Veterinary/animal health thread

The Something Awful Forums > Discussion > Pet Island > Veterinary/animal health thread

Waffle Grid: Apr 22, 2009; You think someone would do that, go on the internet and lie?

My dog had dental work done yesterday (extraction of 108 due to a slab fracture, as well as prophylaxis work). I took a peek in her mouth today to get a baseline for how things were looking and saw something that I feel concerned about. I e-mailed the vet with a picture and he doesn't seem concerned... but I'm skeptical and wondering if someone here could give me their opinion?

My message to the vet described how when I lifted her flews to see the surgery site, there was a white fragment of something sticking out of the gums - it's visible near the top of the photo. It seemed fairly hard, but was thin and maybe a bit flexible? It was hard to tell. As I tried to get a better look, I pulled up on her flew a bit more and I could see the skin tear slightly around this white thing sticking out. I was worried I was making things worse and took my fingers away. As I did so I could see this white thing slip back behind the gums. I opened her mouth a second time, delicately, and the white thing wasn't visible anymore, but it feels as though if I were to pull up her flew again and make the skin taut, that there is something bulging underneath in that spot.

My vet's response was:

"it is hard to tell from the photo . There will be periosteal bone fragments that will be present. I did not completely suture the socket . Drainage is important. the carnassial tooth was removed in three fragments from the original slab fracture. The periosteal fragments will resorb. Currently there is no redness or swelling. sutures are holding fine. Umi should be eating well after a few days. Thanks for the update feel free to contact me if any questions"

Googling "periosteal bone fragments" isn't turning up anything, and although I can find lots of stuff about bone chips being left behind in human dental surgery and gradually working themselves out, I'm not seeing much about this sort of thing after canine dental extractions. I wonder if the vet is looking at the correct area, because this thing sticking out of her gums is not in the socket.... Does this seem normal to anyone here? I asked them to do x-rays if they thought it was necessary/important but they didn't feel that it was and didn't do them. I'm seeing lots of stuff online now about how x-rays should be done before and after to make sure everything is out. ugh.

Waffle Grid fucked around with this message at 14:33 on Jul 30, 2020

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Waffle Grid: Apr 22, 2009; You think someone would do that, go on the internet and lie?

Slugworth posted:

Vet tech here, so defer to someone smarter than me if they answer, but I do a ton of dentals, so I'll give this a shot since this thread doesn't always get replies super fast. Your vet isn't wrong though, it's very difficult to tell what's going on from a photo.

There are a few different ways to pull a tooth, but a 108 that's still got healthy purchase to the jaw will generally be removed by cutting the gum tissue and pulling it back from the bone. The bone is then burred down to reveal the tooth roots, and the tooth is cut into pieces and extracted. The leftover bone tends to have lots of little sharp bits from the work done, so the surgeon will then burr the bone down a bit to smooth it out, and then the surgeon or the tech sutures the gingival flap over the whole site. It *looks* like maybe they missed a sharp bit of bone, and it has poked through the gingival flap.

That being said, it's not ideal, but my guess is your pup will be fine. Mouths heal well, granulation tissue forms over small bits of exposed bone, life goes back to normal. Is she eating well, acting herself, doing all the normal dog things? If so, stick to a soft food diet for a little longer than your vet may have suggested just to give that site longer to heal up. Keep an eye on the site, but be gentle with it. I've seen worse looking extraction sites (total dehiscence) heal on their own quite well.

Thanks so much for the fast and informative response - I really appreciate it! Sunday (the day of surgery) was pretty much a write-off for her behaviourally because she was exhausted from the procedure. Yesterday she was much more herself, but not 100%. She didn't eat a ton, but when she did eat (soaked mushy kibble and/or wet food) she didn't seem to be having difficulty. She's a chronic under-eater anyway though so take that for what you will. She's normally a very playful dog that loves chewing on things and using her mouth a lot, but understandably didn't have any interest in those activities yesterday. I feel like it will take a bit of time to see if she returns to normal in that regard since I need to keep her from these types of activities for now, especially in light of the potential bone shard.

Any ideas whether the fragment will always be there even if the tissue heals around it, or if it will instead push itself out or resorb? Or any long term complications even if it heals up for the time being?

I understand that things don't always go perfectly in surgery, no matter the skill level and how good intentions were... but is it reasonable for such an obvious bone shard to have been missed? It makes me question the rest of the clinic's work I guess and if I should return to them or not. Anything I could do to help ensure that this doesn't happen in future if she gets another tooth removed? Insist on before/after x-rays?

Waffle Grid fucked around with this message at 14:39 on Jul 30, 2020

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