dental issues in an older sickly dog

Question
QUESTION: I adopted a 16-year-old 2-kg Chihuahua from a rescue group about a year ago.  He has heart issues (moderate), gall bladder & liver issues (gall bladder somewhat severe), and an intestinal hernia (which was operated on once but reestablished itself; currently has a grossly distended anus and severe intestinal issues and I need to help him with elimination).  He is very frail but loves life.  Although sickly, he was fundamentally happy enjoying his golden years until a few weeks ago.

The dog has only 5 teeth remaining, all front teeth, 4 in the upper jaw and 1 in the lower jaw.  All are extremely wobbly and covered with tartar (you can barely make out the teeth below all the tartar buildup).

Over the last 2 to 3 weeks, the dog has stopped eating.  He clearly has an appetite and cries for food and searches for it but does not eat.  After about 2 days without eating he finally becomes so ravenous that he will in fact eat.  Then he stops eating again until he next becomes ravenous.

I believe this results from his dental issues.  Part of his upper jaw has recently appeared to "dissolve"-- the ridge in which the teeth normally sit has "melted away" in parts to show large craters in it now, instead of looking like one full, smooth ridge.  (This is a very recent change (last 2 weeks).  Other than that, his teeth are horrific, but no more so than when I got him a year ago.)  There is no swelling or redness in his mouth that jumps out at me.

Occurring simultaneously to the food boycott is an intense itch that develops atop his nose immediately after/as he eats.  He will eat something liquid/runny (such as yogurt) and 5 seconds later have an intense, all-consuming desire to scratch the top of his nose.  He runs his head from forehead to nose across the carpet trying to scratch himself on the snout, and has scratched up his corneas badly and given himself a bloody nose/face in the process (no more hair left atop his nose).  (He is now on eye drops & using an Elizabethan collar but he still manages to find ways to scratch himself on the snout on furniture/the rug despite the collar.)

I am thinking that perhaps this too is related to the dental issues (yogurt hits a nerve under his top teeth & becomes painful?) but the vet doesn't think so (he thinks it is stress-related).  Even drinking water sets him off, as do liquid-y foods, while cheese and meat set off the intense itching only sometimes.

His blood test results show he is at medium to high risk for dying under anesthesia (gall bladder issues), which is also why we have not addressed his hernia/intestinal issues.  However his quality of life has gone down so dramatically so quickly that I am wondering how to handle this.

My questions are:
(1) Do these issues (refusal to eat, scratching) sound like dental issues?  Are there other issues we should consider?

(2) Would removal of the teeth be likely to improve his situation/improve his quality of life?  Should I instead hope that the offending teeth fall out?  (While quite wobbly, they are not on the verge of falling out anytime in the immediate future.)  Because the anesthesia could kill him, the risk/reward issue is important to consider.

(3) My 3 other Chihuahuas are also from shelters, and all over 12 years old.  They have heart disease but would probably be OK for anesthesia.  Should I consider getting them dental X-rays and then thorough cleanings now before they get too old/too sick to be candidates for anesthesia, even though they have no pressing dental issues?  I use dental gel "drops" on their teeth regularly, but they still have plaque built up.  We do not brush per se.  One would let me if I pushed it hard enough, one would let me get away with it once but never again, and one would bite my hand off (traumatized dog from the shelter).

I would be truly thankful for any advice you can give me.

ANSWER: Bless you Anne for taking in these frail little dogs. This is a tough one because what you are describing (craters in the gum) sounds like he has developed large fistulas or holes in the gums. These open up right into his nasal cavity, which is why when he eats the food is actually going up inside there and making him itch,need to sneeze etc.

It's not the bad teeth that are left causing the problem but the holes in his gums.
There really isn't much you can do at this point because of these gaping holes. As you said, he is a high risk candidate for surgery and only surgery will fix these holes.

If his gums have gotten very friable then that isn't even an option. I don't understand how your vet doesn't think this is related to the itching etc.

As you said, liquid foods (which tend to get into holes easier) bother him more, but other more solid foods do not. Cheese is not something he should be eating at all.
But since I am not there seeing the dog nor am I a vet (I am a vet tech) then I can't really say what is causing this since I cannot see the holes or craters you are describing.

I am going by what makes logical sense here. Have you tried to raise up his food dish a bit off the floor? that might help, might not do anything.

The reason I do not think it's his teeth is because the teeth he has left he wouldn't even use for eating. Those teeth are more like nibbling teeth, grooming etc. His molars and shearing teeth are all gone so the ones he has left barely are affecting him.

You might want to get another vet to look in there and see if there is anything that can be done for these 'craters' to fill them in or something. That seems like the only feasible thing to do at this point.

As for your other dogs, they should all have their teeth cleaned at the vets if their blood work says they can go under. Bad teeth cause more than just mouth issues. They also cause heart, kidney and liver disease as well as some joint issues (bacterial overload in the body). Bad teeth constantly 'seed' the body with bacteria and these finally take their toll on these organs.

So get them into the vet's soon and any other dogs you rescue have their teeth done right away. You can't just stop there however, you need to brush them or put them all on a diet such as T/D, which is a diet made just for dental issues. It is a fully nutritional diet that is optimized for dental and oral health. It is a better diet then Purina, or these other junky foods from the store and it will keep their teeth in tip-top shape. I had a cocker spaniel come in every six months for a dental with the worst teeth until we put that dog on T/D. He came in for his six month dental and check up and his mouth and teeth looked like I had just cleaned them. I was totally amazed at the difference it made in this dog.

So I can recommend it with confidence as I have seen the results. It will even help dogs with really bad teeth- but of course it can't take the place of a full dental cleaning first.

So contact your vet and get a bag of the small bites.
As for your little old sweet man, I hope that you can find someone to resolve the issue with his craters.

Please let me know how he does.




---------- FOLLOW-UP ----------

QUESTION: Thank you so much for such a thoughtful and extremely helpful reply.  I really appreciate you volunteering your time and your expertise to help people.  People like you make the world go around.

I will approach the vet about fistulas at our next appointment this weekend.   Actually I hadn't noticed the "craters" in the dog's gums at the last appointment-- these were a new discovery for me last week.  The one I am worried about appears to be getting bigger every time I look at it (and I am not even sure if these craters are singular or plural).  

One big one started out as literally a gaping hole in the dead center of the side of the gum "ridge" and over about 3 days expanded/grew so that now there is a surprisingly large, upside-down U-shaped "dent"/hole/indentation in the gum ridge.  

Just an hour ago the dog bit me when I tried to touch his mouth (first time he has ever bitten me.  He has shown no reaction towards me touching his mouth/gums the past few weeks-- no apparent evidence of pain until just now).

As for the cheese, actually I am trying to get him to eat higher-calorie foods to keep his weight up.  He hasn't been eating much at all and even snubs his old favorites, and a week ago he needed a subcutaneous injection because he had lost so much weight (skin sprang back into shape just fine, bloodwork looked OK (no apparent signs of malnutrition/starvation) but you could count all his ribs easily).  For some reason, he is at times willing to eat cheese even when he won't eat anything else, including his favorite foods.

All my animals are on a human grade/"real" food diet (but I will look into the T/D for my three other dogs!).  I will need to experiment to see what foods are least painful for him.  Until now, I have been hand- (force-)feeding him ground up food using a needleless syringe on days he has refused to eat on his own (using the side of his mouth without the fistulas), even if only to get a little nutrition & liquid into him daily.  But tonight he bit me when I came anywhere near his mouth, so I am wondering whether he will let me hand-feed him at all in the future.

Would something like Ambesol (dental pain relief gel) be safe for a dog?  Or any other products that can deaden the pain for a little while, at least for the length of a hand-feeding?  Or, would that be a danger in that he would not sense the food entering his nasal passage?

I guess we are getting into "quality of life" issues here.  He seems genuinely miserable, and the pain seems constant.  He is normally a champion sleeper (20 hours a day-- very elderly dog, possibly older than the 16 yrs old we estimated) but is very restless now and awakens every 20 minutes.  So, maybe I have to think about end of life issues in the near or near-ish future.  But for now we'll fight on and do whatever we can.  I'm guessing that his gums/bones are so far gone that repair will not be an option, but I'll definitely look into that.

The rescue group didn't think that he would survive very long at all-- just wanted a place he could live out the end of his life in comfort-- but we are already starting month 14, so he's had a good run so far.  And still basically spunky and wonderful except for this one issue, so hoping for the best over here.

Answer
HI Anne,
I am glad you brought this up (the quality of life issue) because I didn't want to just yet, but it weighed on my mind the whole time I was answering your question. Because you are talking about an eroding gum (bone with it) this has to be very painful for this little guy. Some dogs get a condition where the whole upper maxilla will turn into a rubbery feel and start to literally dissolve away. I can't remember the name of it off hand but we have seen it in older dogs such as this one. I remember my boss taking the snout of this dog and bending it backwards like it was made of flexible rubber. Now it isn't always painful and I doubt if your dog has it, but the point is that these types of gum/bone issues are not uncommon and he could very well be suffering from one of them.

In that respect, you are correct- how much quality of life does he have if he is now in enough pain to bite at you. I wouldn't use Ambesol on him- the fistulas are much too large and it is toxic in large quantities. It won't really do the trick anyway since it is the food going up inside his nasal cavity that causes all the side effects, and the open holes are just plain painful all the time.

The eating away of the bone and gum have to be very painful to him. I can barely stand it if I get a sore spot on my gum from over-brushing my teeth! It is a very debilitating pain.

As far as the cheese goes- in this case forget what I said about it! Let the poor little guy have what he will eat.

You are facing a tough decision soon and if he cannot eat, or sleep very well (the pain doesn't stop in his sleep) then it's time to give him that one gift of ending his suffering. It's always a tough decision but for a little one in so much pain with no hope of relief there really isn't much else you can do.

I know it will be hard but I know you will make the right choice when it's time. And yes, that might be very soon.
Thanks for writing back and please let me know how he does.