Toothy Thomson

Toothy Thomson Board-Certified Veterinary Dentist & Oral Surgeon 👩‍⚕️ This page is FOR YOUR education - 🦷❤️

Don’t let infra-erupted teeth fool you! While probing depth >3 mm is abnormal, this is 𝑨𝑺𝑺𝑼𝑴𝑰𝑵𝑮 that probing depth is 𝔼ℚ...
09/05/2026

Don’t let infra-erupted teeth fool you!
While probing depth >3 mm is abnormal, this is 𝑨𝑺𝑺𝑼𝑴𝑰𝑵𝑮 that probing depth is 𝔼ℚ𝕌𝔸𝕃 to attachment loss OR pocket depth.
And this is just NOT the case with infra- or under-erupted teeth.
When 🦷 are INFRA-erupted the alveolar bone is ABOVE (or coronal) to the Cemenoenamel (CEJ); normally the alveolar ridge is AT or BELOW (apical) the CEJ.
With this “overlap” of bone you have a space or 𝑝𝑠𝑒𝑢𝑑𝑜pocket along these teeth as the alveolar bone CANNOT attach to the enamel overlying the crown.
Therefore, what you are measuring with your probe is (at least in part) the 𝑝𝑠𝑒𝑢𝑑𝑜pocketing. While there COULD be a true pocket (attachment loss), there will always be some of the probing depth that is NOT from disease.
In the case seen 𝐇𝐄𝐑𝐄, the probing depth of 10 mm was ALL 𝑝𝑠𝑒𝑢𝑑𝑜pocket, without ANY attachment loss (there was a PDL all the way along the root length - see video).
HOW do we tell 𝑝𝑠𝑒𝑢𝑑𝑜pocket from 𝒕𝒓𝒖𝒆 pocket?!??!
YEP! ＲＡＤＩＯＧＲＡＰＨＳ!
These 𝑝𝑠𝑒𝑢𝑑𝑜pockets will often lead you to believe a tooth requires extraction.
I’ve been there too *see last slide*
BUT do not fall into into that TRAP 🪤.
I am NOT saying nothing should be done, something SHOULD be done, just not extraction.
IF you set out to extract this tooth it will be A LOT of work. WHY? Because this tooth has FULL attachment and is DEEP within that jaw (in this case, the mandible).
INSTEAD, I recommend “crown lengthening” of this tooth to ᖇᗴᗰOᐯᗴ the 𝑝𝑠𝑒𝑢𝑑𝑜pocket by removing the alveolar bone above the CEJ and apically repositioning the mucoperiosteal flap.
ADDED BONUS: catch these patients at spay/neuter and extract the crowded incisors that mechanically prevent full eruption of mandibular canine teeth.
Bye bye infra-eruption 👋

09/03/2026

Don’t let these little pug mouths trick you. .. the mandibular canine teeth are *always* there.
*I’ve never met a pug mouth without them*
Once this cutie was under anesthesia we could see the itty bitty cusps of her canine teeth.
They were severely INFRA-ERUPTED.
When 🦷 are INFRA-erupted the alveolar bone is ABOVE (or coronal) to the Cemenoenamel (CEJ); normally the alveolar ridge is AT or BELOW (apical) the CEJ.
With this “overlap” of bone you have a space or 𝑝𝑠𝑒𝑢𝑑𝑜pocket along these teeth as the periodontal ligament CANNOT attach from the alveolar bone to the enamel overlying the crown.
Therefore, what you are measuring with your probe is (at least in part) the 𝑝𝑠𝑒𝑢𝑑𝑜pocketing. While there COULD be a true pocket (attachment loss),this highlights the importance of reviewing oral examination (probing) with the dental radiographs.
For this pup the 6 and 8 millimetre probing depths were allllllll 𝑝𝑠𝑒𝑢𝑑𝑜pocket from the crown being below the alveolar bone and gingiva.
A Type 2 Crown Lengthening was performed on both canine teeth. The incisors were remove as well as the alveolar bone that what coronal to the CEJ and then the mucoperiosteal flap was trimmed and then repositioned APICALLY along the new alveolar bone margins.

Ever felt like you could just pluck a tooth out it’s so diseased?!!?OR maybe you saw a cat whose canine tooth just fell ...
09/03/2026

Ever felt like you could just pluck a tooth out it’s so diseased?!!?
OR maybe you saw a cat whose canine tooth just fell out??!?
That is what happened to the cats pictured here.
Cat 1️⃣: a patient of mine, lost their right maxillary canine and I removed the left canine with minimal traction on extraction forceps.
Cat 2️⃣: a patient of my mentees who presented after their left canine fell out.
Cat 3️⃣: another patient of mine, presented for surgical removal of retained roots and buccal bone expansion and a 7 mm probing depth was noted on the right maxillary canine.
These are classic presentations of Buccal Alveolar Osteomyelitis or Buccal Bone Expansion (BBE), and is a response cat’s bodies have to inflammation. As the fibrous bone is laid down this creates space between the bone and the tooth and that allows gingival “down-growth” and replaces PDL attachment.
This results in normal alveolar bone HEIGHT, but a loss of attachment around the tooth root.

*dental radiographs appropriate bone height, BUT you do not see a radiolucent PDL space or radiodense lamina dura*

IF the tooth is simply avulsed - either on its own or by you - there is still a gingival or epithelized tissue lining the alveolus that will never heal over and remain a source of discomfort and a “catch all” for debris.
I always remove the epithelized tissue from within the alveolus - a Miller Surgical curette works great.
IF I removed the tooth, I also trim the gingival edges of the mucoperiosteal flap.
IF the tooth fell out, I make an elliptical incision around the empty alveolus with 3-5mm of gingiva removed.
What you seen cases like this?
FOLLOW Amy | Veterinary Dentist | Dentistry Courses & Advice for more dentistry tips and advice 🩷🦷

08/31/2026

80% of all dogs and cat over 3️⃣ years of age have Periodontal Disease.
This is THE MOST COMMON disease seen in our pets. BUT it’s is NOT NORMAL.
The phrase “their teeth look good for their age” ignored early or less severe disease and IMP is, in part, why many pets do not get treatment until the disease is significantly worse.
Instead let’s say: “while their teeth are not as bad as many dogs their age, I AM seeing severe calculus/gingivitis/fractured teeth/mobile teeth/etc and I’d really like to get that treated”.
What’s been your experience with senior pets and oral health??!?
COMMENT “SENIOR” for access to ⬇️

Do you radiographs ALL worn teeth? EVERY single tooth? Or just the teeth with (obvious) problems???This dog was being se...
08/30/2026

Do you radiographs ALL worn teeth? EVERY single tooth? Or just the teeth with (obvious) problems???

This dog was being seen for a Root Canal Treatment for this “complicated”/enamel-dentin-pulp fracture of his left maxillary canine (204) tooth.
My policy is even with an OBVIOUS problem tooth, each patient gets a tooth-by-tooth and oral/extra-oral examination and FULL mouth dental radiographs.

While all canine teeth had distal abrasion, only the right mandibular canine (404) tooth was non-vital on radiographs.
ONLY minimal abrasion AND was still non-vital with a large periapical lucency/pathology-PAL OR PAP with external inflammatory resorption.

While the fractured 204 tooth pulp bleed - active pulpitis, therefore “caught” before pulp-necrosis (tooth death), the pulp in 404 was necrotic.

This handsome fella got 2️⃣ Root Canal Treatments.
YES! Even with a PAL, RCT is STILL AN OPTION!
FOLLOW Amy | Veterinary Dentist | Dentistry Courses & Advice for more dentistry tips and advice 🩷🦷

08/27/2026

DON’T just crown amputate!!!
While “crown” amputation IS an appropriate treatment option* for TYPE 2 (NO PDL visible) Tooth Resorption - which is REPLACEMENT resorption.
It is NOT appropriate for TYPE 1 (visible PDL) Tooth Resorption.

*crown amputation SHOULD NEVER be performed in cats with Feline Chronic Gingivostomatitis

REMEMBER: dental radiographs are REQUIRED to determine TYPE of Tooth Resorption.
The quality of your images can impact your ability to make that diagnosis.

08/23/2026

“Why do you drape the mouth? It’s dirty!”
I get asked this ALL. THE. TIME.
And I get it, it’s confusing, 🫤 the mouth IS full of bacteria! 🦠
BUT that bacteria is normal for the SURFACE tissues of the mouth.
What ISN’T normal is this bacteria in the DEEPER tissues, nor is bacteria from the fur or skin in those surgical area normal.
So while the mouth is NOT clean, it still makes sense to take an aseptic approach.
ADDED BONUS: no hair, fur or whiskers in your surgical field. AND it keeps the water and blood contained. 👍🏻
I what do you think of this draping business???
FOLLOW Amy | Veterinary Dentist | Dentistry Courses & Advice for for dentistry advice and tips. 🦷🩷

08/19/2026

When extraction is TOO much, BUT cleaning is NOT enough. .. ROOT PLANING.
This procedure is used for “pocket reduction”.
Cleaning of the root surface (and the inside of your flap = gingival curettage) will allow for attachment of the gingival connective tissue to the cementum lining the root.
Once healed it will result in a LONG JUNCTIONAL EPITHELIAL attachment.
While this is NOT the normal alveolar bone - to - PDL - to - cementum attachment, it will provide attachment and reduce the pocket!
IF Root Planing/Periodontal Surgery is NOT performed the disease 🦠 is LEFT BEHIND and will continue to progress.
Who’s excited to add this to your periodontal therapy tool kit 🧰 ?!??!
FOLLOW Amy | Veterinary Dentist | Dentistry Courses & Advice for more dentistry tips and advice. 🩷🦷
rootplaning veterinarydentistry onlinelearning diseasefree calculus cementum toothythomson educationalreels veterinaryeducation vetdentistry periodontaldisease alwayslearning

08/15/2026

Yes, I am a veterinary dentist, but I am a pet parent FIRST!
I was so nervous 😬 AND I heard my inner voice saying “you’re a bad dog mom” when Greta needed 3️⃣ extractions.
Even though that wasn’t rational nor true, it didn’t make those feelings any less valid. An important reminder when discussing extractions with owners.
We, as veterinary professionals, often say “not eating the first night” after anesthesia is not cause for concern. .. that’s SO MUCH easier said than actually felt.
I know Greta wasn’t painful, she had full mouth dental blocks, AND I still questioned it.
I often tell owners to warm up food, as some dogs will have reduced sense of smell after numerous maxillary (upper) teeth extractions. .. guess I will be adding ‘throw food for them’ to the list of things to try if their pet isn’t eating. 🤷‍♀️
All to saw, it’s tough on pet parents. .. it’s important to support them through this, as the outcome is OH SO worth it. 🩷🦷
What did you think of Greta’s first COHAT?!? ⬇️

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