Doggie Dental Decisions

[briannan]

I just noticed last month that my dog's top two front teeth were loose and the gums very receded.  I do not brush daily, but give dental treats regularly.
Took her to her annual appointment and the vet said that I could either have the two bad teeth pulled and clean the remaining or wait for them to fall out.

I was interested in trying ot save the teeth.  Next, I took her to a veterinary dentist, who said it was unlikely the two teeth could be saved.  He would do a full exam, x-rays, cleaning, doxi-robe, etc and pull more teeth if any other bad ones were found.  If the two top teeth could be saved, they would let me know during the exam.  My reservation with the veterinary dentist is that he did not seem to be interested in ensuring that she keep the rest of her teeth and would pull more if needed.  He gave me an example of another small dog that he had pulled 6 teeth.  He also mentioned the bone loss spreading and that it could spread even into the sinuses, which really scared me.  My dog is a smaller shih tzu, with small teeth, and I really want her to be able to keep as many as possible.  

Finally, there is the issue of cost.  $400 for the regular vet versus up to $1,400 (more if the teeth could be saved).  Unfortunately, I don't have unlimited funds.  However, my dog is like my child, and I want to do the right thing for her that also preserves the most teeth possible, no matter the cost.  I just don't feel like I know what the right thing is.  

Thanks!

[Arnold L Goldman, D.V.M.]

One additional thought: Pet owners are often overly concerned with the number of teeth remaining from the original 42 rather than the health of those that can remain and be healthy. That concern while understandable is really quite irrelevant to function. Dogs mostly gulp their food unchewed - ever noticed that vomited dog food looks pretty much as it did going down for most dogs? - and certainly do not masticate food to the extent we need to, to facilitate digestion. Many older dogs who have had complete dental debridements (all teeth removed) eat normally, and often eat the same dry food they always did!  As others have said, the health of the dogs mouth frequently requires extractions. There is no reason to fear or avoid them when they are necessary. And yes, veterinarians do not emphasize dental and oral health to the same degree. The non-optional use of dental xrays as the guide to what work needs to be done mirrors human dentistry is the standard of care and the right way to proceed. That said, since the extent of the dental surgical work that may need to be done cannot be fully ascertained in the awake patient, you should be prepared for a telephone call indicating what visually undetected work needs to be done, as xray imaging reveals. Costs too depend on what is revealed.

[briannan]

Thank you so much for your input.  

I went by my GP and the receptionist said that they did have dental x-ray capacity, but I noticed that there was not a line item for that on my procedure quote from them.  From your answer, if I had them perform them procedure, it would be prudent for me to request it?  

I actually ran into a girl at my apartment complex who said her vet requires a teeth cleaning each year and her dog is the same age as mine.  My vet has never suggested this, but rather examined the teeth and just said they would need to be cleaned at some point.  What is your opinion on this practice?  

I am considering going ahead with the dentist, but I am assuming it would be costly to see him regularly in the future as I am guessing as regular cleanings would cost more than the GPs.  

Thanks again for your input, I greatly appreciate it!

[Jim Humphries, B.S., D.V.M.]

As Tom said, loose teeth in dogs means bone loss, hence the recommendation from both your GP and the Dentist that the teeth be removed.  I agree.  A dental x-ray will confirm.  

Once removed then you do your best in future years to keep remaining teeth healthy.  regular exams, cleanings and home care etc.  

Most dogs do extremely well after a few extractions.  Attempts to save teeth where there is bone loss will prove expensive and not end with good results in a general setting.  

I would recommend you follow the good advice you've had so far, remove the diseased teeth and make every effort at good dental health for her for the rest of her life.  

I understand your concerns and frankly appreciate motivation for her good health.  She will be fine and sounds like you are in good hands.  If you have any further questions, please let us know.  

[Thomas Dock, CVJ, Vet. Technician]

Toy breed dogs, especially those with "pug" faces, like your Shih Tzu, often have dental issues.

When the teeth become loose, that is an indication that there is bone loss from that area of the jaw due to progressive dental disease.   Only a dental xray can let you know how extensive the bone loss is and whether or not the teeth could be saved with oral surgery and therapy.

Does your regular veterinarian have dental xray capability?  The reason I ask is that you won't know for certain how far the bone loss has progressed without the xrays.  Plus, about 28% of dogs that have "normal" looking oral cavities end up with some sort of disease process that can only be seen on the xrays.   SO....that's one point for considering going to the veterinary dentist, especially if your doc doesn't have dental xrays.

Another reason for choosing the veterinary dentist would be the potential to save any teeth.  Many general practitioner veterinarians have an interest in dentistry and might be able to help with this, but, in my opinion, the veterinary dentist will have the the best tools and expertise to potentially save as many teeth as possible.

Cost is a BIG issue and certainly an understandable concern.  As LostGrrl has said below, most dogs will do very well despite the loss of a couple of teeth.  Most dogs have 42 adult teeth and the loss of a couple of incisors (the teeth in the front) won't likely slow her down.   It is BEST to try and save the teeth if possible, but the health of the whole pet needs to be considered as well.

If you are uncomfortable with the dentist's assessment, there are several other veterinary dentists in your area.   You can review the list at the AVDC website...

I hope this helps...I know I didn't give you a clear black or white answer, but a lot of your decision is going to be based on your own comfort level with the specialists as well as your comfort level with the financial aspect.

[LostGrrl]

I'm going through that with my lil chihuahua, he has some loose teeth 4 or so years ago, the vet pulled 3 teeth(that I can recall), he said it was no issue unless his kibble was big. I am now taking my baby in again, he has a seriously painful loose tooth again, I hate seeing him in pain, and I wish they could all come out, but it would make his life more difficult and shorter I'm presuming. I brush his teeth and gums and he's still getting gingivitis - I'm at a loss to find out a better solution other then losing some teeth.

I hope you find the right answer and your baby feels better soon.