"I don't do manual scaling," I said to the lady owner of the 16-year-old Pomeranian that had a mouthful of tartar-covered loose and rotten teeth Somebody in an internet forum had highly recommended me to her.
I elaborated, "Manual scaling refers to the removal of tartar and plaque from the dog's teeth by without the use of general anaesthesia. Some pet shop operators in Singapore provide such a service as the dog owner is worried that the dog may die under general anaesthesia (GA)."
I use ultrasonic dental scaling rather than manual scaling to remove tartar and plaques from the teeth but I did not educate this fair lady in her 30s on the difference between ultrasonic and manual dental scaling.
I knew what she wanted. She wanted her dog to have dental work without GA as the internet forums mentioned deaths of dogs during surgeries and dental work at veterinary practices. This Pomeranian had lived to a ripe old age of 16 years and GA would likely kill her as she had heart disease previously diagnosed by Vet 1 and confirmed by me.
"How many cases of dental scaling without GA have you performed in old dogs?" the lady asked.
No owner had asked me that question in my over 2 decades of small animal practice.
"None," I replied. "I use isoflurane gas anaesthesia for dental scaling in old dogs for the past years as I find it to be much safer a method than injectable anaesthetics. The dog wakes up immediately rather than be groggy for some hours."
The use of sedation and GA is to remove the pain in dental work, but it does not guarantee that the dog will not die of heart failure under GA. Many owners just do not do dental work to avoid this death on the operating table. Bacterial infections of the gums lower the immune system of the dog as the bacteria produces toxins daily and spread them over the body and internal organs. The dog becomes thinner as he eats less and less. This 16-year-old Pom was fed home-cooked food but he was thin. Either he did not get sufficient calories or he had oral pain and ate less. However, he looked much younger than his 16 years. He looked like a 10-year-old dog.
"I have kept this Pom for 14 years," the slim lady had adopted the spayed Pomeranian from the SPCA as a 2-year-old.
Sunday was a very busy day for me. So I did not have time to ask why she did not get the dog's teeth checked during her younger years. But I could understand that this owner wanted her dog to live for more years. To do that she needed the dog's bad teeth to be scaled. But not under GA.
This dog was an extremely high anaesthetic risk. Was there such an option as dental work without GA? Was this cruelty to dogs? The status quo would be for the dog to live in perpetual oral pain and bacterial infection killing her in time to come.
"Assuming no GA and that you are aware that your dog would suffer some pain during dental work," I cautioned the owner. "Your Pom could still die of fright and stress during such dental work (without GA). It would not be scaling but extraction of the rotten teeth," I had checked the dog. She had no fever and her respiratory rate was normal. However her pulse was weak.
The lady had not thought of this real possibility. "Let me have time to think about the whole process," she said. Men with heart disease do die under stress. So do dogs. I thought she would go home as I handled a surgery to remove a patch of necrotic patch 1x1 cm above the neck of the Shih Tzu whose body was full of rashes.
Sunday, May 3, 2009
Thursday, October 23, 2008
1. The internet generation girl
"What are the chances of my dog dying on the operating table?" the internet girl asked me. I call her an internet girl because she had done all the necessary research on dentistry in older dogs and read in the internet forums about dogs dying under general anaesthesia.
Now she had made a decision to get her 7-year-old Jack Russell dental work as there are much benefits to having healthy gums and teeth for older dogs rather than bad breath and a mouth full of bacteria and ulcers and later on, oral tumours.
Her thick jet black eyebrows and hair brought out the fairness in her oval-shaped face and enhances her femininity. I thought she would be in her mid twenties but was way off the mark as she was younger.
"It is not common for old dogs to die on the operating table if they are healthy," I replied. "There are no statistics about the outcome of anaesthesia in older dogs in Singapore. Have you ever undergone general anaesthesia?"
"No," she shook her head.
"Recently I had general anaesthesia at the Singapore General Hospital. One week before the surgery, the doctors took my blood for a health test and did an ECG to check my heart. For your dog, blood test ought to be done but that adds to the veterinary costs. Do you want to do it?"
The internet girl wavered. "I will check the dog's heart condition and if he has no heart disease, I will proceed to do the dentistry," I said. It is quite difficult for the average student to foot out money for general anaesthesia dentistry and blood tests as both could be over $500.
The Jack Russell's heart was normal. His appetite and behaviour were normal and so I decided to get on with the dental work.
The Jack Russell growled as he must be fed up with me for opening his mouth so many times to examine for oral tumours and ulcers as well as to assess the condition of his teeth. I would say that loose teeth and greyish black tartar and gum diseases made his mouth painful. He was patient enough to let me open his mouth once. But he was running out of patience with this troublesome vet gripping his muzzle to open his mouth.
To prevent the dog biting and struggling, I injected him with a very low dose of xylazine tranquiliser at 0.2 ml IM. After 10 minutes, he vomiting yellow froth and was given isoflurane gas. He slept peacefully. He was all right at 1% maintainence gas. He had no problem under general anaesthesia gas as his tongue was a healthy pink.
9 loose and decayed teeth were removed. The rest were scaled. The roots of the upper premolars were exposed as bacteria had eroded the gum line. The dog may
"Wrap your forefinger in a piece of rough cloth and "brush" his back teeth at least 3 x per week," I said to the internet girl. "This will save you a lot of money in buying dog toothbrushes and tooth paste and another dentistry one year later. Also, tartar will form in 12 months time and bad breath recur if you don't maintain the teeth."
As this Jack Russell has exposed gums for his upper pre-molars, he would strenuously object to brushing. I don't know what the young lady would do. I do not know if if had heard incorrectly. Her brother had said that dogs do not dentistry as bad teeth would just drop off.
Now she had made a decision to get her 7-year-old Jack Russell dental work as there are much benefits to having healthy gums and teeth for older dogs rather than bad breath and a mouth full of bacteria and ulcers and later on, oral tumours.
Her thick jet black eyebrows and hair brought out the fairness in her oval-shaped face and enhances her femininity. I thought she would be in her mid twenties but was way off the mark as she was younger.
"It is not common for old dogs to die on the operating table if they are healthy," I replied. "There are no statistics about the outcome of anaesthesia in older dogs in Singapore. Have you ever undergone general anaesthesia?"
"No," she shook her head.
"Recently I had general anaesthesia at the Singapore General Hospital. One week before the surgery, the doctors took my blood for a health test and did an ECG to check my heart. For your dog, blood test ought to be done but that adds to the veterinary costs. Do you want to do it?"
The internet girl wavered. "I will check the dog's heart condition and if he has no heart disease, I will proceed to do the dentistry," I said. It is quite difficult for the average student to foot out money for general anaesthesia dentistry and blood tests as both could be over $500.
The Jack Russell's heart was normal. His appetite and behaviour were normal and so I decided to get on with the dental work.
The Jack Russell growled as he must be fed up with me for opening his mouth so many times to examine for oral tumours and ulcers as well as to assess the condition of his teeth. I would say that loose teeth and greyish black tartar and gum diseases made his mouth painful. He was patient enough to let me open his mouth once. But he was running out of patience with this troublesome vet gripping his muzzle to open his mouth.
To prevent the dog biting and struggling, I injected him with a very low dose of xylazine tranquiliser at 0.2 ml IM. After 10 minutes, he vomiting yellow froth and was given isoflurane gas. He slept peacefully. He was all right at 1% maintainence gas. He had no problem under general anaesthesia gas as his tongue was a healthy pink.
9 loose and decayed teeth were removed. The rest were scaled. The roots of the upper premolars were exposed as bacteria had eroded the gum line. The dog may
"Wrap your forefinger in a piece of rough cloth and "brush" his back teeth at least 3 x per week," I said to the internet girl. "This will save you a lot of money in buying dog toothbrushes and tooth paste and another dentistry one year later. Also, tartar will form in 12 months time and bad breath recur if you don't maintain the teeth."
As this Jack Russell has exposed gums for his upper pre-molars, he would strenuously object to brushing. I don't know what the young lady would do. I do not know if if had heard incorrectly. Her brother had said that dogs do not dentistry as bad teeth would just drop off.
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