This case was a perfect example of why full mouth dental radiographs are needed for every pet undergoing a comprehensive oral health assessment and treatment (COHAT) like we do at Companions Animal Hospital.

What do you see with this tooth?

This is definitely stage 2/4 dental disease and pushing stage 3.  There is tartar and plaque touching the gum line associated with this upper left 4th premolar.  There is inflammatio nof the gum tissue and there is even hyperplastic gum tissue (extra growth of gum tissue).   There was no fracture of this tooth and there was no periodontal pocket.  A periodonal pocket is when there is a larger than normal space between the tooth and the gums and is most often caused by bacterial diseae leading to periodontal disease.  There were no signs of a "draining tract".  A draining tract is caused by an abscessed tooth that has eaten away the bone and pus has pushed out through the weakened bone and gum tissue and is draining through a hole in the gum tissue.

This tooth cleaned up beautifully and looked very normal and healthy.  But, lurking below the surface...

Here is a normal upper 4th premolar for comparison...

On the above x-rays you can see the area of darkness that is where bone is gone and the entire root cannot be seen.  It is almost as if something took a bite out of the largest root of the big tooth in the view shown.  That is what happens with bacteria - they essentially eat away at the bone and tooth roots.  Eventually (and this may take years) the tooth becomes loose and unstable and may even fall out or fracture.  This process is painful that entire time!  On the view to the left you can see the entire root structure with just a thin dark line outlining the roots.  This line is the space where the periodontal ligament is and when you can see it the ligament is intact and healthy. 

Without x-rays this tooth would have sat in the dog's mouth causing pain, inflammation and progression of infection and dental disease.  You would have thought your dental procedure to be complete and thought you helped the pet - but, you would have missed significant disease; and more importantly the pet would still be in pain.  Dental x-rays are needed with all dental procedures.  It should not be optional. 

Treatment for this tooth was extraction - now the pet is pain free!