The little terrier, Peppi, didn't like me examining her mouth: as I lifted her upper lip to look at her teeth, she pulled away.
Her owner steadied her head to stop her from doing this, and I was able to get a clear view. Her teeth were all rotten, with a massive build up of tartar pushing back the gums. Bacterial infection had caused the accumulation of pus, and there was a foul smell around her head. I pushed my gloved finger against a few of her teeth, and they wobbled: they were all loose in their sockets.
There was no doubt about it: Peppi needed a general anaesthetic, and most of her teeth needed to be extracted. As it was, they were acting as a reservoir for bacterial infection in her body.
The bacteria in her gums would move into her bloodstream as she chewed her food, and there was a risk that they'd then infect her kidneys, heart and liver, causing serious disease. There's good evidence that dogs that have healthy, clean mouths live for longer. So the best plan for Peppi was to schedule a full dental clean up as soon as possible: within a few weeks, her mouth would have fully healed and recovered, and she'd be a much happier dog.
There was one catch though: Peppi was sixteen years old, and her owner was nervous about her having an anaesthetic. She had once put an elderly cat through an anaesthetic, and although the cat came through the procedure successfully, she died just a few weeks later. Her owner had always blamed herself, and she had vowed never to allow an older pet to go through such a process.
So now, she felt caught in a difficult place: Peppi needed to have her mouth treated, yet it could not be done without an anaesthetic. What was the safest option for her?
This is a common dilemma, and the right answer is based on science: looking at the risks of each alternative.
What about doing nothing, and just leaving Peppi with her rotten teeth? There are two issues with doing this. First, the advanced dental disease was causing her ongoing pain and discomfort. The reason she pulled away at first when I tried to examine her mouth was because her teeth and gums were painful. Dogs cannot tell us when they are in pain, so we need to imagine how it would feel if we had the same problem as our pet. And if any human had a mouth that was as full of diseased teeth as Peppi, it would be very obvious that a visit to the dentist was needed to relieve the suffering.
Second, the longer that the rotten teeth remained in place, the more bacteria would spread around her body, and the higher the risk that she would suffer from disease elsewhere in her body as a result.
What about the risks of giving an anaesthetic to an elderly dog?
The key to answering this question is the maxim: "old age is not a disease". Just because Pippi was sixteen, this did not mean that she was unhealthy. It's true that older dogs are more likely to have underlying diseases, and it is also true that there is an increased risk in giving an anaesthetic to a sick dog. But if we did everything possible to screen Peppi to make sure that she was in full good health, then the risk involved in an anaesthetic was very low indeed.
So for Peppi, this meant that if we could do our best to double check that she was in great health, despite her advanced age. If there were signs of underlying illness, we would not proceed. And even if she was fully healthy, we would use every possible anaesthetic monitoring tool, so that we could intervene to stop the anaesthetic if at any time there was a hint of complications.
If we did this, I was confident that any anaesthetic risk could be kept to a minimum. It is difficult to put the risk into a percentage, but there was a 100% chance that she would continue to suffer if nothing was done to make her mouth healthy, and probably less than one in a hundred chance of anaesthetic complications. When I explained this to her owner, she readily agreed to go ahead with the procedure.
So first, we carried out full analysis of Peppi's blood and urine, with the results telling us that her internal metabolism was in full working order. We also carried out an ultrasound check of her heart, and this confirmed that she had no signs of heart disease. So I was as happy as I could be that she was a fully healthy older dog.
I then gave her an ultra-careful anaesthetic, using short-acting agents, and monitoring her vital signs with a range of technical measurements that would sound like gobbledegook to readers. I worked as quickly as I could, extracting all of her loose teeth which meant, in fact, that she had no teeth left at all. It's common to need to do this in older pets: owners are often horrified at the thought of a toothless pet, but it is far better to have a healthy mouth with no teeth than a diseased mouth with rotten teeth. And dogs do not need to chew their food with modern pet foods.
Peppi's anaesthetic went smoothly, with no complications, and she made an uneventful recovery, going home that same evening as bright and chirpy as she had been when she had arrived that morning.
Her mouth is now clean, healthy and smell-free, and her owner is delighted. Hopefully Peppi will continue in good health for many years to come.