Periodontal Disease

She was brought to the hospital because she had been sneezing for a week and the owner wanted it stopped.  This was the first time I had seen Trixy, an old, overweight Miniature Poodle. At first I thought she might have a chronic infection somewhere in the nasal cavity that was causing her to sneeze or maybe cancer in the back part of the nasal cavity.  With these problems one often sees intermittent bleeding from the nostrils and there may be reverse sneezing as if there was exudate draining backward into the throat, but this hadn’t happened.  Then, when Trixy was put on the floor, she did a forward sneeze trying to clear something from the front of the nasal cavity.  That was different, not what I expected. The teeth were the cause of the problem!  I could see they were massively caked with a greenish-gray scale that had accumulated over years.  It was accompanied by periodontal disease and that infection had progressed down the teeth causing them to become loose and painful.  In Trixy’s case, infection around the roots of the large canine teeth had eroded into the nasal cavity creating fistulas (holes) so that pus drained into the nasal cavity, causing poor Trixy to sneeze.  To treat this condition one can administer antibiotics which may control the infection temporarily only to have it resume when the antibiotic treatment ceases.  Another way veterinarians solve Trixy’s problem is to stop the flow of pus by cleaning the teeth with ultrasound (brushing won’t do), extracting teeth that are loose or infected and then, surgically close the fistulas between the mouth and the nasal cavity. 

Prevention by routine tooth cleaning is the preferred management of this disease.  Twenty years ago many dogs had fistulas between the mouth and the nasal cavity that developed when canine teeth with severe periodontal disease fell out.  This condition was especially common in small lap dogs that lived indoors and ate human table food.  But over time owners of these small dogs have eliminated table food diets and fed nutritionally balanced commercial dog food which has prevented bone degeneration around the teeth from developing.  They also have had their pet’s teeth cleaned routinely by a veterinarian.