everything. I’m getting very frustrated and I’m sure my dog would like to be normal again.

  161. Doc says:

    Hello, Gauge,

    This should be X-rayed by someone who has good dental X-ray equipment, not just taking some whole-head skull X-ray.

    If your veterinarian can refer you to a dental specialist, that is what I would recommend.

    This could be anything from retained root fragments, to a different tooth involved, to a growth that needs to be biopsied.

    Good luck.

  162. Dentist Sydney City says:

    It really is surprising sometimes how much a small detail can change someone or something’s entire personality. I’m actually a little impressed Tinkerbelle pulled through the procedure at her age.

  163. Doc says:

    While all anesthetic procedures involve an element of risk, with modern methods and monitoring we are able to do some pretty long and involved procedures on some fairly frail patients.

    Pain on a constant basis might be considered more than a small detail.

    Thanks for reading and writing.

  164. Sophie says:


    I wonder if anyone can please help me with regard to a small raised area under my 4-yr old dog’s eye? Having read all these messages about swellings under eyes and tooth absesses, I am wondering if it’s connected. My dog seems 100% herself, eats everything normally, plays happily, chases balls, carries sticks home that she finds on walks and is showing no ill-effects whatsoever. Now and again she’ll rub her eye/that side of her face on the carpet and presumably it itches at times. I put Sudocrem cream on it to keep it clean. I have a picture I took today and I don’t know if you can see it, if so, what do you think please? I am in the UK. THANK YOU, Sophie

  165. Doc says:

    Hello, Sophie,

    This could be a skin tumor, an inflammatory reaction to a bug bite, a skin infection, or a lesion related to an abscessed tooth.

    Your veterinarian can perform cytology examinations both by lifting surface cells and by aspirating (sucking) with a needle. The cells then are looked at under the microscope.

    If these are inconclusive, dental X-rays may be needed to determine if this is an abscessed tooth root (and which tooth is involved).

    You really need to see your veterinarian to sort this out.

    Good luck.

  166. reanna says:

    Hi, my dog has the canassial abscess but the tooth has already fallen out on its own, but now has the abscess under her eye. What does that mean and what do i do?

  167. Doc says:

    Hello, Reanna,

    It is possible that the infected tract in the bone needs to be cleaned out under anesthesia. It is possible that the abscess is actually related to the root of a different tooth that is still there. It is possible that this problem is some other type of problem: a foreign body, or even a tumor.

    This should be seen by your veterinarian and X-rayed to determine what is going on.

    Good luck.

  168. Nichole Gaddis says:

    I believe my 10 year old American Staff has a carnassial tooth abscess. We will be taking him to the vet this week. Before he gets to the vet is there anything we can do to make him more comfortable?


  169. Doc says:

    Hello, Nichole,

    You should call your veterinarian about this. He/she can dispense pain medication ahead of time.

    He/she may recommend an over the counter pain reliever, but many of these are unsafe for dogs. Please don’t just pick something out of the medicine cabinet.

    Best wishes.

  170. Kathi says:

    Thank you for your blog. My 14 year old Bordercollie/Aussie is scheduled for surgery tomorrow morning for an abscess… I now realize I do have to treat this. I hoped I could just use Clindomycin but I now realize that is not the answer. The swelling is gone but not the abscess. Thank you …

  171. Doc says:

    Hello, Kathi,

    While we always offer pre-operative risk factor testing, many clients are financially stretched already and cannot afford the extra expense.

    The benefit of the testing is finding some factor that may affect the way the patient reacts to anesthesia. If you know about it ahead of time, you can be more prepared, or take extra precautions (I.V. fluids, other medications), or use a different type of anesthesia.

    In some of these cases, we just try to take as many precautions as possible, keeping our anesthetic light, and using local anesthetic to control the pain of the procedure.

    While I would offer the option of testing for a fourteen-years-old dog, your veterinarian has actually seen your dog and knows the medical conditions.

    If you have concerns, share those with your doctor, and ask for more explanation about the anesthetic plan.

    Anesthesia is always serious, but with the more modern drugs and monitoring equipment we are usually able to treat the patient successfully. We have done some major procedures on some really old, really sick patients.

    Best wishes for you and your pet.

  172. Nora says:

    My 13 year old Great Pyranese is a rescue. She was severely abused and does not allow new people around her. I haven’t taken her to the vet for this tooth problem. When she is picking at the gum it bleeds and I deal with it by feeding her eggs (scrambled no milk); boiled rice with a little hamburg. I believe there is an infection now as she is lethargic for the last two days as she has been ripping at the tooth and bleeding. I have been giving her warm water to drink instead of cold. Can you let me know what type of antibiotic would assist with the infection treatment.

  173. Doc says:

    Hello, Nora,

    Most antibiotics do not penetrate into bony areas like infected tooth sockets. There are some that should, but I really cannot prescribe medications for animals I have not seen.

    Your dog really needs to see her veterinarian. The tooth may be broken, as well as abscessed. Antibiotics might help reduce the level of infection, but they won’t remove the pain.

  174. Kim Gorman says:

    Thank you for this excellent, informative blog. We have an 18 1/2 year old 21-pound terrier mix with a bad canine tooth. (Won’t let us touch her gum, swollen gum area above tooth and black demarcation line on tooth at gum level.) We had her on clindamycin drops for one year, since our vet was very hesitant to put her under again. The clindamycin makes her sneeze and causes her to have tremendous nose bleeds, which she hasn’t had in the past month since switching to Baytril. My question is: will Baytril take care of an abscess? We hate to go through the constant vigilance of watching her sneeze and bleed on the clindamycin. Thanks so much!

  175. Doc says:

    Hello, Kim,

    This is a tough situation. I’m glad that she isn’t having side-effects with the Baytril. I suspect that the initial choice of clindamycin is because of how well it distributes into the actual bony tissues. Most antibiotics don’t do that very well.

    The sneezing and bleeding are something I’ve not encountered with clindamycin myself. Very unusual.

    The problem with antibiotics and abscesses is that they can’t really get into the middle of the abscess pocket to destroy all bacterial life there. So things calm down, but the “seed” remains, and the problem keeps percolating.

    You might ask your doctor for referral to a dental specialist. He/she may not have better anesthesia capability (or they may), but they are likely to be much quicker in performing the needed procedures, intra-oral X-ray and extraction.

  176. Lori says:

    I have a 16 and half year old pomeranian he has the drainage under his eyes it has actually reached the point o where it started bleeding. He is kind of frail because of his age, He has lost a lot of weight, would a vet be able to pull his carnisal teeth safely with out my dog dying.

  177. Doc says:

    Hello, Lori,

    You need to start by taking your buddy to see your veterinarian. He can evaluate your pet’s ability to handle anesthesia.

    With our modern anesthetics and careful monitoring, we can usually handle these successfully.

  178. Madeleine Gsell says:


    A few weeks ago we noticed my dog wasn’t eating and acting very sluggish and not normal. We then found an abscess around one of his teeth and 2 days later in the middle of the night he started breathing really heavy and wining and it seemed as if he was struggling to breathe. Within an hour or so he died. I was wondering if that could have been the cause of his death? The abscess? If so how does the abscess lead to death? How long do you think it was there for it to eventually kill him? And also what causes a tooth abscess in dogs? Thanks for your time.

  179. Doc says:


    Teeth usually develop abscesses because of some injury to the enamel. This allows bacteria to invade the tooth. Sometimes a broken tooth is obvious, but the crack can be almost microscopic and still allow bacteria to invade.

    I cannot tell you exactly how long it takes an abscess to develop, as we usually don’t know when the injury to the tooth occurred.

    I think it is very unlikely that the tooth abscess was the cause of your dog’s death.

    I am sorry that I am unable to offer you closure in this.

  180. Gagi says:

    Hey Doc,

    Great info above. My 9 yr old just had 2 teeth removed, one abscessed, the other cracked. The abscessed tooth was like pic 1, where it was swollen under her eye and drained from her gums. During the surgery they flushed it out and the swelling went down. When we picked her up, the area was swollen again. The vet was a bit confused but gave us antibiotics, pain meds and anti inflams for her. After the meds, she still had the swelling and it was draining again from her mouth (at times if it got really big it would drain clear fluid but it was majority of the time it was blood). The vet gave her a dose of strong antibiotics for 1 week to see if it helped as he thought that the abscess caused a pocket of inection, it didn’t so we brought her back in to open her cheek and remove any infection. When he opened her cheek, he did not see any infection but thick tissue so he removed it and left an open incision to allow it to drain. 3 days later (today) and the incision closed and her cheek is swollen again with drainage from her gum. The vet suggested to place a drainage tube in her cheek for a week and if that doesn’t work to remove all of the tissue. I would greatly appreciate any feedback you may have. I hate that my senior is going through this, she is in overall good health and her energy level hasn’t been down at all through any of this.

  181. doc says:

    Hello, Gagi,

    At this point, dental X-rays need to be done, if they haven’t been done already. If your veterinarian doesn’t have this capacity, ask for a referral to someone who does a lot of dog dentistry.

    An X-ray could show that another tooth is also diseased and the source of the problem. It also could show bone destruction with an abscess.

    If there are no other diseased teeth, then I suspect that more surgery will be needed to clean out the area, as your veterinarian suggested. At this time, you would want a biopsy to be sure that there is no cancerous growth in the area.

    There are some really good veterinary dental specialists out there, and if your veterinarian knows one, he might recommend referral.

    I am more than a little handicapped in advising you, as I have not seen your dog, nor do I know exactly what your veterinarian has done.

    It sounds like he has done everything right up to this point. Just talk with him about your alternatives. Let him know you still have questions.

    Best wishes.

  182. Lisa says:

    Hi Doc,
    My 9yr old black lab had 5 teeth removed just over a week ago. The carnassial teeth you talk about – on both sides as well as 3 others that were bad. It started with the abscess and swelling under the eye. But still the swelling remains. They switched his antibiotics to one that would penetrate better. He’s been on that for 5 days and no change. The bleeding in the tooth socket stopped then started again. He’s got a follow up appt next week. But wondering why the swelling won’t go away. The vet did mention they weren’t able to properly drain the abscess. I’m worried for more surgery….. help

  183. doc says:

    Hello, Lisa,

    I’m no dental specialist, but I know what they would say. They would say that you need some really good dental X-rays now.

    We would be worried about a retained root fragment, another tooth bad in the area, and possibly some other disease process.

    In a dog this young, you wouldn’t be thinking about a tumor, but it’s possible. It is also possible to have a foreign object that has penetrated to the area.

    Sometimes an abscess in the bony tissue has to be scraped out until you reach healthy tissue. You would culture the area while doing the surgery.

    It really could be something as simple as a tiny bit of tooth root that got left behind, or just another bad tooth in the area.

    If your follow-up appointment is not until next week, I would certainly call your veterinarian to let him know what is happening. If they don’t hear from you, they think everything is going well. They may want you to come in sooner for re-evaluation.

    If your veterinarian is not happy with the way things are going, then he/she may suggest referral to a dental specialist.

    Without seeing your dog, I really cannot give you very good specific advice. Please let your veterinarian know your concerns, and give them a chance to help.

  184. Erika says:

    Hi there, I just found your blog while doing a Google search. My 9-year-old Labrador just had a carnassial tooth extraction done today by my vet. It wasn’t abscessed, but it was cracked and half of it was coming off.

    I buy her raw marrow bones to chew on and I had just given her one on Saturday. I’m pretty sure she cracked the tooth on that sucker. Luckily, I poke around in her mouth pretty often, so I noticed this right away.

    I know this post is from 2007, but I just had to comment on pricing — I just paid $625 for one extraction (plus pre-anesthetic blood work, the anesthesia, etc)! Sounds like your client’s dog had a way worse situation; can’t believe it was only (to me) $400! LOL, I guess price is so relative.

    Anyway, I noticed a little while ago that my dog had some bleeding going on and I freaked a little and called our local e-vet (since it is 11 pm) who said it is normal. Keeping on eye on her. :/

  185. doc says:

    Hello, Erika,

    Too many unknown factors to make any kind of price comparisons. “Apples and oranges”, you know.

    The dental specialist’s rule on chew-stuff is “If you wouldn’t hit yourself in the kneecap with it, don’t give it to the dog to chew on.”

    The big bone comes under that category. We see lots of dogs with slabs fractured off the side of that tooth, and the pulp exposed.

    I’ll bet everything will soon be fine. Just keep your veterinarian informed as to what’s going on with your dog. If he/she doesn’t hear from you, they suppose that all is well. They also don’t mind hearing from you when all is indeed well.

    Best wishes.

  186. Cathy says:

    I have a 4lb Chi and he had swelling under his eye, so the vet removed several teeth and the swelling under his eye went down, but then a few days later he developed a lump along his jaw line. I at first thought it was a tumor, but it was not attached to the jaw bone. The vet gave antibiotics, and we watched it. It did go down and then formed an abscess. It started draining last night. Could this be from the tooth extraction, and what should be done now?

  187. doc says:

    Hello, Cathy,

    I really cannot say what has caused the abscess. However, since it is there, it needs to be opened for adequate drainage, flushed to remove debris. It is possible that a change of antibiotic will be necessary. Warm compresses will help until you can get him back to the veterinarian, which you should do as soon as possible.

    Run a pan of water as warm as you can keep your own hand in it. Use a cloth to put moist heat on the area for 10 to 15 minutes three times daily. This increases blood circulation to the area, promoting healing, and helps it drain.

    Do take him back to the veterinarian as soon as you can.

  188. cc wilson says:

    My 8yr old english springer has what we an abscessed tooth but arent sure. We looked at it and it is in the back top of her mouth by her molars. It oozed thick white pus when my husband touched it. Her whole left side of her face is swollen and its worse by her eye. Her eye is barely open. It has gotten so bad her mouth randomly bleeds and two of the teeth have fallen out near her big molar in the very back and she is slowly oozing pus like stuff and blood from her nosteral on the same side. We have called many vets but they all want way too much up front. We just moved before this all came about. We have for kids a lot of bills and expenses for us to even get by. Can not afford to put money aside each we never have money left. What is going on and what can we dofor her. Please help. We have had her since she was born.

  189. doc says:

    Hello, CC,

    I wish I had a home remedy for you, but this is a serious medical condition. Your dog needs oral surgery, and there just isn’t a shortcut here.

    Warm compresses may help drainage, and cool compresses may help with the discomfort.

  190. Irina says:

    Hi, I’m hoping for some advice. I have a 5-month old cocker spaniel and she is teething. She has an abscess on one of her back teeth on the lower jaw. I am taking her to the vet tomorrow. We’ve been already once and she took CLyndamycin for 7 days which did nothing. She doesn’t seem to be in pain. Eats fine. Is it possible that this was caused by her baby tooth not coming out right? I’m hoping she doesn’t have to lose an adult tooth. I have no experience with this vet I am taking her to tomorrow. How urgent is to have a surgery if it is an abscessed tooth? Can it wait 5 days? Since she’s been off antibiotics it hasn’t gotten worse. Thanks for advice and for your blog in general. It is very helpful.

  191. Doc says:

    Hello, Irina,

    It would certainly be unusual to have an abscessed tooth in such a young dog. Of course, if a tooth gets cracked, that usually leads to an abscess.

    It is certainly possible that a retained baby tooth is causing problems. That would be the simplest thing to deal with, generally.

    If you really have an abscessed tooth, then it would be painful for the dog. Five days may or may not make a difference in how severe the abscess becomes. It is possible for it to damage more areas of bone as it goes along.

    I am curious as to how the diagnosis of abscessed tooth was made.

    Does the tooth look bad? Is there drainage in the mouth? Drainage from a facial wound? Dental X-rays?

  192. Irina says:

    Sorry, I re-read what I wrote and realized that was misleading – she wasn’t diagnosed to have an abscessed tooth. They don’t know what it is yet. I was looking at all the pictures, and that is what it looks like – there is a large pocket of “stuff” that looks like puss and the area looks very inflamed (I can try to take a picture but don’t know how to send it to you. Nothing has drained so far. So today I took her to a different vet who couldn’t diagnose it. Referred me to yet another vet for x-rays and diagnosis. I understand that Maya (the puppy) has to have anesthesia for the x-rays. And overall I was given a $750 – 800 range if an extraction was necessary. Is there any other way to diagnose what is going on? They put her on a different antibiotic and some pain meds until she can see this board-certified vet that specializes on dental problems. There are only 3 in the state. Is this really so rare that only those vets can do it? Seems that maybe if they could drain the pus they could see what is under it. And if the x-rays are still necessary, then do them. Or does it never happen in that order? I doubt it is her adult tooth because none of those back teeth have come in yet. I’d appreciate any advice!

  193. Doc says:

    Hello, Irina,

    Regular X-ray machines do not take satisfactory pictures of the mouth. You really need specialized equipment to get meaningful images.

    There are veterinarians who are not specialists who do have dental X-ray capability.

    A dental X-ray would certainly be the best thing here, rather than just pulling teeth until you get the right one. It is also possible that the problem isn’t actually the tooth. You could even have a foreign object embedded in the mouth.

    My experience with the dental specialists is that they do charge more. However, they get it right the first time, and get the job done faster. Shorter anesthesia, less trauma, faster recovery.

    I also think that if they find it is something less major, they are not likely to put your dog through any unnecessary procedures.

  194. Ricki W. says:

    My dog is going through this currently. (or so its believed) she is a 13 year old black lab. It’s ridiculous how much we have to pay for it to be done. Roughly $1600. As my family is on the lower side of the middle class, we can not afford this and all the medication. It has left us with giving her antibiotics and crying over the ridiculous prices. Hopefully we can raise some money soon.

  195. Doc says:

    Hello, Ricki,

    $1,600 is the range the board certified veterinary dental specialist in Memphis, Tennessee would be charging for a root canal.

    Are you trying to save the tooth, or will it be extracted.

    Does your dog have a lot of other medical problems that will be complicating her anesthesia?

    I really cannot speak to costs for a patient I haven’t seen who may be in an area where the cost of operating a clinic is very high (like California).

    I would say that if you are contemplating root canal therapy, extraction would be much less complicated, and less costly. The dog can eat fine without that tooth, and that should eliminate the recurrence of the abscess.

  196. Lynne says:

    Hi Dr.
    I have a 17 year old Shitzu and tonight I was patting him and noticed he has a scap under his hair under his eye. I took a warm compress and clean it only to find a gaping whole which clearly shows his gums. I have an appointment with the vet tomorrow and they told me not to feed him. I don’t think my dog can go under and make it. What do you think is the best for a 17 year old shitzu? I am so afraid to lose him.
    Thank you

  197. Doc says:

    Hello, Lynne,
    I can appreciate your concern. If anesthesia were good for you, you wouldn’t lose consciousness.

    We always take any anesthetic procedure seriously, and certainly we have more concerns with an elderly patient.

    Having said that, modern anesthetics and monitoring equipment enable us to help even really, old sick dogs successfully. One can never say there is no risk, but the risk can be minimized.

    If your dog has an abscessed tooth that is draining on his face, I can guarantee you that it is causing constant pain.

    You should certainly at least let your veterinarian examine the dog.

    If the tooth does need to be extracted, the anesthesia can be kept very light, and the pain controlled with a local anesthetic numbing the area, just as your dentist would do for you. This makes it easier on the dog as your anesthesia is simply controlling the annoyance of someone in his mouth, rather than trying to stop pain.

    Share your concerns with your veterinarian.

  198. Michelle says:

    My dog formed an abscess under her eye. The vet did surgery to drain and remove the abscess under her eye on her face. Years later, she has developed a bad smell coming from her mouth that seem to go into her ears and eyes.. as both had pus coming from them. After a round of antibiotics and ear drops, all seemed to have cleared up. She had her teeth cleaned right after, I smelled infection once again coming from her mouth. Once again, her ears and eyes seem to be infected. I took her again to the vet, now another round of antibiotics. Vet says sinus infection which could be coming form tooth root? Can the infected tooth cause infection in eyes and ears? She is part fox terrier and rat terrier. Michelle

  199. Doc says:

    Hello, Michelle,

    I wouldn’t expect tooth problems to affect the ears, or to affect the eyes directly.

    The abscess under the eye is strongly suggestive of an abscessed tooth. If the tooth was not extracted, there is probably still an abscess there. This could account for the mouth odor.

    The abscess could penetrate into the sinuses. The bone is very thin between the tooth roots and the sinus or nasal passages in some places.

  200. Pam Metzger says:

    Hi Doc,
    My schnorkie, who I believe to be about 6.5 years old, had her right carnassial tooth removed about 6 weeks ago, and I have had her back to the vet to drain that darned sinus pocket drained twice. When he aspirates it, it looks like water-thinned blood, and he claims there is no infection, but he isn’t sure why it won’t clear up, as he normally sees it resolve itself. The last time I took her, it came back the next day. This time the vet told me he thinks maybe she needs to go to a vet dentist and that surgery will cost me 800-1000 dollars. Do you have any idea why this refuses to stop filling up?



  201. Doc says:

    Hello, Pam,

    I am by no means a dental specialist. I remove lots of these teeth, and so far without any complications like you describe.

    Certainly this area needs high quality dental X-rays and somebody with great expertise to view them. Since these must be taken under anesthesia, there is more cost than if you or I were having dental X-rays.

    I hope that the cost quoted also includes a treatment plan.

    In rare instances, you would need a C-T scan instead of just X-rays.

    I don’t want to second-guess your doctor. If he has already taken post-op X-rays, he would know whether there is a root-tip left, which could be a source of continuing problems.

    We have also seen dogs with tumors in this area.

    I hope that the dental specialist is able to resolve your problem quickly.

  202. Debbie says:

    Our 3 month old puppy had a lump under his armpit and the vet said it was an infected lymph node . The doctor said it could be a tooth or ear infection or he could have hit it. She put him on amoxicillin. But never looked in his mouth. Two days later I happened to look at my puppies mouth and in the top left side same side as the lymph node there is a black spot on his tooth . My question is…if it is an infection but it’s his baby tooth, would it have to be pulled or would they wait for it to come out?

  203. Doc says:

    Hello, Debbie,

    Your post is a little confusing. It’s hard for me to visualize a connection between his armpit and his teeth.

    If the baby tooth is damaged, it depends on what kind of damage it is as to whether it needs to be extracted, or just wait until it falls out.

    You don’t want the damaged baby tooth to interfere with the eruption of the permanent teeth.

    You should ask your veterinarian these questions, as he/she has actually seen your dog.

  204. Gisela Ellsworth says:

    13 year old Russell Terrier- clear discharge from right eye. No other symptoms – no swelling, no fever, eating & acting totally normal. Was put on 10 days of antibiotics plus eye drops. No change.
    Vet thinks could be tooth, no x-rays taken. Can it be something else?

  205. doc says:

    Hello, Gisela,

    It could certainly be something else, even a tumor in the eye socket.

    Dental X-rays would certainly be a good start. That would be where I would start.

    Veterinary ophthalmologists often use ultrasound to examine the eye and the socket area.

  206. Marie says:

    Hi Doctor, I’m so upset and don’t know what to do about my dog’s condition. He’s a 12+ year old chihuahua-mix, and because of bad lab work in the past (first elevated liver enzymes which are now back to normal) and now he is in renal failure again (he’s at the vet now for 3 days of IV fluids.) Last time he got out of it and felt much better afterwards/kidney values came back down.) He has a heart murmur, and along with the kidneys, they really don’t want to do anything with his teeth, which are pretty bad. I believe he has something going on with an upper back tooth, because for 3 days he kept reverse-sneezing, coughing, blowing through his nose, and drooling (usually after drinking water.) His left eye is running and his left nostril has a yellow discharge coming out of it. Right now he’s back at the vet and they’re giving him the fluids for the renal failure along with IV antibiotic. But what can be done for this bad tooth that probably now is affecting his eye and left sinus, infection could possibly even be eating right through to his nose? They can’t put him under, his heart and kidneys are the main reason. He still has a lot of life in him, loves to go for walks, eats (as long as I cut his food up into 1/2 inch pieces and cook for him.) I can’t put him to sleep, it’s not his time and he still has more living to do, it’s just something I know as his owner who happens to love him very, very much. If you’d see him, you’d never even know he’s in renal failure as of right now. He’s a “toughy”, if you know what I mean, and all he wants to do is stay here with me. WHAT can be done in this situation? Antibiotic treatment alone? Will his nose and eye always go back to draining/running because they can’t put him under to do any dental work on the main tooth that I suspect is causing the sneezing/eye running/drooling/nasal discharge? I am so desperate to help him, but I don’t know how. I’m not sure they would even attempt to do light sedation for dental X-rays alone. What could I do to keep it at least semi-under control? Cooking his food in Coconut oil? A pinch of garlic in his food? He won’t let me touch anywhere near his mouth, and vets are literally afraid of him because he’s so snippy when it comes to doing anything with his mouth. One vet even refuses to see him because of his behavior alone. But I love my boy and he loves me and I’ll do anything to help him, no matter how outrageous it may be. Please advise, any info would be greatly appreciated. Thanks so much.

  207. Doc says:

    Hello, Marie,
    This is obviously a very difficult case.

    Antibiotics may calm this down, but as long as there is a bad tooth, the problem won’t go away.

    My best recommendation would be to ask for referral to a dental specialist. A dental specialist will be able to X-ray and handle the problem much faster than a general practitioner. This minimizes the time under anesthesia.

    Many of them are associated with other specialists so that there can also be additional support with anesthetic choice and management.

  208. Sandy says:

    I have a 2 year old chiuaua and she has severe gingivitis. She has been to the vet several times. on strong anti biotics and had 3 teeth extracted. And the infection just keeps coming back. She is gaining weight. Has a healthy appetite. But once again, today I noticed her left side of her mouth is red and yellow pus coming out. I am making an app now to take her back to the vet. What could this be???

  209. Doc says:

    Hello, Sandy,
    I would be concerned about a different tooth being affected now. You could also have some sort of foreign object embedded in the gums. She is rather young, so I doubt it is a tumor.

    Good dental X-rays are what is needed next. If your veterinarian is not equipped for this, I would ask for a referral to someone who can get good pictures of the bone structure and tooth roots.

  210. Adriana says:

    Hello, My dog had that tooth extracted back in March of this year and in the last month the cheek has form another lump and is draining again. Is this possibly another tooth?

  211. Doc says:

    Hello, Adriana,

    It certainly could be another tooth, but could be some other sort of infection or problem.

    The best thing to do would be to let your veterinarian examine the area. He may put a needle into it to get cells for examination. Probably he/she will need to take dental/oral X-rays to evaluate it.

  212. Steve says:

    Our 12 year old Golden Retriever, Eddie, had his upper 4th pre-molar/Carnassial tooth extracted yesterday. The Vet showed us before & after x-rays that showed the infected tooth and then the film with the complete tooth & roots removed. He also gave us the tooth. My question is Eddie has a lot of facial swelling. He didn’t after the procedure, but some swelling developed before we left the Vet. The Vet didn’t seem concerned with it, and rechecked his mouth, but I can’t find anything saying this is a common post-op occurance. He gave us antibiotics as well as pain meds. Is it uncommon to have swelling on the affected side of the extraction & when should it go down? Thank you

  213. Doc says:

    Hello, Steve,

    This type of post-operative swelling is unusual in my experience.

    If this persists, you should certainly have your dog rechecked by the doctor.

    He may have you start using cool or warm compresses for the swelling. Cool is used early after an injury, as it slows leakage from blood vessels. Heat is used later as it increases circulation to speed healing. You don’t want to increase the circulation while something is still leaking, which is why we use cool compresses in the early stages of recovery.

    Let your veterinarian know how your dog is progressing.

  214. Tracie Washington says:

    Hello Dr.

    I found your blog researching my dog child abscess.

    Spike is a 15 year old chauauaha. He got his first abscess in November 2015. I took him to his he has a Carnassial Tooth Abscess and possibly has a heart murmur and would need an EKG to verify and see if surgery is an option. Till EKG can be scheduled he was given antibiotics.
    I paid $350 for EKG which verified that he has a heart murmur. I was advised that he possibly would not survive surgery. The alternative to surgery is antibiotics 2 weeks on and 2 weeks off and frequent checkups.
    I went for a second opinion and was given the same treatment and diagnosis.
    His condition is getting worse he has had 3 abscess episodes since and Spike has cut the abscess under his eye and know has a gash that has healed over twice. I am treating and cleaning the area to prevent infection. I know my Spike cant take much more of this. Are there any other options other then euthanasia.

    Thank you for your time regarding this matter.

  215. Doc says:

    Hello, Tracie,
    A heart murmur is a noise. The ECG can’t tell you anything about a noise. The ECG evaluates heart function and damage by examining the electrical conduction of the impulses that cause the heart muscle to contract. It is an important tool, but tells you nothing about the murmur.

    A murmur is a noise caused by a malfunctioning heart valve (or valves). It can be a mild defect in a valve that doesn’t affect function, or it can represent a severe change in the heart. Chest X-rays will help to evaluate whether the heart is enlarged (weak and flabby – bad) and whether the lungs are clear (good) or congested with fluid (bad) due to poor heart function.

    An echocardiogram (ultrasound) is the best way to evaluate heart function, which is what you are interested in, with reference to the dog’s ability to withstand anesthesia.

    There is no question that a fifteen years old dog has greater risks with anesthesia than a younger dog, with or without a heart murmur.

    The tooth will never get well or stop hurting without extraction or a root canal treatment.

    Ask for referral to a veterinary dental specialist.

  216. Kelly says:

    Hi Dr.

    I have a 16 year old Maltese with cushings, high BP, a clotting disorder, and very bad teeth.

    We inherited him about 4 years ago and immediately took him in for extractions. That’s when we found out about all of the other issues.

    He is doing well with these issues and only needs a little enalipril and amlodipine for his BP and a Vetri Liver chew. His liver values are a little high, but medicine throws him into addisons.

    However, he is now starting to scratch at his mouth every few days and will snip at the groomer when he tries to groom that area.

    I’m sure he’s in pain and I want to do what’s best for him, but I hate to put him to sleep over a tooth when he is still bright, alert, energetic, and happy otherwise.

    What would you recommend to a patient in your practice? Is there even a way to do extractions with the clotting disorder? Or anesthesia with age and liver issues? If he were to pass during surgery would he be in pain?

    Thank you!

    PS> I think it’s really awesome that you find the time to respond to most everyone! Cheers!

  217. Doc says:

    Hello, Kelly,
    Thanks for your kind words.

    This is obviously a very difficult case. Easiest question first – if he is already anesthetized and his body succumbs, he will not feel any pain in passing.

    His anesthesia will obviously take very careful management, and certainly there is more than average risk involved. If I had to work with this patient, I would be consulting with the anesthesiologists at the veterinary school for advice.

    This is not a patient where you can just sort of hope for the best. He would need I.V. fluid support, and the ability to monitor blood pressure, end-tidal carbon dioxide, ECG, pulse oximetry. And have somebody there who know what to do when they saw it going south. This might require visiting a referral institution like a vet school, or a big specialty practice.

    Certainly, the teeth can be extracted, despite the bleeding disorder. A specialist in veterinary dentistry would be faster and more precise, which would help. However, even a doctor who is not a specialist, but skilled in extractions should be able to control the hemorrhage. Since it is in the mouth, one can apply direct pressure to the area (which you couldn’t very well do with internal organs after you closed the patient). There are also devices to aid in stopping the bleeding – sponges that provide a clotting surface and can be absorbed by the body. Vetspon is one trade name.

    I would say that your best bet would be to seek a veterinary dental specialist.

    While it is possible that you might lose your friend in the attempt, I know that you don’t want his last time with you to be marked with constant pain.

  218. Kara says:

    Hi Doc,

    First off let me say thank you for taking the time to answer all of these questions from everyone on this board. It is so nice of you to take the time to try and ease peoples minds and answer questions in between vet visits.

    I am currently in a situation where my almost 7 year old yellow lab was chewing on her usual Nyla bone yesterday when I noticed blood on it. Being a lab, she is a rough chewer in general and luckily just had a clean bill of health with her teeth 8 months ago at her dental cleaning, but when I looked in her mouth there it was, a cracked carnasial molar. Vertically cracked from the gum line right down to the bottom and when I pressed on the other section of the tooth you can see the blood forming right down the line of the crack. It has since seemed to stop bleeding and I don’t see any pulp exposure or swelling that I noticed. I have a feeling something was starting (maybe a small crack that now turned full blown) for a little while now cause she has been doing weird mouth things lately but when I looked didn’t see anything. Anyways, we brought her right in and the vet suggested extraction at this point. She injured one of her little front teeth on top and a top canine playing at doggy daycare maybe 4 years ago and had those removed. But for some reason this extraction is worrying me with this big tooth. Especially after reading your posts about needing dental xrays and all of that to avoid future issues. My vet did not do any dental xrays or make any mention of them. They are a reputable office that have been great with my dog and I’ve never had a previous issues, but they are kind of “old school” as I am more of a holistic type approach person when I can be. They do cleanings and extractions there all of the time, but are not really considered a “dental specialist” type. Do you think this will be a problem down the road to have this tooth taken out and not know if there is any root left in there, etc without the xrays? I don’t think they did any last time with her other two either, not that I know of at least, and those were fine and have been fine since. But they were much smaller and in the front opposed to that huge on in the back.

    The other thing is, since this happened suddenly, I have a business trip out of town for 5 days coming up and we had to postpone the extraction for one 8 days from today. I just did not want to leave her with my mom right after having oral surgery. The vet seems to think she will be OK and prescribed an anti inflammatory/ pain reliever in the meantime. I have read horror stories about side effect so am also scared to administer that while I am away, I am a googler, ha ha. But do you think this is too long to wait to get this taken care of? Till next week? I feel like a bad mommy, even though I know I take great care of her.

    My other question was how long does this typically take to remove? I am always worried about the anesthesia, I know this is a more involved tooth with the 3 roots, but how long from start to finish would she probably be under for that one tooth?

    Thank you for listening and your help. I am giving myself anxiety about leaving for this trip knowing my baby could be in pain and all of these questions I didn’t think to ask till after I left yesterday. I appreciate your time and kindness!

  219. Kara says:

    Sorry, but one additional question. Is there anything that I can topically put on the tooth or any kind of pain relief I can offer at home for the next week until she gets the tooth removed? I hate to see her feeling pain and not be herself. But the horror stories regarding the side effects of the rimady makes me nervous to give it to her ESPECIALLY while she is in my mom’s care for a few days. She is very sensitive to to new things to begin with. But also want to help relieve her pain. Today she had her ears back and was drooling a lot after eating and kept licking her lips. I feel terrible. Thank you again for any help.or advise you can give me.

  220. Doc says:

    Hello, Kara,
    Side effects with the Rimadyl are extremely rare. Tell your mom to follow your veterinarian’s instructions. If the dog seems to feel bad (unlikely), she should stop giving it and call the doctor.

    This is painful. The dog may not show it much, but it is. I have seen these where the tooth was broken MONTHS ago (now covered with tartar because too painful to chew on), and it breaks my heart.

    As to how long it will take to extract, that depends on a person’s expertise. It usually takes me about 30 minutes to elevate a flap of gum tissue, section the tooth into three pieces with my high-speed dental handpiece, and extract the individual roots. With a fresh fracture, it can take longer, because none of the roots have abscessed yet, so are not a bit loose.

    I removed plenty of them before I had X-rays. It is certainly better to x-ray first and after, but a lot of them don’t get it. One thing is to be sure you have the right tooth when the dog has a problem. This is obvious in your case. The other thing is to see if the roots have a weird configuration that will make them hard to extract, and finaly whether you got all the root tips.

    You can use the stuff that you get at the pharmacy for people with tooth-aches, the topical local anesthetic. It would be safe for your dog.

    I would certainly start the Rimadyl.

    Talk to your veterinarian about your concerns. He/she has seen your dog and can give you better advice than “Dr. Google”.

  221. Kara says:

    Thank you so much for your response. As you can tell I am one of those crazy worried dog mommies. ha ha. I was reading so many bad things online about the rimydal from so so many people. My vet basically thinks the worse that might happen is she could get stomach sick and in that case just stop it. Just still worries me to read such horror stories with the medicine and then leave her with my mom with it. People were saying extreme lethargy, throwing up blood, seizures, etc. And some were saying it was only after 3 days. It just seemed like a lot of people from a lot of different sites saying it. So it did worry me. I think I am going to have my mom give it to her to take the edge off when she is around this weekend opposed to when she is at work. Just in case she has one of these rare reactions. But I trust that you are saying it is rare. I also read that coconut oil helps teeth pain in humans and pets and there is no harm in it. So I bought some of that to try and help as well. It also has antibacterial properties. So we’ll see. But I will definitely give her the rimadyl. Do you think giving her a half dose will help take the edge off, or that wouldn’t help at all? Thanks so much again!!! You rock!

  222. Doc says:

    Hello, Kara,
    Half a dose is pretty useless. I agree with your veterinarian that an upset stomach would be the most common side-effect, thought it is quite uncommon at that. I tell people to look for loose stool, blood in the stool, or vomiting, or loss of appetite. There are reports of very rare occurrences where the drug caused liver damage. This is not a side-effect of the drug, but what we call an idiosyncratic reaction. That means the drug does that in this one particular individual, due to some genetic weirdness.

    It is NOT safe to combine drugs in this class. So, you wouldn’t add aspirin or other anti-inflammatories.

  223. Kara says:

    OK. Good…. I will give it to her when I get home. I thought they would have given us an antibiotic for her. I was worried about infection. The tooth is now starting to turn a tan color too. They said she will have antibiotics after the extraction. Do you think that she will be ok without prior antibiotics in the regards of infection entering the bloodsteam from now till next week? Or should I request them before I leave tomorrow? Last questions. I promise! ha ha. Thank you again so much. You have truly helped ease my mind and you are so kind to have this blog and answer these questions.

  224. Doc says:

    Hello, Kara,
    The antibiotics aren’t going to keep the tooth from getting infected. They only relieve pain if you have an abscess already.

  225. Kara says:

    So Nala had her tooth extracted today and the vet said it went well. She’s recovering and was hungry and thirsty so we fed her a little wet food earlier. But I just noticed her mouth had a little blood coming out of it. She won’t let me lift her lip to look at the site, but it worried me. The vet is closed right now to call. But when my husband picked her up they didn’t mention anything about if it bleeds. Just to call of we saw swelling or anything like that. Shes on the rimadyl and clavamox antibiotic. Is some bleeding normal or is this a problem? And if it’s normal, for how long afterwards?
    Thank you!!

  226. Doc says:

    Hello, Kara,

    Sorry to be so late in replying, really covered up the last few days.

    A small amount of oozing after a major extraction would not be unusual, even if the gums were properly sutured closed. Any trauma at all (as in chewing) could get a little bleeding going.

    I hope things have resolved by now.

  227. Myrna says:

    I have a 13 year Chihuahua. We noticed swelling in the upper left side of his mouth. Being disabled and on a fixed income we didn’t have money to take him to our vet whom we have taken our animals to for 13 years. I called the office and told them I didn’t get paid for 2 weeks but I was really worried because it was swelling more as the day went on. They said there was nothing they could do without payment to give him benadryl. I said you can’t see him or give him something? I will pay you on the 3rd. She said no I’m sorry. So we tried to keep him comfortable. The next day it was so swollen he couldn’t close his eye. I said this is rediculous he will die! So we put him in a towel and took him to the office. I said look at him! She said I’m sorry we can’t do anything. I turned around and sat down in the waiting area. I turned to the Lady next to me and said what happened to compassion? She said I don’t know shaking her head. At that point the lady went in the back and got the tech. She came out and looked at him and said he has an accessed tooth but I can authorize seeing him without payment. She said it would be up to Dr. Sachs and he was in the other office. She went in the back and the receptionist came back out and said you can call the other office and talk to him. I asked for the number and called and asked for him and of course he was in another county seeing a horse. I asked them to please have him call me. She said it will be at least 45 minutes I said there fine I’ll be waiting. I told the lady and she went in the back again. She came back out after a few minutes and said I spoke to Dr. Sachs wife and she says if you post date a check we can see him. I don’t have checks of course. She said you could go to your bank and get one and bring it back. I said OK can you go ahead and see him while I go? She said yes. So my wife stayed with him and I drove 45 minutes one way and back with a check. I got back and my very unhappy wife told me they looked at him and said we have to schedule him for two weeks for the to extract and clean his teeth. I looked at the woman and she said he has to be on antibiotics for 10 to 14 days and then they can treat him. They gave me ZydaClin 1 ml twice a day for 10 days and Quellem 12 a tab 25mg once a day for 3 days. Now he has had 5 doses of the antibiotic and his eye is swollen shut. I don’t know what do do? Help me please he is our baby.

  228. Doc says:

    Hello, Myrna,

    I can see both sides of this issue. It is obvious and natural that you would have great concern for your dog’s welfare and pain, and knowing that the tooth needs to be extracted as soon as possible.

    It is also obvious that this is a big job that takes a lot of the doctor’s time and support personnel and materials and equipment. It’s a little hard to just “shoehorn” it into a full schedule. There are only so many hours in the day.

    Quellin is for pain, and ZydaClin is an antibiotic that gets into the bone of the tooth socket, so those are both excellent choices until the procedure can be scheduled. I understand that it isn’t curing the problem.

    I really don’t know what else to do until the tooth can be extracted. Sometimes warm compresses will help. I use a pan of water as warm as I can stand to put my hand in it, and use a warm cloth to apply moist heat for 10 to 15 minutes, three times daily.

    I don’t know what your relationship with the doctor is or has been, as far as working out financial arrangements. This is a big job for the doctor, and his responsibility is to be there and do a good job. This is your dog, and it is your responsibility to pay for his care.

    Perhaps instead of asking the doctor to loan you the money (which is what a delayed payment for services really is), you could ask a friend to help you out.

  229. Karen Nottonson says:

    Hello Doc:
    I must say that I am very impressed with your concern and courtesy towards your online”patients”, I found your site while searching for an explanation of my dogs’ symptoms.
    I have two Italian Greyhounds about three years old. IG’s are notorious for bad teeth. I just noticed that both of them have black spots on or next to their upper molars, on the inside of the mouth, perhaps on the second or third tooth from the rear. No bad breath,both of them can still chew through a Sequoia without blinking. Tried to send Photo but Puppies not cooperative. Spots about 4mm each. Any ideas?
    Karen N.

  230. Doc says:

    Hello, Karen,

    Black spots on the teeth themselves can just be a stain. Some tartar stains are black and very tenacious and hard to remove, even though very thin.

    Black spots on the gums may just be pigment. Melanomas (tumors of pigment-producing cells) usually have some dimension to them, i.e. a little bump, rather than just a dark spot.

    This is really a case for hands-on examination.

  231. Tiffany says:

    Hi Doc,
    We have a 14 year old teacup chihuahua whom I fear has this tooth abcess… It’s actually huge now one one cheek. 2 vets, both state they aren’t sure unless they biopsy. No matter what we choose to do, anesthesia is required. Trouble is she has a collapsed trachea… They aren’t sure she’ll breathe on her own after the procedure when they remove the intubation tube! Also, the vets in my area charge between $2000 to $3000… We can’t afford, especially if she doesn’t survive. I am at a loss. Antibiotics for the past week hasn’t helped at all, seems to grow more every day. My husband says it better to put her down… Behavior wise, she’s perfectly normal. Eats, very active, cuddles… But I can’t fathom the idea of her suffering. Bit to put a sweet dog down upsets me too… Are there any other suggestions you may have??
    Thanks in advance, Tiffany

  232. Doc says:

    Hello, Tiffany,
    I agree that you’re talking about a lot of money there. Unfortunately, I don’t know what to do short of addressing this surgically.

    I understand about the collapsing trachea. With smashed-face dogs like Pugs and English Bulldogs, we just leave the endotracheal tube in their windpipe until they are coughing it out on their own. We may follow that with an oxygen flow – “blow-by oxygen” means no mask, just keeping an oxygen tube in front of their face until they are fully conscious.

    I cannot fault your doctor for being concerned about this, and warning you of potential problems, because they are real.

    I wish that I had some easy answer for you, but I really don’t.

  233. Ki says:

    Doc, I have a 13-14 yr old shihtzu. He has extreme halitosis and a hard time breathing through his nostrils. Vet said dental disease or a mass. The past two days his right eye looks red and swollen, like it’s going to pop out of its socket eventually. I am wondering at this point if an extraction is worth it or if it is time to put him down? My husband and I don’t know how to decide this, but the extraction estimate was about $1000. Please help!

  234. Doc says:

    Hello, Ki,

    The only way to sort this out is with dental Xrays under anesthesia. If this is a mass, then the prognosis would be poor, as you really cannot surgically remove everything in most cases.

    That means follow up with radiation therapy or chemo, and that would indeed be tough in a senior patient like that (not to mention the expense, which is considerable).

    A thousand dollars seems like a lot for an extraction. I would expect a board-certified veterinary dentist to charge in that area.

    Of course, that estimate may include a lot of other things, such as I.V. fluids and other diagnostic testing.

    If this is an abscessed tooth, removing it should be curative, and would make your dog’s remaining years much more comfortable.

  235. Tiffany Ward says:

    Hi, Doc. I’m very impressed with the many years you’ve remained active on this blog and the kind advice you give to each person. It’s obvious that you have found your passion.

    My 11 year old miniature dachshund had 23 teeth removed, including his carnassial teeth, 2.5 weeks ago. Unfortunately, this was due to my neglect of following my vet’s suggested dental cleanings. He finished his full course of antibiotics and pain meds and is still on a canned food diet. I rinse out the holes where the carnassial teeth were daily by using a syringe and tap water (like I was shown to do after having my wisdom teeth removed). My concern is that he is still “chattering” his jaw like he did before his teeth were removed and will sometimes paw at his mouth. Should I contact my vet immediately or give it some more time? I feel like I call my poor vet all of the time and hate to pester her, again.


  236. Doc says:

    Hello, Tiffany,

    You should let your veterinarian know about your concerns. I cannot tell you the significance of your dog’s behavior.

    Your doctor will be able to compare the state of the dog’s mouth to what she expects to see healing-wise at this time.

    Schedule a follow-up examination instead of trying to do this over the phone.

  237. Laura Gandolfo says:

    Dr. I can see how much you actually care after seeing how you have responded to this blog for years.. i have a soon to be 11 year old shih tzu. Ty is his name, i scrolled upon this blog just trying to rest my own mind. he was diagnosed with a heart murmur as a pup but nothing that ever needed meds, it has been about a year since his last dr appointment he is a good happy healthy pup. Anyway he had the swelling under his eye,he must have popped what i didnt know it was an abscess until it came back a few days later, then took him to his doc. Finding out that his heart condition got worse and now needs to be on meds, had the ekg done to know the severity. , but still need the tooth pulled. He has been on antibiotics for about a month due to he needs to be on the heart meds for a min of 2 weeks, his surgery is scheduled for this Tuesday the 17th and i am worried about him going under anesthesia to have the tooth removed. The cardiologist advised waiting the 2 weeks but i guess i just need more reassurance or something. Do you see an issues with anesthesia to have his tooth pulled and his heart condition? & do you see any harm to be on the antibiotics for so long?

  238. Doc says:

    Hello, Laura,

    The long-term antibiotic treatment should not be a problem.

    We are always concerned about our anesthesia, and especially so if the dog has other problems. Your cardiologist is the best person to advise you on the relative risks.

    The good news is that only very light anesthesia is needed to remove the tooth, as we rely on local anesthetic to numb the area. That way we can keep the patient pain-free without going under deep anesthesia.

    Leaving the abscessed tooth untreated is debilitating to the dog, with infection shedding into the bloodstream all the time, in addition to the pain of the situation.

    While there is certainly an element of risk in performing the surgery, there is also an element of risk in letting things go.

    With the cardiologist’s approval, I would go for the surgery.

  239. Beth Loonery says:

    My 3 yr old fox terrier mix recently had oral surgery (carnassial tooth extraction), about 4 days ago. The tooth was fractured and eventually became abscessed, thereby causing the swelling on the side of the face to open and start draining. The vet removed the tooth, stitched her gums (and did some type of flap over the gums?), and put her on a 7-day course of antibiotics. I was told the stitches will dissolve in about 14 days, and to keep her on soft foods throughout that time. My question is: how long should I expect the opened sore (on side of face) to continue to drain? And should it have closed by now? I should note that she occasionally (not a lot) will scratch (VERY gently) at the sore. Is this compromising the healing process? One day it will drain a little, and the next it’s dry, so on and so forth.

  240. Doc says:

    Hello, Beth,

    I would expect the draining tract on the face to take a week or more to heal.

    If she is just rubbing it a little and not traumatizing it, then I wouldn’t worry about it compromising the healing.

    A warm compress applied to the area for 10 to 15 minutes three times daily will speed the healing in most of these. It stimulates the circulation, bringing in more oxygen, nutrition, and antibiotic.

    If it does not get steadily better, be sure to let your veterinarian know. When we don’t hear from you, we assume everything is doing well.

  241. Darlene Long says:

    My dog has abscess tooth it can’t be removed because she has chf and her heart is bad does simplicef help help abscess tooth

    • Doc says:

      Hello, Darlene,
      I don’t think Simplicef is liable to help an abscessed tooth. Clindamycin is one antibiotic that actually penetrates bone, so it would be more likely to help. Talk to your veterinarian about this. Antibiotics can calm down the abscess, but won’t cure it.

  242. CY says:

    Hi Doc,
    Just recently noticed some mild swelling and a small/slightly raised bump right along and above the carnassial tooth on my dog, a 11.5 yr old silky terrier. I brush him daily hoping his teeth would last as long as possible since his breed is prone to dental disease, and thus noticed it when i saw the puffy spot and when I brush over it, it bleeds easily almost like a tiny ulcer or perhaps draining?

    His vet thinks it’s dental disease and possibly draining tooth root abscess. Based on examining, she suggested a dental cleaning, dental xrays at the time and then see if tooth extraction is needed. But she didn’t seem too concern and said I could wait or not do it if I dont like the idea of putting him under anesthesia since he is older or could be proactive now while he’s still in good health. We decided to do blood work and urinalysis, all came back normal except for a slightly elevated ALP (218) which she was not concerned about.

    The earliest dental availability is 1.5 months out, is that too long to wait given my pup’s situation?? And is it best to go ahead with the dental while he’s still in good health even at 11.5 yr old? Vet didn’t needing to do chest xray or ECG, but did say his heart sounds good. He is other eating well and acting his usual self, excited for walks and going out and playing. Is it worth seeking to go to a veterinary dental specialist instead?

    • Doc says:

      Hello, CY,

      I agree that an ALP of 218 in a dog this age isn’t anything to write home about.

      I think that I would go ahead and make the appointment to get this handled. Since your dog appears to feel fine, it is probably okay to take that next appointment. If you’re concerned about anesthesia, then get the chest films and ECG to be a little more sure about things.

      I think that if your veterinarian finds things on the dental X-rays that she is uncertain about, she will wake up the dog and refer you to a specialist. If she is performing dental procedures on a regular basis, then extracting an abscessed tooth should be no problem, and I wouldn’t think you would need a specialist.

      • CY says:

        Thank you Doc for taking your time to reply on here! Really appreciate it.

        I’m glad to here the ALP value here isn’t a concern. His vet suggested just routine blood work/check up of 6-12 months to monitor, does that seem appropriate? Is it very common to see an elevated value here for senior dogs with no significance?

        I have made the appt for a dental cleaning already, they are scheduled a month out but his vet said it should be fine to wait. Fortunately, it appears the swelling and ulcer like appearance has improved and gotten better and almost unnoticeable now! However, I did notice his front teeth has been bleeding more easily with brushing and this morning when he was play and brought over a toy, there was blood on it and it was the front teeth bleeding (gums I should say) again. I do see that the gums in the top front teeth have receded some as there are spaces between the teeth now and that the side corners look a bit rotten. His bottom front are all loose and receded, so they will probably be removed (although it never bled).

        Will the dental cleaning address the gum bleeding and bad breath (he has very bad breath despite my efforts of daily brushing)?

        The vet clinic I go to seem to perform dental cleaning and teeth extractions on a regular basis. Regarding the chest xrays and ECG, how come vets don’t usually suggest to do this prior to anesthesia? Is it not a routine thing? Would I need to go to a more specialized place for an ECG?

        • Doc says:

          Hello, CY,
          We would love to get blood-work, chest X-rays and ECG on all of our patients prior to anesthesia, but it often comes down to cost. Some clients just can’t afford the extra expense. If the animal seems really healthy otherwise, we just go ahead and try to be as safe as possible.

          The gum bleeding and bad breath should resolve very quickly once the bad teeth are out of there.

          Your brushing will really help keep this from coming back once a normal mouth is restored.

          It is not uncommon for older dogs to have changes in their blood values that don’t really indicate a significant disease. It depends on what is out of whack and how much. You have to look at the whole picture, and treat the patient, not just treat the numbers.

          • CY says:

            Hello Doc,

            I want to thank you for your time on this forum, from creating this knowledgeable page to answering everyone’s question posted, you are indeed a very committed and wonderful doc!

            I just wanted to come back and give an update, especially to those pet owners whom may be reading and interested in an update. We went ahead with the dental procedure and he had several teeth extracted. A full examination and xrays were done, and no infection or abscess was scene. The previous swelling/ulcer may have just been due to periodontal disease or injury from chewing on a cod stick. It would not be something that was missed if a full exam and full xrays were done had it been something else, correct?

            The extractions went well and my pup is recovering well from the procedure. Only downside is they did find a mass on his tongue which they did a partial removal for biopsy. His vet said she was not overly worried as she sees a lot these growths that are usually benign, so hopefully it is nothing.

            But overall, his mouth has been restored to good health again and I’m glad we proceeded even though I was nervous about his age and anesthesia.

          • Doc says:

            Hello, CY,
            Thanks for the feedback. I’m glad your buddy is doing better. It’s great that the X-rays ruled out more serious problems.

  243. Gail says:

    We just had this scenario with our 2 year old siberian husky. After 2 visits to our vet (one for diarrhea and another for lack of appetite), a round of metrodiazinole, xrays which showed gas in the intestines, and being put on an appetite stimulant, we watched our usual energetic husky become more lethargic. After 3 days of the appetite stimulant, I noticed a small bump underneath his left eye above his mouth that was VERY tender to the touch. A trip to the ER vet on Saturday night and we had a possible tooth root abscess diagnosis.He was very sensitive to having his muzzle or mouth touched. Went home with pain meds and antibiotics. We had an appointment at the veterinary dental center the following Tuesday. The swelling under his eye was already going down. The vet said probable tooth root abscess although no visible draining. So, a call the next morning with a cancellation we took the spot. Xrays not too remarkable, other than seeing a small tooth behind the canine that was impacted, but the upper one was diagnosed as grade 3 furcation bone loss of the left maxillary PM4 after a CT. He said the abscess defied gravity — he did have a small pocket on his gum above that tooth that when probed resulting in bleeding. He also examined his nasal cavity, TMJ and bones of the face/skull and everything was normal except that PM4 abscess. It’s been 6 days. He is supposed to be on Clindamycin for 7 days post op….and was given Rimadyl for 3 days. When the Rimadyl wore off, he looked like he was painful again, not really wanting to eat…and sleeps quite a bit. The vet provided 4 more days of Rimadyl and he is eating fine again. My guess is that he is still painful after such a big extraction (well really 2 extractions). His 2 year old husky brother doesn’t help…periodically bumping into him or trying to play with him not realizing that part of his mouth is still healing. We are managing that. Although he is DEFINITELY better than what he was before the extraction is it normal for him to still be a little painful at this time — all dogs are different but given the procedure I would imaging this would take more healing time and he might still be a little sore. We have his follow up appointment on 5/12.

    • Doc says:

      Hello, Gail,

      My own experience with having my wisdom teeth cut out was that I was pretty painful for about 3 days. I had less soreness after that, but still a little. I usually send home pain medicine for 3 to 5 days post-op after extractions. Some of it depends on how difficult the extractions are.

      Best wishes at your recheck appointment.

  244. Roni Dale says:


    My Rottweiler had bad teeth when I rescued him

    He got an abscess under his left eye

    It came back after each of three surgeries to extract one tooth each time

    The 4th surgery to extract 4th tooth … drainage hole in gums closed ….abscess came back … it burst into his eye socket

    Antibiotics have not cured it … he has had pus oozing from his eye for nearly a year … yesterday it flared up … the worst yet , most pain, pus is three colors, glueing his eye shut.

    Vet gave antibiotics and appt in 48 hours

    Is there a way to find the cause of the infection and fix it. My SamSam had had an infection in his face for at three of his 4 1/2 years. I’m sooo worried it’s going to affect his heart, eyeball and/or shorten his life .

    How can I best advocate for him.

    • Doc says:

      Hello, Roni,

      If your doctor is able to take dental X-rays and the problem still hasn’t been localized, then you probably need to get him to a facility where they can get a C-T scan of his head. If your doctor is not able to take dental X-rays, then you need to get him to someone who can.

      There are also veterinary dental specialists. Sometimes they see more on the dental X-rays than we general practitioners see. They also may take better pictures.

  245. Mary Ellen Zenzie says:

    I wrote about our 16.5 yo rat terrier who had the carnassial tooth and 13 others removed in july.. 3 post op visits continued drainage from facial wound. Told takes time. Today continued drainage, vet who didn’t do surgery saw her. Pushed below her eye, above wound and pus poured out in her eye! Opened her mouth and pushed on something and blood gushed out. Dog never bled after surgery so this is surprising. Vet said…oh this is not right. Come tomorrow morning to see vet who did extractions. WOULD A TUMOR SHOW ON THOSE PRE OP XRAYS? IS IT POSSIBLE THAT A TUMOR COULD SHOW UP IN A MONTH? IS IT ALSO POSSIBLE THAT THOSE POST OP VISITS WERE NORMAL AND NOW NO?? How do we know surgery was performed correctly? I know you probably can’t answer these questions but I just don’t know what to do going forward. Comment today was..a culture is $300! Told to be npo for morning visit. Thanks for listening. Nite

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