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January 09, 2007

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Georgia

How old was tinkerbelle when she had this surgery? My pomeranian is 14 years old and it is the second time the abscess has come back but the docter is apprehensive to do the surgery becuase she is a senior dog. Is it still safe to do this surgery to a 14 year old (very heathly otherwise) pomeranian?

Any advice would be helpful! Thanks!

Doc

Tinkerbelle was almost 14 when she had the procedure. The safety of anesthesia for any dog must be assessed individually. If anesthetic were good for you, you wouldn't lose consciousness.

Pre-operative assessment of liver and kidney function, blood sugar, electrolytes, electrocardiogram, chest X-ray and blood pressure give you a better idea of what you can expect during anesthesia. Support with I.V. fluids and patient warming are both helpful. Have a good monitoring set-up so that you can adjust things as soon as they take a downward turn, rather than several minutes later.

Anything you do like this requires a "risk versus benefit decision".

Sorry I was so late responding. I've been out of town for a few days.

Thanks for reading and writing.

Sarah

I have a 7 year old Catahoula who gets puffy faced right in the spot above her carnassial tooth and under her eye, as seen in the figures above. The funny thing is that the puffyness comes and goes, she can be normal for weeks and then suddenly the sides of her cheeks swell up, it's not hard, and it's not soft, and over the course of a few hours it will subside. I don’t see anything leaking inside of her gums or onto her fur as if an abscess had ruptured, and I haven't been able to link the occurrence to any food allergies, or anything else. For a while I wondered if she has a clogged or inflamed salivary gland. Often it will happen on both sides at the same time, but not always. And she can go weeks without any occurrence and then she'll get 3 or 4 in a week, or just one, it is very sporadic and random. Her mood or behavior doesn't change and she even lets me push on them and stick my fingers into her cheeks to look inside.
She crunches on her food, will spend hours devouring a bone when I give her one to chew. Her symptoms don't sound like a tooth abscess to me. But the puffy region is just like shown on the figures you provided. This has been happening for over a year, she doesn’t seem to suffer for it. Any ideas on what it could be?

Doc

Your dog needs to have dental X-rays performed, with a dental X-ray machine and dental film, NOT a big X-ray machine and "whole-head" pictures. Despite the fact that your dog continues to eat and function, there may still be pain. What is the alternative to eating? Starving? I really don't think you should ignore this.

Thanks for reading and writing.

Jacque

I have a 9 year old Lhaso Apso that has had a chronic ear infection for about 9 months. Dr.'s thought it was due to dust mite allergy. I took her to a Dermatologist who treated the infection so she could see into the ear, but then the dog developed yeast infection, then this abscess under the eye. There is no bacteria growing in the culture that was taken last week, however this abscess has continued to drain for a week. Could the abscess be related to the ear infection or the ear infection and abscess be related to Carnassial Tooth Abscess? The Dr. thinks that a saline solution injected into the abscess to see if it comes out the ear may explain. So far I have 3 vets that are baffled by this.

Doc

Hello, Jacque,

The doctors seeing the case are in a better position to evaluate it than I am. In addition to the saline injection, they may be considering a fistulogram. This is where a dye that will show up on X-ray is mixed with saline and injected in the abscess tract to see where it goes. Certainly good dental X-rays would be helpful in evaluating whether this is a tooth problem or not. In fact, they are the only way to evaluate WHICH tooth is involved, if it IS a tooth.

Your dog's case sounds complex and frustrating. I hope that your doctors are able to resolve it speedily. It sounds as though a C-T scan or MRI might be necessary.

Good luck, and thanks for reading and writing.

Jacque

I took my Lhaso Apso in to a surgeon and he came to the conclusion that it was an ear problem - so she had a Total Ear Canal Ablation and bulla Osteotomy on Tuesday. The abscess is still draining from her face. Dr. said the abscess was draining out from way below the ear. Hopefully this will solve her chronic ear problems.

Doc

Jacque,

That is one major surgery. It will take a while before your dog is recovered just from the surgery, so don't expect immediate relief from all the problems. Where the deep ear structures are irreversibly damaged, this is certainly the best course, and the only way to eliminate the dog's pain

Nicole

Dear Doc,
My almost 1 year old Belgian Sheepdog has an abscess around his carnassial tooth and it goes partially across his mouth. He is behaving normally though- and I was just wondering how you can tell if it is a carnassial tooth abscess or if he just chewed something sharp and poked his gum there. He eats EVERYTHING! If it isn't hurting him do I still need to get it looked at? And how soon? I can't really afford to take him to the vet but now I'm worried and need advice.

Doc

Hello, Nicole,

I am glad that your dog still has a good appetite. However, this does not rule out pain -- his alternative is to painfully starve to death or painfully keep eating. If he has a big hole in his mouth, it hurts.

There are times when the only way for me to assess a dog's pain (or lack thereof) is to put him on pain meds for a few days and see how his behavior does or doesn't change (Use human meds with care: for instance, some dogs have developed bleeding ulcers with a single dose of ibuprofen. Consult your veterinarian). A big hole in his mouth is not so mysterious.

I know finances can be a problem, but you need to figure out a way to help this guy.

Thanks for reading and writing.

Tiffany

doc,
My 8 year old collie mix came up with a swelling yesterday sometime I noticed it last night similar to the second picture - It's obviously extremely painful he's always a very mild mannered dog who likes gum massages but when I tried to very gently lift the swollen lip to see if it was draining he tried to take my hand off without any warning, obviously he needs to see a vet asap but I live in a small town and the vets here don't have dental x-ray machines, only one out of 5 even has an x-ray machine, they don't believe in using IV's for dogs or any animal under any circumstances... in short I'm seriously worried that when I take my dog in to have the tooth extracted the vet will kill him - we've lost a young dog and a cat to this vet's incompetence already. It's a heartbreaking situation because this dog is my absolute best friend he grew up with me and I know he'll suffer and eventually die without treatment but a 100 mile trip is out of the question - what can we do to minimise his risk, what procedures should we insist on before/when he goes in for surgery? I have reason to believe he has kidney problems AND possibly diabetes but the vets here all refuse to do bloodwork because they say it isn't needed.

Doc

Hello, Tiffany,

I am sorry that you do not have a relationship with your veterinarian where you have confidence in one another.

Even though your veterinarian may not offer pre-op blood work routinely, I am surprised that they wouldn't be interested in doing it for a client who wants it.

With the information you have given me, I would suggest seeing your regular veterinarian so that you can possibly get a different diagnosis. If the tooth problem still is at the top of the list, then perhaps they could get some pain medication and antibiotics started, and help you with a referral to someone who will do the type of work you want.

Good luck

Trina Johnston

Hi Doc, I have a 8mth old GSD just noticed today he has a large round lump exactly the place you show on pic but it seems to be more in the cheek than in the gums. if it's an abscess at that age should it be extracted?

Doc

Hello, Trina,

If the tooth is abscessed, it needs either extraction or root canal therapy. If there is an undiagnosed lump, then we would start by trying to aspirate it (use a needle to suck out some of the insides) to see what it is. YOu might have to X-ray the upper jaw, which would take dental films and general anesthesia.

Your veterinarian needs to take a look at this.

Thanks for reading and writing.

Trina Johnston

Thanks for answering so quickly, I took Ozzy to my vet this morn she thinks it's a foreign body like wood chip as she can feel the whole lump on the cheek more than the gum I pray to God that's all it is. Thanks again Doc I really appreciate your response.

A HENDERSON

My dog has carnassial abscess like tinkerbell. My vet took the tooth out but pus in still coming out. The operation took place in Sept, I went back after a couple wks coz it was still leaking and they put her on long course antibiotics, they have just finished and it is still leaking !! What would u suggest 2 do nx ???

Doc

Hello, Arleen,

The main thing right now is to let your veterinarian know that things are not going well. They are best equipped to advise you.

Fore me, the next step would be to re-X-ray the mouth and see if there is another tooth involved, or a pocket of infected bone (with or without another tooth involved).

Another bad tooth would need extraction, a bony pocket would need to be scraped out.

A complicated case may need to be referred to a veterinary dental specialist. (I wish that I had one closer to me than 200 miles).

Thanks for reading and writing.

ARLEEN

Thanks for your help especially since I'm in Scotland !! Took her to vet yest. for check up and she went in today for x-ray,they saw tooth was badly decayed the the flesh eaten away so she had tooth out and they flushed through where the pus was draining out, hopefully that should be it , she's like a different dog already !!!!
Thanks again.

Heide

Can a dog have these same symtoms in othere areas of the teeth and can a dog form an abcess if they have punctured an area of the gum and it may still be lodged in there.

Doc

Hello, Heide,

Yes, to all your questions. The carnassial tooth (4th upper premolar, or #108 and #208) just happens to be the most commonly affected.

This is why dental X-rays are so helpful.

Thanks for reading and writing.

Dee

Our 12 yr old golden retriever just had his
carnassial tooth extracted today by a highly respected veterinarian. Our dog had broken it and a large lump under his eye appeared. We thought it was due to a spider bite or allergic reaction. But the vet took one look at his face, opened his mouth and "aha" there was the evidence. We were able to take him home today with a course of antibiotics. A couple of hours ago, we noticed some blood coming out of the nostril that is on the same side of his face as the lump. Not alot but dripping.
I called the emergency vet and they said unless it is bleeding profusely, it is probably nothing to worry about.
Just thought I would see what you think and then others who go through this can be aware.

Iris

My beloved, elderly, arthritic, deaf pit bull at age 15 puffed up under her eye on one side of her face a six months ago. The vet put her on antibiotics and also Rimadyl, for her arthritis. The swelling went down immediately and she responded wonderfully to the Rimadyl. However, now, 6 months later, she stopped tolerating the Rimadyl, and she puffs up on one side or the other of her face in the Carnassial abscess spot, every day or two, then it mostly goes back down. I've taken her to the vet twice and he's mentioned that it might be an abscessed tooth, each time. There is no draining pus, inside or out. He's given her two rounds of antibiotics and she did seem to feel better at first with this one.

But, only tonight did she show signs of being off her appetite. I always soften her food for her with warm water and wait a few minutes, but tonight she only wanted to eat if I fed her soft kibbles by hand. Of course that could be something else, but I worry it could be pain from this tooth, or teeth (both sides seem problematic).

The vet said each time, "We could put her under and go in and explore it, or you could take her to have a dental x-ray done... here, let's try her on antibiotics and see what happens."

Because he wasn't actively recommending either course of action, just saying we "could" do that, I just went with the antibiotics. She is losing muscle mass and has ever weaker hindquarters. Do you think he hasn't recommended action more strongly because he worries she might not tolerate or recover from surgery? How can I better understand the risks?

My fear is that, as I have heard happens to some older dogs, she simply wouldn't recover any kind of tolerable quality of life post-surgery, and then might have to be put down after suffering the injury of surgery (in which case it would seem to have been wrong to put her under the knife). But I am able to pay for any treatment, I only want to do what's best for her. (She also gets extremely extremely anxious and tense at the vet's, though the vet himself is gentle and I think very good.)

Would an x-ray be better, i.e. less invasive and adequately accurate, compared to putting her under and going in to explore?

Thank you for answering! Thank you so much for all this information!

Mary

Hi,

I just adopted a 4 yr old dog rescued from a puppy mill. I did not know she had problems w teeth, since were told they were in good shape. Her breath was so bad and when I investigated her mouth, the carnassial teeth are obvuously the cause of the odor. The teeth have holes in them w pulpy material which probably means they are absessed. I will take her to the vet next week but am trying to educate myself first. What is the reason they pull these teeth vs root canals? Is it the difference in cost? I hate to see her lose these teeth. Are they still able to eat dry dog food without these teeth?
Thank you!
Mary

Doc

Hello, Dee,

I would not say that it is expected or customary to have a nose-bleed after an extraction. However, if there were an abscess, it could have easily broken through the thin bony wall into the sinuses. This would explain the discharge from the nostril

The odds are good that with the abscess opened, and the tooth removed, that things will heal while taking the antibiotics.

Good luck.

Doc

Hello, Iris,

It sounds as though your dog may be developing some other health problems in addition to the arthritis and the probably abscessed tooth.

With recurrences after repeated antibiotics, I think it unlikely that the tooth will get better. A dental X-ray will make sure whether an abscess is the problem AND (important) which tooth is involved.

Dental X-ray does require light anesthesia. The dog won't hold still with a dental film in its mouth while it is awake.

If your veterinarian is not comfortable with treating your dog more aggressively, ask him/her to refer you to a dental specialist. At this dog's age, I would certainly want to do pre-surgical risk factor assessment, i.e. ECG, blood chemistry panel, chest X-rays.

I can certainly understand being reluctant to anesthetize an aged animal for a potentially major procedure. There ARE risks involved. On the other hand, it sounds like your dog's quality of life is deteriorating. It sounds as though the condition may be painful.

Ask your veterinarian if he/she knows of a dental or surgical specialist within driving distance. Also, you might ask for another type of pain medication, since your dog doesn't tolerate the Rimadyl now.

Your veterinarian is really the best person to advise you, but they may be reluctant to push you, considering the age of the dog. Just let them know that you are ready to jump in with both feet and guns blazing.

Thanks for reading and writing.

Doc

Hello, Mary,

Yes, they will still be able to eat dry dog food without these teeth. They can gulp it down whole with no problems as a general rule.

They might not be able to take down a goat and rip it to pieces, but how often is that going to be a problem?

As far as root canal versus extraction, there are several considerations. First, as you mentioned, cost: a root canal will cost a lot more than an extraction, several hundred dollars per tooth.

Second, it takes a veterinary dentist with special expertise and tools. Many veterinarians (such as myself) can do a fine job extracting the damaged tooth and suturing the gums and getting it to heal, yet have absolutely no way of doing a root canal.

Third, a root canal may not be an option is there is extensive bony damage from the abscesses. Again, it may take a good veterinary dental specialist to make that evaluation. It will certainly take good dental X-rays taken under anesthesia.

I hope this gives you some help. It sounds like you need to have a little more discussion with your regular veterinarian. They can see the dog and I cannot. If you are interested in saving the teeth, then let them know that.

I hope this is helpful.

gena

Hi I have an 8 1/2 yr old shepherd mix who has always had slight bumps on his cheeks if you will. About a month ago I noticed that the right side is now much larger. It almost looks like he has a marble under his skin. My vet said he does not believe it is and abscessed tooth or an infection. It is hard and it doesn't seem to hurt him. He lets me touch it and push on it. He is acting normal..eating, drinking, sleeping. Any ideas?

Thank You
gena

Doc

Hello, Gena,

We often refer to that sort of nondescript lump as a "growth". Why that's better than lump, I don't know. A "growth" suggests that it's something that "grew there", which it apparently has.

Differential diagnoses would be some sort of tumor (whether benign or malignant), some sort of tooth problem, a reaction to some foreign body penetration (the body trying to wall off a sliver of something).

Diagnostically, the first thing I do is try sticking a needle into it to withdraw some cells for microscopic examination. This can often help you differentiate between an infection and a tumor, though it is unlikely to tell you what kind of a tumor it is.

Taking an X-ray of the area would also be helpful, to let you know if bone is involved, or if the mass is confined to the soft tissues.

To really know for sure, you would have to remove a piece of the mass (a biopsy) and let the pathologist examine the whole section under the microscope. This allows them to see not only the cell types, but the structural relationships. This is what it takes to make a definitive diagnosis in many cases.

There are many cases where older dogs grow little lumps that just sit there for years and cause no problems at all. There are others that don't look like much, but are the early stages of bad cancer.

As in people, you look for lumps that are growing or changing, lumps that bleed, sores that won't heal, etc.

At the very least, I would measure the lump weekly and record its size on your calendar. That way you've got some objective measure of whether or not it's growing, and how fast.

You might ask your veterinarian about getting a fine-needle-aspirate cytology. He/she can make the preparations for microscopic exam and look at them, or send them out to a pathology lab for evaluation (which will certainly cost more). Most dogs will allow this procedure without sedation, but it is certainly a little trickier on the face.

I recommend that you talk to your veterinarian about your concerns. Since I cannot see the patient, I am in a poor situation to make recommendations. It is possible that he/she has very good reasons for not being terribly concerned at this point. Sometimes we don't do as good a job explaining as we might.

Good luck.

vicki alberti

My dog has two cracked teeth. One tooth abscessed and was removed 2 months ago. In hindsight, both teeth probably should have been removed, but were not. For almost two weeks now my dog has had lameness in her right front and rear paw. The vet did blood work for tick disease, all normal. Last night I noticed her face swollen. I believe her other tooth is abscessed. Is it possible that the infection in her mouth has spread to her paws?

Doc

Hello, Vicki,

It is extremely unlikely that the tooth problem is causing the lameness. Despite what you hear in the song "Old Dan Tucker" ("combed his hair with a wagon wheel and died of a toothache in his heel"), it just isn't likely at all.

You should re-visit your veterinarian. He/she may want to take X-rays, do additional blood-work, or try some anti-inflammatory medication. You also need to get that tooth handled.

Good luck.

Lana Washburn

Dear Doc,
My 7 year old mixed rotty and golden retreiver has been 'sick' for 2 weeks already. He won't eat anything (turkey...roast beef...hot dogs...sausage...) and he is very subdued. My vet has done blood work,a urine test, a fecal test, 2 chest x-rays, and every thing looks normal. She put him on Baytril and we can't tell if that is doing any good or not. I have to go to her to have her give him his pills because I can't open his mouth like that, and he won't eat anything, so I can't just hide the pill in a piece of good food.
Just tonight she was wondering if possibly he has an abcessed tooth in the back because when she opened his mouth wide he made a whimper. I have no idea what could be wrong with him. I am of course very worried that it might be a cancer inside somewhere. He WILL go for a walk, and he trots right along, but seems to get tired easily. He's usually a very happy boy. Lately he doesn't even stretch when he wakes up, and he has been sleeping way more than normal.
I don't know what to do.
He sometimes has this little sort of blowing type quiet cough too. Like when he wakes up to just stand up and change his sleep position.
Do you have any ideas???
Thank you so much.
Lana.

Lana Washburn

Doctor,
I forgot to tell you that my dog also has been having a temperature. Initially it was 105 when we first saw my vet, then it went to 103 the next morning, and then back to 104.3.
Today she did not take his temperature as I had to see her on her 'day off' in order to have her give my boy his pills.
Thanks again.
Lana Washburn.

Doc

Hello, Lana,

Seven years old is a lot older for a Rottweiler than for some other breeds. The Golden has a higher incidence of cancer than many other breeds, but not generally short-lived, like Rotts. That's the worst thing I have to say. So, quit fixating on the worst-case scenario, and let's go on to what we need to do here.

Some dogs develop an abscess behind their eye: "Retro-bulbar abscess". The jawbone (mandible) is L-shaped. When you open the front of the mouth, the "sticky-up" part of the "L" cranks forward and puts pressure on that area behind the eye. If you're normal, it doesn't hurt. If you have an abscess there, it REALLY hurts. Treatment consists of short anesthesia and lancing the abscess from inside the mouth. Antibiotics are needed to follow up, but usually won't relieve the problem.

At this dog's age, there are certainly a lot of other things that could be going on. Your veterinarian has assembled a good database with the previous testing. The dog wasn't showing the pain when the mouth was opened before, so there was no particular reason for him/her to consider this.

Your veterinarian may want to take dental X-rays at this point. This does require anesthesia (though not deep, and your lab tests are good, so probably that will go well). Sometimes when you anesthetize the dog and open the mouth, you can see an obvious bulge. Unfortunately, many times with the retro-bulbar abscess, I could see nothing. I just lanced "where it's supposed to be" and followed up with antibiotics. Sometimes pus runs out, sometimes nothing appears to happen, but you've given the pressure an escape-route and the dog gets better.

Your best bet is to stay in touch with your veterinarian, giving good feedback on what the dog is doing. This way you and he/she can look at the case in a new unit of time.

Good luck.

dental clinic california

"Their teeth function to catch prey and tear them into pieces small enough to gulp down." its very informative.

florence

Jackrabbit

Dear Doc,
I have an almost-12-year-old black lab with a carnassial tooth abscess that didn't slowly appear at all (meaning, Wednesday, there was nothing visible; Thursday I woke up and it was the size of a golf ball). I rushed him to the vet the very day he woke up with it, and the vet put him on Clavamox and scheduled him for surgery (tooth extraction) next week.

Some questions:

1) Is an antibiotic sufficient to make this abscess shrink or does it only kill the infection? If the abscess should shrink on the medication, how many days/doses should my dog be on antibiotics before I see improvement?
2) I read that the abscess should be gone before they do any dental surgery. If it’s not, what does that mean, and what’s the next step?
3) Since the abscess is so big, does this mean it's been causing him pain for a long time prior to it showing up, or do they develop rapidly?
4) Do I have to worry that the infection has spread to other parts of his body? And will it affect his eye (the eye it's under can't fully open because of its size)?
5) Is there something I can do to relieve the swelling? The vet mentioned a warm compress, but what does that mean, exactly? Is a warm towel and mild pressure sufficient?

I’m so worried about him because of his age, but he is very healthy and just had a full blood work-up done a month ago that came back immaculate. I’m hoping this means he’ll tolerate surgery well. I guess my fear is that I keep reading all the problems that can happen if left untreated, and I have no idea how long this thing's been festering before showing up.

Thank you in advance for any help you can give me.

-JR

Doc

Hello, JR,

I strongly suggest that you ask these questions of your regular veterinarian. He/she is probably thinking that everything has been explained so well, and would appreciate the opportunity to address your questions.

1. Clavamox is an antibiotic with a good record of effectiveness at killing the bacteria that usually live in the mouth. It is not so great at penetrating bone. We hope that it will slow down the infection, keep it from getting worse, and maybe help the dog to feel better. An abscess is a pocket of pus and it won't totally go away without being drained and cleaned out.

From your description, I would expect two to three days before seeing much improvement with the antibiotics.

2. If the infection could be largely cleared up, then we would have less complications in recovery from the oral surgery. It is very unlikely that the infection can be completely eliminated with medicine alone. If the infection is still pretty bad before the surgery, the healing may be slower. It is possible that a second surgery would be necessary. The first would remove the tooth and allow drainage,after which it should be easier to clear the infection. Then a second surgery might be needed to close the area.

3. The dog may have had low grade pain for a long time that has suddenly gotten worse, as the abscess enlarged. I have had low-grade aches that came and went for a while before getting bad enough that I absolutely HAD to get to the dentist.

Dogs are pretty stoic about these things. It is quite possible that after his tooth problem is handled, he will be much more playful and "acting younger". That will let you know that he has had some pain for a long time.

4. The infection is unlikely to spread to other parts of the body, though this is possible. The Clavamox should prevent that from happening. It is unlikely to damage his eye, but it can be painful when the mouth opens. The back part of his jaw-bone comes forward when opened and can put pressure on the whole area.

5. Heat causes capillaries (microscopic blood vessels) to open. This brings more circulation to the area: more oxygen, more nutrition, more antibiotic, more infection-fighting cells.

I usually run a pan of water about as hot as I can stand to put my own hand in. Then I wring out a dish-towel and use it to apply heat. When the towel cools off, I re-soak and wring it. Ten to fifteen minutes, three times daily is optimum.

It sounds to me like your veterinarian is doing everything right and has you on track to get this problem handled. The only other thing I'd be doing would be to ask about some pain medicine. I'm sure they will send you some after the surgery, but your dog could probably use some pain relief right now.

Please talk with your veterinarian about this. Do not use over-the-counter human pain meds.

Good luck.
Everett Mobley, D.V.M

Jackrabbit

Dear Dr. Mobley,

I can't thank you enough for your quick response -- it really put my mind at ease. I actually ended up doing exactly what you described (regarding a warm compress) for lack of any other ideas immediately after I wrote you, and the swelling really seemed to go down a bit. My dog is more alert, playful, and relieved today after 2 full doses of the antibiotic, too, and I'm sure he'll be even better after the surgery and healing.

So often in searching online for answers, I read things that just don't get to the heart of my questions, and/or are answered by people with opinions instead of facts backed up by experience. I have done extensive research into every aspect of my dog's care, which is why I take him to holistic vets, monitor his nutrition (by giving him the highest quality food (Abady) and herbals/supplements), and ask a million questions to make sure I'm doing the best I can for him! It means a lot that you care so much about animals (and their owners) to take the time to write such thorough responses to animal lovers searching for clarity. Thank you so much for doing what you do.

Warm regards,
JR

cosmetic dentistry beverly hills

Abscessation at the root of the carnassial tooth may give rise to an inflammatory reaction, then a fistula on the face, below the eye. Called also carnassial abscess, facial abscess, facial sinus. Less often, abscessation of the roots of the lower carnassial tooth can drain through the skin over the mandible or into the mouth.

-heather-

mary

my pekingese is only 3 but she has that problem. I am torn because she had a neurological problem when she was just a baby that made her twitch a little so the vets felt that she couldnt go through surgeries coz if they put anestesia on her she wouldn't ever wake up. So not, I do not know if it still applies now that she's older. I really don't know what to do. She hasn't played coz it hurts so much and been moody n distant. any advice?

Doc

Hello, Mary,

The tooth really needs to be fixed. It's really not okay to let her continue in constant pain.

It is time to re-evaluate your puppy's risk factors for anesthesia. Talk to your veterinarian about getting blood-work, chest X-rays, and an electrocardiogram. Then they can get a consultation with a veterinary anesthesia specialist, if needed.

Your veterinarian can help you with this. Talk to him/her.

Good luck.

Heather Taylor

Hello,
My 7 yr.old St. Bernard(150lb.) needs Help.. I took for his 1st dental cleaning in July. 3 weeks later his Jaw seemed dislocated. It came on instantly within an hour. I called our vet, not in, took him to animal hospital. They said it's a Retrobulbular Abscess. They xrayed, put him under and lanced it to drain and sent us home with 10days worth of Clavamox (1000mg.) On the 12 day, jaw pain again, our vet was in, they perscribed Chlorampenicol (500mg.) 3 timed a day, for 7 days. By the 8th day his jaw was sore again, Called vet, they perscribed, Metronidazole(500mg) and SM2 TMP, twice a day. It's now day 4 and he seems to be getting worse. I'm not sure where to go with this. He's an inside dog and is again in pain and not wanting to take his meds this morning because of jaw pain. He is not swollen at all.. We just held him down and took a look in his mouth and his gums look great along with the back of his mouth which was huge when the onset had occured.
We need help, not sure what to do, or where to go.. Do I keep seeing my Vet or go back to animal ER.
If anyone has dealt with anything similiar or if anyone has any idea concerning the treatment he has received of why he's not getting better.. Can You Please Help Me???
Thank You, Heather

Doc

Hello, Heather,

Retro-bulbar abscesses usually cause pain when the mouth is opened. The wider the mouth is opened, the more pain there is.

This is an abscess below and behind the eyeball. The jawbone (mandible) is L-shaped. When the front of the jaw goes down, the upper part of the "L" goes forward, pushing on this area behind the eye. Thus, the pain when the mouth is opened.

If this is truly the problem, it may have to be re-lanced and drained again. The fact that there was a lot of swelling in that area before strongly suggests that retro-bulbar abscess was the problem. They frequently do NOT appear swollen in the mouth, even when they are pretty bad.

There may be an abscessed tooth in the area that is causing the problem. If in doubt, I would consider asking your veterinarian for a referral to a veterinary dental specialist.

It is difficult for us general practitioners to get great dental X-rays unless we are doing a lot of it. You need to rule out tooth problems.

Good luck.

Heather Taylor

Dearest Doc,
I can't Thank You enough for the reply, it's just nice to know when someone cares because Doc, I feel so bad for him because I can't get him any Better. We have a relative out in the West and Im going to hopefully get a referral from him for a Dental Doctor here on the east coast and maybe we can begin the steps to ending this.
When I decided to take him for a teeth cleaning, it was only because all my friends and family have begun to take their dogs for cleanings. I thought, well, he's a bigger dog, I've done everything I could to keep him healthy and want to continue making sure nothing is ever getting overlooked and he gets to live a real long time. He has always been in completely perfect shape, maintains 145lbs., perfect bm, and the biggest baby you could ever imagine BUT Smart.... He knew this morning that he needed help and tried to get me in the car but it's the holiday, anything open is only the ER. He's still taking Metronidazole(500mg) and SM2 TMP, twice a day and was perscribed that as of this past Friday(almost 4 days treatment)and he's hurting more. He hasn't been taking pain meds but I did give him 1 Dermaxx and it calmed him so he's not sitting here panting but in the meantime, I just don't know what course of action to take.... He will need to be seen tomorrow, at this point his face isn't swollen, looks perfect and while he was panting, we were able to get below him and look inside his mouth with a spotlight and there is no lump in the back(as when it 1st occured)and all the coloring seems even but hurts him when he pants and lets his jaw go open furthur, he'll jump and do a squell as if he got shocked. I made him burger for breakfast, hopeing to give him iron and I just wish I knew HOW TO GET HIM BETTER... I feel so bad for him but he's laying comfortable now, but Dr., Thank You so much for your time... Have a Wonderful day.. Cheers, Heather

michael

Doc,
Our dog Roxy had an absessed tooth extracted today and after bringing her home her hind legs are slouching quite a bit. She walks okay, but the whole rear of her body seems to lag behind and sway like an intoxicated person would. My wife called our vet and she seems to think it's just the anesthesia in her system. Although it's early, I wonder if these are normal symptoms for this type of thing. She was put under for her dental cleaning a year ago and had none of these symptoms then. Any thoughts?

Doc

Hello, Michael,

It does seem odd that your dog has had difficulty after anesthesia this year when she did not on the previous occasion.

However, some time of anesthetic after-effect does sound like the most likely situation.

If your dog is not making continuous improvement over the next 24 hours, your veterinarian will want to know and follow up.

Stay in communication with your doctor.

Good luck.

Heather Taylor

Dearest Doc, We went to a dental doctor for Herbie(he has now been seen by his reg. vet, 2 trips to the Animal ER where they put in a drain for a retrobular abscess, and another local vet to just get labs, to make sure his HCT was within rage because at ER it was at 22% and I needed to follow up with that level and hoped he might also notice something that no one else had because Herbie wasn't getting better.) There are only a few certified Dental Doctors in America and Dr. Velese took the intiative to do in depth blood work and Herbie has LYME DISEASE.. I'm from Pa and it's common in our area but it isn't looked at as the 1st type of treatment unless you see a specialist. My Dental Doctor said he sees many cases of Lyme Disease symptoms in the jaw for pets. I do hope this is read by many and people realize that any form of discomfort can easily be Lyme Disease. Herbie showed no signifigent lameness besides jaw pain, no weight loss, tiredness, or stiffness in other joints. This has been a costly experience between a surgery(which wasn't necessary), many types of meds with exams and an ultrasound. Who would have thought....... Thank You for your time Doc... Have a great day because mine finally looks Sunny !!

Doc

Hello, Heather,

I'm so glad to hear that Herbie is now doing well. That is certainly a dramatic and unusual story. Thanks for the follow-up.

Dehaluyi

I am amazed by your estimate of doing TWO extractions!
Maybe I can fly my little 9-year-old Chihuahua-Pekingese mix up to you for the surgery I know is coming? For now the Clindamycin has cleared the infection & the swelling & lesion are gone, but we know we'll eventually face surgery.

Just wonder why ONE extraction here would be $950.00 PLUS anesthesia & overnight stay.

Doc

Hello, Dehaluyi,

I'm not sure what your veterinarian is including in his/her cost estimate. Also, I don't know what their cost of operations may be. It is certainly different in different parts of the country.

If I were in a metropolitan area, I know I would have to charge a great deal more to cover my overhead just for the same things I am doing now. If I were including additional services or personnel, I would have to factor that in, as well.

It's really an "apples and oranges" kind of thing.

Tony

I have a 10 y/o Chihuahua and she has some swelling under the right eye on her snout. This just appeared this morning but has grown throughout the day. She doesn't want to eat hard food, and isn't really chewing anything. She is also shying away from anything that is too cold to drink. I am certain this is an abscess and normally I would have no problem taking her in to get it taken care of. Here is the complication this time. We are on the road for a cross-country journey which will culminate in leaving the country to work in Dominican Republic (DR). We are taking our dog with us, and literally ALL of our money is committed to the trip, so a $500 root canal is out of the question. What other options do I have? We have a vet in the DR, and we will have more money to provide better care for her. Is it safe to just let this run its course and treat her later as needed? The only other option I have is to put her down... We love this dog like family and I really don't want to do that for something so small. Please help!

Doc

Hello, Tony,

Long distance diagnosis is always tricky. It certainly sounds like an abscess. An extraction would certainly be cheaper than a root canal, and may be needed anyway.

Starting the dog on antibiotics and pain medication in the meantime would be a possible option.

You would still need to see a veterinarian for this. I'm guessing clindamycin and possibly some type of narcotic for pain. You really need to get her in to a veterinarian.

Good luck.

Heather Taylor

Dearest Doc,
I have previously written concerning my St. Bernard (Herbie) who began mouth issues back in august. He had taken Doxycycline for 6 1/2 weeks as of last weekend. We wern't sure when he would have a long enough dose to put the Lyme into remission but felt this was a longer than normal cycle of it. We have kept a Deramaxx 1000mgs. also in him daily. (His jaw has been irritated and I'm assumeing permanetly from the flare up that initialy made him go lame in the 1st place.) Within 2 days of no doxycycline he began doing a whine, holding his jaw funny, limping and panting and this whole lameness again occured suddenly, like within 2 hours... We called the vet and he said start the doxycycline 400mgs. BID. We also continued the Deramaxx 1 daily. In 2 days, his jaw was feeling terrific and his leg isn't any better and now holding it up. We then felt it thouroughly and noticed above the joint, going into the tibia, he is swollen and hard as a rock. I called the vet and he set up an x-ray for Monday and it's now Saturday. Doc, I'm fearing the worst... He is uncomfortable and I'm now giving him 1 1/2 Deramaxx Daily until Monday. Please tell me there is something other than Osteosarcoma that can cause a bone to be this deformadly swollen and rock solid, suddenly ??.. He has had a distemper shot, so I'm not thinking Paget's.. So my biggest question is that I need an educated opinion on, goes as follows, If this is Bone Cancer and we elected to begin a pain free healing process such as amputation, Would the Lyme Disease that's in his system inhibit the healing process of his amputation ?? Doc, any response is welcome, I may be looking way to deep but if I'm going to be told that we need to make decisions on Monday for my Very Loved Herbie, I absolutely have to be educated in every avenue of treatment that could possible present itself here both Medically and Humanely... Thank You very Much for all your time..
My Regards, Heather

Doc

Hello, Heather,

I'm a little out of my depth when trying to answer your question.

The first test would usually be an X-ray of the leg, looking to see if this looks like a tumor. Sometimes osteomyelitis (infection in the bone) can have a similar appearance and confuse the issue.

A biopsy may be required to make the diagnosis. While waiting for results (or if you feel that it IS cancer), you proceed to stage the disease.

"Staging" the cancer means looking to see how much of the body is affected. Typically we do chest X-rays and abdominal ultrasound to look for obvious tumor spread. If those are clear, you would also get current bloodwork.

If there are already tumors in other body parts, it's not going to help very much to amputate the leg. In a case where the tumor has already spread, you would be looking at using more potent pain-killers, like narcotics, to keep the dog comfortable for as long as possible.

If there is no indication that the cancer has spread, then amputation would certainly be reasonable. Dogs do really well on three legs, even big dogs. Removal of the affected limb relieves the pain that is caused when the tumor destroys the bone.

As to the difficulty with a relapse of the Lyme Disease, your veterinarian will need to consult with an internal medicine or infectious disease specialist (and I am neither).

I am sorry I cannot be of more help.

Heather Taylor

Hello...
Dearest Doc,
I need to Thank You because for the most part you opened the door of hope for me and my family(osteomyelitis). Keep in mind that as of July, he was in perfect health or at least seemed to be and then all of the sudden these illnesses keep on snowballing. It's been a sad process and we just want him to be comfortable. The mass above his ankle joint is encompassing almost half way up his tibia and is rock solid and waiting to see the vet is making my mind go crazy. His overall body is loving gentle rub downs and you won't believe this one, I was just rubbing him down, and he was sitting between my legs and I would go up and down his back then go to his neck and when I put my hand under his rt ear(he never has had any infection or other ailment with his ears) and the flap seemed heavy so i pushed on it and it's swollen. I didn't poke or probe it but there is no doubt that it's heavier and swollen, looks perfect and the underside has normal coloring ?? Again Doc, Thank You for all your information and if I'm faced with decisions on monday, I need to know what's all involved. I love all my pets and my Herbie is very special to me and trying to work with him during this process has been pretty sad when we keep having a new ailment appear. My poor baby....
Thank You Doc,
Heather

Heather Taylor

Dearest Doc,
You put our minds at ease many times throughout Herbie's ordeal over the past few months and We want to express sincere Thank You's and want to let you know that we did put Herbie down today. Since last Tuesday(3 days after stopping Doxy) he began failing and each day there after it, he was getting worse. We immediately thought that we hadn't treated him long enough for the Lyme(6 1/2weeks) and began the treatment again but Herbie was certainly getting more tired and in pain. By this morning, he wanted to lay in the yard and keep his head down. His breathing over the past few days starting to sound obstructed. I read many articles concerning Doxycycline suppressing tumors and I wondered if there were any effect on his, while we were treating him with high doses for the Lyme. Our vet did confirm the Osteosarcoma, we had sad hopes that he'd say "Oh. he has a broken leg", but luck wasn't there for us today. He was in much pain, and lost more weight than we even realized since all of this begun.....RIP.... Thank You again for all your responses, you've been a life saver when we have been racking our confused heads on what could be wrong with him, he's finally in peace and painfree...
My regards,
Heather

Doc

Hello, Heather,

I am sorry to hear about Herbie. Sometimes the body can no longer support the spirit. Francis Bacon once wrote, "A healthy body is a guest-chamber for the soul, and a sick one is a prison."

It is hard to lose a friend, but harder still to see one imprisoned in a broken body.

Best wishes.

Monqique

To whom it may concern: I took my dog to the vet today, and she definately has a carnassial tooth abscess. They sent me home with antibiotics and an oral rinse. I have a 14yr old female chihuahua. They estimated the price to be anywhere between $1,300-1,800. Is that a decent price for such a procedure?

Doc

Hello, Monqique,

I really cannot speak to prices here. That sounds like a lot, but I don't know what all is included, what the general cost of operations are where you live, etc.

With a dog that age, I am sure the figure include some pre-anesthetic diagnostic testing, and a lot of support during the procedure, plus pain control afterwards, and so forth.

I am sorry that I cannot give a meaningful answer to your question.

Dan

Hi Doc,

I have a 8yr old herding dog who has an active tooth abscess of either the upper left canine or adjacent first molar. She is a strong chewer and has essentially flattened out all her teeth chewing/playing with rope and kongs. Other teeth show root canal darkening and pitting. What is the prognosis and your suggestions?

In the story above you said it was $400 to take out the 2 teeth, did that include x-rays and lab work? I am struggling with the delicate balance of costs and overall health(ok except for mouth)and age.
Thanks for your work on this site.

Doc

Hello, Dan,

It's been quite a while since I wrote that, and I can't really remember what cost what. I don't think there were X-rays, but there was labwork and I.V. Fluids, I'm pretty sure. The dog was pretty old at the time.

If you can put a probe into the pulp chamber, then it's a matter of "when, not if" on the development of an abscess. You either get a root canal (bigger bucks), extract the tooth, or live with constant pain.

Did you ever watch "Cast Away" with Tom Hanks? He uses a rock and an ice skate to punch out his abscessed tooth because he can't stand the pain.

You need to do something about that tooth.

Good luck.

Amy

My dog, age 11, has carnasal tooth absess on one side and the vet said the tooth needs to come out. My dog has Cushings Disease and the vet did a CBC and just about everything looked okay with the exception of his kidney results - everything regarding kidney output was elevated. He said that indicates renal failure due to Cushings. He also noted that my dog does not seem to have a heart murmur but did say that his heartbeat was irregular. He said that the surgery was risky and that "quality of life" needed to be the main consideration at this point because the swelling on the side of his face had to be causing him pain. He said that before the surgery a catheter would be inserted and fluids would be pushed during and after surgery in an attempt to keep the anesthesia from harming his kidneys. He said he would do all he could to help my dog come through surgery with as little damage as possible, but that I needed to understand that the most likely scenerio is that he would suffer some damage and his life would most likely be shortened due to the surgery, if he survived the surgery. He did prescribe an antibiotic (Clindamycin 150 mg 1x daily for 14 days) and pain medication. He has been on the antibiotic two days now and the swelling has gone down a bit and he seems to be feeling better. Is there a chance that the antibiotic will take care of the problem with the absess?

Thank you.

Amy

Doc

Hello, Amy,

I am glad that the clindamycin is making your dog feel better. However, it is unlikely to provide lasting benefit. The infection will be reduced in severity, but there will still be a pocket of pus and dead tissue to re=start things when you stop the medicine.

Your veterinarian is familiar with your dog and his medical conditions and his current labwork. He/she is in the best position to advise you. I do agree that letting the dog live with constant pain of an abscessed tooth is not really a good way to avoid the risk of anesthesia. Everything we do in life requires some evaluation of risk versus benefits.

If your veterinarian is uncomfortable with the risk levels, thus making YOU uncomfortable with the risk levels, then you might consider asking for referral to a specialist. A veterinary dental specialist in a specialty clinic may have more support for anesthetic monitoring. More importantly, he/she will probably do the procedure more rapidly, thus having less time under anesthesia.

Good luck.

Carmrn

I have a 12 year old pit bull female, I took her to the emergency room last night because the left side of her face looked droopy, her left eye was swollen shut she was drooling and has not been eating. They said she has an ear infection, sinus infection possible abscess and possible parasites. I'm not sure what to do. Although I love my dog dearly my financial situation is tought, however if this is the only things wrong I may be able to borrow money for her. My question is at this age is it worth putting her through all the exams and trial/error meds, could this the beginning of her started to fall apart and should I put her down. Very Very confused.

Doc


Hello, Carmrn,

I wish I had a simple answer for you.

Ear infections often require both topical therapy (treating the ear directly) and systemic therapy, such as cortisone injections or tablets to shrink the swelling (and open up the ear canal, and relieve pain), plus antibiotics for deeper infections.

An abscessed tooth really should be extracted. Antibiotics may help temporarily, but only temporarily.

It is certainly possible that at this age, you may go from one crisis to the next. Unfortunately, the only way to deal with multiple problems is to treat them all.

If this is not financially doable, then you may have to consider euthanasia. You may be able to "buy some time" by treating with antibiotics and pain medicine and seeing how much improvement you get.

Only you can make the decision as to whether or not your dog has an acceptable quality of life. If she is going to have more bad days than good days, or no good days, then it may be "time".

Sometimes it does come down to money, and sometimes it doesn't matter how much money you could spend: not all problems are fixable.

Sorry I don't have easy answers for you.

Kelly Hall

Hello Doc,
We have a 8-9 yr old Weimerraner (sp?). We were given the dog so are unsure of his exact age. He does appear to have hip issues, and takes awhile to get moving in the mornings. A few days ago, he developed swelling under his left eye. I automatically assumed an infected or abscessed tooth. My husband thought a spider bite, or other kind of bite. But, after a few days he was yelping slightly while trying to eat. I did soften the food the first day, and he didn't have any trouble. Today, he ate it all, but did yelp somewhat. We too are unable to spend any or alot of money on this dog that we love, which is sad! We are wondering if a human antiobiotic would work just as well until we can get him to the vet for an extraction if that is the problem. What do you suggest. Thanks sooo much, this forum is so great!! Kelly

Ella Jane

dear doc,
this morning my nine year old miniature dachshund suddenly had a large swelling under her right eye, just above the 4th premolar. She has been having problems with her teeth for two or three years now. I know the tooth probably needs to be extracted at this point (I need a root canal myself and can't afford it, I don't think we'll be able to do it for Snickers), but here's my question: my paycheck doesn't drop until tomorrow. Is this an issue that we can wait overnight for, or should I put it on the credit card today? She seems about like usual, happy to play and run around outside, she just doesn't want the swelling to be touched.

Thanks so much for all your advice.

Doc

Hello,Ella Jane,

This is not life-threatening. The sooner it gets handled, the sooner your dog's pain will be handled. Can it wait until tomorrow? Have you ever had a toothache and waited until tomorrow? It's hard to say how much it hurts.
I've treated patients who had been suffering with draining lesions for months. They feel a lot better when it's taken care of.

Do it soon.

Good luck,
Everett Mobley, D.V.M.

richy

i have a 17 yr old male jack russell which is still fit and healthy, recently he got a carnassial tooth absess which the vet treted with antibiotics, but know its back and really smells. the vet says he wouldnt advise surgery because of his age so can you advise any medication to control problem. thanks

Doc

Hello, Richy,

Re-treating with antibiotics (like clindamycin) may get things quieted down again, but the only way to really handle it effectively is to extract the tooth.

I can appreciate your veterinarian's concern about anesthetizing such an old dog. However, if he is otherwise fit and healthy, it should be feasible.

If your regular veterinarian is not comfortable with this, you might ask him for a referral to a veterinary dentist, or even a specialty practice (not necessarily a dentist) that has more sophisticated monitoring and anesthetic capabilities.

Good luck.

richy

i have a very lively 11 yr old jack russell bitch, while playing with my other dogs she stopped and looked like she was going to pass out. this was 3 days ago and she now hardly moves and has stopped eating but still drinks water. any advice would be great. thanks, richy

Kim

Dear Doc,

We are fostering an 8-year-old Chihuahua who was rescued from the local shelter with bilateral facial abscesses. The rescue league treated them with antibiotics to no avail, finally got her to a vet with dental x-rays, and one week ago she had both carnassials removed. One side of her face is still steadily draining fluid, and neither opening has really started to heal. Should we be patient, or should we get her back in for further diagnosis?
Thank you!

Doc

Hello, Kim,

While one might not expect complete healing by this time, neither should you have continuous fluid drainage at this point. I would certainly get her back in to your veterinarian for a follow-up. When we don't hear anything, we just assume things are going great. They aren't, so let him/her know.

Thanks for reading and writing.

Karen

Dear Dr. We have an 14 yr old lab mix and he has gum disease and has lost a bunch of teeth. HE WENT TO THE VET FOR A TEETH CLEANIN, the vet said he wouldn't advise putting him under any more cause of his age. Lately we have notice a swelling type abcsess looking thing above his rt. canine. Were both unemployed and freakin out. This evening I knowtest that he was bleeding where the abcess was. now it's not swelled jusst a dark purpleish color. My Question is should we scrap up (TRY)MONEY FOR AN EXTRACTION OR WOULD ANTIBOTIC MAYBE WORK???

Doc

Hello, Karen,

Antibiotics like Clindamycin may help give temporary relief, but they won't get rid of the abscess.

I wish there were a simple answer for this, but if your description is what it sounds like it is, you have an abscess and the tooth needs to be extracted. It is bound to be painful.

If the nerve to the tooth is blocked with local anesthesia, then you can use a lighter degree of anesthesia, and this lessens the risk.

Good luck.

grant taylor

dear doc,
my dog is a 14 year old full blood boxer. her face is swollen on the left side but there are no drain holes but her eye is swollen and pink and she doesnt like to eat either what could this be?

Doc

Hello, Grant,

"Steak & Shake -- famous for steak-burgers"
Boxers -- famous for cancer.

Your dog could certainly be having tooth problems, or a retro-bulbar (behind the eyeball) abscess (which isn't a tooth problem). Both of these could cause pain and swelling in this area.

With an aged Boxer, I would also be concerned about cancerous growths in the area.

Your dog needs good examination, maybe x-rays, maybe even a CT-scan for diagnosis. Sometimes one can insert a needle into the swelling and get enough cells for a diagnosis. This is called "Fine Needle Aspirate Cytology".

She needs to go see her veterinarian.

Good luck.

Kayla

Hi Doc,

I have a 8 month old Cairn terrier and he developed a very hard lump right under his eye. The size seems to be increasing, and it'll soon be hard for him to see out of it. It's not pussy or leaking anything at all, so I'm not sure if it's his tooth or not. I thought it was a bee sting at first, but it's not going away. I thought only older dogs got tooth problems. =/

I have an appointment for him Saturday morning. I hope he's okay until then. He seems to be his happy self, running around playing and eating. What do you think this could be? If he does need his tooth pulled about how much will this whole procedure cost? When I called the vet they didn't sound like they would even need to do an xray, so this confused me..

Thank you. :]

Doc

As long as he feels good, I think you're okay until Saturday. It would be unusual to have such a bad tooth problem at this age. Your veterinarian may put a needle in to the lump to get a better idea what's going on, possibly X-ray as well.

I really cannot speak to the cost without knowing what the problem actually is. This is one of those things where it's going to take the "hands on" approach. Good for you for already scheduling your appointment.

Good luck.

J Bo

Hi Doc, my 4 year old dog in otherwise excellent health broke the tops off both her upper carnassials about 6 months ago chewing on compact hide bones.

Why she would do such a thing I can't imagaine!

There's seemingly no pain or discomfort, but the teeth don't look good - and the broken ends are going brown and the teeth obviously starting to go bad. I think there is a hole into the pulp chamber on both.

My main question is - what is the risk of anaesthetic in a dog like this. Is it essentially routine with very minor risk. I'm thinking it is probably best to get them removed now while she is younger, though I have been really fretting about it.

Is removal a straight forward process that will be 'clean' so to speak (in terms of being able to remove all nerves). I pretty certain there is no absess or anything at present.

Also, just in last couple of weeks on one of her pendant ears, she has developed a little sort of spot (a couple of mm wide) that keeps just scabing over, because it is leaking very slightly.

I've been wondering if the two might be connected - or if she has just had an insect bite or thorn type injury there, etc.

Many thanks in advance,
J-Bo

Doc

Hello, J-Bo,
Sorry to be so late on this. We have been changing over our practice management computer software in the last week and it has been killing me.

A four-years old dog in good health otherwise would not be expected to have any unusual anesthetic risk. Nothing is guaranteed, but I would not expect a problem.

These teeth have three roots, which are usually solid in a situation like this. Thus the gum tissue has to be lifted up, some bone removed, and the tooth cut into three pieces. Then each root is extracted individually. It's pretty major.

Then the gums are sutured shut. You go home with antibiotics and pain medication. Prognosis is good.

I would think the ear thing is a separate problem.

Good luck.

Carrie

Hi Doc-
I have a 9 year old Chihuahua with bad teeth. By "bad" I mean he's had many pulled (12?) over the years and what's left have an unbelievable amount of tartar on them. Unfortunately, this has been a problem since he was very young. During his last dental cleaning, in 2008, my vet told me that once she cleaned some of the teeth, she discovered that tartar was all that was holding them in and pulled them.

To complicate matters, Chili started having seizures in November of 2008. During the first couple of seizures, he lost 2 large teeth (molars?). Shortly after, I broached the subject of having more of his teeth pulled with our vet. I don't want him to be toothless, but I am terrified these teeth are or will cause more severe problems. At that time, and at subsequent times since, my vet has maintained that putting him under anethestic to do the procedure is too risky given his age and history of seizures. He is currently taking phenobarbital daily, twice per day which has reduced the seizures to 1-2 per month. He is otherwise healthy, no abnormalities in his bloodwork, etc.

I recently moved cross-country and plan to have this discussion with our new vet once I am employed again (soon, hopefully) but wanted to get your opinion on the matter. Are there alternatives to anesthesia?

Doc

Hello, Carrie,

I do not believe that your dog's dental problems can be handled without anesthesia.

The good news is that you should be able to find a doctor who can successfully anesthetize your dog. Dogs with seizure problems can be anesthetized and have surgery. If the rest of your blood-work is okay, this should be doable.

I would suppose that when your new veterinarian examines your dog and his bloodwork that he/she can advise you on this. If I were to do it, I would probably get a consultation with an anesthesia specialist first, if I were uncomfortable with the dog's situation.

These problems do need to be handled. Being toothless is really of no consequence to a dog who eats commercially prepared dog food. They don't really need to chew it, as it turns into mush when it gets wet.

Dog teeth are pretty much all sharp cutters for catching prey and slicing it into chunks small enough to gulp down whole. They don't really have much in the way of grinding surfaces, like a person's molars. The dog food is already in small chunks, so teeth are not needed.

With no teeth, your dog will quit having gum disease. His tongue may hang out a little, but you can live with that.

I urge you to pursue care for your dog's dental problems.

louise

Hi we have a 1.5yr old samoyed called meiko, he cracked his fang tooth in half with slight pulp showing, we have been refered to dental specialist 150 miles away from us who has put him on painrelief and antibiotics for 2 months apparantly untill the tissue around the tooth dies so that they can do root canal. This doesnt seem right and is costing a fortune! what do u think?

Doc

Hello, Louise,

I am no dental expert and I have not seen your dog. Having said that...

If the canine tooth (fang) has exposed pulp, then you really have three alternatives:

1. Do nothing, let the tooth abscess. The dog could be in pain for years. Bad idea. Imagine your tooth is broken and the nerve is exposed. Now imagine that you can't do anything about it... for weeks. Now imagine that it doesn't hurt. Good luck with that, huh?

2. Extract the tooth. The root is about twice the size of the exposed fang - huge, not all that easy to extract. This is oral surgery, and it isn't cheap, but it sounds cheap when you compare it to the cost of the root canal.

3. Root canal therapy. Saves the tooth (probably) and eliminates the dog's pain. Costs a lot, as it requires specialized equipment and specialized knowledge. Believe, as someone whose family dentist performed a root canal that should have been done by an endodontic specialist the FIRST time, you don't want a "bargain" root canal.

In the immortal words of Charley Allnut in "The African Queen", "you pays your money and you takes your choice.

Good luck.

Jeremy

Hi Doc, I have sort of a lengthy question here. My 8 year old Corgie/Mix has been having some nasal problems and he has a couple of bad teeth. I took him into the vet and they told me that yes the teeth were bad and rotted and cracked but they did not think the bleeding was from that. My dog started out bleeding a little bit at night in may and it never got worse, but we brought him to the vet in late June to figure it out. Anyways, the vet didn't want to mess with the teeth which is what I though the problem was and I still think it is. The vet did a nasal aspirate and sent the cells to be examined but did not find any sort of cancer cells or anything. Abouth two weeks ago he got a bump on his face that is right below his eye that is real squishy, but give hime no pain when I touch it. He has been on Prednisone for the last 4 weeks and ever since the vet put him on that he has not been able to breathe out of his nose. My dog has always had some allergies and has had chronic ear infections for the last 4 years on and off with treatment. Anyways, to make a long story short I have spent nearly a thousand dollars trying to figure this out and the vets refuse to believe that it all may be linked to teeth and want to blame cancer, but have not really found any evidance of cancer. They would like me to get an endoscopy done, but that would cost me another $1000 and I am pretty broke as of right now. If you have any ideas I would greatly appreciate it and if you know if Prednisone can cause a dogs nose to plug? Thanks you in advance.

Doc

Hello, Jeremy,

I wish that I had a simple answer for you. The only thing I can think of that would worsen with prednisone and stop up the nose would be some type of infectious problem.

In other words, if you had granulomatous inflammation (where the body's reaction to the problem is producing a growth of tissue), and this was due to an infection, then the prednisone could slow down the body's defenses. Thus, the infection could get worse, and the tissue growth would get bigger, and the nose would stop up.

You could have tooth problems, cancer, fungal granulomas, a lot of things. Certainly endoscopy of the nasal passages would be the most direct approach. The other things one might do would include X-rays of the tooth roots and nasal passages.

Unfortunately, X-raying those areas requires anesthesia, as you have to place the X-ray film inside the dog's mouth and hold it still. That is not happening in an awake dog. Same thing for scoping the nasal passages, which also requires a tiny endoscope, which many practices do not have (including mine).

I am sorry that I don't have a quick fix for you.

Good luck

Angie Crowder

Hi. I have a 13 year old Shepherd mix. He developed a golf-ball size lump in the same exact spot in the photo you have posted. It's like it appeared overnight. I didn't know if it was a bugbite or beesting, so I've been giving it a few days before taking him to the vet. I came home tonight (he's had this for three days now) and it has been bleeding. No pus is coming out, but it has been steadily bleeding all day. Do you think this is related to an absess with his teeth? He's still eating and drinking and acting normal. I plan to take him to the vet tomorrow.

Sharon Adams

I have a golden retriever, collie mix from the shelter 4 yrs. ago, I think he is about 6 or 7 now. About 6 months ago I noticed that this back upper cheek on the right side was a little bigger than the other side, I pressed on it and it felt like the rest of his gums just a little more raised. I didn't think that much as about it as I guess it was gradual, he didn't favor it when he ate, he didn't have a temperature and acted playful like he normally does. About 1 1/2 years ago the vet said he had two cracked teeth, one would need to be pulled, but they said the other cracked one wasn't that bad so they would leave it. I had changed vets and a few days ago I had him in for his annual exam. I really hadn't thought that much about his mouth but showed the vet, I said I found a very little red round spot at the top of his gum in the back where his cheek meets his gum, she looked at it and told me it was very serious and his tooth would have to come out, it would be major surgery for him as they would need to scrape the bone also, that they would put him on antibiotics right after ( although I read they usually also put them on ahead of the surgery which they didn't) his surgery is scheduled in 2 days (11/2) they want to also clean his teeth while he is out, is that a good idea? I was also told it would be expensive, about $600.00, I'm on unemployment but my family is going to help me with the cost. The vet said they would take an x-ray before the surgery. Does this sound right to you? He is my best friend and I would do anything to see he got the best treatment and I have only been to this vet for shots on two visits. Should I get a second opinion as she told me it would be very painful for him. I only have tomorrow to find out with the surgery in 2 days, I don't know how long you take to reply. I'm glad I found you website, sounds like you really help a lot of people concerned about their their pet as well.

Doc

Hello, Sharon,

I know that $600 is a lot of money. However, just anesthetizing and cleaning the teeth is usually going to run in the $150 to $200 range in a low-income area like the one I practice in.

The X-rays help you be sure you are removing the correct tooth or teeth.

Those back teeth are very big, and have three roots. You have to peel back the gums, remove some bone, and then cut the tooth into three pieces so that you can remove each root individually. This is a LOT of work.

Then we usually suture the gums shut, and you have to use special small suture, which costs more.

It also sounds like you will need antibiotics and pain medicine for a few days.

Teeth that are cracked into the pulp chamber will eventually abscess. If you have ever known someone with an abscessed tooth, it really hurts a lot.

I have had several patients who "came back to life" after these painful teeth were removed.

It sounds to me like your veterinarian is trying to do the best for you and your dog.

Good luck.

Doc

Hello, Angie,

That could certainly be an abscessed tooth. In a dog that age, I would also be concerned about a tumor or cyst.

Your plan to take him to your veterinarian is the best recommendation I could give you.

Good luck.

Angie Crowder

I am so thankful I found your blog. I took Shiloh to the vet today and it is an abscessed tooth - 4th pre-molar. He is scheduled for surgery in the morning. Thank you for your blog.

Doc

Hello, Angie,

It sounds like you guys are on your way to a happier life.

Thanks for reading and writing.

Barb

Hi I am not sure what to do my dog Bambi is 3 pounds full grown chihuahua. Just this year in March she suffered a bad concussion to her head, about 3 months after she had a grand mal seizure. I had noticed before the head trauma in March she had bad smelling breath and was rubbing the sides of her muzzle with her paws. She still eats twice a day and I have been brushing her teeth although she struggles really bad and hates it. I was trying to wait awhile after her head trauma before putting her under the stress of a dental procedure. She did not have any more seizures until yesterday morning I woke up an she was having another grand mal seizure in my bed while sleeping. I did call me vet and let him know what happened but they said if she is not having more than one a month then it should be ok. What I am curious about is could tooth pain cause a seizure like this? My vet also told me that he would do a dental procedure but there were more risks involved when a dog has had head trauma in the past. So that is why I put off doing dental work to see if she had more seizures, which she has now had another. I feel like I am in between a rock and a hard place. I did a full blood work after the first seizure in March and she had some elevated liver enzymes which the doctor said he could still do the dental work because it was not elevated high enough, and could have been higher due to the stress on the liver from the first seizure. Anyways sorry for so much info I just do not know what to do.

Doc

Hello, Barb,

Your veterinarian who knows your dog is the best person to advise you on this. Without seeing your dog and having a relationship, I really cannot prescribe for you.

That being said, it sounds to me like it is time to go ahead and get that mouth problem taken care of. While it is true that there are additional risks in anesthesia with a seizure patient, I fear that your dog is living with constant pain in her mouth.

This may not be provoking seizures, but it's really not a good situation. Seizure management usually becomes a life-long situation, but the dental problem should be something that can be handled and finished with.

The seizures are unlikely to go away, and most seizure disorders are progressive, meaning that over time she will have seizures that last longer, come more frequently, and are more severe.

Generally speaking, it would be better to get your other problem handled earlier, rather than later.

Talk to your veterinarian about this.

Good luck.

katy

Hello Dr,

My 14 year old pit bull, who is generally in great health has carnassial infection and swelling. I took her to the vet today, he gave her an antibiotic shot and take home antibiotics for two weeks (although he said they usually don't work). He is testing her blood to see if she has strong enough liver function etc to perform extractive surgery. He also wants to xray her when she is under if she is fit for surgery to rule out cancer. I'm very upset because I hate to think of the trauma/risk of the surgery for her and the pain she may currently be in.
If she is not fit for surgery, does this mean she will suffer with this endlessly if it can't be cleared with antibiotics? Are there any other options? I would love a second opinion. Thanks so much

Doc

Hello, Katy,

The doctor who is seeing your dog is in a much better position to advise you than I am.

If your dog's lab-work and X-rays should indicate a higher than normal risk for anesthesia, and your veterinarian does not feel good about doing the surgery, then you might ask for a referral to a dental specialist.

These folks can get the job done much faster, therefore you have less time under anesthesia. Typically they have a good support staff, as well.

There are very few dogs that just cannot be anesthetized at all, so the odds are good that this painful condition can be handled.

Go ahead and let your regular veterinarian proceed with the risk-factor assessment that has been recommended, and then you can go to the next step.

Good luck.

teresa mccrary

I have a 16 year old femaile rat terrier. A few weeks ago she all her teeth removed expect maybe 3. She was fine but now she started having nose bleeds. Last night was a bad one to. How long will these continue? I guess they are from the sockett. SHes not on anything for her mouth. She does take a heart pill and a congestion pill. Thanks Teresa

Doc

Hello, Teresa,

Have you asked your veterinarian about this? This is not supposed to be happening.

The canine teeth (the fangs) have enormous long roots. If these have been diseased, there is a VERY tiny amount of bone between their sockets and the nasal passages. It could easily have been destroyed by infection.

There could be a communication between the mouth and the nose, you could have bone-infection in the nasal passages, even a tumor.

You really should let your veterinarian know about this. He/she will have a better idea whether this is related to the previous problem, or you need to have the mouth and nose X-rayed, or what.

I would not ignore this or just "hope it gets better". It is also possible that your dog is having blood-clotting problems and could have a serious, life-threatening hemorrhage.

Do call your veterinarian, please.

Best wishes.

Tammy in AR

Dr.-
I have read your entire blog on abscessed teeth this evening.

I freaked out last night when the swelling occurred in my Katie girl's cheek. Didn't know what it was - called my vet immediately. Spoke with the vet on duty and she said it sounded very much like an abscessed tooth or allergic reaction to a bug bite and to bring her in first thing in the morning. Which, I happily did. However, I wish I had read this blog prior to my 8am appt. It sounds like the only way to FULLY treat this is extraction/root canal. My vet this morning only prescribed anitbiotics and pain meds. Which, I was grateful for this morning and thought was the best course of action. It sounds like we should have done more than meds this morning. So, now I've spent the $200 today - which really should've been spent on extraction expenses. The vet even said, lets see if the antibiotics work. Would you say that eventually, regardless of the anitbiotics - she's going to need that tooth extracted?

I appreciate what you're doing with this blog. Very helpful.

Doc

Hello, Tammy,

I always feel that the doctor who is seeing the pet is best qualified to judge what is needed. That doctor not only sees the condition, but is acquainted with the rest of the pet's health status, and can factor that into the treatment plan.

If your dog truly has an abscessed tooth, then it is not very likely that antibiotics will resolve the situation permanently. This is according to the dental specialists (and I certainly do NOT claim to be one of them).

Having said that, putting the dog on antibiotics may give some rapid relief of the swelling and pressure, and make the extraction process less prone to complications with the healing. So, not a bad thing.

I recommend that you share your concerns with your veterinarian. Just ask what he/she feels the odds are of this really giving you a long-term handling. Let him/her know that you would really rather get things taken care of and resolved than deal with a recurring situation. Ask if there are there reasons NOT to go ahead do an extraction.

Communication is the universal solvent, so apply some communication to this situation.

Good luck.

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