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?

[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.

[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

[Wtps]

Great point. I will definitely be taking him to the vet dentist in 6 months to establish ourselves there and to see what they recommend. Will be repeating the blood work etc. as well. As far as the xray for his back I might just take him in later this week.

We used metacam for pain management after his dental. Funny thing about that if when I gave him his dose he was great. Right before he was due for another does he'd lay down then once I'd give him to dose he'd be great. I'm not sure if that was because of the dental pain of if the metacam was also helping any pain in his back.

The vet mentioned that it seems to be a bone thing and said either arthritis or a malformation. He said just looking at him and testing his range of motion he seems fine but we won't know until we take a look with the xray.

Will update with more info.
Thanks again!

[Wtps]

Hi,
We went to our appointment today. Everything healed up well and looks good. He's been eating some hard food with no problems so that is good. The majority of it I soften or feed canned food/mixed.

We talked about the dental vaccine and I don't think I'm going to get that as of right now. Can I ask you your honest opinion of the vaccine?

We also talked about the globulin levels and was told to come back in 6 months for checkup on the teeth and to repeat blood work then. Does that sound about right? I have a copy of his blood results too everything else was fine and in normal range.

With brushing, oravet and the prescription diet my vet feels that the remaining teeth will be fine and the ones filled with gel he feels will make it and he told me that they weren't that bad. We will see.

I did notice though that my dog doesn't like it when I brush his hind quarters. He lets me but it's with much resistance. So I'm taking him back for an xray because the vet checked him out and he whelped when pressure was put on his back. The vet also said the back seems a little weak then also said his knees and legs were strong and he's not sure if there's anything going on. The only way to know is with xray, but he seemed to think I maybe pulled at his skin near his legs when I was grooming him with the brush and that the skin might be sore or since my dog doesn't like people looking in his mouth that not letting anyone near his legs might just be temperament.

He lets me rub his legs and never whelped so I think he's OK but will do the xray just in case to be sure.

Is it common for small breeds to have somewhat weak backs? If it turns out to be a malformation or arthritis what happens next for treatment and are those conditions common in small breeds?

[Wtps]

Thank you so much. You have no idea what sharing your knowledge and expert opinion has meant to me. I truly appreciate it.

I'll update when we go in again.

[Wtps]

Is the slightly elevated globulin anything to worry about? My other vet said that his lynph nodes seems a bit swollen and she too said it's prob. the teeth.

Yet the other vet never mentioned the lymphs. What do you think?