molar infection - what to expect?

[maryam]

Hi all -

Our younger (3.5-year-old) chin, Mishti, has been getting her incisors and molars trimmed for the last six months. She's always done very well afterward, eating almost immediately after waking up.

I took her in today (five weeks after the last trim) because her poops were looking inconsistent and dry, and she's been grinding her teeth a little. Dr. just called and said that the trimming went well, but she noticed that one of her molars was infected:

• infection around 2nd to last molar - top left side

• food material packed around tooth, when cleaned revealed pocket of infection

• infected tooth more loose than other teeth, discharge around tooth

• need to extract molar, and if it's broken from the root, a new tooth might grow

The Dr. mentioned a case where a chinchilla she saw had a molar extraction, seemed fine and recovered well, went home, but died 2 days later. That TERRIFIES me. I can't lose my baby girl.

How sensitive a procedure is this? Any ideas for how we should proceed and when we should schedule the surgery? Also, what can we do before/after surgery to maximize her chances of surviving? Our baby has been through so much stress, she's really a survivor, but this really makes me nervous. I just want to make sure I'm doing the best I can for her.

I'm also going to bring up these points with the Dr. when I see her later this afternoon, but I'd appreciate any ideas and advice. Thanks so much, everyone.

 

[ticklechin]

Since the chin already has a infection, I would if it was mine, premedicate a few days prior with a antibiotic, have it done, then use the antibiotic after. I would make sure I had metecam and hand feed with CC until healed. The risk during the procedure is the aspiration of the blood, saliva and pus if the vet is not good at control of the fluids during the procedure. The risk after is infection.

 

[maryam]

Thank you so much! She's getting the procedure done tomorrow morning, so I'm premedicating with TMS and Metacam as needed. She's not doing so well now (choking/sneezing) so I fear that the infection has spread. Thankfully the chin dentist is very experienced, so the procedure should go well. I just don't want Mishti to be in pain

 

[maryam]

From what I'm reading here, it seems like Mishti's issues are a lot more serious than I thought. Would anyone be able to look at her skull x-rays from ~3 years ago, and tell me if you see any signs of malo? My uneducated eye sees some root elongation in the upper jaw. She had eye watering at that time.

http://www.qaiser.net/babies/mishti/x-rays

So euthanasia is the kindest thing to do given that she needs to get her teeth filed every five weeks, and she has an abscess now? She's been in remarkably good spirits up to this point, bouncy, happy, affectionate, eating, but she's grinding her teeth and her eyes are wet I have such a hard time accepting that this is happening to my baby.

 

[Snickers]

I feel for you I have been there with a molar infection and malo with different chins. I spent a lot of money all within a 1 1/2 years. It's hard to make the decision but my vet said, "it's the quality of life you need to base your decision on". Only you can make the decision to euthanize.

 

[maryam]

It would probably be the hardest decision we've ever had to make. We're going to ask for a skull x-ray tomorrow, before they proceed with the surgery, and we'll take it from there. This is heartbreaking.

Thanks so much for sharing.

 

[Chibigirl]

I wish you the best and I hope everything goes smoothly for you. Sending you good vibes!

 

[Claire D]

I am sorry to read that your chin has problems.

Although I am not a vet I'll post what I can see - there looks to be root elongation visible on those Xrays, especially the upper roots.
If your chin now has wet eyes it would suggest that the upper roots are pressing onto the tear ducts.

I think asking for an Xray is a good idea - dealing with tooth problems is heartbreaking & I wish you all the very best in making your decision.
FWIW the adage I use is "rather a minute too soon than a second too late" - every time it breaks my heart and it never gets any easier.

Best wishes.

 

[maryam]

Thanks everyone. Sorry I didn't update earlier, things with Mishti have been a little distracting.

So the dentist looked at the x-rays and said that there was a tiny bit of elongation, but not much. She did another set of x-rays and the roots looked just fine. The problem is that her molar was infected, and the inflammation was putting pressure on her tear ducts and sinuses (or something like that).

So she was put on baytril and metacam and within a week was back to "normal," though we had to hand-feed her the entire time. Super energetic, no more whimpering/"quacking" noises.

After she was feeling better, we took her back to finally get that molar removed. We received a call in the afternoon that the doctor just couldn't get it out, and didn't want to be too aggressive and possibly hurt Mishti.

So now, a week after the antibiotics were discontinued, we're having watery eye and pain noises again. Tomorrow we're taking her to our normal chin vet, who is super chin-experienced, to see what she thinks.

At least it's not root elongation, right? Sigh I just want to get that tooth out so she won't be in pain anymore. If tomorrow doesn't seem hopeful, we'll drive up to the UC Davis vet school and see what they can do for her.

Any advice or ideas?

 

[ticklechin]

Are you seeing Dr. Beers and Dr. Johnson or Dr. Nakamura? Dr. Beers from Albany VCA is the best there is as far as vet dentists go here in the bay area.

 

[maryam]

Yes! Actually, Dr. Beers is the dentist Mishti's been seeing, and she's stumped. Her normal vet is Dr. Johnson, who we're seeing today. We also see Dr. Nakamura for our rabbits.

Hopefully we'll get some answers! My husband noticed something strange last night - it seems like Mishti's pain grunts/quacks/barks happen right after she poops I have no idea...

 

[mishellyshel]

i am sending good vibes to you and mishti. one of my chins tooth had to be extracted but it was so loose it just pretty much fell out. i hope they are able to figure things out and get your chin to be pain free.

 

[ticklechin]

I have been going to Dr. Beers for 10 years now with assorted chins, she is the best there is and I trust her 100%. Dr. Johnson is a good choice for a second opinion but I would not have her do any work on teeth. Dr. Beers has see literally 100s and 100s of chins and she is truely a expert on teeth. I would not be suprised if they put her back on baytril for 14-20 days and see what happens, once the infection gets into the bone which is what it sounds like its a royal bear to get rid of and takes a long course of antibiotics-I like to use TMS for long duration antibiotics, easier on the digestive tract but if the infection is bad baytril is the way to go . Is she pooing still?

 

[ticklechin]

Also, ask Dr. Johnson about putting her on a opioid such as buprenex for pain-its way stronger than metecam and infections like this are very painful. Talk over the disadvantages such as the depression of the GI tract and possible stasis (reglan should be on hand using this drug) VS. the pain she has based on the X-ray results and is it worth the risks.

 

[maryam]

Thanks Michelle ) The hope is that it will get looser over time and it'll just come out easily. The dentist had a really hard time getting her tooth out despite it being loose. Fingers crossed!

Ticklechin - I'm very pleased with Dr. Beers' communication and her conservatism when it came to surgery - she really wanted to make sure that Mishti wouldn't be hurt. We really appreciate that. So far she's tried to get this tooth out three times and faced different obstacles. Mishti is the first chin she ever had issues administering anesthesia to! Then she tried to extract the loose [previously-infected] molar and it wouldn't move.

Mishti generally tolerates TMS a lot better than Baytril (with the latter she'll just completely stop eating), and we do have reglan, propulsid, and plenty of critical care on hand. She's thankfully pooping a lot now that she's been off Baytril for a week, but they're still on the drier side. Maybe it hurts her to poop because of a lack of lubrication or the texture of her poops? Or something?

I'll mention all this to Dr. Johnson. They have the dentist at Adobe, but we're a little reluctant to use her because she was doing her tooth trimming for a while and didn't mention the molar issue at all. My hunch is that getting good, clear x-rays, and getting Mishti on a longer course of antibiotics like you said, along with better pain meds, will be a good approach until her next tooth trimming with Dr. Beers, and she can attempt to get that tooth out again. Let's see what Dr. Johnson thinks about that approach (or if she finds something different).

The hope is that getting this tooth out and resolving the infection will make her use both sides of her mouth for chewing, so that she won't need to get her teeth trimmed anymore! Mishti is such a problem child...

 

[ticklechin]

If she is not drinking enough water she might be getting a bit constipated-have Dr. Johnson make sure she is hydrated enough.

 

[maryam]

Good point! She was avoiding the water bottle for a while and only recently started drinking on her own again. I will bring it up.

 

[maryam]

Dr. Johnson saw Mishti on Wednesday and said that she feels a little doughy. She prescribed more Metacam (2x daily) and some Reglan (3x daily). It's been close to 4 days now with NO change.

She's eating, drinking, and pooping. Totally active. Willingly eating Critical Care from a syringe. But EVERY time she poops, she makes a series of sharp little barks, almost like quacks. It's been keeping us up all night and she's obviously uncomfortable. We called Dr. Johnson and she put in a prescription for Buprenex, which is helpful, but it still doesn't address what's wrong with Mishti.

I cannot find anything about this online. Mishti's has had GI stasis at least a half dozen times in the past, and she has never acted like this. We're running out of options.

And on top of all this, we have to work on getting that molar out.

 

[ticklechin]

Ask Dr. Johnson for a ultrasound of the GI tract, not a x-ray. I have had two chins that had lifelong problems that were not diagnosed until the ultrasound was done, the result was euthanasia in both cases but at least the answers were found.

 

[ticklechin]

Also, they were both patients of Adobe, ask if would help to review their charts, you can PM me for my info on them.