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Dentistry & Oral Surgery 2017-04-15T23:47:31+00:00

Oral health is an important factor in your pet’s overall health. Your pet’s health and quality of life can be seriously affected by disease or injury to the teeth and oral cavity. One of the most common diseases in cats and dogs is periodontal disease, an inflammation of the gums and tissues surrounding the teeth. This can occur without routine home care and professional dental cleanings. While 4 out of 5 dogs over the age of 3 years of age suffer from some sort of periodontal disease, it is certainly not the only aspect of your pet’s oral health that should be considered. Oral tumors, malocclusions, tooth and jaw fractures, tooth resorption and stomatitis are conditions that require advanced surgical and dental care as well.

READ BIO

Complete oral exam and professional dental cleaning

A complete oral exam includes a visual exam using magnification, probing around each tooth to look for attachment loss, occlusal evaluation and taking and interpreting dental radiographs. All abnormal findings such as missing teeth, fractured teeth, resorptive lesions, mobile teeth, gingival recession, periodontal pockets and discolored teeth are recorded in a chart that is part of the pet’s medical record.

Dental radiographs are the only way to evaluate teeth for subgingival pathology such as bone loss, root resorption, periapical disease and impacted teeth. They can be used to assess puppies for complete dentition, determine if an oral mass is invading the bone and visualize the temporomandibular joints in small patients. Dental radiographs can help avoid complications associated with tooth extractions such as retained roots and jaw fractures. Dental radiographs can only be obtained while your pet is under general anesthesia. The phosphor plate or sensor has to be inside the mouth and your pet has to be perfectly still to get a diagnostic image. All patients get full-mouth dental radiographs and we will contact you during the procedure if any abnormalities are found.
Each patient receives a set of medications that is customized to their particular needs. Using smaller amounts of a combination of drugs can avoid the side effects associated with higher doses. Every patient is monitored by a technician whose only focus is the safety of your pet. We monitor blood pressure, ECG, body temperature, heart and respiratory rate, tissue oxygenation and end-tidal CO2 in every patient and all patients are closely observed in the critical post-operative period.
Oral surgery can be painful and the best way to control pain is to prevent it. Every patient receives medication to prevent pain prior to surgery. In addition, whenever possible we administer a local block to numb the area before treatment. Constant rate infusions of pain medication can be used for more invasive procedures or to help balance anesthesia for individual patients.

REASONS TO VISIT A VETERINARY DENTIST

Also known as periodontitis, periodontal disease refers to pathology that affects the structures that support the tooth. These structures include the gingiva, periodontal ligament (connects the root to the bone), alveolar bone (bone surrounding the tooth root) and cementum (the outer layer of the tooth root). Periodontal disease is caused by the formation of plaque and the body’s response to plaque. Symptoms include bad breath, inflamed gums and loose teeth. Dental home care combined with regular complete oral exams and professional dental cleanings can help prevent or slow the progression of periodontal disease. Small dog breeds and retired racing greyhounds are predisposed to periodontal disease. In some cases, root planing and perioceutic placement or guided tissue regeneration can be used to treat attachment loss due to periodontal disease.
Fractured teeth with pulp exposure can abscess when bacteria get inside the tooth and destroy the pulp but intact teeth can abscess as well. Some abscessed teeth cause acute facial swelling or a chronic draining tract on the face while others can only be detected by dental radiography. If a dog has a swelling under the eye, it is almost always a tooth root abscess. The swelling should improve with antibiotics but will recur until the affected tooth is extracted. Dental radiographs are necessary to determine which tooth is causing the swelling.
A persistent deciduous tooth is a “baby” tooth that is not lost when the corresponding adult tooth erupts. When deciduous teeth do not exfoliate on time, it can lead to crowding and periodontal disease and sometimes malocclusion. Persistent deciduous teeth should be extracted. If there is no corresponding adult tooth, the deciduous tooth does not need to be extracted.
Tooth resorption is a common disease affecting up to 70% of the general population of cats. It is a destructive process whereby the body’s own cells destroy the tooth structure and do not rebuild it. Symptoms include missing teeth, fractured teeth, pain when eating and gingivitis. If the crown of the tooth is affected by resorption, the process can be very painful. In other cases only the roots are affected and dental radiographs are necessary to detect the disease. Once a tooth is affected, the process will continue until the tooth is completely destroyed. The cause of tooth resorprtion is unknown and extraction (or crown amputation in select cases) is the treatment of choice in order to alleviate or prevent pain or fracture of the affected teeth. Dogs can also be affected by tooth resorption but it is much less common.
FCGS is a disease of the oral cavity in which the immune system overreacts to plaque on the teeth. Symptoms include pain when eating, drooling, foul breath, decreased grooming and weight loss. Although the symptoms may improve with medical therapy, full or caudal mouth extractions provide the best chance of resolution of the clinical signs. Some cats require long-term medication (immunosuppressive and pain medications) after surgery to remain comfortable.
Fractured teeth with pulp exposure will lose vitality and can abscess. This painful process may not be visible without dental radiographs. Any mature tooth with pulp exposure should be treated with root canal therapy or surgical extraction before it has a change to abscess. Once an abscess has formed, root canal therapy is less likely to succeed and surgical extraction may be the only option. For young animals with a recent fracture, vital pulp therapy is also a treatment option. Fractured deciduous teeth should be extracted immediately before bacteria have a chance to damage the underlying adult tooth. Fractured teeth that do not have pulp exposure should be monitored with dental radiographs because they may abscess in the future.
Discolored teeth have a high probability of being non-vital. The discoloration is a result of hemorrhage of the pulpal tissues through the dentinal tubules. Dead teeth have a high likelihood of abscessing and this painful process may not be visible without dental radiographs. The recommended treatment for discolored teeth is root canal or surgical extraction.
An oronasal fistula is a communication between the nose and the mouth. Fluid and food particles can enter the nose from the mouth causing sneezing, nasal discharge and infections. Periodontal disease, malocclusion, dehiscence of an extraction site or traumatic removal of a tooth can cause formation of an oronasal fistula. Some oronasal fistulae can be detected during a routine physical exam but others can only be found during an anesthetized complete oral exam. The best time to repair an oronasal fistula is the first time as repeated surgery leads to the formation of scar tissue that can make repair more difficult.
Fractures of the mandibles or maxillae can occur secondary to trauma, periodontal disease or during tooth extraction if proper technique is not used. Symptoms include bleeding from the mouth, swelling or bruising in or around the mouth, malocclusion or inability to close the mouth. In cases of trauma, supportive care should be administered on an emergency basis until it is safe to perform surgery. Pathologic fractures can occur slowly and may not have obvious symptoms. Dental radiographs are critical for diagnosis and treatment.
The oral cavity is the 5th most common site for cancer in dogs and the 3rd most common for cats. Any abnormal growth in the mouth should be biopsied and treated and ideally this should be done before it becomes too large or invasive. Many growths are benign but can recur if not completely excised. Some benign growths are very invasive and require removal of associated teeth and bone for a cure. Even malignant tumors can be treated if diagnosed and resected early in the course of the disease.
Enamel defects can be present due to trauma or disease affecting the animal during the development of the tooth buds or because of a genetic condition. Affected teeth may be weaker than normal and can stain and acquire tartar more easily than teeth with normal enamel. Teeth with enamel defects should be radiographed to assess vitality. Remaining abnormal enamel may come off during scaling. Vital teeth with exposed dentin should be treated with a dentinal bonding agent to decrease sensitivity and help prevent bacteria from leaching through the dentinal tubules into the pulp. Large defects can be treated with composite restorations to improve cosmesis and protect the tooth.
CUPS is a disease of the oral cavity in which the immune system overreacts to the presence of plaque. Affected dogs may have foul breath, drooling, pain when eating and ulcers where mucous membranes contact the teeth (“kissing ulcers”). Clinical sign may be controlled by meticulous home care, regular professional cleanings and immune suppressant medications, Most dogs require selective surgical extraction of teeth in the most severely affected areas. Many progress to requiring surgical extraction of all teeth.
A malocclusion can be caused by a discrepancy in jaw lengths or by individual teeth being out of position. Malocclusions can be hereditary or can occur secondary to trauma or persistent deciduous teeth. While some malocclusions are considered normal for the breed (i.e. brachycephalic dogs), others can cause chronic pain, oronasal fistulae or prevent an animal from being shown in conformation. All young animals should have their occlusion evaluated by a knowledgeable veterinarian. Early intervention such as interceptive orthodontics can help prevent more costly treatment later. Genetic counseling is available for breeding animals. Class II malocclusions (where the upper jaw is longer than the lower) is always abnormal and is frequently painful.
Mandibular canines can sometimes erupt in such a way that they are contacting the soft tissue or teeth of the maxilla. If this condition is present in a patient with deciduous dentition, the deciduous mandibular canines and sometimes incisors should be extracted to relieve pain, allow the mandible to grow to its full genetic potential and hopefully allow the adult canines to erupt in a normal position. If the adult teeth are base narrow then they should be treated by either crown reduction and vital pulp therapy, orthodontic movement of the teeth or surgical extraction. If left untreated, base narrow adult mandibular canines can cause loss of palatal bone, oronasal fistulae and destruction of the tissue supporting the maxillary canines.
Also known as gingival hyperplasia, gingival enlargement can occur because of a genetic predisposition or due to the use of certain drugs. Boxers are frequently affected as are both cats and dogs taking cyclosporine. Gingival enlargement creates pseudo-pockets between the gingiva and the teeth where plaque and debris can accumulate leading to severe periodontal disease. Gingivectomy and gingivoplasty to reduce and recontour the excess tissue is indicated. This condition is frequently recurrent but meticulous home care combined with regular professional cleanings to control plaque can delay recurrence.
Teeth that do not erupt on schedule should be treated. In some cases, an operculectomy (cutting a window in the soft tissue) can be performed to allow the tooth to complete eruption. In most cases, the impacted teeth should be surgically extracted because they have a tendency to cause the formation of dentigerous cysts. These cysts can destroy the surrounding bone leading to pathologic fracture and/or loss of adjacent teeth. Dentigerous cysts are generally not painful and may not be visible without dental radiographs. They are benign and can form at any age.
A salivary mucocele is a collection of saliva that has leaked from the salivary gland or duct into the surrounding tissue. The underlying cause is unknown. Sialoceles occur most commonly on the ventral neck (cervical sialocele) or under the tongue (ranula). Draining the saliva can provide some temporary relief but complete resolution usually requires removal of the mandibular and sublingual salivary glands on the affected side. Pharyngeal sialoceles are rare but can be life threatening because they can obstruct the airway.
Animals with cleft palates can have other congenital malformations affecting the bullae of the ears, ventricles of the brain and the inside of the nose. These other issues may or may not result in clinical signs and can often only be detected by advanced imaging techniques such as CT. The defect in the underlying bone is often larger than the soft tissue defect. The ideal age for surgical correction of the cleft palate is 3-4 months of age. Some animals require more than one surgery for resolution of clinical signs.
There are a variety of reasons why an animal might be unable to close their mouth. Some common causes include TMJ luxation, bilateral mandibular fractures, neuropathy, open mouth jaw locking and abnormal contact between the teeth or between the coronoid process and the zygomatic arch. Animals who cannot close their mouth need supportive care in order to stay hydrated and fed until the underlying cause can be determined and treated. Diagnostic tests include the physical examination, dental radiographs and CT.
There are a variety of reasons why an animal may be unwilling or unable to open their mouth. Some common causes include masticatory myositis, TMJ ankylosis, retrobulbar disease and zygomatic salivary gland inflammation. Diagnostic tests may include physical examination, CT and for masticatory myositis, a blood test and muscle biopsy.
Carious lesions are also known as cavities or tooth decay. Although this is the most a common human dental problem, the incidence in dogs is low and non-existent in cats. Caries lesions usually occur on flat or concave occlusal surfaces such as those found on the maxillary first molars. The lesions are sticky on probing and can have a bad odor. Affected teeth can be treated by removing the diseased dentin and placing a composite restoration (a “filling”). If left untreated, the decay can lead to pulp exposure requiring root canal therapy or surgical extraction.

Oral Surgery

Dogs and cats have relatively large tooth roots. Extraction of these teeth often requires creating a flap in the soft tissue, removing some of the bone over the roots and sectioning multi-rooted teeth. Careful planning and execution can prevent iatrogenic jaw fracture and alveolar osteitis (“dry socket”) delayed healing. All extraction sites are closed using dissolvable suture. Animals who have had teeth extracted should eat a soft diet and not chew on any toys for two weeks after surgery.
In select cases, teeth that are undergoing resorption do not need to be fully extracted. Crown amputation involves removing the crown of the tooth, closing the surgery site and allowing the body to continue replacing the root with bone. Taking dental radiographs is the only way to know if this treatment is appropriate for a tooth. Some animals may have multiple teeth that are reabsorbing but only some of the teeth or roots can be treated with crown amputation.
Every jaw fracture is unique. Some can be treated with a simple tape muzzle or maxillomandibular fixation while others require intraosseous wiring, placing bone graft material and/or using an interdental splint with the teeth acting as the source of stabilization. Most treatments require at least two procedures, one to stabilize the fracture and the other to assess healing and remove the stabilizing materials. Sometimes teeth need to be extracted as well. In most cases, dental radiographs are adequate for locating the fractures but CT is best for detecting multiple injuries.
Cleft palates can either be congenital or secondary to trauma such as an electrical shock or pressure necrosis from having a stick wedged across the roof of the mouth. Animals with congenital cleft palates may need supportive care for feeding and treatment of aspiration pneumonia until they are old enough for surgery (3-4 months of age).  The surgery involves sliding flaps of existing palatal tissue over to cover the defect. Traumatic clefts usually require different flap patterns and it may be necessary to extract some teeth first and close the defect later.
The key elements in oronasal fistula repair include tension-free closure, successful repair on the first attempt and not placing any foreign material in the nasal cavity. Many oronasal fistulae can be repaired using a mucogingival flap but other techniques require incorporating palatal tissue, auricular cartilage or bone graft membranes into the repair. The repair must be protected during healing. Feeding a soft diet, placing an Elizabethan collar and not allowing the patient to place any objects in their mouth are all part of the post-operative instructions.
The prognosis for many oral tumors is greatly improved by complete excision. This may require a partial or total mandibulectomy or partial maxillectomy. These surgical techniques can allow the animal to have a functional and acceptably cosmetic result. A biopsy is always recommended first to determine the diagnosis and prognosis. A CT scan can be performed to plan the surgical margins as well as provide information on the presence of metastatic disease. The CT can detect metastatic lesions in the lungs with more sensitivity than traditional radiographs.

Procedures

Endodontics

During a root canal, the dead pulp is removed and the inside of the tooth is cleaned and shaped so that it can be filled with a material that prevents bacteria from getting into the tooth again. Any tooth can have a root canal performed although in cats this treatment is generally only used on the canine teeth. Root canal therapy has a high success rate but it is recommended to monitor the treated tooth in the future using dental radiographs. Root canal therapy does should not weaken the tooth but a fractured tooth may be at risk for further fracture damage. Metal crown restoration can help protect a treated tooth from further damage.
Vital pulp therapy is a technique that can be used to keep a fractured tooth alive so that the pulp can continue to produce dentin and make the tooth stronger. It is most effective in young animals with recent pulp exposure or during a crown reduction procedure.  A substance called MTA is placed on the pulp to stimulate dentin formation and then the tooth is sealed with a restorative. This technique can also be used when mandibular canine teeth are being reduced to treat a malocclusion. It is critical that teeth treated by vital pulp therapy be re-radiographed regularly to verify that the treatment was successful and that the tooth has continued to mature. If the technique fails, the tooth will need a root canal or extraction.

Restorative Dentistry

Cast metal crown restoration of damaged teeth is recommended in animals where there is a likelihood of future trauma to the teeth or to prevent further damage to a worn tooth. Examples include dogs who perform bite work, cage chewers and dogs who play with tennis balls or other toys to the point of causing excessive wear on the teeth. Crowns can be placed on teeth that have fractured and had root canal therapy or to protect healthy teeth. Crown restoration is a two-step process. During the first anesthetic episode, the tooth is shaped to create retention for the crown. Impressions of the tooth and occlusion are collected created and sent to a crown laboratory. The crowns are custom made from the impressions and are generally available in two weeks. The crown material used most commonly in dogs is a metal alloy that is silver in color. When the crowns arrive from the laboratory, the patient is anesthetized again to cement the crowns into place.
Composite restorations are used to close areas of pulp exposure or endodontic access sites after root canal or vital pulp therapy. They can also be used to replace missing enamel in animals with enamel defects but they are not as strong as normal enamel. A third use is in the treatment of caries (tooth decay). In humans, this is what is used when you get a “filling”.
Dentin may be exposed by trauma to the tooth, enamel defects or intentionally when a tooth is reshaped. Exposed dentin is sensitive and can be permeable to bacteria. Exposed dentin can be sealed with a clear bonding agent to prevent sensitivity and bacterial ingress.

Periodontal Surgery

Periodontal disease can lead to the formation of pockets where the gingiva is no longer attached to the underlying tissue. If left untreated, these pockets can become deeper leading to bone loss, tooth mobility and tooth loss. Root planing and subgingival curettage remove infected material from the pocket and then a gel or powder containing antibiotic is placed in the pocket to help keep it clean and allow the gingiva to reattach. Periodontal pockets can be identified during a complete oral exam.
In certain cases when bone loss has occurred around a tooth root due to periodontal disease, the bone can be replaced using guided tissue regeneration. Freeze-dried demineralized bone graft material is combined with a membrane that prevents soft tissue from invading the area while new bone is able to grow. The success of this technique is partly dependent on your ability to perform home dental care such as daily tooth brushing.
In cases of gingival enlargement, the gingival tissue can be surgically resected and shaped to restore the natural height and contour which can help prevent periodontal disease.

Orthodontics

The term interceptive orthodontics refers to procedures that are performed on young animals to prevent orthodontic problems when the adult teeth erupt. The most common example is early extraction of deciduous mandibular canines that are base narrow or positioned lingually so that they contact the palate. The adult mandibular canines erupt on the lingual aspect of the deciduous canines, exaggerating this condition. Early removal of the affected deciduous tooth or teeth may prevent malocclusion of the adult teeth which is more complicated and costly to treat.

What our clients say

Dr. Redman was absolutely one of the most wonderful doctors I have ever dealt with! Very compassionate towards my dog and myself – a wonderful doctor. She made me so comfortable.
Babyboy's Mom, Sandra
I am very pleased with Dr. Redman, staff and treatment of my pet. I feel I went to the “best”.
Joey's Mom, Diana
I was so scared to have Katy’s impacted teeth removed. Dr. Redman was so very patient with all my concerns and questions. She is so calm and reassuring. I would definitely recommend her.
Katy's Mom, Laura
This was a difficult procedure for my cat and a worrisome time for me, as well. Dr. Redman and the staff at the clinic took good care of both of us and I was reassured by their warm and professional manner. Would recommend to anybody who needed specialized care for their beloved pet.
Joyeuse's Dad, Dallas
Dr. Redman was exceptional! She is so down to earth and so kind to me and my pet! It was very appreciated at this emotional time.
Emmy's Mom, Holly
I have a 13-year-old Golden Retriever and was extremely nervous about having her teeth cleaned and being sedated. From the moment I entered the clinic the staff and other clients in the waiting room put me at ease and trust. Dr. Redman did a fantastic job in explaining the procedure and my Zoe is feeling fantastic.
Zoe's Mom, Debbie
Dr. Redman is awesome! Not only is she gentle and caring as she meets and assesses my baby, Nala, but she is informative and kind when she discusses her diagnosis with me. She is very patient and thorough and it never feels like she’s rushing you. She also provided additional education to enhance the care I provide to my furry family. I’m glad I don’t have to see her much, for obvious reasons, but I am glad that she is there when my baby needs her!
Nala's Mom, Tina
Dr. Redman was excellent, explained everything in detail, highly personable while maintaining professionalism. She was wonderful!!
Abigail's Mom, Holly
Dr. Redman and the staff at MVS were friendly and professional. The staff quickly and efficiently answered all of our questions, both in person and by phone. Thank you so much! The discharge forms that detailed post-surgery diet, med schedule, etc. were helpful and a good reference tool in staying on track with our pet’s recovery.
Nibbles' Mom, Lisa
Dr. Redman and her staff were fantastic with my puppy Ripley’s surgical needs. As a dental surgeon, Dr. Redman was very kind and explained the procedures needed to correct my lil pups broken jaw. They were booked for previous surgeries, however they made sure my pet was confortable until her surgical appt date. The cost as expected was unforseen, however after being walked through each line item, we understood and took responsibility for the charges to assure our pets livelyhood.
Ripley's Dad, David

FAQs

Daily tooth brushing is the most effective way to prevent periodontal disease and can also help owners notice other problems in the mouth. Start by finding a pet-safe toothpaste that your pet likes to eat and allow them to lick a small amount of it off of your finger each day. Gradually progress to rubbing your pet’s teeth with your finger and then start to use a small soft-bristled toothbrush or electric toothbrush. If you establish a routine, your pet may soon start to prompt you to brush the teeth. Although daily tooth brushing is the gold standard, there are many other options for home dental care. The website for the Veterinary Oral Health Council (vohc.org) has a list of all of the home care products that have been proven to be effective.
Many objects that are sold as chew toys for dogs can actually harm their teeth. If a toy is so hard that you cannot bend it or indent it with your fingernail, it is hard enough to break a dog’s teeth. Real bones, hard nylon bones and antlers can all cause dental fractures that are painful and can be expensive to treat. Tennis balls can cause severe abrasion of the teeth, sometimes to the point of pulp exposure in dogs who chew on them or carry them around all the time. No toy is perfectly safe for all dogs to chew and dogs should be monitored while they are chewing to be sure that they don’t ingest toy parts.
During a professional dental cleaning, the operator’s hands are in the pet’s mouth and so are a variety of sharp instruments. Injury to both the pet and the operator can occur if the pet is moving. It is not possible to perform a complete subgingival cleaning around all aspects of the tooth in an awake animal. In addition, the inflated cuff of an endotracheal tube protects the airways from bacteria-laden debris and fluids. General anesthesia allows us to safely monitor and control the pet’s vital parameters and plane of anesthesia as well as provide pain control as needed.
Dental radiographs can only be obtained while your pet is under general anesthesia. The phosphor plate or sensor has to be inside the mouth and your pet has to be perfectly still to get a diagnostic image. After the initial consult, we will schedule a date when your pet can have dental radiographs and treatment at the same time.

Your pet may be less hungry than usual the night that they go home but they will be allowed to eat. If you pet has any oral surgery, crown preparation or an orthodontic appliance, you will be instructed to feed a soft diet and if you have a dog, they will not be allowed to chew on toys for at least two weeks. The soft diet can be a canned diet, homemade food or kibble that has been soaked in water until it is soft. Dogs and cats can eat without any teeth at all and once the mouth has healed, they can even eat dry kibble.

All oral surgery can cause pain although often the pain from surgery is less than what was present before treatment. All patients receive pain medication prior to their procedure because it is more effective to control pain before it occurs. Whenever possible, oral surgery sites are numbed using a local anesthetic. Your pet will be monitored throughout the procedure and additional pain medication will be given as needed. Pain medication will also be dispensed for you to give at home.
After having oral surgery, it is not advisable to force a pill into your pet’s mouth because this may cause pain or affect healing. For most dogs, pills or capsules can be disguised in a highly desirable treat such as Pill Pockets. If necessary, we can administer long-acting injectable or transdermal forms of some medications. If you have a preference for pills vs liquids or would like to have your pet’s medications compounded into a tasty treat, just let us know.