When vets have conflicting advice - dental

[Papillon Kisses]

I am in a situation where two vets at our practice are in opposition regarding treatment and I'm not sure what to do.

 

Malcolm (Chi x) has gingival recession in one tooth and his breath stinks. The other teeth aren't bad except maybe one which looks like it's getting gingival recession too (my check today). In saying that, I brush daily and with Malcolm's history of periodontal disease sometimes his teeth have looked better than they are. The brushing is getting harder to do, especially near the bad tooth.

 

Anyway, Vet 1 is saying that the recession isn't bad, that the tooth has a good attachment and isn't causing him pain. She doesn't want to do a dental due to his age (11 or 12), Addison's Disease, and need to take medication the morning of a dental (which Mal's VB is not at all concerned about), but I feel like her understanding of Malcolm's bizarre presentation of Addison's is lacking. She says so long as I flush the pocket daily with hexarinse or saline it won't get worse and the gingiva will improve. I have been doing this but I think it's getting worse. She is refusing to do a dental and says if it is affecting his quality of life, and she doesn't think it is, then we should see a specialist and have them do it.

 

Vet 2 is saying that the tooth needs to come out, that it is becoming loose and causing him pain. She has seen the tooth more recently and I could see she was taken aback by vet 1's advice. She is unconcerned about doing a dental but she's not the principal vet, vet 1 is. I think vet 2 has more understanding of Malcolm's unique presentation of Addison's and I trust her more, but the check she did of the tooth wasn't as thorough. That said, she saw us more recently and perhaps it didn't need to be inspected more closely if it has worsened, which I think it has. I mean if it's obvious from a little look and feel that a tooth is loose and painful then you're obviously not going to do more poking around.

 

I think I need another opinion, just not sure whether to go to a completely different GP vet (who wouldn't have Mal's full history) or straight to the specialist (who would) or have vet 1 check it again and see if her opinion has changed.

 

I don't want Malcolm to be in pain or sick (infection = organ damage) or have an unnecessary dental or die. But I also don't want to spend thousands of dollars on having a specialist do a dental if he's not actually high risk and vet 1 is unnecessarily worried. (Our Pap's cost $3500 over 10 years ago.)

 

And I'm not even sure we could say "one last dental until you die" due to his dodgy dental conformation, though in saying that the bad tooth is one that frequently needs to be extracted in dogs as they don't really use it.

 

I wish I could speak with the old head vet 'cause I really trusted her a lot, especially with her management of older and/or complex cases, but she's retired.  

 

In case it isn't clear this is really stressing me out.

 

Just wondering if anyone has any thoughts / could help me unpack mine / any experience, etc.

Edited April 18, 2017 by Papillon Kisses

[The Spotted Devil]

I'd go straight to a specialist I think. I have done that with serious eye issues twice now - first time (cat) they had several vets look at him and they voted "would be great surgery to do but not necessary at this stage due to awesome quality of life" and the second time (pup) it was immediate surgery, not negotiable. 

[karen15]

my old staffy had his bottom canines removed when he was young as he broke them. When he was 11or 12 he snapped off his top right canine, so was a doggy pirate with one pointy tooth remaining :D Due to his age and the difficulty in removing teeth we left the stump in, even though we did a cancer removal after he had broken it.

 

we visited the vet monthly so we both kept a close eye on it and it remained fine until he died.

 

in your situation if you think it's worse and needs removing, I'd talk to the vet you're most comfortable with, discuss removal and the impact of the procedure given his age.

 

IMO he's probably just young enough to do it. If you put it off and it gets worse and has to come out later, he's only going to be older and the procedure will be harder on him.

 

my staffy had his last op two months before he died to remove a tumour that had changed and grown. He came out of it really well and was just shy of 14yo, but my vet wouldn't do the tooth, so it must be more intensive / take longer.

Edited April 18, 2017 by karen15

[Rascalmyshadow]

I can't give advice on who would be best to do the surgery but personally I wouldn't leave it, I have seen way too many dogs suffering with dental issues, it is painful I don't care if a vet says otherwise, a lot of them don't see the little changes that indicate pain, just because a dog is still eating doesn't mean it's not sore or uncomfortable.

i have also seen some nasty outcomes of owners refusing dentals, holes in faces, green spongy teeth and meningitis to name a few.

 

[Dogsfevr]

For us we would be removing now in a dog that age ,getting a clean and hope it lasts .

 

[Rappie]

What a difficult situation for you to be in  I can't give you the right answer but you need to discuss it enough with the vets you trust for you to be comfortable making a decision. Certainly a specialist referral will be an option for you, and the benefit of that will be an experienced dentist with the aid of specialist anaesthetists, internal medicine specialists and an ER / ICU team for monitoring. It isn't possible for any of us to say whether this is 'necessary' in your situation. If you don't pursue a referral then I would suggest you talk to whichever vet you feel most comfortable with (or a new one) and find out from them all of your options, if they recommend proceeding or not, how they intend to manage the medical case and anaesthesia if you go ahead, potential complications and outcomes etc. In general, it can be easy to underestimate dental disease as a lot can be going on under the gum line that is not visible to the naked eye and will require either thorough examination under general anaesthesia at a minimum and often dental radiographs as well. 

[ness]

I don't really have an answer but noticed your in NSW and if this is indeed the case - I took one of my girls over from SA to Dr Christine Hawke a specialist dental vet many years ago now.  - http://www.sydneypetdentistry.com.au/

 

She was super helpful and friendly and happy to have a phone conversation with me and discuss possible options. If your after a specialist I can highly recommend her.