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Date:   21 July, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pigs & rabbits
 
2000 CASE: THE 6-MONTH-OLD DOG'S MOUTH IS FULL OF SALIVA
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 3 July, 2000
Updated:
21 July, 2010
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
"Lots of saliva flowing out of his mouth every day," complained Ms Palomaski. "What would be the cause of this and how come he had such bad breath?"

Excessive salivation a 6-month old male part Alsatian part Labrador dog adopted from the animal shelter called Noah Ark sometime ago was unusual. He was very good looking but in such a manner that you could not remember how he looked like after a while.   

Cross-bred dog.  Smelly gum ulcerations on left upper gums. toapayohvets singaporeHe looked healthy and had an excellent appetite.  His teeth were snow white.  But he would not permit his mouth to be opened for further examination by Dr Melissa Chua. The veterinarian said:  "I hope your dog is not suffering from a malfunctioning salivary gland which leaks saliva profusely into the mouth!"

"Be careful, he bites," warned Ms Palomaski. "It must be painful. If you can't cure him, he may have to be put to sleep as the carpet is all wet and smelly with his thick saliva."

A tranquiliser was injected into his back muscles.  There was a bad smell of rotting tissues.  Cross-bred dog.  Right upper gum ulcerated with rotting tissues. toapayohvets  singaporeThe upper gums on the right side were ulcerated too. As if a virus had attacked the gum tissues.  These tissues started to rot and strands were hanging loose from the gums and lip commissures as the bacterial germs took advantage of the breakdown of the tissues.
 
What cause the severe mouth ulcerations.  Young cattle in Scotland do get oral ulcerations caused by the mucosal virus.  But this is a dog, a different species. What virus could cause such an extensive damage?  

Why the affected ulcerations were present only in the upper gums and not everywhere?   The dog did not eat bones or was known to bite gates.  The cause remained unknown.  

It was most likely a viral attack due to the decrease in the immunity of this young canine.  He was never vaccinated and might have encountered one of the dog viruses.  Most cross breeds in Singapore don't get vaccination to protect them against viral diseases nor do they get dewormed.  Internal parasites could cause the immune system to be depressed, leading to the inability of the dog to fight off viral infections.     

Antibiotics would be taken for at least days for this patient.  Plain water and dry dog food were given.  Recovery was good once the antibiotics killed off the necrotising bacterial germs and the dog becomes stronger in his immune system as he grows older.

  

2010 CASE: THE 6-MONTH-OLD BICHON FRISE HAS A VERY PAINFUL MOUTH AND SEPARATION ANXIETY
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
21 July, 2010
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

SEPARATION ANXIETY.
A couple in their 30s purchased a Bichon Frise at around 2 days ago. The dog barked a lot when the couple went to work. He has "separation anxiety,"  I said. The couple had tried all solutions from the internet including placing a clock. "The neighbour downstairs now close their windows. They do not do that before," the wife observed. This meant that the Bichon must be barking the whole day long. How to solve the couple's problem?  I asked the couple to check out the dog's previous routine. He was always caged at home as the student owners were busy.  So the dog has no exposure to the outside world.

1. Spend time with the dog but this is not possible. Spending time means changing clothes to go out to work but the couple goes out and comes back in 5 minutes. Then increase the time of outing. Don't go out after dressing to go out. These need several days to be effective.

2. Bring the dog outdoors more often. Not a practical advice. "The dog is afraid of going out. He just wants to sniff around," the husband said. He had asked the previous owner and found out that the dog was seldom taken outdoors.

3. Get another puppy. Not practical as the HDB apartment regulations prohibit more than one and the couple has no intention of getting two puppies.

4. "Get a rabbit," I wanted to let him adopt a rabbit on a trial basis as I have one for adoption but nobody wants him. "The dog will kill him," the husband said.  "Put the rabbit inside the cage for a few days first," I said. "Let the dog know him. Later, let both meet and observe. If the dog and rabbit gets along, this dog will have company." The couple rejected my "thinking out of the box" idea. The rabbit can be returned to me later but they don't like the idea of an extra responsibility, I presume.

So, I took the young rabbit home. It is hard to put a young rabbit to sleep. The ex-owner could not keep the rabbit as she sneezes whenever she is near the rabbit and had requested euthanasia. My radical idea has no chance to work in this case. It may work but then the couple will have two creatures to care for.   

5. "Come back for lunch daily," I said. This was not practical in the long-term as the husband has work obligations and the wife definitely cannot make it.     

6. The husband found out from the previous owner that the dog does not bark if let out of the confined room and is given access to the whole apartment. "Don't do this," I said. "He will pee and poop every where." This was true, as the dog did that with the previous student owner.

7. "There is no solution," Mr Aung, my groomer said when I asked him. "De-bark the dog." This was not acceptable by the owner as it was deemed cruel. 
"Electric and chemical collars don't usually work," I said. In any case, the owner was not interested in this method of controlling barking.
 
8. Final recommendation. The dog had been warded for 2 days as he has a rare problem of the gums (see below). When the dog is taken home, this is the following advice to try.
 
7.1 Continue to put the dog inside the crate and don't give him attention after coming home from work. Cover the crate with heavy towels of 3 sides so that the dog feels secure and uses it as a den. Put the crate inside the bathroom as the dog seems to prefer the bathroom with the door open.

7.2 The dog will pee and poop onto the floors or newspapers of the bathroom. This floor will be easy to clean. Take the dog out to play for half an hour and put him inside.

7.3 Use Kong balls with food inside the ball now that the dog can chew properly after the gum surgery (see below). Give the dog treats around 7 days later as the gums need to heal after the surgery.

7.4 Give the dog a routine of eating and playing and see what happens to his separation anxiety.  

7.5 Neuter him later if the owner wants to. 

 

bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore "The dog has great difficulty eating dry food," the owner said. I checked the teeth. This dog had a congenital abnormality of the gums - a very rare problem.

Here are some pictures of the operation done by me. The anaesthesia was isoflurane gas. Electro-surgery was useful and there was little gum bleeding. 

 
bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore My intern Ms Lai finally manages to pry open the mouth for me to take these images before the gum surgery
bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore
Can't see the premolar 4 as it is enveloped by the abnormal gum Electro-incision is done on the lateral sides first for both upper jaws Undermine the tissue which is not attached to the premolar 4
bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore
Puppy premolar 4 is seen below the permanent one Electro-incision of the medial side Electro-incision of the medial side
  bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore bichon frise 6 months congenital abnormalities of dog's gums gingiva  toa payoh vets singapore
  Premolar 4 is now exposed after the abnormal gum tissues are cut off  After electro-incision of the lower gums. Puppy teeth is extracted. Dental scaling done later
Anaesthesia:  Isoflurane gas with no sedation as this is the safest method. 

Surgery: Electro-surgery is useful as there is practically no bleeding when compared to the use of the cheaper scalpel blade. The electrode incises the lateral sides of the gums first for both upper jaws. Then the medial sides are incised. The whole gingival (gum) epithelium is undermined with scissors and cut off. Around 3 puppy teeth trapped inside are extracted. The whole surgery for upper and lower jaws take more than an hour. Beautiful snow-white teeth can be seen now. The dog still feels gum pain and so I cannot show the couple the results of the surgery. The dog was purchased for $400 but the anaesthesia and surgery cost around $700 which is considered inexpensive.

Reducing veterinary costs
I reduce the owner's cost by not demanding blood tests and X-rays which will have grossed me more revenue of around $300 as I consider this not ethical. Sometimes, ethics take second place to generating revenue to sustain a business but in vet school, the professor will advise blood tests and X-rays. Sometimes it is best to do it as part of defensive medicine in case the owner sues for not getting the test done. 

Economics of puppy ownership

If the couple is calculating, it seems that it is preferable to buy a new puppy. But they appear happy that the dog now is going to be normal in mastication. 

No veterinary inspection post-purchase
How this poor dog lives to 6 months old without normal back teeth to enjoy eating his food, I cannot understand. He can only eat wet food and eating dry food is painful for him. He probably just swallows them.   

Post-operation
Painkillers and antibiotics. A/D diet. The dog goes home on the second day. He has diarrhoea. The owner is asked to observe another day and not to give dry dog food for 24 hours. The dog is to be crated in the bathroom as described in above.

Painful mouth for the last 6 months
Ms Lai, a young intern who wants to study veterinary medicine although she has a first degree was fortunate to see this case of the abnormal gum development as it is a very rare case.

She has little dog handling experience as I can see that she cannot open the dog's mouth for me to take photographs. The dog moves his head up and down and sideways. I waited patiently for 5 minutes. She could not do it. I showed her how to do it. Somehow she managed and I took some pictures of the gum prior to surgery. Based on the difficulty in opening the mouth, I had presumed that only the upper jaws were affected. During anaesthesia, even the two lower jaws were affected too as the gum envelopes all the back teeth (see images).

On Day 2 after the gum surgery, I asked Ms Lai to open the dog's mouth again to test her. The same difficulties for her as the dog weaved his head up and down. Sideways and away from her. She would consider a failure in dog restraint. I asked Mr Saw to do it. He encountered strong resistance. A Shih Tzu client whose puppy had diarrhoea was waiting for me. I had to do it. I held the dog's muzzle and gave the dog a loud command. The dog appeared to be obedient and permitted Ms Lai to pry open the lips for me to quickly snap some images which I will display later.    

Ms Lai had gone to the U.K last year to have an interview for admission to the vet school but was unsuccessful. She practically had no veterinary knowledge and why she went to attend the U.K college interview, I do not know.

I feel sad for her as the money going to U.K was money down the drain. But life nowadays is so competitive and the young ones with average academic results must be humble and know what to do to get a place in college that requires interviews. Or get a job unless he has top academic scores. There is no guarantee of success for such young ones as they are not proven in academic excellence nor in the battle of commerce. They usually go for job interviews with no idea of what to prepare well prior to the interviews and this is incredible in the golden age of the internet where knowledge is so easily accessed.

In this Bichon Frise, the gum surgery practically can guarantee that he will have a normal life eating and enjoying his food and I hope his separation anxiety will diminish as he becomes normal.

P.S
Gingiva (gums) is the mucosal layer that covers the jaws. It has 3 different types of epithelium - gingival, junctional and sulcular. These 3 types form the epithelial cuff between the tooth and the mouth.

Gingival epithelium - No direct attachment to the tooth.
Junctional epithelium - Attaches to the tooth
Sulcular epithelium - Touches but is not attached to the tooth.

In this Bichon, I presume that it is the gingival epithelium that has developed abnormally since birth (congenital) and prevents the back teeth from erupting.
What is the medical name for this condition, I don't know yet.
 

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More info at: Dogs or Cats
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