Were you ever faced with the sad reality of multiple extractions for your pet’s less-than-perfect teeth? I deal in this kind of dental crisis on a weekly basis. And nine out of ten times the conversation goes the same way:
“But how is she going to eat?”
Newsflash: If she’s eating “just fine” now, it’s probably because she’s not using her teeth anyway. I mean, have you ever really looked in there?
To be fair, many “bad” teeth don’t really look all that horrible when they’re sitting placidly in the mouth. Even when they’re surrounded by red gums and smocked in heavy tartar, it’s hard to predict what’s happening underneath. In many cases, it’s only when the animal is anesthetized and each tooth is individually examined and X-rayed that you can truly tell what’s going on.
In these cases, pet owner denial is absolutely understandable: “But they look just fine. How bad can they really be?” Hmmm...really bad. As in: useless, painful sources of infection. At this point, they really don’t function as teeth at all. And they never will.
If they were in YOUR mouth you’d have no problems begging your dentist to have them removed––no questions asked, no X-ray evidence needed, just get those suckers out...NOW!
But here’s where the miracle of animal resistance to severe pain comes in: Pets with severely compromised teeth either don’t suffer like we do or they don’t display pain the way we do. Based on pain studies in human babies and animals, the latter option is more than likely the case when it comes to oral pain in pets. Which means they DO suffer...and we don’t know it.
Still, it’s hard for many of my clients to admit that this is the case. That’s especially true when faced with the mother of all dental procedures: the full mouth extraction.
Except for a limb amputation, perhaps, this procedure is the one most pet owners most tend to balk at. Never mind that these teeth are mere placeholders for open sores. Forget the evidence of abscessation and the possibility of bone infection at every tooth root. It’s the fact of extracting these hunks of futility that freaks my owners out.
Then there’s the obvious to overcome: "You want me to pay how much to remove each tooth? Seriously? If they’re as bad as you say they are how hard can it be?"
Well...think of it this way: I can “pull” a tooth or I can “extract” it. If you want me to “pull” it....
- don’t expect that I’ll be treating the ravaged bone below,
- don't expect me to use a high-speed drill (and other pricey equipment) designed specifically for small carnivores,
- don't expect me to apply multiple local, pain-relieving injections along with other forms of pain control,
- don’t expect I’ll be making sure I don’t leave behind pieces of broken tooth,
- don’t expect I’ll be carefully cutting the gumline beforehand and sewing the flaps back afterwards
- don’t expect me to take X-rays ahead of time to make sure the tooth needs to come out and X-rays afterwards to ensure I’ve done a good job
- don’t expect a low complication rate,
- and don’t expect a comfortable mouth––maybe not for many weeks.
“Pulling” is not surgery. “Extracting” is. And it’s HARD work. In fact, it’s harder than most other surgeries I perform. Yet no other procedure earns me as little, hour per hour, than dental extractions. I know; I’ve done the math. It doesn’t ever earn me flowers or extra thank yous or even an impressed lift of the eyebrows. Not like removing bladder stones or sewing up a laceration. ‘Cause it’s just “pulling teeth.”
Enough of the rant. Now you know. And next time your veterinarian gives you the dental lecture maybe you’ll think on mine. But then, I’m, probably preaching to the choir...again.
Add Comment29 Comments
Thank you so much for this post.
I have found it easier to explain this to clients than veterinary professionals. Everyone working in a veterinary facility that provides dental services needs to read this so that they can understand the importance of communicating clearly with clients and conveying the need, complexity and value of oral surgery.
Renee August 18th, 2009 11:42:03 AM
I have to admit, I'd be horrified if my vet suggested a full-mouth extraction. I think it's because those of us who've had teeth pulled shudder at the pain, the agony of aftercare... plus it sounds so drastic. =( I'd be a compliant client, once the vet showed me the rads and advised me it's the best option. But it would hurt my mouth just to think of it.
And of course, probably unbeknownst to most folks, you get the unattractice side effect of the dog not being able to easily keep its tongue in. Yick.
Yeah, even as reluctant as I am to putting older dogs under, I'd rather have yearly dentals done (probably 2x yearly for the little dogs) rather than the full-mouth extraction. It's just a visceral reaction I have to the whole proposition.
Julie in OH August 18th, 2009 12:39:29 PM
Actually, I didn't know the difference, so thank you for clarifying. And my pets get dentistry as required, and I brush, and so on. I've just never had it explained before.
Carole M August 18th, 2009 01:21:33 PM
I'm all about yucky teeth coming out. I've seen enough cat vomit to know that there's very little chewing of the food most of the time anyway. And even if I didn't know they were in pain before extractions I could tell the difference after.
And the same for Munz's(thrown from car and apparently landed on it) eye-it was causing him pain so out it came! Not a problem.
rheather August 18th, 2009 01:46:58 PM
Obviously a bunch of female posters here... Boyfriend's heart aches... just rip it out. ;-)
Bob Jones August 18th, 2009 03:05:29 PM
If we don't feed the silly troll, maybe he'll go away.
KateH August 18th, 2009 03:38:19 PM
My dog had 11 extractions last year. I think it's the first time she'd had a dental. We got her "free to a good home." Thank goodness she came to us because I don't think some people would have put the time or money into her. She's getting another dental this year too and I'm expecting more extractions. I have a cat that has terrible teeth and she absolutely needs yearly dentals. I call her "dragon-breath....."
Faith August 18th, 2009 03:41:40 PM
In response to some of you, the way to avoid a full mouth extraction scenario (and, yes, you don't have to tell me it's a nightmare as I sit there for hours slaving and stressing) is to have annual (or even semi-annual) dental procedures performed. That way each tooth can be removed (or saved, of course) bit by bit in a far less stressful way. Full mouth extractions tend to happen when a lot of denial has built up over time in the form of one horrid oral cavity. And denial is a nice word for it, btw. Sometimes, it is about the expense, of course. But it's so much easier to pay as you go than get hit with a $1,000 bill and a backlog of pain on your conscience.
Dr. Patty Khuly August 18th, 2009 04:06:29 PM
Maybe you should call it 'oral surgery' instead of 'extraction'. Extraction sounds like you'll be going in with a pair of pliers. Anyone who has had root canal or wisdom teeth extracted can relate to the complexity (and pain!) of a full mouth extraction. I never knew this, so thank you for the clarification.
BTW, how long is recovery time from this? Can the animals eat right away or do you have to be fed from IV for several days?
lin August 18th, 2009 04:54:58 PM
lin, the recovery can be pretty darn fast.
I don't mean they heal instantly, but getting nasty, ouchy, teeth out and letting the nasty, ofen hidden infection actually go bye-bye can shave years off a pets attitude and appearance.
I'm not a vet, but I've done rescue a long time. Dogs go into surgery with us wondering if it was worth putting the poor, old, stinking, skinny sick dog through the ordeal and after a day or two of pain control and antibiotics, many are ready to get back to the business of being really alive. Dogs with really ad mouths have not chewed for a long time, have been hurting and their bodies have been fighting off a constant barrage of bacteria and toxins.
A good example is the 11 year old girl who came in last month a rack of bones with a mouth you could smell across the room. 11 teeth including all her molars were pulled. She went from not eating except a few bites here and there to cleaning her bowl three days after surgery. In a month everything about her condition has improved, She's gone from 11 going on dead to 11 going on 7 or 8.
JenniferJ August 18th, 2009 05:08:36 PM
I cannot agree more, a bad tooth or several needs to come out. I never had one stop eating, but seeing them chew a biscuit on one side makes it obvious or touching the jaw or teeth.
The worst time making that decision is when they are elderly, but I have had to do it. My 12 1/2 yr. old had a bad bottom molar & then went on for another 2 good years. Couldn't leave her in pain, that's for sure.
My best toothed/bite Scottie ever, had gum recession set in at 6 yrs. and it was downhill from there. First 5 were pulled, then 10 at once at over 11 1/2. But if I were charged x dollars per tooth, I would have fainted. The easy "extractions" were free & the difficult ones were charged by "time".
When I think back, no pain meds to follow, but didn't matter to him. He ate every morsel of softened food with not a whimper.
Barbara A./NH August 18th, 2009 06:40:22 PM
It "ouches" my pocketbook, but I always pay whatever I have to for the dental work, xrays and all. And there have been several "resorptive lesion" related extractions on my two herpes kitties. :(
My vet usually discusses it with me in detail both before and after and once even called me mid-surgery to consult with me on something. She knows that I want to spare whatever teeth can be, but if they gotta go they gotta go.
Still, I've heard horror stories about apparently overzealous dentals ending in death after 4+ hours and removing nearly every tooth without consulting with the client. Especially with aging pets, no matter how bad the teeth are, wouldn't it be more prudent to limit the time the pet is kept under and do part of the work, wait a while, then come back for the rest?
Stefani August 18th, 2009 07:20:24 PM
BTW, LOL re: $1,000 for a full mouth of extractions.
My cats dentals are now up to $500-600 and thats with one or two extractions. I had two done the same day and the bill was over $1k. So I'm doing the maintenance and still paying that much. I think just a cleaning alone is now $350-400.
Stefani August 18th, 2009 07:33:57 PM
Stefani: It's a tough call--doing it all at once vs. 2 or even 4 procedures. Finances figure into it, as you can imagine. In any case, the work has to be done fast and fearlessly––with digital X-rays (they make the process extra-fast relative to the old way of developing X-rays while the pet was still under)––but thoroughly. It's always a hard decision to make––for everyone.
Dr. Patty Khuly August 18th, 2009 08:21:16 PM
HI Dr. Khuly,
My Louie is a hairless Chinese Crested. It's well known among Chinese Crested owners that the same genetic mutation that causes hairlessness in some dogs of this breed also causes anomalies with dentition. They don't have normal mouths, have few teeth to begin with, and those teeth they do have are shallowly rooted and usually begin to fall out at age two or so. There's really nothing I'm aware of that can be done to prevent the loss of teeth, no matter how well the teeth are cared for.
Not all vets are familiar with this breed and its unique dentition, so sometimes they assume that these dogs are being horribly neglected when that is, in fact, not the case.
At twelve years of age, Louie only has a few molars left, and the last time I took him in for a dental cleaning I was charged the same fee they would have charged me for a dog with a mouthful of teeth. My question for you is whether or not the amount of work to do a dental cleaning is the same for a dog that only has a few teeth. Whenever I take him to the vet for this procedure I feel a bit like I'm being robbed. What are your thoughts on this?
Louie's Mom August 18th, 2009 10:45:36 PM
"But here's where the miracle of animal resistance to severe pain comes in: Pets with severely compromised teeth either don't suffer like we do or they don't display pain the way we do. Based on pain studies in human babies and animals, the latter option is more than likely the case when it comes to oral pain in pets. Which means they DO suffer...and we don't know it."
Gosh, I never thought that dental pain can be so equally terrible for animals as well...What's so scary is that we as owners DO NOT have any idea that they're suffering so much :(
I am very happy that I stumbled on this very usful article, it sure had thought me a lot. Thanks :)
Chloe August 18th, 2009 11:47:11 PM
This one is very timely for me. I finally got a look at Baby's teeth last night. I swear it looks like the bottom teeth between the canines have been filed down. She's only 3. No wonder she doesn't want anyone opening her mouth!
Dr. K, any chance you could write more on this topic? Can vets do all the stuff a human dentist can do? Bridges and dentures don't seem very feasible but how about implants?
I'm one of those humans who has BEGGED to have teeth extracted. There's only so much one can do to overcome genetics and, surprise, dentures can actually be a blessing when weighed against constant mouth/face/neck/sinus pain and the variety of infections that are actually dental related. I'm guessing animals' pain is limited to the local area of the teeth either and that they can get systemic infections from bad teeth too. This is one of the few areas where I feel a bit more competent when talking to a vet but, so far, with the exception of a couple of broken teeth over the years, my critters have had better genetic luck than I so we haven't had too many dental issues. Funny though, now that I think about it, more dental than other issues. I wonder if that's because I have a better grasp of the concepts. I'm certainly more likely to notice and recognize this and subtle signs of pain than many other things...
Bob Jones, My son says the same of us women folk. We are indeed the subset of the species who usually have to make the tough decisions - outside of wars that is ;)
PJBoosinger August 19th, 2009 07:48:14 AM
Louie's Mom: I certainly don't mean to make light of the problem some particular pets face or condemn those whose pets happen to be genetically predisposed to periodontal disease. It's common for many smaller breeds, including Chinese cresteds, of course. The key is to start early and keep it up--every six months is need be. I liken it to the problems big dogs face with respect to osteoarthritis. It's expensive to maintain one of these sufferers and often leads to very expensive surgery, but big dog owners have become accustomed to handling it (mostly, though that's the subject of another rant). Smaller dog owners are somehow more willing to neglect a mouth in my experience, believing it doesn't hurt as much as it does. They consider it more of a cosmetic/smelly problem.
Of course I'm clearly not referring to you. I know how much you've gone through for Louie.
As to feeling like you're being ripped off for Louie's dental cleanings: Few teeth does not necessarily equal an easier time of it. Even one diseased tooth can require significant amounts of time in root planing and other survival tactics. Moreover, much of the price of a dental is in all the "ancillaries": anesthesia, monitoring, IV catheters, etc. If you're going to do it, I say do it *right.*
Dr. Patty Khuly August 19th, 2009 08:30:37 AM
Thanks for the explanation. I am soooo squeamish about mouths - my own and my pets'.
I had a rescue years ago that had such bad teeth, you could smell his breath from across the room. Yuck. He was also very thin and HW positive. I had to somehow get weight on him to build him up to undergo the HW treatment before we could have him neutered and his teeth fixed. I know his poor mouth hurt - sometimes I would spend hours coaxing him to eat - sitting on the floor with him, hand feeding canned dog food. He ate only to please me and hear, Good dog! (I gave him doggie breath mints so we could stand to be in the same room with him!) Once he was treated and declared HW free, we had him neutered and he got the dental he needed so badly. (8 teeth pulled) That was one dog that never bothered his neuter stitches - he had a brand new mouth and was ready to use it! He gained 5 lb. in the two weeks after surgery.
We also got a trio of dogs that we rushed to dental surgery - 11, 12 and 13 teeth extracted! We've had some that have very few teeth left, but they never seem to mind the missing teeth - once they are awake from surgery they're ready to eat. I am convinced even one bad tooth must be horribly painful, just from watching a dog so eager to eat once the bad tooth is gone.
Robinsdogs August 19th, 2009 09:37:09 AM
Just a little friendly correction––by way of highlighting how points of view evolve. Even those of you above commenters (who clearly care tremendously for your pets and value dentistry highly) have continued to use the verb "to pull" instead of "extract." I understand how it's come to be like that, yet the terms we use can make all the difference to ow we view crucial procedures like this. I hope that doesn't sound like a rap on the knuckles. I intend it simply as an explanation.
Dr. Patty Khuly August 19th, 2009 10:05:36 AM
Thanks, Dr. Khuly. I truly appreciate your explanation; it will help me to avoid the feeling of being taken for a ride the next time I have one of my two cresteds in for their dentals.
Knock on wood, we've not needed any extractions yet, but with these kids the extractions tend to take care of themselves!
Louie's Mom August 19th, 2009 02:07:03 PM
I had long running problems with a milk molar when I was small, sometime it hurt for a week or 2, then got better, then again it was hurting. One way or another I never complained, something was wrong but well I did not know I could do something about it, unless somebody pinched my cheek on the affected side (I almost fainted once because of that). I was eating normally, mainly on the other side. Then my parente noticed that something was wrong, my face was swollen one side and I was a bit grumpier than usual, and took me to the dentist, he decided to give me antibiotics for a while then extract the offendig molar because it was too rotten to be saved. I never feel better that after that extraction, even not being able to eat that side for one or 2 days I was free from the nagging pain in my face.
When my cat was a kitten and was growing adult teeth he actually was looking unhappy and his "face" swollen for a couple of days, fortunately his teeth were perfectly good for the rest of his 14 years long life, no tartar, no bad breath. He was fed a mixed diet or dry cat food and raw meat and offals, may be was the chewing may be was just lucky genetics.
FS August 21st, 2009 03:55:35 PM
I have a cat with HCM, and we have put the dental off for a couple of years because of the anesthesia factor. Finally the teeth were bad enough to make me think about what would do more damage. So I had the echocardiogram (overdue anyway), then two days later a trip for ADR (cat made himself sick with anxiety), and then finally, two weeks later, the dental with 2 extractions. Oh, and did I mention, the cat is also allergic to Clavamox. If I added up the bills, I would be sick to my stomach, so I won't. No offense, Dr. K. I am a teacher, and I haven't been paid since June. But I must say, it was worth every penny. Well, maybe not for the ADR visit. But this guy is eating so much better now (and believe me, he's big-boned anyway), I wonder how long he was really in terrible pain. I surely didn't mean to make him suffer, and for the past 2 years, I have been diligent about brushing the chompers of 3 cats and a dog.
KB August 21st, 2009 08:23:10 PM
I am a Vet nurse practicing in Australia and I completely appreciate the time and effort it takes to extract teeth, being the nurse who has to monitor long anaesthesias! It is hard to put across to clients how much time it actually takes and the sheer effort of taking teeth out - Use of drills etc and putting your back out!
I do like a good clean mouth after a dental though, and seeing nice white polished teeth. It is very satisfying cracking plaque off teeth! (Definitely a vet and nurse thing I think!)
You make very good points and I shall definitely use them the next time someone moans about the cost.
Lorelei August 21st, 2009 10:59:40 PM
I have one cat who has had most of her teeth extracted. It is unfortunate, but now she is doing just fine. This did not happen until her senior years. It was admittedly a bit shocking and made me feel badly, but I do the best I can for my cats. Home dental care for cats can be a real challenge, and I get them in for cleanings when and as I can.
When my vet told me the cat would be able to eat just fine after the extractions, I felt much better about it, and I was happy to pay the money for it, so that my cat would not suffer or become ill.
I'm trying to learn to do basic dental cleaning for them at home, but a lot of my cats don't like to be handled too much. Clipping nails is challenge enough with them. Touch their mouths? Forget it! I'm not giving up, though.
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