Closeup of dog's teeth
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?”

The answer: really bad. As in, ineffectual teeth that are painful sources of infection. In fact, at this point, those brownish-gray-coated things really don’t function as teeth anymore. And they never will again. Moreover, if they were in your mouth, you’d have no problem begging your dentist to take them out ASAP.

But here’s the thing about pain: Pets with severely undermined teeth either don’t suffer like we do or they don’t express pain in the same way. Based on pain studies in human babies and animals, the latter option is more than likely the case when it comes to oral pain in pets. In other words, they do suffer, and we don’t recognize their discomfort for what it is.

Still, it’s hard for many of my clients to admit that taking teeth out is absolutely necessary. Except for a limb amputation, perhaps, this procedure is the one pet owners most tend to balk at. Never mind that these teeth are mere placeholders for open sores. Forget the evidence of abscesses and the possibility of bone infection at every tooth root. It’s the fact of “pulling” these hunks of futility that freaks my clients out.

This, despite the fact that most pets eat way better after they lose these rotten teeth (a truth I never fail to impart).

Why Does It Cost So Much?

Then there’s the obvious to overcome: "You want me to pay how much to remove each tooth? Seriously? How hard can it be to pull a tooth?”

Actually, it can be pretty difficult. That is, if you want to do it right.

Think of it this way: We can “pull” a tooth by brute force the way barbers used to in centuries past, and possibly leave a festering root behind or even fracture the jaw. Or we can do it the way modern dentists do, by performing a precise surgical procedure referred to as “dental extraction.”

After all, “extraction” employs water-cooled, high-speed drills designed specifically for small carnivores, sterilized surgical instruments, X-ray technology and local anesthetics (along with other forms of pain control). Even so, it can still take strong hands and a lot of patience to unearth a large premolar with three stubborn roots. It’s hard work!

In fact, extracting teeth is harder to do than most other surgeries I perform. What’s more, it’s probably the one we’re least compensated for. Nor does it earn us flowers, an extra thank you or even an impressed lift of the eyebrow (truly all I ever crave). I mean, it’s not like removing bladder stones or sewing up a laceration. Because it’s just “pulling teeth,” right?

Enough of the rant. Now you know. So next time your veterinarian gives you the dental what-for, maybe you’ll think twice about your reply.

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