Holly the Jack Russell Terrier had a strange swelling under her eye

A few weeks ago, Joyce noticed that Holly had a blemish on her face.  A small dome-like swelling, the size of a small grape,  appeared on her right cheek. It had a smooth, red appearance, and Joyce’s first thought was that it might be a tumour of some kind. At ten years of age, Holly is an older dog, at the stage of life where all sorts of illnesses, including cancer, become more common.

When she brought Holly in to see me, Joyce was prepared for the worst, so she was relieved when I reassured her that the situation wasn’t as serious as she feared. The swelling on Holly’s face was typical of a common problem in older dogs, and it’s something that’s easily cured. The most likely cause was a tooth root abscess which can be permanently sorted by extracting the diseased tooth.  

Tooth root abscess

Although this is the most common cause of a blemish in this location, there are other possibilities. A simple superficial infection could look like this too, and it would be cured with a course of antibiotics, with no need to extract any teeth. After discussing the situation with Joyce, we decided to give a general treatment first. If this did not work, we would then have no choice but to carry out a more detailed investigation, perhaps including dental extractions.

Joyce had no difficulty giving Holly the antibiotics: they are designed to be tasty to dogs, and the little dog enjoys her food, so the tablets were easily hidden in her dinner. The swelling became steadily smaller, so that by the time the ten day course of tablets had finished, it was barely visible.  

I had warned Joyce that even with a tooth root abscess, Holly would be likely to improve, but that when the antibiotics finished, the swelling would reappear. As it turned out, this is exactly what happened. Joyce brought her back to see me four days after the end of the tablets: the swelling had started to grow again and was now more prominent than ever. I scheduled Holly for a day procedure but the evening before she came in, the lump burst, and a trickle of pus ran down Holly’s cheek. This strengthened the suspicion that it was an abscess, and the only way that she could be permanently cured would be by extracting the affected tooth.

Surgery

The next day, under anaesthesia, I took a series of xrays of Holly’s skull. These showed that there was a black, halo-like zone around the roots of one of her cheek teeth. This was definite proof that she had the tooth root abscess that we had suspected all along. Cheek teeth are not easy to extract: they need to be patiently loosened with sharp stainless steel instruments before being gently lifted out of their socket.  When I pulled the offending tooth out of its socket, there was a satisfying small flow of  infected liquid from beneath the tooth: this was definitely the cause of the problem.

Tooth root abscesses seem to happen spontaneously, but it’s likely that bacteria track up, beneath the gums, into the root. As the bacteria multiply, they produce pus, and as this gathers to form an abscess, the pus follows the easiest direction of flow to the  surface of the dog’s face. The typical swelling forms on the cheek, as Joyce had observed, and if it is not treated, it bursts, as had happened the previous night.

Now that the infected tooth had been extracted, Holly’s problem has been solved. She’ll have a few more days of those tasty antibiotics and the unsightly bump on her face will be gone for good.

Tips

• Tooth root abscesses are common in older dogs
• A definite diagnosis requires xrays
• Extraction of the infected tooth is the only long term answer