Pomeranian 6 years 6 months old dental cleaning. I'm worried about anesthesia.

[Wtps]

My 6 year 6 month Pomeranian went in for his yearly shots. We finally got a good look in his mouth and found that he has 3 loose teeth. One tooth fell out 2 weeks after his yearly visit so back to the vet on Thursday was told no sign of abscess or infection. I gave him bones used enzymatic toothpaste when HE would allow me yet it didn't work out and I feel terribly about this. He was supposed to go in for a dental last year but I put it off b/c my friends said I was insane to put a dog under anesthesia for a cleaning and I was scared to put him under and didn't know what I know now. Moderate build up on some teeth and he needs a dental. I'm having a consultation w/the vet on Monday and hopefully will have him done next week. He banged his snout a few weeks ago while chasing a cat would that cause the teeth to become loose? Now that's the background here's the issue. I'M DEATHLY AFRAID of him going under the anesthesia. I know tooth loss and decay causes worse problems but I've been crying myself sick and have been ultra nervous about this. I thought I was doing the right thing by giving him bones and brushing with the enzymatic toothpaste but I just couldn't reach all the areas.
I'm afraid he will die at the vets. It's terrible I've lost sleep and can barely eat. I just feel my best friend is going to be lost. Can you please tell me any precautions I can ask the vet to do? I heard certain small breeds don't do well under injection anesthesia and should be given as gas, but on the website it says they pre-medicate with an injection, then IV medication to lose consciousness then gas to keep them under. I heard bad stories about the injections and I'm fearful. This is an animal hospital that is AAHA certified. This isn't a vet dentistry office. Do I need the specialist or am I OK at this vet(this vet also performed my dogs neutering using Isoflurane anesthesia. Does isoflurane involve the injections too or is it just gas? Could his heart and kidneys be damaged?

[Arnold L Goldman, D.V.M.]

Dear Wtps,

I understand your anxiety and dilemma only too well. This is an example of justified anxiety about anesthesia being weighed against allowing ongoing disease to progress.

Unchecked dental disease, especially when infection is present, often "seed" bacteria to the blood stream with disturbance such as chewing or other normal activities. That can in turn cause colonization in such places as the heart valve leaflets, kidneys and pancreas. Indeed, a paper published last year in the human literature, tied untreated periodontal disease to human pancreatic cancer. So that is the benefit of addressing dental disease regularly and thoroughly, avoiding progression and new problems, some serious.

The down side, is the risk of death with poorly administered general anesthesia, and much less common, but still plausible unseen and unknowable idiosyncratic adverse reactions.

In a young, otherwise healthy animal such as yours, the risk of anesthesia may be less.

In a brachycephalic (short-faced) breed, there are added challenges and risks with anesthesia. No question, careful management of this and every pet is of course warranted.

In the end, only you can weigh the risks and benefits of going ahead with the procedure. If in doubt, get a second opinion from a dental specialist in your area.
One can be found at:

http://www.avdc-dms.org/dms/diplomates.cfm

Finally, please read my blog and associated links on the risks of anesthesia here:

http://www.medhelp.org/user_journals/show/162049?personal_page_id=864097

Please let us know what you decide and how it turns out. Thank you.

Sincerely,

Arnold L. Goldman DVM, MS
MedHelp & PDOC

[Jennifer Mathis, D.V.M.]

I agree with Dr. Goldman.  I am a member of the American Veterinary Dental Society and am working on my specialty degree.  You are encouraged and welcome to see a veterinary dentist as Dr. Goldman said, "http://www.avdc-dms.org/dms/diplomates.cfm"

Many non specialists do a good job with veterinary dentistry, but seeking another opinion should help you understand that the minimal risks of anesthesia significantly out weight the large risks of dental disease that is present and progressing now.

Please read these files.  It explains the need for dental care as well as anesthesia risks.  Please be aware that this first one mentions prices from 1997, which are about 1/2 of what they may be today, given advancing technology and increased costs of drugs.
http://www.toothvet.ca/PDFfiles/mythology.pdf

http://www.toothvet.ca/PDFfiles/Dental_Truths.pdf

I would not hesitate to do the dental with anesthesia.  Please be sure that pre-operative bloodwork is done as well as IV fluids during the procedure (to support blood pressure, speed recovery, help flush bacteria (from mouth) through the body, and provide an emergency port should a problem arise.)

Please let us know should you have further questions or concerns.  It is a plus that your veterinary hospital is an AAHA hospital, but it does not require them to do every thing, it suggests that they can and will and likely do require the best medicine for your pet.

[Wtps]

Dear Arnold L Goldman, D.V.M., Jennifer Mathis, D.V.M.,

I want to sincerely thank you for the wealth of information that you both provided me with. I greatly appreciate the time you spent helping me. You have educated me and put my mind at ease (I'm not going to lie I'll be a wreck the day he goes under though). I decided that I will have the dental done at the same place that he was neutered because I really trust our veterinarian there especially since we had not one issue with the neutering. I knew waiting this long would not be the best thing to do however I thought his teeth would be OK and thought that the risk of anesthesia was worse than the need(boy was I wrong and I feel terrible about that). I strongly feel that he needs this and it is necessary and just know that it's for his better health and a longer life with me!

We go next week for the consultation and I made a list of everything to ask our Dr. (Most of my questions are addressed on the Dr.'s website but I just want to be sure)

Since he had Isoflurane in the past I'm assuming he was only given gas for his neutering and will ask (if possible) that he receives the same since there were no issues in the past. I'll also ask what our Dr. recommends if that can't be done.

I thank you both tremendously for your responses. I was able to calm down and think rationally about the situation and you both provided me with information to make an informed decision. There was no doubt in my mind he needed this, I just worry so much about him because he is so special to me and the thought of losing him is the most painful thought. I realize now more than before that worse things can happen if you let this go too long.

I pray that his pre-blood-work panels come back healthy. I'm going to be vigilant about dental care after this whether he likes it or not :)

I will update you both once I know more. I just know I'm not going to be able to leave the facility until I know he's done and he's back in my arms with tail wagging. I'm so attached to my boy and the bond we have is amazing.

Thank you both again so very much! Your kindness and helpfulness helped me tremendously.

[Wtps]

We had our consultation appointment and exam today. We had blood taken for pre-anesthetic blood work and I asked for urine to be taken as well. The results will be back tomorrow 2/23. I'm praying there are no abnormalities.

It turns out his periodontal disease isn't moderate as we were first told by another veterinarian but it is severe. We also discussed the Porphyromonas vaccine, but I don't feel that I will go with that at this time. I'm going to do a prescription diet after the cleaning and use oravet as well as brush and give good chews.

I will update tomorrow with results. I really hope he is OK. I'm so scared.

Our vet said that they use propofol as part of the procedure. As well as the isoflurane gas. He also mentioned valium pain meds for take home. Does this sound right? The thought of propofol scares me.

I found that he will be monitored as if he was a human during the procedure.

However when I asked if they had a fibrillator the Dr. said they don't have one and told me how in his scope of practice they've never needed one and using one probably wouldn't unless the heart is in a certain way(sorry I can't remember the technical terms)

Is it ok that there's no fibrillator? This is the same vet that did my boys neutering without a problem and he's a wonderful vet.

Your thoughts and suggestions/feedback would be appreciated. Anything I missed etc. Thank you so much.

[Jennifer Mathis, D.V.M.]

Using an iv or im drug prior to isoflorane is the best medicine.  I would not worry about the propofol - that's good medicine to make it less stressful your little boy's procedure.

It's okay that there's no fibrillator.  At the university emergency clinic, they once commented that it was almost an unnecessary piece of equipment it rarely changes the outcome even when used promptly properly.

I hope valium is not the only pain med they're using.  I would recommend a combination pain protocol starting with an NSAID prior to the procedure (assuming he'll stay hydrated and warmed with IV fluids during the dentistry), a nerve block (think novacaine from your dentist, but slightly different) during the procedure, and ideally morphine during/just post op assuming teeth need extraction.  If bloodwork is good and fluids were given during the procedure, an NSAID should go home with you.

The porphormonas vaccine can be good, but needs a clean slate to be administered and may have a local swelling at injection site that is less so on the booster 1 month later.  If many teeth are removed, it may not be worth doing until the mouth has healed, but it is a beneficial vaccine.  A dental diet and oravet are good choices.  I use CET veggie dents in addition to those two home care options for my little dog.  A combination approach is best, but nothing will prevent the need for a cleaning in the next 6-12 months.  You will delay the buildup with your home care making the problems not as bad for future - ie less systemic damage over time.

Good job for taking care of your little guy!
Dr. Jen

[Jennifer Mathis, D.V.M.]

Oh, you mentioned brushing teeth.  I wanted to share a surprising fact from new research:  If you brush your pet's teeth 5, 6, or 7 times a week, brushing is beneficial for your pet.  If you brush your pet's teeth 4 times a week, it's equal to not brushing!
ie unless you can commit to brushing your pet's teeth AT LEAST 5 times a week - ie every weekday or practically every day, you may as well not brush.

Honestly, I cannot commit to that with my pet, so I just use oravet weekly and don't brush my dog's teeth.

Also, never pay a groomer/veterinary personnel to brush your pet's teeth.  Unless that person is doing a professional cleaning under anesthesia or you are also brushing your pet's teeth daily as well (which if you are, you likely wouldn't pay someone else to do it).

[Wtps]

Thanks for clarifying about the fibrillator, that's what our veterinarian also said exactly as you put it. I couldn't remember exactly what was said!

Our veterinarian mentioned about keeping him warm and how they have this balloon type thing or something to that effect. (sorry I'm so stressed about this I can't keep it all together) Everything is monitored etc. and he said they carefully monitor and make adjustments if needed etc.

He did mention the nerve block so that's good and told me I'd be going home with pain meds to administer to him at home for the rest of next week.

I had a question about the CET veggie dents are they made in the U.S.? I just checked out the CET Chews Petite for Small Dogs and they seems like he'd choke on them? They are really think and hard(I'm not going to give any to him now, obviously I can't but wonder if this is a good choice for him) plus they were made in Mexico and my other vet said try to preferably get things made in the U.S.

We discussed using a prescription diet tonight and will be going with the d/d by hills. I'm also going to buy some of the treats for him(I feel terribly that he's not going to be able to enjoy them for some time after this though)

This was a real eye opener to me. I feel like I've failed him. After this he's getting dental care daily even if he's in a bad mood.

[Wtps]

Wow thanks for letting me know about the brushing. It's a real eye opener. I need to commit to 7 days a week there's no excuses now. I've been doing some reading about people using ice chips to help the dogs teeth and keep tartar off. I'm not sure what to think of what I've read.

Forgot to mention that I will also be going home with oravet next week as well. I bought CET cat toothbrush and small dog finger ones with malt and chicken paste for after we are out of the woods with the cleaning.

I've honestly been beating myself up over this. I had no idea how severe it had become because he was head shy and didn't like to let me all the way in so most of the time I only saw his front fangs and the small tiny upper and lower teeth. I know that's not an excuse but sometimes I'd try brushing and he'd absolutely make it so that I couldn't continue. The I had him on greenies for about 2-3 years and his teeth were better, but I found them to be a choking hazard at times because I'd watch him when he was eating it and then what I saw it get small I'd try to take it and sometimes he'd try gulping it, plus all the horror stories about the formulations scared me.

Forgot to mention the Dr. said his heart and lungs sound great and that his knees are strong.
Thank you so so much for answering my questions. I will update tomorrow with the blood and urine results. Hopefully it's good news.

[Wtps]

One last piece of info. He seems a bit tired, obviously in pain and just not himself. I've been soaking his food in water getting it soft and feeding him that. He hasn't wanted his petstages orka bone but just 5 mins ago decided he wanted to chew. Thanks again.

[Wtps]

I'm wondering if it would be possible to do just the isoflurane for the procedure(cleaning and extractions)? The plan is to use propofol and valium along with the gas, but I read online that cleanings can be done with just the isoflurane?? And that you don't need any other drugs? Is that true? I'm clueless please help.

[Wtps]

Scratch that I just read for extractions it's necessary. Hopefully that was right info. though.

[Arnold L Goldman, D.V.M.]

Hi,

Propofol is among the safest induction agents we have. The use of isoflurane requires inserting a plastic or silicone tube into the airway ( as afety factor) and the ability to do that requires the rapid ability to control the head and airway. Induction of anesthesia is most frequently accomplished with an injectable induction agent like propofol. The propofol/isoflurane combination is among the safest. You need not second guess your doctor's jusdgement about the drugs used. Presence of an iv catheter, blood pressure monitoring, airway intubation, warmth provision and other factors are in my view far more critical in the average patient than the actual drugs used to induce anesthesia.

Please let us know how your little guy does.

Sincerely,

Dr. G

[Wtps]

Hi,
Thanks for replying and the info. on the Propofol I didn't know that. That helps me feel better about it as I'm a ball of nerves.

Blood test and urine test results came back urine looks good his kidneys are functioning healthy, no signs of urinary tract infection etc.. The blood work came back the globulin was a little high but I was told the cause is most likely the inflammation from his dental disease.

I'm grateful everything came back and that I can take him to have the dental done.

Thank you both tremendously for helping me.

I will update once the dental is done.

Thank you both so much again.

[Wtps]

Is perioglass/bio glass usually used during extractions routinely? Or is that something I'd have to request? Also if any of the teeth could be potentially saved what are my options for my baby if any and will my vet be able to use the perioglass and possibly save teeth? Or is that a veterinarian dental specialist type of thing?

Thank You

[Jennifer Mathis, D.V.M.]

The second article by Fraser Hale about dental truths states that once there's a problem tooth - almost always the only options are extraction or root canal.  They can actually eat hard food well without any teeth, if the teeth are removed correctly and no retained pieces nor hiding teeth remain.  A dog has 42 teeth and really only 10 could do the same function.  Often it is better to loose a tooth than have that unimportant tooth continue decay and damage an important tooth.  If what I think is happening in your baby's mouth is really going on (xrays under anesthesia will tell), it is best to extract teeth and not try to save them.  All too often a borderline tooth is much worse than we think and damages other teeth and the body. Again, remove any damaged tooth.

Bio glass - I think you are referring to a product called Consil.  If consil gets placed in a socket where much bacteria are or if the socket has so much damage it communicates with the sinuses, problems can result.  It's not so much the bacteria as the body's reaction causing tissue irritation.  ie don't over use it.  There are non specialists that have this material.  If it's a case of the remaining bone of the lower jaw may fracture once the damaged tooth has been removed, consil or the like is a good choice.  You  may need to see a specialist on that one, or your DVM may have it.  Please let your veterinarian make the choice.  Consil, when it works, improves the jaw bone by about 10% over nothing but the blood clot - ie it is often not needed.  If you really want to have something there, see a specialist that uses an osteoallograft or OraMend -- the new much safer products than the bio glass that don't cause the irritation that sterile glass shards can cause.

ie let your veterinarian make the choices for the best health of your pet.  I do use the OraMend graft and have Consil, but rarely is it needed - ie your baby will likely have the same outcome either way unless the jaw is destabilized.

Best of luck!

[Wtps]

Thank you!  I have faith in my vet I just really need to relax...can you tell? lol My baby seems to be doing better because I've been soaking his food with water for an hour then mashing it up. His energy is much better than it was a few days ago. I can't wait to get this all taken care of. I hate knowing he's in pain.I wanted to get him some canned foods but I'm afraid of changing his diet especially since he is having his dental on Mon. I'm def. going to get some prescription diet as the vet suggested while I'm there. Once this is over and done he will get brushings daily and I will never again let him run the show as far as tooth brushing goes. He's always disliked anyone touching his mouth. I remember bringing him home and struggling to brush his teeth, giving up trying again for years. I sure wish I laid down the law better now. Regrets.

When he was neutered I also had 4 milk teeth removed that had been growing on top of his adult teeth, they were in double rows. Could this have been a sign/warning of bad teeth to come? I just thought of this now.

[Jennifer Mathis, D.V.M.]

Don't beat yourself up.  I think I stated I don't brush my dog's teeth.  I do do other comprehensive preventatives though as well as regular anesthetic dental cleanings.  I've even had to do extractions on my own dog - better that have body problems/pain.

If you mean baby or deciduous teeth by "milk" teeth, it's a common issue that is unrelated to what you are likely seeing now.
The warning of bad teeth to come is the size of the pet. 85% of all pets have dental disease by age 3.  It higher % and earlier in pets under 25#.  ie any pet under 25# will have dental problems - it is a known fact that is often under emphasized by many veterinarians.

[Wtps]

Hi,

Just an update on my Pom. He had his dental yesterday everything went well with the anesthesia etc. So that was a relief. He needed 10 extractions mostly from the upper arcade in the back. I nearly fainted when I was told that. I was expecting 5-6 when I was told 10 I felt terrible and still feel like I let him down. I didn't know then what I know now. :( I picked him up that same night and brought him home.
He moaned a few times throughout the night I stayed with him and cuddled him which helped. He's eating fine and going to the bathroom fine.

He's on metacam and clavamox(started the clavamox a day before the dental)

He will not let me near his mouth to look in and the aftercare instructions say to look in. I've even had to put his metacam on a small amount of food(he ate it all) because he won't let me squirt the syringe in his mouth for obvious reasons.

Is it OK to squirt the metacam on his food, so as long as he eats it all in one sitting?
The clavamox is taken separately from the metacam, hours apart and I've need to squirt this on his food. Is that OK to do?
I'm going to call the office as well to be sure.

Doxirobe gel was placed on several teeth into the pockets. I really hope he doesn't lose anymore teeth. Now I'm concerned that he will only be able to eat moist foods because of how many teeth he had out. Is that what happens?

Also I was looking to get him the porphyromonal dental vaccine, as recommended by my vet. once he's through all this. But I've read that small toy breeds tend not to take to it well and have reactions, get really sick etc.?

Can anyone tell me how many teeth a 5.6 pound Pomeranian has? Is it the same as larger dogs? I'm really concerned about the amount of teeth extracted. While I understand it was for the better I feel it's a lot and that can't obviously be good for the future.

[Jennifer Mathis, D.V.M.]

Hopefully Doxirobe works, but if several pockets are present, they usually lead to teeth loss.  Again it's much better off without a tooth than a painful tooth.  Dogs and cats WITHOUT ANY teeth can still eat hard food.  If no teeth are present, it's better to feed soft food or moistened dry food as having more moisture is better for the body.  Soft food tends to have more fat which is not good for the waist/joints. Soft food will damage teeth faster, so hard is better when teeth remain.

20% of small dogs get sore at the injection site with the porphormonas vaccine.  My own little dog (12 lbs) with tooth loss (fractured and damaged and finally removed) was sore, but improved within 3 days, and was less sore with the booster given 4 wks later.  Given the pockets you've reported it may not be beneficial to give the vaccine as it helps prevent problems that may already be present and the vaccine is not 100%.  It becomes a personal choice.

All dogs have essentially the same number of teeth (unless they didn't come in from birth).  IT IS BETTER OFF WITHOUT A TOOTH THAN A PAINFUL TOOTH. You cannot change the past.  They can still eat hard food.  They are no longer painful without the tooth -- ie don't worry about the # of teeth extracted - only very few teeth are important for function, but function is still fine without ANY teeth.  A toothless dog has a better quality of life than a dog with few teeth with pockets and recurring pain.

[Wtps]

I hope it works too. Maybe the vet thinks they can be salvaged? Or maybe he didn't want to pull too many at once?

I'm feeding him his hard food but letting it soak for an hour in water then feeding it. Is that OK? I'm also wondering how long is too long to leave the soaked food out? I usually get rid of the soaked food within 4-6 hours and start a new bowl of soaked food. I was thinking of getting him some cans but not sure if I should introduce new food(don't want to upset tummy)

I'm blaming myself. Mainly because I was recently diagnosed hypothyroid and have felt 100% better lately. But last year was hell. I was so tired all the time and many other symptoms. I can't help but think if I wasn't so tired all the time then he would have more teeth than he does because I would have been on top of things more.

I will think about the vaccine. The vet said the lowers look good though so maybe we can save those at least.

Thank you so much again

[Wtps]

My furbaby is doing well today. Just a quick question for you. I asked our vet after the initial consultation about his teeth if my dog needed x-rays and was told no. I'm just wondering why? The vet said after the procedure that they got all the roots etc. but I just wanted to know why some vets do some and why some don't? Is it because of my dogs accessed condition and our vet figured it wasn't necessary because some of the teeth were already loose? Or is it because they got all the roots so didn't need to x-ray because they had all the roots? Should I get him some x-rays? Or is he OK?

[Jennifer Mathis, D.V.M.]

Please clarify.  Did your vet say your dog didn't need xrays of the mouth at all? or not again after the procedure until next dental (6-12 months depending on pet/mouth)?

ie were xrays ever taken?

If not, there is likely still a problem present in your baby's mouth.

I'll wait for your reply to let me know what xrays were taken/when to clarify my answer as there are lots of reason xrays may or may not be needed at different times depending on what is happening in a pet's mouth.

It is needed at least at the first procedure, though - -MINIMALLY.
Dr. Jen

[Wtps]

Hi,
My vet said that my dog didn't need xrays of the mouth at all. He said this after he looked into his mouth at the loose teeth etc. I asked two times before the procedure and was told he didn't need them.

The next dental I'm not sure if there are going to be xrays taken.

I was wondering why he didn't need them and thought it was strange. Is this bad he didn't have them?

[Wtps]

The vet I brought him to to do the dental this week is the same vet who neutered him etc. I then moved a few years ago and found another vet close by in my new town. I brought my dog to the vet close to me ever since for his yearly checkups and shots.

Two weeks ago when I noticed the bad teeth they told me that he didn't need pre dental antibiotics and that one of the machines I inquired about probably wouldn't be used to monitor him during the procedure. They also cut me off when I was asking questions so I decided not to go there since basically none of my questions were being answered.

I then took my dog back to our original vet because he's great. And that's where my dog got the dental.

I would have taken him to a specialist in Vet. dentistry but I never had that vet in the past and wasn't comfortable taking him someplace that I was unsure of (even though I'm sure they are great) I just felt since he was neutered by this vet and the vet did a great job with the anesthesia etc. that it was less risky.

The other issue with seeing a specialist is there is only 1 in my state and since I never used them in the past I was weary especially considering my experience with the local vet that he will now never go back to.

Forgot to ask:  Do all vets do sutures and flaps after a dental? Do the sutures dissolve?