"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
The bacteria from the decayed roots of this premolar had dissolved
the nasal bone area and made a hole. This condition is called an oro-nasal
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.
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!"
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 (oro-nasal 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 money is better spent travelling."
first, she did not heed my advice to do extract the infected premolar No. 4.
The facial wound just would not heal and it cost her time and money to apply
medication with no good outcome
wound closed after a few days when I phoned the lady owner to follow up after
extraction of the infected teeth. "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 Pomeranian. 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. UPDATE IN FEB
2013 I have not seen the Pomeranian since 2007. He was 4 years old then.
In Feb 2013, the owners came with the Pomeranian wanting to board the dog for
Chinese New Year. I took the following image of him with a face that has no more
oro-nasal fistulas for the benefit of readers.