Kebo Has A Dry Socket :(

[Guest greytkidsmom]

We went to our regular vet Monday for a 2-week followup for Kebo's teeth. He had the lower canines and a couple of molars removed by a specialist. I thought everything was going well - off pain meds, eating great, good energy. She pointed out a little bit of pus way down in the socket of the right lower canine. Well crud. Her first instinct was to prescribe a long course of antibiotics but she wanted to call the specialist for advice. He wanted us to use a cotton tipped applicator to clean the socket twice a day (no antibiotics). Two days with dilute chlorhexidine, then switch to just dry. I had filled the antibiotic prescription before she got to me with the specialist's recommendations but didn't start it yet. We have been following his directions but tonight there seems to be a lot more pus than before. I went ahead and started those antibiotics and sent her an email letting her know what it looks like and what I did. Does anyone else have experience with an infection following extraction? We have got to nip this in the proverbial bud - I can't bear the thought of him getting infection down in the bone or having to have yet another surgery on his mouth.

[JJNg]

Did they not completely close the extraction sites with a mucosal flap? Or did the flap break down? When my whippet had a lower canine extracted by the dental specialist, they put in a bone graft and sutured the area closed, so there was never an open socket. I'm a little surprised that they would just want to treat topically and only for 2 days with chlorhexidine. As you mentioned yourself, an exposed socket is bone, and with pus coming from the area, I'd want him on systemic antibiotics.

[Guest greytkidsmom]

Did they not completely close the extraction sites with a mucosal flap? Or did the flap break down? When my whippet had a lower canine extracted by the dental specialist, they put in a bone graft and sutured the area closed, so there was never an open socket. I'm a little surprised that they would just want to treat topically and only for 2 days with chlorhexidine. As you mentioned yourself, an exposed socket is bone, and with pus coming from the area, I'd want him on systemic antibiotics.

 

He amputated the root and left it in the mandible. The tooth and root were healthy (allegedly) and the root was so fused in he didn't want to risk breaking it (the mandible). Quoted many recent studies that this was what was recommended and that he personally had success with the technique. He didn't do a mucosal flap but closed it loosely and said that the cavity would fill with clot and heal. He made a point to tell me that the closure was loose but that it would all heal. He told my vet that if it didn't get better to take a rongeur and scrape the wound base until it started to bleed or do a "blood patch" using blood from a peripheral stick under local sedation. Not sure I would feel comfortable with that if there was infectious material there. I wonder if I should flush it with a syringe rather than manipulate it with a cotton swab. My biggest fear is osteomyelitis - he is missing his rostral maxilla already. I'm really worried.

[JJNg]

Hmm...I'm a little confused... Are you saying they did a crown amputation and left part of the root in place to heal over? Can't say that I've ever heard of that technique, but I'm not a dental expert (hence having the dental specialist do my whippet extraction). However, from everything I remember learning about extractions, there are few cases where it is considered a good idea to leave any part of the root behind.

 

But...if they didn't remove the root, then why is there an open socket? And if part/all of the root is still there, wouldn't scraping the 'wound base' just be scraping the top of the root? Guess I'm having trouble picturing exactly what was done...

 

The only procedure that sounds similar is crown amputation or reduction, where the canine tooth is cut down even with the other teeth or the gumline, then the exposed pulp cavity is capped off. But with this procedure, there is no socket that needs to heal.

 

Was this a board certified veterinary dentist (AVDC) or a Fellow of the Academy of Veterinary Dentistry? Is there another specialist you can go to for a second opinion?

[sweetdogs]

Sending ever more good thoughts for your sweet Kebo.

[greytpups]

Dry sockets in humans are very painful and one reason why you don't use a straw after an extraction. I'm not a dentist but I wondered if the pulp was exposed by leaving the root (perhaps the nerve died? not sure what term to use). I would think if it's infected, you need some meds. It sounds like he wants it to start bleeding again to form a clot.

[Guest Adrianne]

More good thoughts for Kebo. My son developed a dry socket after getting his wisdom teeth removed, and that was some awful pain for him. How is Kebo's pain level?

[LuvEarsies]

Sending good thoughts for Kebo and you

[Guest greytkidsmom]

Hmm...I'm a little confused... Are you saying they did a crown amputation and left part of the root in place to heal over? Can't say that I've ever heard of that technique, but I'm not a dental expert (hence having the dental specialist do my whippet extraction). However, from everything I remember learning about extractions, there are few cases where it is considered a good idea to leave any part of the root behind.

 

But...if they didn't remove the root, then why is there an open socket? And if part/all of the root is still there, wouldn't scraping the 'wound base' just be scraping the top of the root? Guess I'm having trouble picturing exactly what was done...

 

The only procedure that sounds similar is crown amputation or reduction, where the canine tooth is cut down even with the other teeth or the gumline, then the exposed pulp cavity is capped off. But with this procedure, there is no socket that needs to heal.

 

Was this a board certified veterinary dentist (AVDC) or a Fellow of the Academy of Veterinary Dentistry? Is there another specialist you can go to for a second opinion?

 

He is a board certified dentist with 40 years of experience who does a lot of teaching. He came highly recommended by my vet practice and someone here on GT.

 

Crown amputation - that sounds right. Not sure how far down. He said that he would start with attempting extraction but if it didn't work that is what he would do. He quoted a 1% infection risk based on recent literature. From what he told me it sounds like there was a space between the top of the amputated root and the gumline that he expected to fill with clot and heal. There is definitely a "socket" there for lack of a better word. You can get most of the cotton part of a cotton-tipped applicator down there. I agree, scraping the root doesn't make sense either.

 

We have been meticulous with making sure he has a soft diet even though the dentist said we could give him regular soaked kibble and have taken away all of his toys. My vet has had some difficulty getting him on the phone which hasn't helped matters. I think I have his email somewhere - will try that if I don't hear from my vet by the end of the day.

 

More good thoughts for Kebo. My son developed a dry socket after getting his wisdom teeth removed, and that was some awful pain for him. How is Kebo's pain level?

 

He doesn't seem to be in much pain - he eats like nothing is bothering him. He doesn't like it when we mess with the "socket" but I usually give him a tramadol about 30 minutes before.

[JJNg]

Didn't you decide to have the teeth extracted because he wasn't eating as well and one of the canines seemed to be painful? Were x-rays taken? If the roots of the teeth were ok, was it determined what the cause of the discomfort was? Usually if the tooth itself is painful, that is indication for the entire tooth to be pulled, since leaving part of the root could leave the source of pain.

 

Situations where crown amputations are done is if the tooth itself is completely healthy, but it needs to be shortened or removed for some other reason, such as poor alignment causing the tooth to hit another tooth or dig into the palate. And I'm only aware of crown amputations being done above or even with the gumline. But again, I'm just general practitioner and may not be aware of advanced techniques.

 

Anyway, sending good thoughts that the infection resolves quickly, and that everything heals well.

Edited March 15, 2013 by JJNg

[Guest greytkidsmom]

The gums had receded so badly that part of the root was exposed which is what we think was making him hurt. He did do x-rays but it was pretty obvious that if you touched any part of the exposed root that he would pull away in pain. He wouldn't even let me brush them anymore. I guess that if the gum was so recessed that was why he amputated them so deeply (total guess). In any event, whats done is done and all I can do is try to figure out how to stop the progression of whatever is going on. I keep second guessing my decision to go with this guy rather than wait until April and go to OSU but it didn't seem fair to let him hurt for so long. I guess I need to have a little more faith and patience that it all will work out as it should.

[Guest greytkidsmom]

So my vet called on Monday to check on Kebo and we decided that waiting until Friday was too long. She saw him yesterday and sedated him for x-rays and exam. The roots were indeed ankylosed (?sp) into the mandible and she could see where he had drilled the tooth out. When she probed the side that was draining, she hit bone (and likely exposed nerve ending) and didn't think the blood patch the dentist recommended would be enough. She irrigated the heck out of it and covered it with a mucosal flap. We have rimadyl, tramadol, and more antibiotics for him.

 

Poor fella - she said that even though he was sedated, the tech grabbed his mouth to intubate him and he cried out because she had accidentally grabbed the side that was hurting. He ate a great dinner and breakfast this morning and hopefully this will be the end of this part of the journey. When I paid the bill the amount was much lower than I think it should have been. Should I speak to her about it or just leave it? She didn't cause this problem, another vet did. She shouldn't lose money because of it.

 

Thanks everyone for your thoughts.

[macoduck]

Certainly speak up if you think your vet shorted herself on charges. If she says don't worry about it I'd be bringing her some treats for the office -doughnuts, cookies, etc.

 

Hope your boy is feeling much more comfortable now.

[JJNg]

Poor Kebo. I hope this takes care of the problem and that he recovers quickly. I agree with macoduck's suggestion about the vet's charges. If she charged you what she meant to, then she'll let you know. And if any items got accidentally left off, she'll be very grateful you brought it up (and might still not charge you for them).