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Biting Be Gone, By Doctor Jan Bellows

By Doctor Jan Bellows

Romeo, a 4 year old, 3.5 kg, neutered Italian greyhound, presented for chronic oral pain so severe that the dog’s owners could not approach the dog’s face without being bitten. The dog’s teeth were cleaned and polished at 2 years of age, and semi-monthly to monthly repositol steroid injections were administered by the referring veterinarian for 1 year prior to presentation. The injections resulted in dramatic behavioral improvement that lasted 2 to 3 weeks. Daily oral hygiene with toothbrush and dentrifrice and weekly application of a plaque preventative wax polymer were recommended by the referring veterinarian. Unfortunately, the owner was unable to provide consistent oral hygiene.

Bilateral caudal vestibular mucositis, cheilitis, glossitis, and ulceration adjacent to the maxillary canines and incisors were present. Other physical examination findings were unremarkable. The maxillary and mandibular incisors were mobile secondary to stages 3 and 4 periodontal disease. The client was advised that a closer examination of the oral cavity was needed under general anesthesia.

Further communication with the owner included an explanation of the oral assessment, treatment, and prevention (Oral ATP) process. Recommendation for the initial preoperative laboratory testing (CBC, serum profile, and thyroid panel), anesthesia, intraoral radiography, and a tooth by tooth examination was accepted with the understanding that a treatment plan would be formulated and discussed after the intial assessment. The client was advised that treatment of chronic oro-phayngeal inflamation typically included multiple extractions.

Laboratory test results were within normal limits. The dog was premedicated with hydromorphone at .1 mg/kg IM, combined with acepromazine at .02 mg/kg IM; induced with propofol at 3 mg/kg IV; and intubated and maintained on 2% isoflurane mixed with oxygen. The body temperature was controlled with the Hotdog patient warming system.

Individual clinical and radiograph tooth examination revealed stage 2 and 3 mobility of the maxillary and mandibular incisors.

A recommendation for extraction of the right and left maxillary first and second incisors, canines, the third and fourth premolars and first and second molars, as well as extraction of the mandibular incisors, first, second, and third molars was made to the owner. This would be needed to relieve gingival inflammation, even in areas where the underlying radiographs appeared normal. The treatment plan was approved.

The oral cavity was irrigated with .12% chlorhexidine solution. Envelope gingival flaps were created using a #15 scalpel blade to incise vertically into the gingival sulcus circumferentially around the teeth to be extracted. A Freer periosteal elevator was used to expose the alveoli of the teeth to be extracted. A #2 round carbide bur loaded on a sterile saline-irrigated high speed drill was used to remove the coronal aspect of the alveoli for ease of visualization and extraction. The multirooted teeth were sectioned using a #701 surgical bur to create single-rooted segments. A sharpened wing-tipped elevator was gently rotated perpendicular to the alveolar margins to help create sufficient mobility to deliver the tooth segments from the oral cavity using extraction forceps.

Alveoloplasty using a #2 carbide round bur loaded on a sterile saline-irrigated high-speed drill was performed in all exposed areas to smooth the coronal extent of the alveolus before closure. Intraoral radiographs were exposed and examined to confirm the extraction sites were free from root fragments. The incised gingiva was closed with 4-0 monocryl (Ethicon) suture using a continuous pattern. The dog made an uneventful recovery from anesthesia. The owner was instructed to medicate with clindamycin at 15mg/kg q 12h, firocoxib at 5 mg/kg q24h, and tramadol HCL at 2 mg/kg PO q12h.

Follow up examinations at 1 month and 6 months after surgery revealed total clinical resolution of the oropharyngeal inflammation, as well as the aggressive behavior. A recommendation of home oral care included twice daily application of a dental wipe infused with sodium hexametaphosphate (DentAcetic Wipes, Dermapet), and application of a wax polymer (OraVet, Merial) every other day.

By Doctor Jan Bellows