"Why didn't you come for the surgery?" I
admonished the lady owner of the Pomeranian. "You
wasted more money buying more antibiotic powder
from the pet shop to dust
onto the facial wound, hoping it would heal.
"For
ordinary skin wounds, the antibiotic powder would heal
them, but I had already explained to you why the wound
would never heal without dental extraction of the
infected tooth." |
 |
Her 4-year-old Pomeranian had a weeping wound of around
0.5 cm in
diameter below the left eye, above the maxillary
4th premolar tooth. It did not heal over the past
weeks despite various medications and
powders she had
sprinkled on.
Some 14 days ago, I had patiently explained to her
by illustration how the infection from the root of the
maxillary 4th premolar spread into the nose from
the diseased gums to the skin below the eye.
The bacteria from the
decayed roots of this premolar had dissolved the nasal
bone area and made a hole. This condition is
called an oronasal
fistula. Dental surgery to remove the infected
premolar would resolve her Pomeranian's
non-healing wound problem once and for all.
"The vet did a slick sales presentation to make
me spend money unnecessarily" the husband of
the dog owner must have told her. "How can a
rotten tooth inside the mouth cause a hole on the
skin below the left eye. This doctor is nuts and
is desperate to make money. Mouth and nose. So far
apart. How can there be a connection?"
Back to the
present, I said, "Surgery was to be done 7 days
ago after 7 days of antibiotics. But you did not
turn up till today --- 14 days later!"
The middle-aged lady shook her head. I forgot my
bedside manners by scolding her. The customer is
king.
The general anaesthesia and tooth surgery was affordable for
her as I had discounted my fees but that money could buy another sari from Niven
Road's sari shop.
I was annoyed because there was an optimal time to do
extraction of the infected and decayed tooth. It
was after 7 days of antibiotics and she had not
kept her appointment nor cancelled it.
She just did not turn up as there was less weeping
of the wound due to antibiotics. However after the
course of antibiotics, the
bacteria in the infected teeth had resumed their
attack and the facial wound became wet again.
The lady pulled up her fine and most colourful sari
and smiled sheepishly, "My husband wanted to
use the money for the dog's anaesthesia and surgery to go
to India for holiday lah!"
Now that the dog is no longer on antibiotics,
should I operate? There was no urgency in the
sense that it was an emergency.
But it would be in the best interest of this poor
dog to be cured as soon as possible.
The Pomeranian's teeth were not brushed at all as
this is a common practice in Singapore.
Initially bacteria attacking the food debris on
the tooth gum line would die in 3-5 days to form a
plaque on the tooth surface. As the dog's
teeth were not brushed daily or at all, more
plaque accumulated on the surface of the teeth.
Soon they become tartar (calculus). The gum
became infected, leading to gingivitis. The
root of the 4th premolar tooth of the upper jaw
became abscessed due to bacterial attack. Abscess
tracked upwards towards the nose and side of the
face. Soon a facial wound appears to form a
connection (oronasal fistula) between the tooth
and the skin, discharging pus daily. As the pus
and fluid from the mouth is discharged daily, the
wound can never heal as it is always infected.
The decayed 4th premolar and lst molar
became loose
as their roots had been exposed as the diseased
gum diseased shrivelled. The supporting structure
of the teeth was weakened by the bacterial attack,
leading to a loose tooth that would fall out in
time to come.
At this time, there was no choice but to extract
these two loose teeth. Otherwise the Pomeranian
would suffer from daily toothache as the owner's
husband might thwart her from doing the right
thing for her dog. I put the Pomeranian under
general anaesthesia gas and got the offending
teeth extracted and scaled the other good teeth to
remove the tartar.
 |
"How can
a rotten tooth inside the mouth cause a hole
on the skin below the left eye. So far away.
This doctor is nuts and is desperate to make
money." the husband must have had advised
his wife.
|
|
The facial wound
closed after a few days when I phoned the lady
owner.
"You are a
good vet," the lady surprised me with her
compliment especially after my admonishment.
She needed not clean the wound daily
and her dog was more active and has a livelier
demeanour. And what more joy could a lady have
than to see her companion having a higher quality
of life? |
 |
BLOOD TEST & OTHER PROCEDURES.
There was no pre-anaesthetic blood tests to
assess the liver and kidney functions and blood
cells of this younger Pom. Veterinary costs would
be additional $150.
Most likely the poor Pomeranian would not receive
any veterinary attention if an increase of $150
was added to the veterinary
expenses.
Therefore I did not require blood tests and had
reduced costs in not prescribing pain-killers and
pre-op i/v drip and antibiotics.
Physical
examination of the Pomeranian indicated that there
was no cardiac problem and there should be no
death from general anaesthesia. The dog's
anaesthesia was uneventful. He went home on the
same day and had no more facial wound below the
eye as the cause was removed.
More interesting cases of dental problems in
Singapore dogs:
Toa Payoh Vets Clinical Research: Mouth problems
in Singapore's dogs |
|
TOA
PAYOH VETS
