Lower canine extraction in cats

Re: Lower canine extraction in cats

bob lehner — Tue, 26 Oct 2010 13:30:55 GMT

[quote user="Evelyn Barbour-Hill"]

Incidentally, I have amputated limbs on many occasions and the cat or dog has run around as fast as ever.

[/quote]

Blimey - that's a bit heroic ...thought they might fall over in a heap. I've never considered taking off more than just the one.....

Re: Lower canine extraction in cats

Anonymous — Tue, 26 Oct 2010 13:10:32 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="David Beattie"]My boss had a double-take when he came back from a cow caesar or other heroic task to find an exasperated nurse beckoning him to remove the teeth on my behalf ;-)[/quote]

And what did he do I wonder? Whip 'em out in five minutes? I doubt it. Maybe he was the senior partner and so he told you "Just snap 'em off level with the gum, that's what I do." [/quote]

He let me finish and picked up some of the slack of uncompleted other tasks (actually just looked relieved that I'd booked the dog in for my own op day and not his!) - good boss.

[quote user="David Beattie"] - must say while I appreciate the official answer is that any fractured canine with pulp exposure requires removal,[/quote]

Thanks - my error, didn't mean this. For 'removal' should read 'treatment' (though in most first opinion practices the two do tend to get equated unless local endodontic facilities exist).

[quote user="Evelyn Barbour-Hill"]

[quote user="David Beattie"] I do give owners the option of leaving it alone (explaining that it is likely to eventually lead to a tooth root abscess if the dog lives ad infinitum and may well cause pain long before that...) and find that most do, those that still want the tooth removed can usually be deterred by the offer of a dental referral 4hrs away[/quote]

Which just goes to show that owners will generally do what they think you are hinting that they should do.[/quote]

Good point. It's almost not worth giving all the options if you present them in leading fashion, other than to 'cover yourself'. I say almost because I recently discussed 'all the options' with a client regarding a distal limb spindle sell tumour and they elected £6000 radiotherapy requiring an 8hr round trip 3 times a week for 4 weeks to my amazement! (most people with that sort of money don't have that sort of time I tend to find). Guess it shows you can't pigeon-hole folks all the time.

I've only ever had one client take me up on a dental referral (more down to distance than anything else), but would have to say it was the most professional referral establishment in any discipline I've encountered and definitely worth the trek to get the problem sorted first time. Cost wasn't an issue as they offered a direct claim from the insurance.

Re: Lower canine extraction in cats

Hannah Wynne Richards — Tue, 26 Oct 2010 11:07:42 GMT

I'm glad I'm not the only one who finds cat mandibular extractions stressful

Micheal Since you can't actually ask the dog if it has toothache, I tend to err on the side of caution, and assume it has- better for the patient than assuming it hasn't

Wynne

Re: Lower canine extraction in cats

Evelyn Barbour-Hill — Tue, 26 Oct 2010 10:42:37 GMT

[quote user="i am ed"]

[quote user="Evelyn Barbour-Hill"]what do you do with, for instance, the tooth with a deep periodontal pocket?[/quote]

What do you call too deep?

[/quote]

Sorry, too deep for what?

Re: Lower canine extraction in cats

Edward Jones — Tue, 26 Oct 2010 10:04:37 GMT

[quote user="Evelyn Barbour-Hill"]what do you do with, for instance, the tooth with a deep periodontal pocket?[/quote]

What do you call too deep?

Re: Lower canine extraction in cats

Evelyn Barbour-Hill — Mon, 25 Oct 2010 23:58:46 GMT

[quote user="Michael Woodhouse"]

[quote user="Mark Holmes"]Last time I referred a dog for endodontic treatment the bill came to iro £2000. One tooth ... Maxillary canine

[/quote]

I'm obviously doing something wrong. Or maybe I'm doing it right.

[quote user="Michael Woodhouse"]A dog or cat doesn't NEED any of its teeth. I have removed everything on a few occasions and the animals have still crunched on biscuits.[/quote]

I quite agree.

Incidentally, I have amputated limbs on many occasions and the cat or dog has run around as fast as ever.

[quote user="Michael Woodhouse"]

'm sure it's far more satisfying restoring teeth, but I'm not sure there is ever a need. I have an uneasy feeling that people are offering human standard treatment to pets that they just don't need.

IF it gets a tooth root abscess I can take it out, but the number of dogs with broken teeth I see compared to the number of tooth root abscesses I see would suggest that it's not really that common.

[/quote]

But the original point of this thread was that some teeth are quite difficult, time-consuming, traumatic, "traumatic"" and expensive to extract.

[quote user="Michael Woodhouse"]IF it gets a tooth root abscess I can take it out, but the number of dogs with broken teeth I see compared to the number of tooth root abscesses I see would suggest that it's not really that common.[/quote]

But what about the number of dogs with broken teeth that you see, with periapical pathology that you don't see because you don't radiograph them with dull toothache that you don't see because you can't detect it by "occasionally probing" them?

[quote user="Michael Woodhouse"]A scale and polish, remove if required for a reasonable fee suits most pets.[/quote]

Hmmm. And when you do your scale and polish, what do you do with, for instance, the tooth with a deep periodontal pocket?

Re: Lower canine extraction in cats

Michael Woodhouse — Mon, 25 Oct 2010 22:54:39 GMT

[quote user="Mark Holmes"]Last time I referred a dog for endodontic treatment the bill came to iro £2000. One tooth ... Maxillary canine

[/quote]

This is my point really. I am pleased enough to see farm collie dogs for boosters many have broken teeth. They would never spend hundreds of pounds on a tooth. I occasionally have probed these and no obvious sign of pain.

A dog or cat doesn't NEED any of its teeth. I have removed everything on a few occasions and the animals have still crunched on biscuits.

I'm sure it's far more satisfying restoring teeth, but I'm not sure there is ever a need. I have an uneasy feeling that people are offering human standard treatment to pets that they just don't need.

IF it gets a tooth root abscess I can take it out, but the number of dogs with broken teeth I see compared to the number of tooth root abscesses I see would suggest that it's not really that common.

A scale and polish, remove if required for a reasonable fee suits most pets.

Re: Lower canine extraction in cats

Mark Holmes — Mon, 25 Oct 2010 22:42:41 GMT

Last time I referred a dog for endodontic treatment the bill came to iro £2000. One tooth ... Maxillary canine

Re: Lower canine extraction in cats

Evelyn Barbour-Hill — Mon, 25 Oct 2010 20:30:49 GMT

[quote user="Louise Alexander"]

Just out of interest, because I really have no idea how much it costs to inform owners properly. How much roughly does it cost to have root canal treatment?

For example, in the young cat I extracted the canine from?

Nice to be able to give informed options!

[/quote]

In the cat? Not much more than the extraction, assuming you charged by time for the extraction. And of course the cat still has its tooth at the end, and undergoes less trauma.

Re: Lower canine extraction in cats

Louise6732 — Mon, 25 Oct 2010 20:23:50 GMT

Just out of interest, because I really have no idea how much it costs to inform owners properly. How much roughly does it cost to have root canal treatment?

For example, in the young cat I extracted the canine from?

Nice to be able to give informed options!

Re: Lower canine extraction in cats

Evelyn Barbour-Hill — Mon, 25 Oct 2010 20:10:55 GMT

[quote user="David Beattie"]My boss had a double-take when he came back from a cow caesar or other heroic task to find an exasperated nurse beckoning him to remove the teeth on my behalf ;-)[/quote]

And what did he do I wonder? Whip 'em out in five minutes? I doubt it. Maybe he was the senior partner and so he told you "Just snap 'em off level with the gum, that's what I do."

[quote user="David Beattie"] - must say while I appreciate the official answer is that any fractured canine with pulp exposure requires removal,[/quote]

Eh? Who said that? Lead me to 'em, I'll hammer 'em. Any broken tooth with pulp exposure needs treatment. A broken canine tooth with pulp exposure needs endodontic treatment (unless it's absolutely shattered with longitudinal splits ). Extraction is the very last resort when nothing else is possible, being equally time-consuming, equally expensive, much more traumatic (in the true sense of the word) and much more "traumatic" (in the rather silly metaphorical sense in which the word is so often used nowadays).

Which just goes to show that owners will generally do what they think you are hinting that they should do.

[quote user="David Beattie"](my current practice doesn't have sufficient dental equipment in my opinion to be undertaking mandibular canine extraction in a large dog where the root is healthy.)[/quote]

But good on you for recognising that.

Re: Lower canine extraction in cats

Evelyn Barbour-Hill — Mon, 25 Oct 2010 19:44:42 GMT

[quote user="Martin Atkinson"]This is where I fall out of Evelyn's good books.[/quote]

You certainly do.

[quote user="Martin Atkinson"] It is certainly better than drilling or chiselling into the socket and causing further iatrogenic damage.[/quote]

Certainly it is............ but how about doing a proper surgical extraction and not causing iatrogenic damage?

Or how about getting endodontic treatment done and avoiding the unnecessary extraction?

Re: Lower canine extraction in cats

Martin Atkinson — Mon, 25 Oct 2010 17:03:33 GMT

This is where I fall out of Evelyn's good books. I struggle to extract these teeth but have generally found that trying to remove every last fragment is counter productive and unless it is grossly infected leaving a broken root behind so long as is below the alveolar bone does not seem to affect healing and the cats seem to recover fully with no apparent continuing discomfort. It is certainly better than drilling or chiselling into the socket and causing further iatrogenic damage. I used to be uneasy about it but not anymore.

Re: Lower canine extraction in cats

Anonymous — Mon, 25 Oct 2010 13:50:29 GMT

Did see a good pictorial guide in UK vet, think it was the following article (but could have been a different one...)

UK vet vol 11 (issue 8)

Oral surgery : Part 2 Mandibular canine extraction

Smithson Alex

http://www.ukvet.co.uk/issue.asp?vid=11&iid=8&journal=Companion%20Animal (though journal is not available online, so not much use unless you have archived copies kicking around your practice bookshelves...)

Of more use might be: http://www.rvc.ac.uk/Review/Dentistry/Extraction/canine/lower.html

Good videos, but if you add up the time for them all it comes to somethng like 5mins, which did lull me into an alternate dimension of time. First time I did this was a young labrador with discoloured upper and lower canines on one side of mouth and it did have dental pain and only ate from the contralateral side. My boss had a double-take when he came back from a cow caesar or other heroic task to find an exasperated nurse beckoning him to remove the teeth on my behalf ;-) Have been a bit relucant to repeat the *x hour* ordeal - must say while I appreciate the official answer is that any fractured canine with pulp exposure requires removal, I do give owners the option of leaving it alone (explaining that it is likely to eventually lead to a tooth root abscess if the dog lives ad infinitum and may well cause pain long before that...) and find that most do, those that still want the tooth removed can usually be deterred by the offer of a dental referral 4hrs away (my current practice doesn't have sufficient dental equipment in my opinion to be undertaking mandibular canine extraction in a large dog where the root is healthy.)

Re: Lower canine extraction in cats

Evelyn Barbour-Hill — Sun, 24 Oct 2010 19:46:47 GMT

[quote user="Michael Woodhouse"]

Why did you have to remove the tooth? Was the cat showing obvious signs of pain?

I ask because this is something we see quite often at routine checks and the animals seem not bothered. My understanding was that it may be painful to start with, but with exposed pulp cavity the nerve will wither and the tooth will stop being painful - it's basically dead.

So unless there is a obvious discomfort I leave them alone.

[/quote]

The exposed pulp is painful and sensitive until it dies (I don't think "wither" is quite the word). Sometimes it does not die for a very long time. If the whole pulp is necrotic, of course the pulp itself can not be painful, but the region around the tooth apex may well have a constant grumbling toothache. You now have a channel of necrotic stuff leading straight into the depths of the mandible. Actual septicaemia is rare, but a periapical pathological process is very likely: periapical lucency is likely to be seen on radiographs. That means toothache. That is bad enough, but sometimes it will proceed to periapical abscessation which can cause enormous damage.

Re: Lower canine extraction in cats

Evelyn Barbour-Hill — Sun, 24 Oct 2010 19:35:10 GMT

[quote user="Louise Alexander"]I used the surgical extraction method, but I really struggled to get the root out. It took me a long time. I did get in out, intact, eventually. I saw it back for a revisit 2 days later and the extraction site looks fine.[/quote]

Well done.

[quote user="Louise Alexander"]-Does everyone else struggle with lower canine cat extractions? (when there is no periodontitis and the root is healthy i.e. not falling out already!)[/quote]

Yes it is a tough job. It takes time and it needs patience. It needs a surgical method. Bear in mind that the root is angled lingually - I mean the apex is nearer the medial side of the mandible than the lateral. You need good instruments too. Never apply any sort of leverage as you will either break the tooth or the mandibular symphysis. Fahrenkrug elevators can help but I find them too thick.

[quote user="Louise Alexander"]-Does anyone else worry about the size of the socket that is left? I do manage to suture the gingival flap from the surgical extraction over the socket.[/quote]

Yes I always do worry, but needlessly as it heals very quickly as long as it has been left clean and hygienic with no odd bits of bone splinter, tooth splinter, tissue tags or whatever in it. It's not always essential to completely close the flap over it, but that is a really good thing to do as long as you can achieve it without tension.

[quote user="Louise Alexander"]-Why can I not find any articles describing surgial extraction in a lower canine? They are all shown on upper canines![/quote]

I suspect it is because the upper canine is easier...............

There was a step-by-step article describing it in the dog, in JVD a few years ago. I can't remember which issue offhand.

Edit: JVD volume 18 no.1 (March 2001) page 48

The difficulty of the extraction procedure makes endodontic treatment the treatment of choice in a case such as you describe.

Re: Lower canine extraction in cats

Rachael Winder — Sun, 24 Oct 2010 15:25:04 GMT

This is the area of dentistry that really scares me- I've referred the last couple of fractured lower canines ( both in young bull type breeds) for someone a lot more skilled than me to deal with! My boss found a very good step by step video with commentary via a google search- I think it was in the CPD archive from RVC.

Rachael.

Re: Lower canine extraction in cats

Louise6732 — Sun, 24 Oct 2010 15:13:41 GMT

A fractured tooth where the pulp is exposed either needs extraction or root canal treatment. Pulp exposure is very painful. An animal will eat despite dental pain because if it doesn't eat it will die. The trouble with dental pain is that it is often chronic and thus difficult to detect.

An exposed pulp acts like a straw to allow bacteria to travel through the tooth and potentially cause septicaemia.

If your tooth was fractured would you just leave it alone?!

Re: Lower canine extraction in cats

Michael Woodhouse — Sun, 24 Oct 2010 14:25:03 GMT

Why did you have to remove the tooth? Was the cat showing obvious signs of pain?

So unless there is a obvious discomfort I leave them alone.