The upper 4th premolar (carnaissal tooth) has two deep roots that must be properly removed, or the abscess will remain, and the tooth will continue to drain under the eye. The tooth and its root are large in comparison to the other teeth, and must be removed in segments.
A chronic drainage tract usually is present just under the eye. Sometimes there is an actual hole in the skin, other times there is only swelling or discharge matted to the hair. Most pets resist when you pet them on the muzzle. An odor might be present also.
A high speed drill is needed to cut through the tooth enamel. It is a precision instrument that is powered by our dental unit. The high speed means there is little trauma to the surrounding tissue.
The tooth is split in half with the high speed drill. This allows us to remove each half of the tooth separately, aiding in root removal. We use a dental elevator to remove this tooth just like a retained deciduous tooth. Each half of the tooth is gently elevated out.
The split tooth is gently removed with the elevator. This is the most arduous part of the procedure and can take 15 minutes or more to complete. It is important to remove all of the root for the problem to resolve. After removal the opening in the gums is flushed with an antibacterial solution to remove all of the infection.
The hole that remains can be sutured or left to heal on its own. The healing time is within 1-2 days, whether it is sutured or not. The drainage under the eye disappears within a few days also. Antibiotics are usually administered at home for 7 days.