Barnum’s Oral Surgery: The Details

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:

close-up of Barnum's lower front teeth, six incisors and two canine teeth

Front view of Barnum’s lower incisor and canine teeth before surgery

And here’s the same view after surgery:

but with the rightmost incisor missing and the canines about a third of the previous height, so they are just a little bit taller than the incisors.

After surgery, one incisor removed and two canines considerably shortened, then crowned.

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:

X-ray of a lower canine with four incisors next to it. The pulp of the tooth is clearly visible as a thick gray line all the way through the tooth, from top to bottom.

X-ray of lower canine and some incisors before surgery. The gray line running through the middle of the tooth is the pulp.

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.

x-ray of the same canine tooth as the previous image, but shorter and with a bright white filling in the pulp at the top of the tooth.

The bright white area is where the pulp has been “freshened.”

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….

View from below of the inside of Barnum's palate. There are three white arrows lettered A, B, and C.

The roof of Barnum’s mouth. The arrows point to areas of trauma from malocclusion.

“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.


Comments

Barnum’s Oral Surgery: The Details — 16 Comments

  1. I feel sad for Barnum that he was in such pain before the procedure, but so glad you got him the help he needed. Good job. I will pray for him to heal up quickly and that this procedure will be all it takes to restore him to his original good health. I know it is traumatic any time something is up with our furry friends/partners/family. *gentle hugs* to you and Barnum.

    Sarah S.

    • thank you Sarah. I think the infection in his mouth is gone and it’s all healing very nicely. I’m worried something might be going on with one of his paws, and he still has the ear infection, but otherwise he’s acting very happy and healthy. I will be glad when we can just get back to normal! Or perhaps better than normal. 🙂

  2. Wow, poor babe! Very impressed with this dentist’s ability to figure things out and find a good solution while preserving those canines as much as possible. Hoping he starts feeling better fast!

    You might want to let the breeder know if you get a chance in case some other pups in the same litter are dealing with the same issue.

    • yes, I hope the canines will survive. There is always a chance that the pulp will die, and then it would need to be pulled. That’s why he’ll need to get x-rays in six months and then annually.

      I did email the breeder after he got diagnosed — I sent her the vet’s diagnosis and treatment plan — and I haven’t heard back yet. But this breeder is well known for her rigorous health testing and is, in fact, a veterinarian herself and rights educational articles about Bouvier health, so my guess is that she is still taking in the information.

      • I have an update on my communication with the breeder, I don’t think she got my first email. So I emailed her again at a different email address, and she responded with a very thorough discussion about how she had tracked down by Barnum had in overbite and things she has done to try to prevent it happening with any other puppies. I hope to post about our conversation soon because it was very educational for me and also very reassuring, and I think my readers might find it interesting as well. I also really don’t want her to be blamed for this problem because I do not think she is at fault. It is just one of those unfortunate things that happened despite her best efforts.

    • thank you Patti. He seems to be doing really well. I asked the vet if they would take pictures and they told me they always take before and after pictures of all their patients, so they included a lot of pictures in the folder at discharge. However, since they were on paper I couldn’t use them so I asked if they could email me a few specific ones and one of the vet techs very generously did.

  3. I am very squeamish when it comes to oral pain and messing around with stuff in the mouth in general. Please give Barnum a hug for me (or a pat, or whatever would convey sympathy from me). I am SO happy you persisted in finding the root of the problem and finding a the right people to help, and that Barnum is on the road to recovery. I hope you are able to breathe a sigh of relief and relax your worrier now that he is on the mend.

  4. I am so glad he’s on the mend. Your story inspired me to arrange an appointment for Max with a specialist for free SD dental care so I don’t miss anything with his mouth; our SDs love us so much they rarely tell us they hurt and your and Barnum’s tail reminded me of that. Now to see if I can’t get his eyes checked too,

    • good to hear from you, CK. I’m glad to hear that Max is eligible for the free service dogs dental exam. Yes, dogs are often stoic, and Bouviers are particularly stoic. I’m very curious how to approach and tactics will change with all this retreat thing, polling, and grabbing skills once we are allowed to do that again. I hope Max gets a clean bill of health.

      • Ha ha ha ha. I just reread my comment above. I clearly missed some major speakos. me try again. What I was trying to say was this: “I’m very curious how Barnum’s approach and tactics will change with all his retrieving, pulling, and grabbing skills once we are allowed to do that again.”

  5. That was a very intriguing post. I had no idea about any of that dental stuff especially how the lower canines can affect the upper part like it did and it was interesting how they did that special surgery to reduce the size of the canines. Great post with amazing pictures!

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