By Sally Foote, DVM
There are some cases you never forget. The ones that improved despite all odds and the ones that fail horribly. I had a case where the dog improved immediately in ways I never would have imagined. To date, I always think about the impact of dental pain that may only present as aggression.
A neutered male Shih T Zu named Tinker was in my office for a wellness exam. Tinker was extremely difficult, if not impossible to examine. He would growl, snap, lunge all at once for exams–like a Kabuki puppet. Even if I just approaching the exam table, he would suddenly burst forth with growls, snarls and flying hair. This was in the early days of using Low-Stress Handling so did not have the pheromones, supplements or medications to reduce his anxiety; all I could offer were treats. He was always too agitated to take them. My exam routine was a quick towel draped over him as I quickly drew blood, vaccinated or whatever was needed. He was pretty well groomed so I assumed that he was not difficult for that. The clients loved him, and to my knowledge he was not a problem for them to take care of.
One day, as Tinker was lunging, and even more upset than usual, I noticed that he was matted all over. It turns out he was biting the groomer and the owners were attempting to groom him at home. Trying to brush his matts would cause him to nip at the owners. I offer grooming him under anesthesia to get him cleaned up. The owner asked if I could check his teeth and I said “Of course!” Since he was asleep it was a prime time to do all that we could. Tinker had not lost weight, avoided eating, or had any obvious signs of mouth pain.
After the anesthetic took effect, I began the mouth exam. Tinker had horrible periodontal disease. It was not that dental disease surprised me, but the degree of infection in his mouth that did. He did not show any obvious mouth pain – no drooling, pawing at the mouth, ate well, etc. But here it was, a mouth full of severe tartar bridging multiple teeth, deep gum pockets and pus draining around the upper 4th premolars. I immediately started to reduce the tartar and extract the problem teeth. As I recall I removed about 16 teeth including numerous two and three root teeth. He had two out of four canines left and the larger molars on the lower jaw by the time I was finished. He was on IVs, pain medication, and local anesthetic blocks around the extraction sites. Tinker recovered well with very little evidence of pain. I am certain he had some pain, but he was managing well.
Later that day when the owner came to pick Tinker up, I talked to him and explained to him the extent of the dental disease. We went over the antibiotic, soft food, and pain meds to be given at home. I set up a recheck in a week to assess how Tinker was healing. As the tech walked Tinker into the exam room where I was with the client, he was wagging his tail and came to me! Remember this was the dog that would lunge and growl at any sight of me. I gently stroked his back, and he kept wagging his tail! No growling, lunging, or tension. I commented that he must be feeling the benefits of the anesthetic and pain meds to be so sweet. I was very surprised. The owner laughed and said “Maybe he is feeling better already without those teeth.” I really doubted that, but did not say anything.
The next week, Tinker came in for a dental recheck. I was not sure how I would do this, but I would try. Tinker came into the exam room and accepted treats readily. That was new – Tinker typically refused any rewards and would go right into aggression but not today. Tinker did not snarl, growl or lunge at all as I approached. He allowed me to do a full exam, and even look under his lip at his healing teeth. I was stunned. The owner told me he was more active and much better behaved at home. We discussed keeping his coat short, and home care for his teeth. I can still remember feeling a sense wonder, awe and discovery that maybe we found the source of his aggression.
From that day forward, Tinker was a great dog at my office. He had not shown the typical signs of mouth pain, so I did not think of his teeth as a source of the aggression. I just thought he was a difficult dog. Fast forward to 2018. Today we have more information about the physiological changes that chronic pain has on the brain and the body. Now whenever a dog is presented with aggression, I screen closely for any possible pain trigger, even if they are not showing typical signs of pain. In evidenced-based medicine, we are trained to find the source of pain before treating for pain. The aggression may be due to guarding their body to avoid any touch that would be painful. There may also be a change in serotonin levels and other brain chemistry resulting in increased aggression. If you see an increase in aggression, consider pain as a trigger. Teeth are often a source. This was the profound lesson that Tinker’s case taught me.