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Swollen face after tooth removal.

Species: Dog
Breed: Beagle/Boxer
Age: 11-15 years
Two months ago, Chuck (our elderly dog who's become more and more aggressive when the vets look in his mouth) had severe facial swelling - vet exam revealed damaged root apex of premolar #108, oral fistula the size of a dime and high level of infection (2 tablespoons of pus was drained).

Chuck was sedated, the tooth was extracted and the fistula was sutured.

One month later, the facial swelling occurred in the exact same spot, and at the return visit to the vet, Chuck was even more aggressive and attempted to bite the vet when she put her hand in his mouth.

She was unable to get a clear look inside his mouth without sedating him again, so she sent us home with Clindamycin 150 mg (given twice daily for 10 days) for suspected tooth infection, and said to come back if swelling got worse or didn't resolve. Within 6 days, swelling had resolved.

It's now another month later (two months after tooth extraction, one month after last vet visit when Chuck was started on Clindamycin), and tonight I noticed the swelling was starting again in the exact same spot.

I managed to lift up the side of my dog's mouth really fast before he could bite me, and I saw something that looked like a tiny sharp pointy tooth growing out of the very top of his gums, above where the other teeth grow out. And on his gums, where they rest against this sharp pointy growth, there's something that looks like a canker sore.

I definitely plan to call my vet in the morning, but I'm worried that Chuck's in a lot of pain right now - he's currently treated for arthritis with Deramaxx 37.5 mg every morning, and Tramadol 50 mg twice daily (one in the morning, one before bed).

My two questions are:

1) What could this growth be? Could it be related to the tooth that was removed, and how will it be treated?

2) Can I give him 2 Tramadols (50 mg each) before bed if this is causing him a lot of pain?

Thank you for your help.
- Katherine

Online vet, Dr. Marie

Dr. Marie replied:

Oh, poor Chuck. I'm sorry to hear that he is going through this.

A carnassial tooth abscess (i.e. premolar 108) is definitely a common cause for swelling in a dog's face. Usually, removing the tooth solves the problem.

I can think of a few possible reasons for this problem to keep resurfacing.

One possibility is if there was some tooth root left in when the tooth was extracted. Often, extracting these teeth is difficult and sometimes a tiny piece of root can fracture off. Sometimes this does no harm, but sometimes it can cause repeated infection until the root is removed. It is often difficult to remove a tiny piece of root like this. However, if you feel like you can see a piece of tooth pointing out then it may be that the tooth root has migrated to a point where your vet can easily get it with a brief anesthetic.

Do you know if your vet has the capability to do dental xrays? If so, then this is the best way to know whether some retained root is the problem.

Another possibility is if there still is a fistula (i.e. a hole) between the tooth root and the nasal passage. Usually though, removing the tooth will solve this problem. But, it may be something where the vet needs to go back in and thoroughly flush the area in case there is some foreign material in there.

A tumor in the nasal passage or jaw could do this as well, but from what you have described this seems less likely.

Unfortunately I cannot legally advise on prescription medication dosages over the internet. You didn't mention Chuck's weight, but if I do some math to extrapolate his weight from the clindamycin dose he would be no bigger than 30 kg (66 lbs) and possibly smaller. 100mg of Tramadol would be a relatively large dose for a dog of this size. It's not something I would administer without having the ok from his vet first.

The good news is that his Tramadol plus Deramaxx are giving him some pain relief. Both are very good medications.

It's good that you are taking him in tomorrow. It does sound like he will need to be sedated/anesthetized again. Hopefully what you are seeing on his gums is the remains of a tooth root that is trying to migrate out and hopefully it will be an easy fix!

I will be online for about 30 minutes more so let me know if you have more questions.

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thanks so much for your response - I'll be taking Chuck in to the vet first thing in the morning, if they have room in the schedule. Thanks again.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.