Elevated enzymes & root canal

Question
Hi, I've already consulted 3 different vets (& gotten 3 different suggestions!), and would appreciate a 4th opinion on this:

My 13-year-old Jack Russell terrier "fractured" his back molar about a year ago while chewing on a hard treat. Vet #1 wants to extract it, but says I'd have to see a specialist if I want to try to save the tooth & do a root canal.

At his last exam, Vet #1 also mentioned his liver enzymes were elevated & wants to put him on medication right away until an acid bile test can be done. It appears his ALKP results have risen to 248 u/L (from 135 u/L a year ago), and his ALT results have risen to 154 u/L (from just 12 u/L a year ago).

Over the years, I've become wary of Vet #1, so I took my dog to Vet #2 for another opinion. He could only recommend a specialist about the tooth, but said the liver enzymes looked okay, NOT to bother with medication, but would do an acid bile test at our next convenience.

Having a hard time trusting two different opinions, I went to Vet #3. He wants to work on the tooth right away, says not to worry about the liver enzyme elevations at all since it's probably just old age (i.e. my dog has no other symptoms of illness). Recommends an extraction since he's already old, but could do a root canal if I'm willing to pay more to try & save the tooth.

My goal has been this whole time to fix the tooth via a root canal (I'm okay with paying more.) My concern is: Do you think the liver enzyme issue is that big a deal?  It's confusing because the one vet actually willing to do the teethwork is the one telling me that his bloodwork is fine, that it's just due to old age. I guess I'm scared to put him under anesthesia knowing his last lab results weren't 100% perfect.  Am I overthinking this? He doesn't seem to have any other health issues, not even the tooth looks like it's bothering him anymore. I'm having a hard time going on all these recommendations when my dog seems perfectly normal. I'm willing to pay the money to fix whatever issues he has, as long as it's in the best interest of my dog, and I don't know who to trust anymore.

Thanks for your opinion,
-Jen

Answer
Hi Jen,
As you read, I am not a vet but I have over 20+ years of dental experience and was a Certified Small Animal Dental Technician.

In my experience, unless the carnassial tooth that he cracked is bleeding, loose or has raw, exposed pulp, the dog isn't going to care much about it.
Slab fractures on this tooth are very common, and usually from eating a hard treat or bone.

Some dogs do develop abscesses from them, but in my 25+ yrs I only saw probably three a year out of thousands of dogs that came through our clinic. Many of those dogs had old slab fractures that no one even knew were there until we found them on an exam.

Even with root exposure they rarely abscess. If the tooth is split in two, or has a piece hanging off of it, I would say just have it extracted. At this dogs age it isn't worth the 3K someone will charge you to do a root canal and crown for it. If he was a 3 yr old show dog that would be different, but he isn't.

I am just being 'real world' here for you. As far as his liver enzymes go, the vet is right about the age related elevation, but for that reason alone I wouldn't put this dog through a prolonged dental procedure at all. The liver has to flush out all of that anesthetic and it is hard on it when it is already dealing with age-related changes.

The bottom line is this: If the tooth is stable, isn't bleeding, isn't abscessed, isn't broken in half, and isn't bothering the dog at all, then why bother with it? Keep his teeth brushed and don't give any more hard treats.

If it looks worse or the same as some of these photos I will include, then at least have it removed. He will do fine without it.

That is what I would do if it was my dog. I had to remove both of my one dogs carnassial teeth because they were broken before I got her and they were fine for years then one abscessed so I had it extracted. Later the other one did that as well, so I had it extracted.

Here are some fractures that should be removed:
http://www.burnabyvet.com/tl_files/01Home/misc%20pictures/Slab%20Fracture.jpg

http://www.avds-online.org/info/carnassialabscesses_textnphotos.html

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=425680&

This is an old fracture:
http://www.petdental.com.au/images/big_images/DSCN1379.JPG

So if your dogs looks like any of these it should be removed. If it doesn't, then sit with it and decide. But putting him through a lengthy dental procedure just is too risky in my opinion.

Now for the record, my 13.5 yr old dog just had a nasty tumor removed from her front leg but her blood work was better then most 5 yr old dogs, so we went ahead with it. She was out for about 30 minutes total and did great.
Each dog is different, but I can guarantee you that I wouldn't put her under for a root canal and crown!!

I hope that helps you make your decision. Go with Vet #3 and the extraction.

Let me know how it all works out.