Lower canine extraction in a cat

RE: Lower canine extraction in a cat

Evelyn Barbour-Hill — Fri, 13 Nov 2015 22:01:02 GMT

[quote user="cathal rafferty"]I didn't actually use a gag in him at all, I find I rarely do in any. Occasionally I'll use a short needle cap but I don't like the spring-loaded ones in cats.[/quote]

RE: Lower canine extraction in a cat

Glenn Hodgson — Fri, 13 Nov 2015 19:33:51 GMT

[quote user="cathal rafferty"]

[quote user="Glenn Hodgson"]I've seen plenty cats with very painful mouths eating well. Could you hurt. it's jaw with your gag? Surely it would eat on the other side fine if it was your extractions fault [/quote]

I didn't actually use a gag in him at all, I find I rarely do in any. Occasionally I'll use a short needle cap but I don't like the spring-loaded ones in cats. He was drooling from that side as well but wouldn't eat at all, and the other extraction site looked fine. Maybe it was just an ankylosed root that I didn't know was there and so ended up burring much further caudally than I would otherwise have had to.

[/quote]

Worth a thought :some folks ratchet them open.

Non sequitur etc.

Try reading my post it a different way. Read in context OP understood what my sequitur was getting at.

RE: Lower canine extraction in a cat

Peter Southerden — Fri, 13 Nov 2015 18:54:21 GMT

As has already been mentioned, evidence from oral surgery in people shows that post operative pain is proportionate to the amount of bone removal. There is no published evidence that demonstrates this in our patients but equally there is none that contradicts it and so I think it is best to assume that the same holds true.

It is therefore possible that the post operative anorexia was associated with pain associated with the extent of bone removal in this cat. However it is unusual to see this level of inappetence even in cases where extensive bone removal has occurred. Neuropathic pain has a different quality/intensity and certainly can cause anorexia. It seems more likely that there has been damage to the inferior alveolar nerve - do you think this is possible?

Again I agree with other comments that this case demonstrates that preoperative X-rays are important.

RE: Lower canine extraction in a cat

Anthony Todd — Fri, 13 Nov 2015 18:52:12 GMT

[quote user="Glenn Hodgson"]I've seen plenty cats with very painful mouths eating well.[/quote]

Surely this is a non sequitur? If the mouth is/was painful they wouldn't eat would they?

The most universal comment is that "the cat is eating better than ever etc. and that was the day after a big D/O??

Always one of the presenting signs prior to the op is "the cat's not eating and drooling or pawing at it's mouth".

I/we used to say "If the cat isn't eating in 24 hours bring it back, don't delay and returns were usually nil.

I'm sure our dental procedures weren't as atraumatic as currently so it's hard to rationalise?

RE: Lower canine extraction in a cat

cathal rafferty — Fri, 13 Nov 2015 18:20:33 GMT

RE: Lower canine extraction in a cat

Glenn Hodgson — Fri, 13 Nov 2015 18:12:59 GMT

[quote user="cathal rafferty"]

Hi all,

Last week I did a surgical extraction on an old fractured 404 in a cat. I don't have access to dental rads so none were taken.

The tooth was difficult to remove, seemed to be somewhat ankylosed to the bone and I had to burr away a lot of bone laterally. Visually, the tooth was completely extracted. At no point did I feel like the jaw had become unstable. I sutured my flap which seemed to go fine.

However post op pain was high, managed with metacam and buprenorphine (plus had had an inferior alveolar nerve block).

I ended up having to hospitalise him for a few extra days and place an O-tube to feed him. The flap held. He's gone home today feeling much better but this is a problem I have had before. It seems for some teeth I'm taking away a lot of bone and getting very close to the mental foramina with the burr. I think it's probably damage to this that leads to the high post-op pain.

Any advice on how to do these extractions better to avoid the problem in future?

Thanks,

Cathal

[/quote]

I've seen plenty cats with very painful mouths eating well. Could you hurt. it's jaw with your gag? Surely it would eat on the other side fine if it was your extractions fault

RE: Lower canine extraction in a cat

Rob Davis — Fri, 13 Nov 2015 16:25:52 GMT

[quote user="Neil Wheadon"]He has rotten tooth roots on the lateral side, but those medium ones are sound. I split the tooth and attempt extraction. Joyously the rotten ones come out (don't they always) but I am left with a stump on the medial side because that root is still 'alive' (209 - carnassial)[/quote]

If we're talking about the upper carnassial (208 if you'll excuse a little pedantry ), then the mesiopalatal root (the one nearest the front of the mouth on the palatal side) is the one that is most commonly fractured and left behind. If the other roots have come out ok, then you should be able to remove some of the alveolar bone between the two mesial roots with a round or pear-shaped bur so that you can better visualise your root remnant. You can safely remove quite a lot of bone in the maxilla if necessary, and removing this means you're not working blind down a dark hole (good lighting also makes a massive difference). A small luxator (see other thread on elevators/luxators!) can be used to work your way around the periodontal ligament. I sometimes find a root tip pick helpful once the fragment is loose.

[quote user="Neil Wheadon"]2) Get the bur out[/quote]

So, yes, I would probably get the bur out, but NOT to attempt to bur away the root remnant!

[quote user="Neil Wheadon"]) Leave it, it'll be OK[/quote]

See Evelyn's mantra - may be ok to leave in some circumstances, but the owners must be informed that this is the case and ideally it should be monitor radiographically....

[quote user="Neil Wheadon"]Send him to Wales[/quote]

What's the poor dog done to deserve that?!

RE: Lower canine extraction in a cat

Bob Russell — Fri, 13 Nov 2015 15:56:07 GMT

Thanks for the nice comments about the practice!

A hand-held proper (non-lethal Chinese) dental X-ray unit would fit in the pannier and the DR system would fit (very, very gently) in your pocket plus a small laptop!

The Nomad Pro was used in the video we watched on YouTube. Weighs 5lbs apparently. So can be done at a price!!!

RE: Lower canine extraction in a cat

Neil Wheadon — Fri, 13 Nov 2015 15:35:35 GMT

[quote user="Rob Davis"] I know you don't want to hear this, Neil, but radiography really is helpful![/quote]

Aside from Bob Russells lovely practice, I've locummed in maybe 50 places and never seen one. Everyone I talk too would love one (well the assistants) but no one will buy one and my bicycle pannier isn't big enough

Neil

RE: Lower canine extraction in a cat

Neil Wheadon — Fri, 13 Nov 2015 15:32:19 GMT

OK carrying on with this

I have a 10 year old labrador with excessive calculus over 208 and 209 (That's the big ones at the back)

He has rotten tooth roots on the lateral side, but those medium ones are sound. I split the tooth and attempt extraction. Joyously the rotten ones come out (don't they always) but I am left with a stump on the medial side because that root is still 'alive' (209 - carnassial)

I get my elevator out and try to extract but it cracks (we all know that sound) and I am left with a root in with over 2/3 crown removed.

Do I

1) Dig away blindly

2) Get the bur out

3) Leave it, it'll be OK

4) Send him to Wales

Neil

RE: Lower canine extraction in a cat

Rob Davis — Fri, 13 Nov 2015 15:15:18 GMT

[quote user="Neil Wheadon"]Back upper molars of a dog, you know the ones, the carnassials and the big one behind. Need coming out because one root is rotten.[/quote]

[quote user="Evelyn Barbour-Hill"]You must not leave anything necrotic or infected behind.[/quote]

Even when only one root appears "rotten", perio-endo lesions are quite common with these teeth, ie the periodontitis has extended as far as the root apex and the infection spreads into the pulp via the apical delta. Once this has happened, the whole pulp, including in the other roots, will be necrotic, so leaving pieces behind is likely to be problematic. I know you don't want to hear this, Neil, but radiography really is helpful!

[quote user="Evelyn Barbour-Hill"]

You must not leave anything necrotic or infected behind.

You must not leave anything spiky or protruding.

You must not leave anything behind that with a bit of skill you could extract.

You know my methods, Watson. Apply them.

[/quote]

Love this, I think it has the makings of a song....

RE: Lower canine extraction in a cat

Evelyn Barbour-Hill — Fri, 13 Nov 2015 14:19:16 GMT

[quote user="Neil Wheadon"]

[quote user="Evelyn Barbour-Hill"]a) It depends on the reason the extraction was undertaken in the first place.[/quote]

OK humour me

The 2 commonest

1) Cat 'neck lesion' (I can't remember the new name) where you haven't got a dental radiograph (unless you're at Bob Russells place)

2) Back upper molars of a dog, you know the ones, the carnassials and the big one behind. Need coming out because one root is rotten.

[/quote]

You must not leave anything necrotic or infected behind.

You must not leave anything spiky or protruding.

You must not leave anything behind that with a bit of skill you could extract.

You know my methods, Watson. Apply them.

(Love your terminology )

RE: Lower canine extraction in a cat

Neil Wheadon — Fri, 13 Nov 2015 13:54:22 GMT

[quote user="Evelyn Barbour-Hill"]a) It depends on the reason the extraction was undertaken in the first place.[/quote]

OK humour me

The 2 commonest

1) Cat 'neck lesion' (I can't remember the new name) where you haven't got a dental radiograph (unless you're at Bob Russells place)

2) Back upper molars of a dog, you know the ones, the carnassials and the big one behind. Need coming out because one root is rotten.

Neil

RE: Lower canine extraction in a cat

Evelyn Barbour-Hill — Fri, 13 Nov 2015 13:47:57 GMT

[quote user="Neil Wheadon"]1) Burring bone is the most painful thing post proceedure in people[/quote]

Dogs and cats are not people. But we give them lots of analgesia (including post op) and they are generally fine the next day, judged by what means we have.

[quote user="Neil Wheadon"]2) If you snap a tooth root it's OK provided you get 2/3 out in older patients, so don't reach for the burr to get the rest out[/quote]

a) It depends on the reason the extraction was undertaken in the first place.

b) I hope nobody just "reaches for the bur".

( It's bur, not burr. I don't know why, but there it is )

RE: Lower canine extraction in a cat

Neil Wheadon — Fri, 13 Nov 2015 09:24:52 GMT

[quote user="cathal rafferty"] I had to burr away a lot of bone laterally.[/quote]

We have a really good friend who's been a dentist for 25 years. I asked her about tooth extraction last year and 2 things stuck in my head

1) Burring bone is the most painful thing post proceedure in people

2) If you snap a tooth root it's OK provided you get 2/3 out in older patients, so don't reach for the burr to get the rest out

Any thoughts from the experts?

Neil

RE: Lower canine extraction in a cat

Evelyn Barbour-Hill — Thu, 12 Nov 2015 23:18:08 GMT

[quote user="robloxley"] would coronal amputation without burring lots of bone been an answer?[/quote]

Well, perhaps. But the OP did say it was an old broken tooth, so you have to be careful; not much point suturing a flap over to nicely encase some infected necrotic pulp remnant in the jaw......

RE: Lower canine extraction in a cat

Evelyn Barbour-Hill — Thu, 12 Nov 2015 23:04:01 GMT

If you look at the anatomy, you see that the lingual side of the tooth is the thinner shell – so, logically, you get on better removing bone on the lingual side. Although, yes, it's awkward and not easy. You can also quite usefully remove bone on the distal side, i.e. the dorsal surface of the mandible.

It is immensely useful to get a radiograph first so that you know what it is you are attempting to extract. For instance, if the root is well resorbed so that it just blends into a chaotic bone, you are just going to get very frustrated trying to loosen something that cannot be loosened; if you've radiographed it, you know you can be satisfied with what does come out, and you just need to do a bit of remodelling of the hard tissue surfaces and suture a nice sound flap closed.

RE: Lower canine extraction in a cat

Anthony Dennison — Thu, 12 Nov 2015 18:02:05 GMT

[quote user="robloxley"]I used to have an article by Alex Smithson (http://onlinelibrary.wiley.com/doi/10.1111/j.2044-3862.2006.tb00512.x/abstract) that covered mandibular canine extraction, but some previous nurse threw it out when it became well thumbed and bloodied and I'm less keen to pay $38 to download it.[/quote]

I'll try and see if I can access through Liverpool Uni tonight for you if you want Rob.

RE: Lower canine extraction in a cat

Rob Loxley — Thu, 12 Nov 2015 17:49:41 GMT

I used to have an article by Alex Smithson (http://onlinelibrary.wiley.com/doi/10.1111/j.2044-3862.2006.tb00512.x/abstract) that covered mandibular canine extraction, but some previous nurse threw it out when it became well thumbed and bloodied and I'm less keen to pay $38 to download it.

As for your feline case, I'd suggest without radiography it was always going to be hard. Can you get the plate in the cat's mouth to do some kind of view, even if you don't have a 'proper' dental setup. If it was ankylosing then would coronal amputation without burring lots of bone been an answer?