Wednesday, July 8, 2015

2485. Email from the Netherlands about dental work without anaesthesia

I got an email from a Netherlands vet today.




 Dear Dr. Sing, 

I read your report on the extraction of teeth on an old Pomeranian without general anesthesia (http://www.asiahomes.com/book2/20100664dental_extraction_16-year-old-Pomeranian_dogs_singapore_ToaPayohVets.htm). I have a few questions about this case. Please keep in mind that, as a veterinarian, I am just very interested in this case – I am not trying to “catch you out” or criticize your treatment!

First question is: have you used any kind of analgesia? I can’t find it in your report. I would be very apprehensive to perform extractions of teeth without anesthesia, but even more so without any kind of analgesia.
Second question is: how did the dog react to the procedure? I can only imagine that it must have been stressful. Extractions hurt, regardless if you have to use luxators or if the teeth is so loose that it can be plucked.
Question three: Weren’t you afraid of getting bitten? I have had some nasty infected scratches from working with bad teeth, so I’m careful. I have at least 25 years to go in this profession, I have to look out for my fingers. Even under general anesthesia I see some pretty powerful jaw reflexes, although more in cats than in dogs.   

I have performed lots of dental work on patients of all ages. I always use general anesthetic and to no ill effects, on geriatric dogs and cats. I usually advise the owner that living with such bad teeth causes so much pain that it’s inhumane to not do the dental work. In my opinion, it’s the quality of life that counts, not the duration (within reasonable limits of course). Also, I hold the owner accountable for state of the teeth, after all, he/she should have taken care of their animal. So if they don’t want anesthesia, I ask them if they would be comfortable to have their teeth pulled without anything. That usually does the trick. :-)

Furthermore, I have had very reliable results in anesthesia of geriatric patients, many of whom have either mitral valve disease, kidney dysfunction, or both. I provide analgesia with pre-op buprenorphine, anesthetic induction with midazolam/ketamine and surgical plane anesthesia with isoflurane. I supply a drip with Ringer’s lactate, and a low dose of furosemide for heart patients (and catheterization so they don’t flood the operating table). Before starting the extractions, I provide regional nerve blocks to minimize post-op pain, and always provide four day take-home analgesia in either NSAID or Tramadol. I would be glad to supply you with dosages if you’d like. 


Thanks for te time you took to read this e-mail and I look forward to receiving your answers.


Kindest regards,



Drs. Peter de Frankrijker-Schiphorst DVM,

BeterBeest Dierenartsen
The Netherlands




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REPLY DATED JUL 9, 2015

Thank you for your email and interest in this case study.


In reply to your questions:
1. No analgesia was used in this case.
2. The dog's teeth were very loose. There was some reactions when the loose teeth were extracted..
3. The Pomeranian was the gentle type and did not attempt to bite me.  

I give anaesthesia and analgesia in all my dental work except for this case.  This was the only case, since I graduated in 1974 that I did tooth extraction without anaethesia. The owner was much worried about that her 16-year-old dog would die on the operating table. I had promised her that I would extract the loose teeth without anaesthesia and she trusted me. 

I reject another case of a younger dog when the owner did not want anaesthesia for dental scaling being worried about death on the op table. Patient safety under anaesthesia is my top priority

I shall be grateful if you will provide the dosages of drugs you use for geriatic patients.  Best wishes.

Dr Sing Kong Yuen
Toa Payoh Vets
Singapore 

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