Buddy's COHAT
Buddy's Dental Procedure at Pioneer Paws Veterinary Clinic:
Buddy was a 9 1/2 year old terrier mix in April of 2010.  Buddy's dad was aware that
Buddy had very severe dental disease and brought Buddy to Pioneer Paws for Dr.
Songster to examine.  Dr. Songster quickly determined that Buddy needed to
have his teeth cleaned and evaluated and would likely need to have many teeth
surgically extracted.  The rest of Buddy's physical examination, however, was
quite normal - his severe dental disease was certainly his most significant health
concern.  Buddy's dental evaluation was scheduled for June 14th, 2010.  This
page describes Buddy's dentistry experience here in our hospital.
Buddy's Check-in Process:
Buddy presented for a "COHAT" which stands for a "Comprehensive Oral Health
Assessment and Treatment" procedure. Jim went over the "COHAT" estimate and
explained the surgery (because any tooth extraction should be considered a surgical
procedure) and anesthesia consent forms. Buddy's dad was able to see Buddy's
kennel where he would stay during his time with us.  Buddy's dad had made sure that
Buddy didn't have anything to eat since 9 pm the night before so Buddy was ready for
surgery.  Jim placed an ID tag on Buddy and Buddy's dad left emergency contact
information before saying good-bye.
Buddy's  Pre-Anesthetic Evaluation:
Buddy's Anesthetic  Procedure:
Buddy's Full Mouth Dental X-rays (Radiographs):
Our first step once Buddy was at an appropriate plane of anesthesia was to take
x-rays of his teeth.  All patients have all of their teeth x-rayed when they come in
for a dental evaluation.  It is amazing what problems we find on the x-rays when the
teeth "above the gumline" look great. Sometimes several x-rays are taken of one
tooth from several different angles.  We use the same dental x-ray film that your
dentist uses and the x-ray camera is the same as well.  The x-rays are then
developed in a "chair side" developer as it is called in human dentistry.  A more
appropriate name for us would be "table side" developer. Sally can develop the
x-rays while still keeping an eye on Buddy.  The developing process is very quick
and several x-rays can be processed at one time.
These are x-rays of the teeth
present in the upper right jaw.  
Note the large black area in the
center of the large tooth - this
is severe bone loss caused by
bone infection.
These are x-rays of the upper
incisors - see how the teeth
almost seem to be floating in
space rather than surrounded
by white jaw bone.  This is an
example of "bone loss"  
caused by deep seated
infection under the gums.
The tooth shown on the x-ray to
the left is the tooth all the way
to the left in the picture.  
Doesn't look too bad in the
picture, does it?  X-rays tell
"the rest of the story"!
Pioneer Paws Veterinary Clinic, PC,          12399 Olean Rd.,  Ste D                     Fax (716)492-1222
(716)492-1200                                                     Chaffee,   NY,   14030           Email:  pets@pioneerpawsvetclinic.com
First Dr. Songster did a complete physical examination.  Even though Buddy was
seen a month and a half earlier, Buddy again received a physical exam.  Many
things can change in a short period of time.  Dr. Songster found that Buddy had a
very small skin lump on the top of his nose.  This lump appeared to be an
"adenoma" or very benign little skin tag that could easily be removed while Buddy
was under anesthesia.  Next Sally drew Buddy's blood for his pre-operative
laboratory tests.  Buddy's complete blood count and chemistry profile were
completely normal and his heart worm test was negative.  We also collected a
urine sample to measure his urine concentration ability - this was also normal.
Buddy then received a "pre-medication" injection.  This injection contained three drugs - a
pain medication, a sedative, and an anti-anxiety medication.  The purpose of this injection was  
to get a jump-start on any pain that the surgery would cause as well as to help Buddy relax.  
About 15 minutes later, Sally placed Buddy's intravenous catheter and started him on
intravenous fluids.  His fluids were administered using a fluid pump that closely regulated the
rate of fluids.  Buddy's fluid pump followed him through his dental procedure and then into
recovery as well.  Now Buddy was ready to undergo general anesthesia.  He received a
short-acting general anesthesia injection intravenously through his IV catheter port to make
him lose consciousness.  Once he was unconscious, Sally placed an endotracheal tube down
the back of his throat into his trachea (airway).  Buddy was then hooked up to an anesthesia
machine that supplied a constant source of oxygen and a gas anesthesia agent to keep him
anesthetized.  We constantly monitored Buddy's vital signs including his heart rate and
respiration rate and adjusted the amount of gas anesthesia accordingly.  We also constantly
measured his temperature and made sure he stayed warm throughout the procedure.
This picture shows what the
teeth actually looked like.  
All of the incisors needed to
be removed.
Examples of Buddy's Dental X-rays
Buddy's Oral Exam:
After Buddy's dental x-rays were taken,
Dr. Songster examined his mouth tooth
by tooth.  She carefully probed the gums
around each tooth and visually  
inspected each tooth.  Sally carefully
recorded these exam findings in Buddy's
medical record.  Dr. Songster used the
results of the oral exam and the x-rays to
determine her treatment plan.  Since
Buddy had such extensive periodontal
disease, Dr. Songster determined that
she needed to extract 24 teeth!!  14 teeth
were already missing so Buddy would be
left with only 4 teeth!!
Followed by Buddy's Dental Surgery:
In order to extract these 24 teeth quickly, safely and
completely, Dr. Songster needed to perform oral
surgery (not just pull the teeth).  Dr. Songster first
made an incision in the gums and then lifted the gum
tissue away from the jaw bone.  She cut the crown of
the mult-rooted teeth in order to separate the
individual roots and then removed some of the jaw
bone holding the tooth in place using a high speed
drill (just like our human dentists use).  She then
gently "elevated" or loosened the tooth.  This
process requires sterile dental surgery tools, a high
speed drill, lots of light and cooling water spray, and
most importantly - a licensed veterinarian.  (Believe it
or not, unlicensed assistants are responsible for
teeth extractions in many veterinary practices.)  After
removing the teeth, Dr. Songster then stitched the
gums together so the mouth will heal free of pain and
infection.  She also removed the little lump on his
nose as well.
Teeth Cleaning and Polishing Procedure:
Sally carefully rinsed Buddy's mouth out and turned off his anesthestic gas.  Once he
regained the ability to swallow, she removed his breathing tube (endotracheal tube).  She
then placed Buddy in a warm padded recovery kennel in our ICU unit where she carefully
monitored him for the rest of the afternoon.  When Buddy was completely awake and able to
then offered him some dinner.  After Buddy received his final pain medication injection that
would last overnight, Buddy's dad came to pick him up.  Jim went over Buddy's discharge
instructions and made Buddy's follow-up appointment.  Jim made plans to call Buddy's dad
over the next few days for updates.  Buddy's dad told us Buddy did great!!  Sally saw Buddy
back for his recheck exam and his mouth looked perfect!!  Buddy was now a very happy dog.
After Dr. Songster finished Buddy's oral surgery, Sally completed
his dental treatment by completely cleaning and polishing his four
remaining teeth.  This cleaning and polishing process is very
important to prevent further periodontal disease and will help
keep Buddy's mouth as clean as possible.
Buddy's Anesthetic Recovery and Discharge:
Using the drill
Starting surgery
Loosening the teeth
The teeth are gone