It was a very difficult day today. My morning consisted of two very challenging procedures: two stage 4 out of 4 dentistry procedure, each poised to consist of multiple tooth extractions necessitating invasive oral surgery, each in dogs at advanced ages, 14 and 15 years of age. (Dental disease is graded from stage 1-4, 1 being the least severe, 4 being the most severe) One dog is home tonight resting comfortably, the other did not leave my clinic alive.
Why perform dentistry on dogs at such advanced ages, one may ask? Because regular maintenance cleanings were not done on these dogs in years despite repeated recommendations from veterinarians in my clinic, and their mouths were so diseased, infected, and painful, neither could eat without wincing in pain; both had thick, constant drool with offensive odor. Both were so painful that they would not tolerate me looking in their mouth, and their quality of life was so poor that each faced choice either risking the anesthesia for oral surgery, or euthanasia.
Beyond being at an advanced age, the 14 year old dog also had developed cardiac valve disease in the past year, a condition for which severe chronic dental disease likely played a major role in developing.
While the 15 year old had such decayed teeth and jaw bone that I had to extract every remaining tooth in her mouth; she survived the anesthesia and recovered well. Thankfully, she is home tonight and after 2 weeks of antibiotics and pain management; she should go on to enjoy a peaceful rest of her life…albeit on soft food.
For our 14 year old dog with cardiac valve disease, things started off fine. The condition of the teeth was so bad that calling the necessary teeth extractions and bone/soft tissue reconstruction oral surgery almost sounds like an understatement. Despite this, however, the dog remained stable throughout all of the extensive work. The problem began after I placed the last stich, the dog was taken off the anesthetic gas, and we had just begun the recovery process delivering only pure oxygen and preparing to pull her tracheal tube. The heart rate out of nowhere suddenly dropped to a dangerous level.
Cardiac stimulatory drugs given intravenously provided mild bumps in the heart rate, but the rate would continue to tank nonetheless despite repeated dosing. Eventually the heart stopped altogether, necessitating chest resuscitation (compressions and manual ventilation) to support the patient. 20 minutes later, I pronounced him dead, and I had to make the heartbreaking call to his owner to inform her of the loss of her dog.
Both of these owners are good people who no doubt love their dogs and never intended any harm to come their way. Like too many pet owners, they simply failed to heed our warnings of the need for veterinary dentistry. Whether they could not justify the expense, did not believe their dogs were showing pain until things were out of hand and they could no longer hide it, they were afraid of the anesthesia necessary to perform the dentals when they were younger and healthier to withstand it, or some or all of the above; both owners learned a very tough lesson today.
I wrote about this day so that others may not make the same mistake.
Dr. Roger Welton is the President of Maybeck Animal Hospital and CEO/Chief Editor of the veterinary information and blog online community, Web-DVM.