Readers of this blog know that Barnum was scheduled to have surgery at Veterinary Dental Services on Tuesday. But you don’t yet know what actually happened! So now I’ll fill you in, with pictures and everything.
I think Barnum’s whole procedure must have taken between three and four hours. Once Barnum was anesthetized, Dr. Shope conducted a more thorough exam.
She discovered that in addition to the two lower canines scraping against the upper gums and upper left canine tooth, the leftmost lower incisor was also damaging the incisor above it. Therefore, that lower incisor (the left mandibular third incisor, for those of you playing at home) would either need to be shaved down, or if that didn’t shorten it enough to keep it from interfering with the other teeth, it would be pulled. I was much less concerned about an incisor being removed than a canine tooth, because incisors are much smaller teeth (with smaller roots) than canine teeth, and there are also more incisors to carry the load if one is removed.
After the vet and her assistants examined, cleaned, and x-rayed Barnum’s whole mouth, she did decide to pull that incisor. She also performed “crown reduction” and “vital pulp therapy” on the two lower canine teeth.
In case you’re wondering what all this means in practical terms, here are some “before” and “after” pictures for you, courtesy of the good folks at VDS (thanks, Jessica!). First, here is how Barnum’s lower jaw looked before and after from the outside:
And here’s the same view after surgery:
You can see that the lower canines are much shorter than they were before. Because the part of the tooth that is alive, the pulp, extends to almost the tip of the tooth, cutting it involves use of a local painkiller, and keeping it alive requires vital pulp therapy, which is explained here:
Vital pulp therapy is performed in as close to a sterile fashion as possible. A superficial layer of the pulp is removed (“freshened”) to remove surface bacteria and unhealthy inflamed tissue. A medicated pulp dressing is then placed directly on the newly exposed pulp to stimulate healing and provide anti-bacterial properties. Finally, a protective barrier of dental composite is placed – similar to what a dentist would fill a cavity with in people.
Here is an x-ray of what the tooth looked like before surgery:
And below is an x-ray of how it looks now. The bright white part at the top of the tooth is where the vital pulp therapy was done.
The good news is that the upper left canine, which Dr. Shope thought might need to be removed, is still in Barnum’s mouth. Yay! Dr. Shope said that whether Barnum keeps this tooth will depend on how well the tooth and the surrounding gums recover, and that this recovery will depend a great deal on me brushing the injured area thoroughly and frequently, starting the day after surgery. So, no pressure there. More about how I am approaching
poking the outchy area with a stick brushing the traumatized area without ruining Barnum’s willingness to have his teeth brushed in an upcoming post.
So, what is this injured area of which we speak? See below….
“A” and “B” are on the left side of Barnum’s mouth. Arrows “A” and “C” point to trauma caused by the lower canines. You can see at “A” where a large area of gum is worn away, and some of the bone, too. This is likely the spot that has been infected for the last few months. “A” seems to be the spot that is the most outchy, and that is where I will really have to concentrate my brushing energies, for the next four weeks in particular. I think the damage to the tooth and the tissue at “B” was caused by the incisor that was removed.
So, that’s the physical aspect of the surgery. There was a lot going on emotionally, too, but I hope to address that in another post.
I’ve learned a lot writing this post. I’m curious if you’ve learned anything reading it?
Thank you so much to everyone who has offered kind and supportive comments (and tweets, emails, and posts on Facebook). Even if I haven’t responded (which has been because I’ve been pretty sick and overwhelmed, not because I don’t care), I have really, really appreciated your warm wishes. I feel so much less alone when I hear from other people who care about Barnum getting well, too.