February 20, 2011

Tooth Fracture

February is National Pet Dental Health Month. I was going to write a piece on the importance of keeping your pet's health clean, brushed and supervised to ensure your pet never gets through the pains of periodontal disease. Well I guess Gypsy beat me to it...with a slight 'edge'.

It's Sunday around 12:30AM (2/20/11)....that is 3 days after Gypsy's humanoid (aka. me) got her 4 wisdom teeth extracted. Finally off my pain meds I make my way to sleepy land...Gypsy is lying on my side of the bed, on my pillow no less. That's weird. Weird/abnormal in Gypsy world requires further investigating. So I start the Snout-To-Tail Assessment. Nose ok. Eyes ok. Mouth...ooops. Left side is ever so slightly swollen. Peekaboo. Gums ok. 4th Pre-Molar (aka Carnassial tooth) not so dandy (see picture below). Fractured vertically. Upon touch we get the wiggles.
First question: How and when did that happen Gypsy? Answer: Kisses.  
Second question: Does it hurt? Answer: Head tilt.
Ok, so not getting much out of that interrogation. She could have been in pain all day or half the day, hard to tell since she inhales her food any puppy way. That's the glitch with pets. She might have been trying to tell me but my limited Doggish kept me from hearing it.

Two assumptions wag at me: 1)  it hurts and 2) it will have to be extracted. Armed with my fully loaded Rover Respond'R kit in the glove box we head on out to the Hope Center in Vienna. My Rover Respond'R kit includes all their Pet Passports and with that a special page with previous notes from one of the attending regarding her allergy to one of the many anesthetics...kind of important when I expect them to have the tooth extracted. Long story short they take a look, inform me that the tooth cannot be extracted on site because its not immediately threatening her life but help me answer question number 2: Yes it probably hurts a lot.

The extent of a tooth fracture may only involve the outer enamel or it may involve deeper structures such as the dentine or pulp (nerve and blood supply) and in this case the wiggles is exposing the pulp. So now my boo is quietly in pain. Your lesson to be learned: If and when it happens to your pet, take at least a few minutes to call them - the emergency vet - and describe the problem. Not all fractures are the same and not all conditions are the same. A few factors will have to be determined but for the courtesy of recognizing that just because they don't whine as much as we do when we are in pain does not mean they are not! They could in most cases appreciate the pain meds and the antibiotics to keep an infection from biting your quiet hero. You can get a head start on the bloodwork (generally needed prior to submitting your pet over 6 years of age to anesthesia) and getting a dental veterinary referral.

She ends up on antibiotics and pain medication. I also get two referrals for veterinary dental specialists in the area. A dental  radiographs ( X-rays) will have to be performed and is considered essential in most cases to make an accurate diagnosis.  That is the basis for the prognosis and in deciding how to treat her. Contacted my primary veterinarian to expose the problem and ask for her opinion on the referrals I was given - Dr Knode from House Paws via email around 3AM (didn't want to wake up the world that early with a call) and have an answer by the time I wake up: Go see Dr Chamberlain from the Animal Dentistry and Oral Surgery center in Leesburg, VA .

Did you know that there are veterinary specialist out there able to provide Endodontic, Periodontal, Orthodontic, and Restorative procedures for our furry companions? Did you know that cast metal crowns, composite fillings, aesthetic bonding and bridge crowns is not just only for humanoids? I am always up to learning new things...just not always thrilled about the conditions in which I have to learn about them. So this is your chance to look into it before you are facing the inevitable.

So back to question one: How did you do that Gypsy? Although she may never sell the bone on that, pets most often break/fracture their teeth following a trauma (hit by a car, ball, or rock) or due to chewing on hard objects like raw hides, bones, sticks, etc. The most common teeth that are broken are the canine (fang) teeth in the dog and the cat, and the upper fourth premolar (large tooth on the top in the back) in dogs. What did Gypsy have access to today? A pathetic looking stick during the neighborhood walk...and then whatever I didn't get an invite on earlier or later that day.

We are not so different: "After a tooth is fractured, bacteria from the mouth will gain access to the pulp (root canal) and infect the tooth. Eventually, the tooth will die and become a bacterial haven. The bacteria will then leak out through the apex (or bottom) of the tooth, and infect the bone in that area. Eventually, the bacterial byproducts and white blood cell enzymes will cause bone destruction around the root tip. Next, the blood vessels in the area will pick up the bacteria and spread it to other areas of the body. Most specifically, to the liver and kidneys which filter the blood, and possibly to the heart valves. They will form micro-abscesses on the organs, and over time will decrease the efficiency of these vital organs." Source here

So brush your pet's teeth weekly, supervise bone, stick, raw hide and all sorts of chewing to prevent chocking and notice sooner rather than later should something go awry. Cannot emphasize the importance of a Snout-To-Tail Assessment! Sure keeps working on Gypsy! To learn more about the Snout-To-Tail Assessment and on how it recently made a difference for my Gypster, click here. The skills are taught in our Pet First Aid Classes. To register or learn more click here. To find a Pet Tech instructor in your area click here .

Will be posting Gypsy's follow up adventures here below.

2.21.2011 - Emergency Veterinary Dentist Morning Update
Gypsy went in to see Dr Chamberlain at 9AM at The Life Center in Leesburg this morning. He agreed to take her in for emergency surgery later on today. Not sure you can make it out easily on the picture posted here above but that 4th Premolar has 3 roots that go up pretty deep in the jaw. Cringe! Tooth will have to be completely extracted.

2.21.2011 - After Surgery Update
They called way early this afternoon around 1:30PM. Retook bloodwork because the Hope center test results were still missing. They gave her the pre-surgery meds to make her sleepy. What was nice was that she got to stay with me (or vice versa) after the shot and it took about 30 minutes to take effect. Once she went back they ran Xrays and did then proceeded with the surgery. She was out by 5PM but stayed in observation til 5:30 or so. Now home and whining. Still not eating. Mayday petrified of her. Mommy happy. In the process learned that there is 3rd root for that tooth - can't see it on picture as it runs up behind the teeth. Sigh.
Was told that tooth had been fractured for more than 2 days and more along the lines of 2 weeks. I'll accept the week and a half since I brushed both Gypsy & Mayday's teeth when we got back from our holiday weekend at Deep Creek Lake. Note to self: When you perform the weekly Snout-To-Tail assessment remember to check all teeth individually.

2.22.2011 - Morning Update
What a night! She refused to eat or drink until about 9PM. Her tummy was empty and making gurgly sounds.
After a phone conversation with the emergency vet she was allowed to receive some more anti pain meds...and then she accepted milk and yogurt and some wet food. No more gurgly sounds. Still some whining and pacing. She finally laid down but those eyes stayed open for a long time. She got some more milk and watered down 'yogurty meat' around 3AM. By 9AM she was still a bit swollen on the surgical site but altogether rolling in the snow and begging for breakfast.

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