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Sunday, February 23, 2014

Senior dog dental care can turn the clock back - Abby's story

Abby is a sweet, timid terrier mix who loves  her walks and play time.   At 14  years old,  age has caught up with her.   Arthritis has crept into her back and other joints over time. J/D diet, joint supplement and anti inflammatory medications  have helper her over the years, but she was recently slowing down.

Abby's teeth were collecting more tartar causing inflammation as she aged.   Brushing her teeth regularly helped to decrease the speed of build up, but as time progressed the tartar grew.  For us to really help her, a full dental under  anesthesia was needed.   Abby is not a young dog - 90 years would be her human age equivalent.  So, understandably, the risks of anesthesia are a big concern.  It was clear that she was having  increasing pain from her mouth,  so her quality of life was decreasing.  At this point, the benefits of a dental cleaning  were out weighing the risks of anesthesia.

 I talked to the family about the risks of not removing the infected  teeth versus leaving them in.  Intermittent antibiotics could be used to give some relief, but there were risks of creating resistant infection, and rarely can the antibiotic have a real effect on the pain. .   I outlined how staging her dental procedure was important.  This meant  we would  start her on antibiotic ahead of the dental to decrease the amount of bacteria released into the body during the procedure.  We ran blood  tests  to screen for any kidney and liver problems . Knowing her internal  health  helped me  pick the safest method of anesthesia which reduced her risk.

On the day of her dental procedure, Abby was put on an IV catheter with fluids, heart and oxygen  monitors with a  Certified Veterinary Technician  directly assisting her anesthesia through out the procedure.  Local anesthetic nerve blocks and pain medication were given during the dental to minimize while her her anesthetic level while controlling pain.  I had to remove number of teeth and treat gum   pockets around the remaining teeth to address  infection.  Infection  is not apparent when you just look at a tooth.  It is by careful probing, measuring gum pocket depth, and even dental xrays that a veterinarian determines the best treatment.  She did great through out  the procedure with careful monitoring and care.  When   Abby  went home her mouth was comfortable and her pain was well managed.  I dispensed additional pain medication and soft A/D food to feed her as I I was concerned she may not want to eat well for a day or two. 
The brown tartar is hard like a rock and holds a lot of bacteria

One of the techs called to see how Abby was doing the next day.  We do follow up calls to see how everything is at home, and I was anxious to know if Abby was able to at least eat and drink. .  When the tech  talked to her owner, they found out Abby was eating and active and even playing !    A few days later Sue, the owner,  marveled at how much more lively and playful Abby was.  Abby was  getting up on the furniture now and playing with the new kitten the family had adopted. They felt she was much healthier and happier than she had been for a long while. .  All that inflammation and infection was  gone. It was so hard to tell what was affecting Abby before the dental, but with her sudden improvement now we knew it was the teeth that were affecting her.  What a wonderful change.

Dental care in pets is not as straight forward as it is in humans.  Dogs and cats can not brush their  teeth or complain that their gums are sore.  They find ways to avoid the pain by chewing on the opposite side, avoiding chew toys, or being less active due to the chronic pain.  It is easy to miss these signs especially if you have an older pet.  Witnessing the transformation of Abby was a big reminder to me that teeth are at the core of physical and even behavioral health.  I have had cases of aggressive pets who became very sweet after removing infected painful teeth.  Yes it is scary to think of the anesthesia.  Veterinarians have a very difficult time working on teeth without the help of sedation and anesthesia.   Even the best pet will not tolerate someone scraping and probing the teeth.  If you find a painful one - they will react against you due to the pain.  So deep sedation to anesthesia is important to provide the best dental care.  Staging the dental, by addressing the health before the anesthesia and taking extra care through IV fluids, pre-dental antibiotics or anti inflammatory medication  are some ways to reduce the risk for an older pet.
I used a special dental rinse for Butter scotch as he aged to help his teeth
  If you have an older cat or dog with stinky breath who  moves slowly, it is very likely the teeth are a problem .  Take your pet in for a dental exam.  We have photos and ways to explain how the tartar is pushing infection into the mouth and putting the heart, kidneys and liver at risk for damage.   Treating or removing the problem teeth is important to remove the source of chronic pain and inflammation in the body.  Staging dental care  to prepare your senior pet will  greatly reduces any risk. .  Abby is one example of how a dental can make a difference.

Thanks Dr. Sally Foote