Bailey is a 10 year old, 6.6 pound toy poodle who presented to us a few weeks back with a possible fractured jaw. Bailey had been taken to a local grooming salon for his monthly bath that day and the groomer offered to have a “non anesthetic” dental cleaning performed by a dental hygienist while he was at the shop. The owner advised the groomer that Bailey wasn’t very cooperative and would probably give the hygienist a hard time, but he was assured that everything would be fine. Later in the day, when he picked up Bailey, after having paid for the grooming and dental work, the hygienist informed the owner that the dog may have dislocated his jaw and that they should take him to a veterinarian.
Bailey on presentation with broken jaw
On presentation, Bailey was very agitated and painful, so much so that we had to sedate him to examine the jaw. Once sedated, it was clear that the jaw was completely broken in two places. The teeth were still full of tartar and there were multiple teeth that were abscessed and in need of extraction.
We took radiographs of the jaw and teeth and discussed options with the owner. Due to all of the infections surrounding the teeth, the quality of the jaw bone was very weak. Given the age of the dog, the presence of overt infection and the poor bone quality, the prognosis for being able to fix this jaw was very guarded. The owners wanted to do whatever we could to save Bailey’s jaw, so we prepared him for surgery the next day. Standard pre operative bloodwork was unremarkable and we felt confident that the surgery could be performed safely, even if we were uncertain whether the bone would eventually heal.
Severe periodontal disease
Open fracture site
Fracture from side view
Bailey was anesthetized and the Jaw and face were shaved and cleaned in preparation for surgery. A full dental cleaning was performed and 14 teeth had to be extracted due to excessive bone loss from advanced periodontal disease.
Because the bones were so fragile, we could not repair them with a bone plate, instead, an external fixator device was constructed using surgical pins and epoxy to keep the bones aligned in order for them to heal in a functional manner. Since there was such poor bone quality and missing bone at the area of the fracture, we introduced a synthetic bone graft material, called velosity. This is a product which acts as a scaffolding for new bone to grow across moderate sized defects. Pins were placed across the entire jaw and connected with a ring of fast setting epoxy to create a stable construct which would immobilize the bone fragments. In addition, the jaw was wired to the upper maxilla to prevent any motion of the bones and to prevent attempts at chewing.
With the apparatus in place, there would be no way for Baily to eat, so we introduced an esophagostomy tube into the left side of the neck. This is a soft rubber tube which is inserted into the esophagus, down to the level of the stomach. The tube is wide enough that soft, blenderized food can be squirted down it to make certain that Bailey gets enough food during the 8 week recovery phase.
Bailey was discharged a few days later with antibiotics and pain medication. He has an elizabethan collar around his head to protect the fracture site. We are now 6 weeks post op, and Bailey has been coming in once a week for inspection. His surgical implants are stable and there is no sign of infection. We will be taking radiographs again at 8 weeks to see if the fracture has healed. It is possible that it may take even longer, but for now things are looking promising.
Non Anesthetic teeth cleaning is being offered by many groomers, and this case shows an excellent example of why it should not be considered. Equally important, is the fact that “cleaning” the teeth without anesthesia cannot achieve the goal of truly cleaning the teeth on all sides and particularly beneath the gum line where periodontal disease is slowly destroying the teeth and bone. When we perform a dental cleaning, the patient is safely anesthetized with isoflurane gas. Under anesthesia, we have the ability to radiograph the teeth (x-ray), determine what, if any problems are occurring below the gum line, and then clean each tooth on all 5 sides. We are able to probe below the gum line and currette away any sub gingival tartar. Pets are placed on prophylactic antibiotics due to the potential for shedding of bacteria into the bloodstream during the procedure. Owners who have this procedure done get a false sense of security that their pet’s dental needs are being taken care of, when, in fact, they are not, which may ultimately lead to further decay, tooth loss and even bone fractures.