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Thursday, August 23, 2012

Who Do You Believe? Part 1: Bad Teeth

Is it "who" or "whom"?  I always get confused on that particular grammar rule.

Laura recently left a comment on a post I did last year about a case of severe periodontal disease in a dachshund.

I recently rescued a 9 year old chihuahua. He only has 2 bottom fang teeth remaining and they are rotten and loose. He has been to several vets with varying opinions of treatment. I was told to leave the teeth because the jaw will completely breakdown without the teeth there to anchor the jaw. I was told by another vet that if I leave the teeth they will make the jaw infected. The rescue group I adopted the dog from says leave the teeth in because the jaw will break if the teeth are pulled. I'm not sure if this is a question futon website but I would really like some feedback, option and/or experiences with this type of situation.

There are two things to address here.  First, what to do in this particular case.  Second, looking at who you believe and get advice from.

The "fang" teeth, properly called canine teeth (even in non-canine species!) have extremely long, curved roots that go back much further than people realize.  In the front part of the lower jaw the roots of these teeth take up a considerable amount of space.  Removing the teeth can be tricky, especially if there is considerable periodontal disease.  If the infection is severe, you do indeed have a risk of accidentally fracturing the jaw during the extraction process.

Let's take a moment and look at what periodontal disease is.  As tartar and calculus remains in contact with the teeth and gums it causes inflammation.  This inflammation allows easier access of bacteria to the tissues, as well as the bacteria spreading on their own.  When teeth become loose it's not normally due to just the tooth itself.  In these cases the infection is bad enough that it is spread into the bone of the jaw leading to erosion and deterioration.  As the bone erodes its hold on the teeth is reduced, leading to loose teeth.  So by the time the teeth are loose we already have breakdown of the bone in the upper or lower jaw due to infection, which is why the teeth are loose.  The teeth don't anchor the jaw.  The jaw anchors the teeth.  Yes, the teeth do give some stability to the lower jaw, but healthy bone isn't going to break or deteriorate by being worked on.  So if we have a case where the tooth has to be removed due to an injury rather than infection, the chance of breaking the jaw is very low.  With periodontal disease the risk of fracture is because the jaw is already weak and infected, not because you're extracting a tooth. 

In my opinion and in the opinion of every dental specialist I've heard talk, these teeth need to come out.  They are helping to keep the infection persistent and as long as the bad teeth are there the problem won't completely go away.  The vet doing it will have to be very careful during the procedure, but it still needs to be done.  I normally put such a patient on antibiotics for a few days prior to the extraction and then for 7-10 days afterwards.

So what about the second part of this discussion?  I'll get into that tomorrow.

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