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Teeth are always in style. - Dr Seuss


I have to admit I am fixated on nice clean teeth for dogs. Does not have to be sparkling clean but at least not tartar laden.  Perhaps it is my OCD but I get very disturbed when I see dogs with tartar thicker than the depth of blackheads on my face.   There is almost this compulsive urge to jab these dogs with sedative drugs, put on those nitrile glove, start cracking the hideous stack of tartar and start scaling those teeth.

With that said, I am not obsessed enough to brush their teeth every day.  In fact, I don't brush their teeth.  Whenever people ask me about their dental routine, whether I brush their teeth or give them any "dental additives", I would look at them with a grin, "Do I look like I'm that hard working?"

I can already see the vets giving me dirty looks by that confession.

Just for the record....

Daily brushing remains the gold standard to prevent plaque and calculus and slow the progression of periodontal disease. - AVDC Pet Peridontal Disease

Even though I am aware what the 'Gold Standard' is, I unabashedly remain the "Na!  Take your Nylabone and knock yourself out." type of mama.  I am still quite old-school in some of my dog care practices.  I cannot remember where I read it from but I do subscribe to the theory about dogs in their natural environment chew on sticks and branches to maintain their oral hygiene.  That also explains why the boys, especially Flapper, love gnawing on those branches and scrape shavings out of them whenever he gets the opportunity.  In addition, these Nylabones also provides an outlet to vent out some energy on very boring days.

**Warning: 
I know the boys, ESPECIALLY FLAPPER, are powerful chewers.  I buy those solid ones coined as "for powerful chewers".  NOT those gummy, soft ones that they could easily break off and swallow in one chew.  I also make sure that once the bones are chewed to a certain size where they could potentially swallow it, I would chuck it away.  

Please use sense and sensibility and KNOW YOUR DOG'S chew strength before using one of these Nylabones 'lest it ends up being a foreign body in your dog's system = most likely requires surgical intervention and could be lethal should blur owner(s) not realise the dog ingested it.


Whatever Dr Google says, I don't really care.... just as long as it keeps the boys happy!  They love chewing their bones.

Flapper has always got a good set of teeth with the exception of one chipped tooth - the fourth upper pre-molar on the left.  He chipped that tooth a couple of years back and was recommended by one of the vets to have it removed.  But looking at how strong that tooth was and Mr-Good-Threshold-of-Pain did not display obvious signs of discomfort, I decided to leave it be and wait upon such time when it really poses to be a problem and/or the tooth gets shaky (whichever sooner), only then will I choose to have it extracted.

Again, by gold standard.....

An annual visit for a veterinary dental cleaning is an important part of your pet’s oral health care program.  Annual dental procedures under general anesthesia allow your veterinarian to visually examine each tooth and use a dental probe around each tooth.... AVDC Pet Peridontal Disease

The gist of it, the annual dental work is the gold standard for getting the pet's teeth and teeth structure evaluated, preventing peridontal disease and achieving good oral hygiene including daily teeth brushing.

Gold standard, I know!

By Flapper's mummy standard.... ha!

It is important know what the gold standard is as I always say, make a learned decision not just based on "because I think so" or "because Doctor Google says so" or worse still, "because Flapper's mummy said so".

I will say it outrightly, my standard is not gold.  My standard is based purely on personal choice which also means I am willing to accept the consequence should "there's a chance" becomes reality.  No "what ifs", no "if only" and most importantly, no blaming on anyone else.  My choice and mine alone.

So came the month of July - the happening month of 2016 for Flapper.  He was scratching his muzzle a lot more and was frequently rubbing his face against the sofa.  Even I felt uneasy watching his scratching and rubbings.

There were two possibilites -
  1. Dental problem
  2. Skin issue

Here's the interesting about clinical approach to a not-so-straightforward problem - it is called elimination process.  Whichever choice I decide on, I would still need to address the other if the selected choice turned out not to be the problem.

I chose dental first for very simple reasons -

  • It's time to address that cracked tooth - Good news!  There is now a vet who offers dental x-ray and does root canal!  At least I can find out the actual teeth status and make a learned decision rather than 'do it for the sake of doing it'. 
  • It's time for Flapper to have his first dental treatment.  His heart and blood works were good.  If I don't do it while he's healthy, do I wait till he has some liver/kidney/heart problem with a mouth full of rotten teeth and becomes an unsuitable candidate to be under GA... only then I should do?  He's turning 10.  NOW is the time.
  • Even if it turns out not to be a dental problem that caused the scratching and rubbing, at least he will come out with a renewed set of teeth... shiny and bright AND!  No more cracked tooth.

I discussed about doing this dental thing for Flapper with my trusted advisors and contemplated using The Animal Doctors.  I read on their website that they recently introduced dental radiography.  However, my findings were disputed I thought maybe I read wrongly or remembered wrongly.  I did not call to ask either because one of them was quick to suggest, "Hey!  Why don't you try Maranatha Vet?  They are quite new... I heard (or read?) from somewhere they have dental x-ray and offer comprehensive dental service.."

My interest was piqued.

Mara-what?????

Okay, never mind.  I did my search in usual Dr Google style - phonetically.  Mara... nan... tha...vet... Singapore... Oh whatever!  I was sure the highly intelligent Dr Google will pick out the closest available match despite the wrong spelling.  Besides, Mara-something is a rare name.

And true enough, Dr Google found the clinic very quickly.

No website.

Just a Facebook page.

Even though Flapper's mummy is not exactly gold standard in her dental home BUT!  Yes, BUT!  There's always that catch-22!  Muahaha!

Iiiiiii... don't have to be gold standard BUT the clinical practice has to match (if not at least close to) the gold standard stipulated  for dental treatment.

I also say double standards.  But you can't fault a pawrent for wanting the best for her furkid.  Ha!

Anywoof, I saw FOUR posts that won me over immediately and I trusted it would be THE clinic to proceed with Flapper's first and last dental treatment.... unless *touchwood* Uncle gets up to some mischief and chips another tooth.  *glares at Uncle Flapper*

No. 1 - HELLO DENTAL X-RAY!  I HAVE BEEN WAITING FOR YOU FOR... YEARS!




No. 2 - Proper Dental Charting




No. 3 - Proper GA Monitoring




No. 4 - They offer root canal treatment! 

Oh lookie!  This fractured premolar looked looked a lot like what Flapper had except he did not have the "accumulated tar tar".





The decision was made.

Uncle Flapper was going to have his first dental treatment - ever - at Maranatha Veterinary Clinic.

Honestly, I was in a bit of a dilemma.  I could not decide if Flapper's dental treatment should be 'now' or after his cameo filming which means I cannot get his leg shaven to IV Cath for the fluids.  Plus he had his birthday coming up.  Then there is this upcoming new Sony Action Cam thing...  Later will be when?  Next year?

The mental images of his persistent muzzle rubbing and scratching played in my head and I was like, "F*** it!  NOW it shall be."  For his sanity sake, another few months of all that muzzle irritation could be torture.

I quickly grabbed my phone and made a call to book for an appointment.  I must confess though, I sounded like an idiotic dog-mama.

"Eh.... is there by any remote chance you can IV Cath without shaving his leg?  FlapperisinthemidstoffilmingandIcan'thavehislegshaven"

I gushed through the last bit.  I was embarrassed.  I knew that if I were to be the vet, I would want to slap the pawrent who proposes something so bimbotic.  There is a reason why the protocol is in place.

I looked through my Flapper's schedule and decided on 3rd August 2016.

As mentioned in part 1, the first thing I did once I booked for his dental appointment, I immediately proceeded to getting his annual health screening done.  Undergoing GA at 10 years old?  I am not taking any chance here.

What the heck am I talking about?  Regardless the age of my dog, as long as they are undergoing GA, I would run blood test and ensure they are on IV Fluids.  And of course, the vet's duty to do full physical examination.  That I will go by surgical gold standard to ensure my pets are suitable candidates for going under GA.  Period.

I have to admit I was an excited (and nervous) mummy.  I was looking forward to experience this new vet who offers comprehensive dentistry for dogs and cats.  Like freakin' finally!  Dental radiography available!  How awesome is that?

The best part - Dr Nora made an exception to the rule (note that it is an exception!) and agreed to let me watch the dental procedure!  Woohoo!

So here I am, reporting Flapper's dental treatment experience - firsthand.





Tooth Reconstruction and.... Bubblegum or Mint?

3 August 2016
Rain....
Traffic jam

After what seemed like eternal drive to Maranatha Clinic in constipated traffic for over an hour, Flapper and I finally arrived.

I am not going to do some romantic write-up about the clinic's set-up.

Anywoof, the initial suspicion over his glorious god-knows-how-many-years-old fractured/chipped tooth was not... reassuring.  Dr Nora speaks [almost] as quickly as me so all I really heard... "yep!", "fracture", "pulp", can't even remember if I heard "exposed""... then finally "most likely abscess".

In most of these tooth fracture cases, the likelihood of root abscess after being left unattended for so many years is very high.  i-Eep!

Soooo.... here comes reality.  Don't know about you, but don't we love choices?  *guffaw*

I could choose either -
  1. Root Canal Treatment - "just" $3,000 only.  X-ray will need to be repeated in 9 months to check the root; OR
  2. Extraction - Possibly stitch-up required as the fourth premolar is what I call "bitch of a tooth with triple roots".    The burning question here was - SAY after the x-ray and by some miracle the root is still healthy (since I have been pre-empted on possible root abscess), do I want it extracted (for cost reason) and lose the function of a tooth? 
Dilemma, dilemma.

I decided to wait for the x-ray to be done and know what is the actual condition before deciding on which option.

"If the tooth is really bad and needs to extract, I will make sure no photos are taken on that side.  Flapper will soon be the right profile dog.  No left profile.  Just right profile.", I joked to ease my own tension of the possibility that he may end up losing that tooth.

In the meantime, I silently prayed, "Dear God, please please please don't let this be anything major."

And it was time to knock uncle out for his dental procedure.


Step 1: Peridontal Probe
A periodontal probe is used to measure the depth of the gingival sulcus and periodontal pockets in millimeters to help evaluate the extent of periodontal support. The probe is often referred as the "stethoscope and dipstick" of tooth support. - DVM360

In very easy human words, it gives the vet valuable information about the tooth/teeth - i.e. any periodontal disease?  Does the tooth require further evaluation e.g. x-ray?

Dr Nora started on the side without the fractured tooth.  She meticulously and skillfully prodded each tooth and made denotations onto the dental chart - not like I knew what it meant.

While Dr Nora was busy doing the dental checks, I was impressed by the meticulous and consistent GA monitoring performed by the Vet Nurse.  The GA monitoring was charted.  Me like!  For what appeared to be a modest little clinic like Maranatha, they were like Mary Poppins.  Suddenly equipments started appearing and I was doing my mental "Wah!".

No state-of-the-art equipments like some other clinics-that-shalt-not-be-named.  But the monitoring equipments were present with the exception of a ventilator.  The ventilator.  THAT ventilator.

I'm just being an ass about the ventilator.  Just a private joke between my trusted advisors and I... in which the joke shalt-not-be-shared.

When I spoke to Dr Nora after the procedure and complimented their meticulous work ethics and being self-sufficient for respectable GA monitoring, she quipped, "I try to achieve gold standard for the procedures that I do."

Respect.

I knew right there and then that doing Flapper's dental at Maranatha was a good and right decision.  It is now, officially, my go-to vet for all my animals' dental procedures when needed or wanted.  I know they will be in very good hands.




Step 2: Count the teeth

"Did you know Flapper has a missing tooth", Dr Nora asked.

"Errrr..... no????????????", I sheepishly replied.

Never thought about counting his teeth.  I always thought all his teeth were intact.  Obviously I thought wrong!

X-ray will be needed to make sure that was no root embedded in the gum.



Step 3: Bubblegum or Mint?

"Bubblegum of course!  I am not a mint person and I am sure Uncle Flapper would love waking up with bubblegum taste in his mouth.", I burst out laughing as I replied.

Dr Nora had started Step 1 & 2 on the side without the cracked tooth.  And lo and behold!  Uncle had a good set of teeth... other than that anonymous missing tooth.  No extractions needed.  All his teeth were still strong and healthy.

Since all is good on his "right profile" side, Dr Nora decided to proceed with the scaling and polishing - with that bubblegum flavoured paste.

Heave a sigh of relief.

At least "right profile" is good news.



Step 4: Take X-Ray of tooth that require further evaluation

Burning question:
"Why do the animals need to be under sedation when doing dental x-ray?"

"You see that little black plate I need to put IN THE MOUTH for the x-ray?", Dr Nora pointed to that little black plate as she explained, "that plate costs $10,000."

Okay!
Point noted.
10-Gs. 10 Grand. 10,000.... 5 digit.

Even though I still have one hand to count but yep!  Sedation it is.

No root embedded in the gum.  Yay!  Wherefore art thou is thy missing tooth?  Mystery, it is.


Step 5:  Turn Flapper to the other side, repeat step 1- 2 again

Okay.
No mysterious missing tooth on the left side.



Step 6: Moment of truth - THAT CHIPPED TOOTH

I swear I missed out most of what Dr Nora said.

I think I heard "no abscess".

And then something about the "pulp".

And then something about "I don't think we need extraction or root canal."

All I remember is.... in my own interpretation is, "oh my god!  you mean nothing major?"

My beady eyes flung right open with all its might.
It's still beady no matter how big I try to open it.

Everything else shot right past my head the moment the realisation.

Dr Nora explained about being able to reconstruct the tooth.  She was happy.  This meant a shorter procedure over root canal treatment.  I was happy.... like need I say why?

Can la!  Mai tu liao!  Strike 4D also not so heng!
(translation: Go ahead.  Don't have to wait.  Even winning lottery couldn't get any luckier.)

The ah-lian in me has emerged.

I heaved a sigh of relief from every outlet possible.

And of course, I could only give thanks to God for watching over uncle and blessing him that all he needed was just a tooth reconstruction.... and the rest of his teeth were still healthy and good.  Blessed, we were!



Step 7: Take X-Ray to Confirm Chipped Tooth Status
This x-ray can't be explained by me.  Basically indicates... no fracture, no major problem.  Reconstruction it is!


Dr Nora proceeded to take two more x-rays of his front teeth as I highlighted to her about his recent incessant rubbing at the chin.  So just to be very sure that nothing was wrong.... and Thank God again!  All was good!



Uncle Flapper dreaming of his swims at sea while receiving his dental treatment.... unaware of the dental x-ray pointing right at him.








Step 8: Back to Bubblegumming and the case of "worn out teeth"


Now that it is confirmed that all Flapper needs is that tooth reconstruction, it was time to scale and bubblegum (polish) "left profile".

The scaling and bubblegum procedures were fairly quick as Flapper did not have much tartar build up on his teeth.

I can't remember when but Dr Nora pointed out about his worn-out teeth.

"I'm not surprised it's worn out.  The way he chews!  Even the tennis balls are sometimes not spared.", I commented.

"You let them play with tennis balls?  Do you know tennis balls are bad?  Tennis balls are the worse!", Dr Nora said emphatically.

"Well, I get my tennis balls supply for free.  The boys love playing with the tennis balls.  I'll live with worn out teeth.", I replied mischievously.

Yes darlings, I am the no dental gold standard mama.

I am always inclined towards... whatever makes the boys happy as long as it does not kill them.
Look at this happy face going!  How can I not let them have the tennis balls?



Step 9:  Tooth Reconstuction

Dr Nora explained step-by-step as she reconstructed the tooth.  I could not even explain even if I tried to.  In my very layman terms, she slapped some clay-like stuff on the tooth, carefully evened it out, cured it then filed (?) it down so it smoothens out to the natural tooth.

She did not cover the tooth fully as it will not be as strong as a partial coverage.  She warned me that that would be a black line that would appear in time to come.  I accept the black line.  It's only aesthetics.  I am just happy the tooth need not be extracted and the restoration will allow him to regain full function of the tooth.

Again I say, "right profile, no left profile photos please!"

It was fun watching her to reconstruct that darn tooth but it is even more fun showing the before and after photo!


Before
The awful chipped tooth.
A glimpse of the little polyp peeping out from the left can be seen in this photo too.


AFTER
Flapper's beautifully reconstructed fourth premolar!  Looks brand new. :D
That little polyp on the left (I think there were 3 in total).... Dr Nora removed it as well.





And that was that.

Uncle Flapper came out with a renewed set of sparkling teeth and a gorgeously reconstructed tooth.  I hope he enjoyed the bubblegum flavour that mummy selected for him.

On this ending note, I have to extend big thanks to Dr Nora for making this wild exception and allowing me, the no-gold-standard mummy, to be present for the dental procedure.  It was a great learning experience and an eye-opener... and of course, totally awesome to see how the dental x-ray work!

Thank you to Dr Nora and Becky for being so gentle to Flapper and for the respectable meticulous work ethics.  


For any pawrent looking for good dental treatment for your dog or cat, I will definitely highly recommend Maranatha Veterinary Clinic.  Dr Nora has great passion for dogs and cats dental health.   As she said, "I know how much good dental health can improve the quality of their (the pets') lives."

Time for me to make plan for the other two goons dental treatment.  Pebbles tartar is driving me nuts.  The moment I mentioned "schnauzer", Dr Nora knew what I was talking about.

Did I happen to mention some small dogs are pre-disposed to having quick tartar buildup?

*cough schnauzer*

In the meantime, while I continue to admire Flapper's gorgeous teeth and no bone chewing for him for three months but boy oh boy am I so glad that at the age of 10, he still has a full strong set of teeth!

I say again, "Strike 4-D also not so heng!"

Million dollar smile, he has.
Or is it now known as his PR face on steroids?

Flapper's "PR Face on Steroids" as Uncle Nic calls it.
I prefer to call it his Million Dollar Smile.

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