Dental Extractions: a Veterinarian’s Lament

Closeup of dog's teeth
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I have to confess: Last week I performed an unexpected dental extraction on a patient whose owner was unavailable via telephone to OK the procedure. Now, it’s my policy to clear any extractions with owners beforehand. But since I knew this client well and the tooth was really far gone, I took the leap and extracted it anyway.

Of course, this turned out to be a terrible decision. In fact, this owner was so upset over my transgression that I had to apologize profusely and offer her the procedure as a courtesy (no charge). Truly, this had been a bad move on my part. But, in my defense, this tooth had really, really needed to be extracted.

Still, clients can be very sensitive about this issue, and I should have known better. After all, I deal in this kind of crisis on an almost daily basis. Periodontal disease is serious. It's ugly. And tooth extractions can be necessary. Yet four out of five times, the conversation goes badly. Here’s a sampling of the most typical reactions to my recommendation to extract one or more teeth:

“But how is she going to eat?”

“Is that really necessary?"

“Seriously? She went in for a simple dental and now you want to pull her teeth?"

The pushback is enough to make a veterinarian want to give in to the pressure of owner expectations — or throw up her hands in frustration. But that wouldn’t be right — not when we’ve exhausted all alternatives (root planing, root canal, etc.) and know for sure that extraction is absolutely what’s best for the patient.

It's Not Always Obvious on the Surface

To be fair, many “bad” teeth don’t really look all that horrible when they’re sitting placidly in the mouth. Even when they’re surrounded by red gums and smocked in heavy tartar, it’s hard to predict what’s happening underneath the gum tissue. In many cases, it’s only when the animal is anesthetized and each tooth is individually examined and X-rayed that you can find the fractured or abscessed tooth. The bone destruction in the jaw. And even the fistula, or hole, between the mouth and the nasal cavity.

Because pet owners generally don't get to view these harrowing sights, dental denial is absolutely understandable: “But they look just fine. How bad can they be?”

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