Today I had one of my more rewarding moments in practice. BUT FIRST... the back-story.
The carnassial tooth is the dog's fourth pre-molar tooth. It's pretty much the biggest tooth they've got. Sure, the canine tooth (the big fang) may look more impressive, and it's got a root that's bigger than the fang you can see. The carnassial tooth is way back in the back, with only the two little molars behind it. It looks like half of a big pair of shears, which it is. This is the tooth that can cut your finger off (or your wrist if it's a big enough dog). It's got three roots in a tripod arrangment so that it's very stable in the mouth, great for cutting through your luckless prey.
This is pretty important, as dog's don't really grind their food up into pulp the way we do when we chew. Their teeth function to catch prey and tear them into pieces small enough to gulp down. The bigger the piece, the longer it stays in the stomach. Processed dog food just turns into mush when it gets wet, so dogs don't really need to chew it to eat it. They just crunch it up for fun.
Even though dogs may not actually need their teeth to eat that kibble (to say nothing of the bits), they feel a lot better when their teeth are healthy. If you have an abscessed tooth, it really hurts. In fact, it's hard to think about anything else, much less enjoy life. Every now and then, a dog develops an abscess (a pocket of pus that is destroying the tissue around it, creating pressure and pain) around one of the roots of the carnassial tooth. If it goes on for a long time, it may burst and drain.
Sometimes it eats through the bone and bursts out through the skin under the eye, as in this drawing. This is not so intuitively obvious as a tooth problem. It's common enough that these little pictures are in my handy-dandy illustration book that sits on the exam room counter, but it could be something else, like a tumor or foreign-body.
Tinkerbelle is a cute little Rat Terrier. When we saw her in November, both sides of her face had been draining through holes like the one in drawing number two...for more than three months. Ouch! Of course, if the holes had been draining for three months, the teeth must have been abscessed for a while before that. Tinkerbelle had seen another doctor three times for this problem and been treated with antibiotics to no avail. It's not suprising that antibiotics alone did not help. You need to either do a root-canal (which takes a pretty good specialist and about $500 per tooth, not counting anesthesia, antibiotics, etcetera), or extract the tooth. While I can't really know what the other doctor was thinking, I know that sometimes we sell people short, thinking that they just can't or won't pay for what the dog needs. The thing is, you don't know what's in the client's heart or wallet. My job is to offer my best.
"These teeth need to be extracted. They are huge teeth with three roots. Only one root will be bad, so the other two will be solid as a brick. We will have to cut and peel back her gums, grind away the outside of the tooth socket, cut the tooth into three pieces, and extract each root. Then we'll sew the gums back together. It's major oral surgery, on both sides. She'll need I.V. fluids for the procedure because she is old and she will be under anesthesia for quite a while. This is what it will cost." [$400] "Do it!", they said, and we did.
Today, Tinkerbelle came in for a checkup. As her owners were leaving, they said, "Since her surgery she has had a complete personality change." [I thought, "Great, they are going to tell me the anesthetic has made her crazy."] "She is so loving now. We can pet her and she doesn't try to bite us. She likes for us to hold her and love on her now."
Amazing how getting rid of constant pain can make you feel better and act nicer. It makes me feel better, too.