We went to Veterinary Dental Services today (Monday), which is just what it sounds like, a veterinary clinic that specializes in oral health. The staff was terrific, and it will be hard to cover everything I want to in this post before I pass out from exhaustion, but I’m able to dictate tonight, and I think it extremely unlikely that I’ll be able to speak or type tomorrow.
First, let me tell you about the people, because Betsy and I feel so much more confident about leaving Barnum in their care than we did with the last vet. Until today, the only person I’d spoken to there was Susan, who answered the phone when I was somewhat hysterical after having been told by Dr. L — after she’d taken x-rays of only part of Barnum’s mouth — that she couldn’t find anything wrong with him (other than a messy beard). I don’t know if I was actually crying at the time or just hopeless with frustration, despair, and anger. She told me that often people came to Veterinary Dental Services after having seen many vets who were unable to figure out what the problem was. She said somebody had just been there who had traveled three hours each direction.
She was also really helpful in terms of getting Barnum’s records from Dr. P and Dr. L. Most importantly, at that time when I was feeling so helpless and hopeless, she listened to me and gave me hope. Susan also helped me get an appointment a week earlier than we were originally scheduled for. Her own pet dog is a NEADS career-change dog so she seemed to really get it about Barnum being a service dog. (By the way, if your assistance dog is from a program, they will also do a free oral exam on them if you sign up soon.)
Then when we got there today, they were able to take us early, and after Betsy explained to Jessica, the vet tech, about my wanting to wait outside because of my MCS, they offered to do the whole thing — preliminary questions, exam, and consult — outside, which was more than I would have considered asking for. My experience with specialty hospitals is that they always want the animal to come inside. One of the best things about speaking with Jessica was how well she listened and how many notes she took about everything that has been happening with Barnum. The other best thing was that Barnum adored her. Several times he gave her many kisses, which is treatment usually reserved for Betsy and the PCAs. It’s so much easier to work with vets when Barnum likes them!
And then we met the vet, Dr. Shope. She squatted down and looked at Barnum’s mouth and said, “Oh, I think I know what the problem is.” I couldn’t believe it. He has had five or six vets look at his mouth in his adult lifetime — including three appointments with two vets which were specifically for examining his mouth — and everybody was stumped, and Dr. Shope figured it out in 10 seconds!
However, she didn’t tell us right away. My parents were there, too because they live nearby and had stopped over for a visit while we were in the area, and all four of us were like, “What is it?!” But she said she wanted to keep checking to make sure, so we stayed in suspense for a little while. (We were doing all of this outside on the cement wheelchair ramp, by the way!)
She showed us how Barnum’s teeth don’t line up right (a malocclusion) — I’ve known he had an overbite ever since Betsy brought him home after the breeder had shown this “fault” to her — but what I hadn’t ever noticed is that Barnum’s lower canines don’t meet the upper ones properly. Most particularly his left lower canine tooth goes inside the upper canine and is therefore hitting the roof of his mouth. Since this has presumably been going on since his adult teeth grew in at the age of six or seven months, he now has a hole in the roof of his mouth, which is of course painful and a breeding ground for infection. And that lower canine rubbing against the side of the upper canine has also damaged that side of that tooth and the gums in that area.
I was equal parts relieved to finally know what the problem was and horrified that Barnum had been living with this pain for so long. At one point I just wanted to burst into tears. I kept apologizing to him. It is hard not to feel like I’ve let him down, especially when I hear of other dogs who have this having caught it when they were six or twelve months old.
(Above picture from http://www.veterinarydentalcenter.com/pediatric.htm.)
Of course, when we came home and I looked at his teeth, it all looked familiar. I was used to seeing his upper canine on the left side of his mouth completely hiding his lower canine from view. Indeed, I was used to pulling open his mouth to brush the lower canine because I couldn’t get to it if his mouth was closed. But I just never thought about what that tooth was doing when his mouth was shut.
The right side is not perfect either. There, too, the lower canine is not lined up properly with the one above so it is denting into the gums above, causing some erosion near the upper canine tooth. But it’s not nearly as serious as on the left side, which even after a month on antibiotics still has drool and foam and food particles on his beard that the right side does not have. And he doesn’t like to have the left side of his mouth handled.
In fact, if you look at some of the pictures in one of my previous posts about his mouth, you can see the problem. In this “Quest for a Diagnosis” post, for example, the first picture, captioned, “Barnum’s pearly whites,” is of the right side of his mouth. And you can see how the lower canine has nestled into the gumline above. The second picture shows the left side of his mouth, including that the upper canine is almost completely obscuring from view the lower canine.
Here are two pictures I took tonight to include with this post to show the problem, but given that I’d already unknowingly posted pictures that showed the problem I’m not sure if the new ones are even necessary:
So, now the treatment plan. We were fortunate to be able to get an appointment the next day, Tuesday, the day you are now reading this. Betsy will drop off Barnum this morning and he will go under general anesthesia. A complete set of dental x-rays will be taken and his mouth will be more fully examined. The two lower canines will be cut, making them shorter so that they won’t harm the upper part of his mouth anymore. Cutting into the pulp (nerve) will require “vital pulp therapy”: a dressing on the exposed nerve, plus pain medication, and then a permanent composite crown will go over it. Our only other option for these teeth was extraction, which would eliminate the need for as much monitoring and follow-up, but I’d rather have Barnum retain some use of these teeth and also not go through the trauma of having two such large teeth removed. (The roots for all four canine teeth are incredibly long, going very deeply into the jaw, so extracting them is a big deal.)
The big question is what’s going to happen with the upper left canine — how much damage has been done to it? We won’t know till they can really get a good look at everything. If it’s damaged severely, it will have to be pulled. I really, really don’t want them to extract that tooth if they don’t have to. I’m really hoping that the damage is mostly to soft tissue which can recover when it’s not being continuously traumatized.
And after all of the treatment is decided on and performed, they will do a cleaning — to keep everything ship-shape while they’re already there and for preventative care. We will have to follow-up with x-rays on the lower teeth in six months and then once a year to make sure that the pulp is still healthy and that neither of those teeth have died as a result of the “crown shortening.”
Dr. Shope went to great lengths to explain everything to me, to answer my questions, and to include me in the whole process. The hospital even has a book they made that has photos and x-rays of previous patients’ different dental problems and how they were addressed. Dr. Shope showed me pictures of malocclusions and of crown shortening and vital pulp therapy. I think she and her assistant spent almost two hours with us between the two of them!
She also told me there would be a few days’ recovery and that she understood I would need to factor that when setting up scheduling (because Barnum would not be able to work as my service dog in his post-operative condition). This was the first time in almost 15 years as a service dog partner that I’ve had a veterinarian volunteer that kind of information and recognize that my SD’s functioning also affects my own functioning and plans. I was really impressed and grateful for her understanding of the complex role and relationship of the service dog and their human partner.
So, that’s the big update. Of course, as a devoted reader of VirtuaVet — who not infrequently finds more severe or widespread dental problems after taking radiographs than when she does the initial exam — I am really hoping there are no nasty surprises. I’m really hoping what we expect to be wrong is all there is. Fingers crossed.
The big questions hanging over my head are, “What will we be able to do with the damaged upper canine; can it be saved?” and “When all is said and done, what will all of this mean for his job as my service dog?”
I am hoping it will make working even easier and more fun for both of us — that he will be able to do things like pulling tug straps and retrieving things with more ease and joy, that the relief from pain will improve everything about his life including his work. But I don’t know what effect having truncated lower canines or especially possibly losing that big upper canine might have on his abilities to pull open and shut doors or retrieve things, etc. Will small items fall out of his mouth without the canines there to trap them? Only time will tell. For right now, I’m just focused on the surgery and the recovery and wanting him to be healthy and pain-free again.
P.S. This whole post was typed with Dragon speech-recognition software, and now that I’ve published it I see about three dozen speakos that I missed before. So if you read a sentence or phase that doesn’t quite make sense, try reading it aloud and you’ll probably figure out what I was trying to say. I’ll try to proof this piece later.