Expert: Jana Connell RVT, CVT - 1/30/2010

Question
I am inquiring with you in part because you are NOT a vet and appreciate any advice you have on the matter, though you have probably answered this question a hundred times before.  It's about the carnassial tooth.  My Shih-tzu, Blanche, is 10 years old and her left carnassial molar is loose.  There is no abscess and her breath doesn't stink as bad as her two 'sisters' who are two and three.  I believe it probably needs to come out.  But I wonder if there is an antiseptic product which might help the area while I decide what to do.  Blanche has had two dental cleanings/extractions in the past five years.  The first cost $700.00.  The last cost over $1,000!  Last time I went to initiate a cleaning for Blanche I asked the doc to look in her mouth with me, since she willingly lets me probe around her mouth, and specifically asked the doc if she felt she might need extractions.  She assured me that Blanche's mouth looked particularly well maintained for her age and that she couldn't see much of a problem.  I pressed her, not wanting any surprises.  She expressed no concern.  When I came to pick up my little girl she had had 8 extractions, including a little one right in front that I KNOW was not loose.  I know that she may need to lose this tooth, but having had many extractions so far, I don't trust my vet with the teeth that Blanche has LEFT!  Even though dentistry is a crucial part of all our lives, I believe it can also be used to justify high hourly rates for oral surgery procedures, should extractions be deemed necessary.  Pardon my cynicism, I love my vet, but I'm losing faith.  Have you heard of success with root canals or am I getting into an even more exotic area than I ought to pursue?  I know that this would be expensive, but at this point I want the best approach for my girl and I don't want to rush into an extraction if it could be prevented.  Is this tooth as important as it looks to the dog or am I worrying unnecessarily and should just have it extracted?  My love for this dog would drive me to any necessary length, but it also drives me insane.  Please advise.

Answer
Wow Darren! That is some pretty expensive dental work. Our most expensive dental usually runs about $200 tops, and that is with extractions. I really don't know why so many vets charge so much for something they only do part of. The technician does the dental cleanings (at most vet hospitals that is) while the vet does the extractions.

Now don't get me wrong, most tooth extractions are fairly easy, but some of them can be very difficult to remove. One good example is this very tooth, the Carnassial Tooth. It is a three rooted tooth, and oftentimes the roots are curved and hook themselves into the gum.

A loose tooth, however, is usually pretty easy to extract. One reason teeth get loose is due to bone loss, not just receding gums. So without bone to hold them, they are wiggled free and pulled out.

You can always go into the hospital and tell the receptionist that you want to speak to the vet or the technician and have them Write on your chart that you ONLY want the one tooth pulled, no more than that. The problem with this is that if there are other loose teeth they will be left in there, and you don't want that.

As far as Blanche is concerned, losing teeth means nothing to a dog. I have seen plenty of toothless ones that still eat dry dog food and have no issues at all.

I don't blame you for being gun-shy especially at that price! Talk to the vet and tell her you haven't been happy with the extractions being a bit overboard. Now these types of dogs are known for having bad teeth, so unfortunately, unless you scrub those babies every day, she is going to have bad teeth.

You said your other two are also having problems with theirs. How long since they had a cleaning? The thing is, the longer you wait, the more damage is done and more teeth are lost.

I have seen some great results with dogs that were put on the Hill's T/D as their main diet and these dogs had much less problems with their teeth in between cleanings than they did before they switched diets. So that might be worth looking into.

I was pretty skeptical about this actually working until I saw the results with my own eyes.

There really isn't anything you can put on her tooth that will make much difference at this point if it is already loose.

The best you can do is call them or go in there with a determined position on what you want done and really talk to the vet. Ask her why, when the last time you pressed her for no surprises,did they hit you with that bill and that many extractions?

Did they show you the teeth? Did they look nasty? If the roots are looking nasty then they needed to come out.

Root canals are hundreds of dollars, more like a few thousand. They are done by specialists, veterinary endontists, or veterinary dentists, so they charge a lot more. Besides, a dog with bone loss cannot have a root canal because there isn't enough bone left for the tooth to be held with. The Carnassial tooth is a shearing, chewing tooth but dogs do just fine without one of them, or both of them! For one thing I can tell you for sure- it is usually the first tooth that cracks on a dog that eats anything tough like rawhides, etc. I had to pull both of my late dog Cameo's out but I got her at five years old and one was cracked when I got her.

I hope this helps Darren. I know this can be expensive but being the great pet owner that you are, you are probably saving thousands on other care from her bad teeth making her heart or kidneys bad.

You might want to look into some pet insurance also. I heard that the Purina was one of the best as they don't care about the age of the pet.

Might be worth looking into? http://www.purinacare.ca/whypetinsurance.aspx

Please let me know how it goes with her.