Mr Riley is a 13-year-old Labrador Retriever who presented to Southern California Veterinary Dental Specialties and Oral Surgery in November 2013 for a significantly abscessed carnassial tooth. This is a one of the largest teeth in a dog’s mouth, with 3 roots, and is situated just under the eye on the upper jaw. An abscess indicates deep infection, and is painful as well as leading to many other health problems. Mr. Riley’s tooth root infection was only partially responsive to antibiotics and he was suffering with intermittent chronic pain.
Upon pre-surgical evaluation for oral surgery, a heart murmur was found on Mr. Riley’s physical exam. Thus, in order to minimize any surgical/anesthetic risk, we recommended that Mr. Riley be evaluated by a veterinary cardiologist prior to anesthesia. We expected that we would still be planning for dental surgery, as in the vast majority of cases, animal patients with heart murmurs are still good candidates for anesthesia. However, Mr. Riley was not a typical case.
Mr. Riley was seen by Dr. Joao Orvalho at the UC-Davis (San Diego) cardiology service. He diagnosed Riley with a large mass/tumor in his heart (Figure 1) , and explained that this would actually create a high risk situation for anesthesia and surgery. This is because if Riley’s blood pressure was to change much in either direction (get too high or too low) the mass/tumor could move into the valve of the heart and obstruct the blood flow (creating a situation like a heart attack). Furthermore, this heart mass was expected to give Mr. Riley a very poor prognosis ultimately for long-term survival. For these reasons, Riley’s owner/pet parent elected not to proceed with surgery for the tooth extraction. Riley was continued on long term antibiotic therapy which kept the infection at bay.
No direct treatment was available for Mr. Riley’s heart condition. That is, there was nothing conventional medicine could do to offer Riley any further help or to work toward increasing his lifespan. However, Riley was already being treated with acupuncture by a local holistic veterinarian for his arthritis issues. When Dr. Katie Kangas, of the Animal healing Center in San Diego, was informed of Riley’s cardiac condition, she changed his treatment plan to include therapies to address this issue. Riley’s owner did a great job implementing all of his nutritional supplements and herbal and homeopathic medications, as well as scheduling monthly rechecks with the cardiologist. Mr. Riley actually continued to do very well overall, with his biggest issue being flare-ups of the infected tooth.
Seven months after the original diagnosis was made, much to the surprise of Dr. Orvalho, another recheck cardiac ultrasound revealed that Mr. Riley’s heart mass had still not grown or progressed in any way. The only explanation for the lack of progression appeared to be the holistic veterinary care. However, the tooth infection was now posing the biggest problem, as the antibiotics were no longer working to control Riley’s infection or his level of oral pain.
At tis point, Riley was represented to SCVDS & OS. Based on the significant anesthesia risk, we brought in a veterinary anesthesiologist, Dr. Amber Hopkins from Veterinary Specialty Hospital, San Diego. She agreed that Riley’s situation did indeed present more risk, but she felt it was definitely worth proceeding.
Dr. Hopkins anesthetized Riley and Dr. Niemiec performed an evaluation and dental radiographs which confirmed the significantly infected tooth (Figures 2 and 3). Dr. Niemiec then quickly and completely extracted the affected tooth. An intraoperative picture (figure 4), reveals the degree of bone destruction by the infection. Anesthesia and surgery were routine and Riley recovered normally and went home that same night. There were no problems post-operatively! At his two-week recheck, the surgical sites in Riley’s mouth were completely healed. Riley’s owner reported that he was actually much brighter and happier than he had been for a long time, which provided evidence that the infection was bothering him even before the noticeable signs had occurred. (Figure 5)
Mr. Riley’s story is an excellent demonstration as to what can be accomplished when a team of veterinary experts are brought together. The vast majority of patients can enjoy improved health from proper dental care, and even very “sick” or compromised patients can benefit from life altering dental procedures.