Saturday, April 16, 2016

23. A hypothesis of a canine tooth abscess in a 16-year-old Sheltie with right nasal discharge for 6 months

Sat Apr 16, 2016

An unusual rare case correctly diagnosed.
Runny nose, pus coming out from left nostril for past 6 months.
Old Sheltie. What's the big deal? Old age does not mean there must be incurable nasal infections.

A bright clear sunny morning. I did not expect the Sheltie owner to come for dental. In fact, she came for vaccination of the old dog after consulting Dr Daniel as I was away at Queen's Veterinary Surgery and had just arrived back at Toa Payoh Vets. 

10 days ago, the couple consulted me about the left nostril discharging pus. Dr Daniel ahd prescribed antibiotics one month ago but the discharge continues. The dog objected to me opening his mouth on the left side and so I did not force the parting of the left upper lip to palpate the gums.

I had this hypothesis. The dog is very old and the root of the left upper canine had rotted and decayed owing to lack of tooth brushing. The decayed root shrinks and bacteria multiply inside the surrounding cavity. The bacteria made a bridgehead invading upwards into the nasal passage and form an abscess. This is called medically a sinus as contrasted to an oro-nasal fistula in which the skin has a non-healing wound as in a carnassial tooth abscess. This will be a canine tooth abscess, as the canine tooth is involved. Extraction of this tooth will resolve the problem as is done in the equivalent extraction of the carnassial tooth.

The couple appeared to accept my explanation and dental work is scheduled 10 days after antibiotics, namely, today. But I was out and Dr Daniel was consulted. Vets give the usual anaesthetic death warning as part of the informed consent for surgery. He noted that the risk is very high as the dog also has heart disease which is not controlled by medication.

The couple decided not to risk it and so just did the vaccination when I arrived at Toa Payoh Vets..

"If you don't remove the decayed loose tooth, the dog will get persistent left nasal pus discharge and later on, death from pneumonia." I said. "The bacteria will spread up into the lungs in time to come and the dog, being old, has no resistance to its invasion.

"The risk of dying is very low for old dog dental work in my cases," I said. "I cannot guarantee 100% success but your dog has good health from blood test and the risk is the bad heart failing under anaesthesia. However, I use isoflurane gas which is very safe. The whole anaethesia should be less than 10 minutes and so the chances of dying are very low, in my experience."

I have been in practice since 1974 and this is a rare case of canine tooth abscess hypothesis as I had not encountered such a case. Carnassial tooth abscssses are too common and all vets will have encountered them.

The wife consented and all went well. My hypothesis is confirmed and this dog has a case of canine tooth abscess. Very rare and probably not seen by most vets. Nasal discharge from one nostril on the same side is the presenting sign.


April 18, 2016 - 2 days after tooth extraction. The dog was warded as he had vomited twice in the last 2 days. It could be due to medication or endotracheal tube irriation. After an IV drip and painkillers, the dog was OK and went home. 

The owner was very much happier now that the dog's left nostril had no daily discharge as she had to clean up the soiled apartment daily for the last 6 months. Her joy was hard to put in writing but could be heard in the next video. 

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