Drooling, Bad Breath, and The Stick Chewer..

Hank

Hanks mom brought him in on a Sunday to promise me that she wasn't crazy.. "but he keeps licking his lips, won't eat his food like he normally does, and lately has very bad breath. He is normally very happy, playful and full of energy. Oh, and he loves to chew sticks!"

"Huh? Sticks you say?"

And there within two minutes was our answer to all of Hanks ills.

I know that most people would just stick their finger in his mouth and try to fix this problem quickly, but it is a Sunday, and I am only here for another hour,, and well, he doesn't like my fingers sticking in his mouth.
"Could you bring him back tomorrow morning so I could look in his mouth without a tongue in the way, or chomping teeth, and allow me to take care of him properly?" I bashfully inquired..

You see there is a fine line between rogue-vet style (my usual preference where I act like a MASH doctor,, all MacGyver and cast caution to the wind) and performing a task with as few variables as possible. Medicine is all about managing worst cases scenarios, being prepared for them, and jumping in.. (see? That's I love that MacGyver stuff!).

Hank's mom was so happy that I had confirmed that she was an astute mom (and not crazy) that she afforded me the liberty of general anesthesia the following day. That calm quiet Hank under anesthesia allowed me to see...

the culprit...

Wedged very tightly and very deeply in the hard palate (OUCH!! can you imagine?) is a stick!

When it got there is hard to tell? I would guess about 2 weeks?

Within a few seconds that bothersome unwanted stick was out of Hanks mouth.

Are you wondering why I was asking for permission to remove this with Hank under anesthesia?

Here were my concerns initially;

• That stick was wedged so deep that I was afraid the hard palate, or teeth, would bleed like crazy. The gums do this to wash away all that yucky bacteria our mouth is full of.  The advantage to having an excellent blood supply, and bleeding, is that the gums heal very quickly. The disadvantage is that you need to not let blood go down into the trachea. An animal under general anesthesia has an endotracheal tube that seals off the trachea so nothing can trickle down into the lungs. We can tilt the nose down to drain out the mouth, or suction it out of the mouth.
• That stick was just as likely to go down the hatch (trachea) as it is to go out the way it came in. Swallowing a stick, or very worse yet, inhaling a stick, is very expensive to retrieve and potentially fatal. (Not worth my much beloved MacGyver gusto). And,,
• What if I needed to suture the holes the stick left behind? Or,,
• What if it was so wedged I needed that I needed to break  it up to get it out? Worst case,,
• What if there was an open hole (we call it a fistula) between the oral and nasal cavity? (Did you know that you can pierce a hole between the roof of your mouth and your nasal cavity.. it would bleed and hurt and cause massive infection).
• I was worried that there would be other hidden mysterious problems in the mouth. Being under general anesthesia allows us to take a calm, thorough look at them all. 

Hank is a very good boy but a chewing mouth, a stick, bleeding, and a myriad of other possible complications isn't worth asking for trouble.

The stick looks so harmless here.

The stick left behind two puncture holes between the molars. We flushed the holes to remove any residual pieces of stick, all the plugged up debris, and clean the wounds. A few minutes of pressure and the bleeding stopped. Lucky boy, no sutures needed!

But the tongue. Well, it had obviously been licking at a hard sharp object for awhile. Can you see the ulcerated area in the center of the tongue in the center of the photo?

Hank woke up quickly and calmly. He took a few licks of the roof of his mouth and went home with fresh breath and a smile of relief! 

Many Thanks to his mom for letting me share his story with you.

Break down of Hanks visit; Exam: $60, Anesthesia: $100, injectable NSAID; $40, Stick retrieval: Free (because I was so excited to get it on video). Happy mom, Stick free pup and relieved vet: Priceless..

If you have a pet question, a story to share, or just want to be a part of a community dedicated to helping pets and their people please join us on Pawbly.com. Pawbly is free and open to anyone who loves pets.

For veterinary care you can find me at Jarrettsville Vet in Jarrettsville Maryland. Or on Twitter @FreePetAdvice.

Bad Breath..Is it the Food, The Teeth, Or your Nose?

Charlie, my pup, and his excellent pearly white teeth.
When you are examining your pets teeth it is important to look at all of the teeth under the upper and lower lip from the tip of the nose to the far back of the mouth (past the back corner of the eye).
The teeth that tend to see the most damage and tartar are the canines and the back molars.

I have been answering questions on Pawbly.com. Here is one of the most common questions I get;

"My 3 yr old Pom has terrible breath, and has since I became his mommy 18 mos. ago. Will brushing his teeth, improve his breath, and remove the tarter on his teeth??? If so, what toothpaste do you recommend? Toothbrush or finger brush?"

A professional dental cleaning includes general anesthesia, digital oral x-rays,
scaling, polishing and any needed extractions.
Many clients get very upset with the number of extractions that a pet sometimes requires.
If the teeth are compromised they should be removed.
It is far better to remove them now then to have a pet go home with a bad tooth
and the need to return a few months later for another extraction.

Here is my  answer;

"In general bad breath is caused by bad teeth. And the smaller the breed of dog the faster and worse the teeth seem to get. 

Brushing certainly helps keep the teeth from getting caked with calculi and slows down things like gingivitis and gum recession, BUT, if the teeth are already diseased (as evident by having bad breath), then you probably need a professional dental cleaning with your vet before the brushing will be beneficial.

My best advice is to make an appointment with your vet to have them look at the teeth. They can tell you whether it is time for  dental cleaning, or whether the brushing is enough.

A few points to mention:

Brushing needs to be done daily (at least 4-5 times a week) for it to be beneficial. (Afterall we brush twice a day, AND floss..so it makes sense that our pet needs brushing daily).

It doesn't really matter how, or what you use to brush. As long as you are making contact with the outside of the teeth along the inner cheek. Dogs and cats tend to get the worst calculi on the canine teeth and back molars. I recommend gauze squares wrapped around the index finger and then brush/rub the outer surfaces of these teeth just inside the upper cheek..(I will post a video later on my blog with a demo..KMDVM.blogspot.com). I don't usually recommend any fancy products..and pets tend to want to chew your finger if you use toothpaste.

Another thing to discuss with your vet is the food you feed. The soft chewy foods tend to stick to teeth and accelerate the tartar/calculi gum disease process. The flip side is that hard food might help little bit in adding abrasion to the teeth surfaces and probably don't stick to the teeth as much as soft food, you still need to brush daily.

All of those products that are marketed to keep teeth clean (like chew sticks, water additives, chew toys, etc). help a little tiny bit,,,but in the big scheme of your pups 15 year life span they don't make enough of a difference to allow you to not brush.

Last note, unfortunately, I have seen 3 year old small breed dogs who need dentals. So, have your vet take a peek at their mouth. 

Best of luck,, and thanks for the question.

I hope this helps!

Krista"

This molar (at the area of the bleeding, top maxilla furthest to the right, just in front of the finger),
 could only be assessed after we removed the thick layer of calculi.
The roots are exposed and the tooth requires extraction.
The tooth in front of it (to the left) is likely also compromised and likely needs extraction. 

A fractured PM4. Gum recession, and a diseased likely painful tooth.
Extraction is recommended.

If you have any pet related questions you can ask them for free at Pawbly.com..Or you can just visit us there and share your pet  photos, help others with pet questions, or create your own pet topic. Pawbly is a place where people who love pets help other pet people.

Or you can find me chirping away on Twitter @FreePetAdvice.

Or come visit me at the clinic, Jarrettsville Vet.

Here is an excellent blog on brushing teeth, Fidoseofreality.com.

I have every intention of posting a video of my method. It's on my To-Do list, which, gets longer day after day.

Kisses from and to a race observer at the annual
Our Lady's Manor Races in Monkton MD. yesterday.

Laddie, a dear JVC friend models in front of our banner.