Thursday, March 3, 2011

Does this tooth hurt? You betcha!

I get asked all the time by pet owners if I think their dog or cat is in pain.  The simple answer is that if it is something that would cause pain to a person, it will cause pain in a dog or cat.  What is different is how dogs and cats in pain behave compared to people.  The signs can sometimes be very very subtle.  Of course most of us would not miss a dog that just had its foot stepped on and is delivering an ear piercing cry that can be heard halfway down the block.  Puppies are particularly good at this and if anyone has a husky or a beagle, then you KNOW how loud they can be when they are hurt.  But this is a case of sudden onset of pain.  What about chronic pain?  How about an example.

Very early in my veterinary career, I treated a beautiful Golden Retriever whose name escapes me.  I'll call him Max.  Max lived on a farm and like a lot of farm dogs, he would occasionally go exploring in the woods.  One day Max went missing and didn't come home for 3 days.  When he finally showed up at the farm house, he was badly injured and his owner brought him into the clinic for me to examine.  Max's left rear leg had been shot with a high powered rifle.  The tibia leg bone below the knee had been shattered.  No, more like evaporated into nothingness.  Most of the skin and muscle was gone too.  There was a 1" wide strip of skin still there and that was all that was holding Max's lower leg and paw to the upper part of the leg.  So I walk in the examine room and here is this beautiful, happy, tail wagging, bouncing around on three legs, Golden Retriever.  He was so excited to see me and as he was bouncing around the exam room, the lower part of his left leg that was dangling by a strip of skin was twirling around every which way.  He never cried out.  He never slowed down.  Was he in pain?  I guarantee he was.  What happened was that he had just spent the last 3 days out in the woods adjusting to living with his pain.  Life goes onward in a dog's mind.  The end of the story was that I amputated Max's leg and he went on to live his happy Golden Retriever life.

The point of that story is two fold.  First, dogs and cats have nerve endings that send pain signals to the brain.  I am 110% absolutely positively you can't convince me otherwise sure that our pets feel pain.  Second, you cannot always tell if an animal is in pain by its behavior alone.  Sometimes you can, but sometimes you can't.  If there is something that you can see or feel that looks like it should be painful, then it is painful.

On to a tooth story.  Yesterday a regular client brought in her dog for me to check a tooth.  She had heard a story on the radio about dental health in pets and decided to look at her dog's teeth and a back tooth didn't look quite right.  Here is a picture of the tooth:

Do you see that pink spot on the tooth?  That is where the outer enamel has broken off the tooth and is exposing the pulp cavity of the tooth and yes, exposing the nerve.  Does that not make you cringe seeing that raw tissue exposed?  It makes me cringe.  I just wanted to rush over and give this client a big hug for being so observant and knowing when something didn't look right.  But I did restrain myself because, well, you know, it's probably not proper exam room etiquette to rush into someone's personal space and give them a big bear hug.  *grin*  I do just love it though when pet owners are really in tune with their animals.  Now this dog was not showing a bit of behavior that would make you think it was in pain.  I can guarantee this tooth was painful.  There are two choices for treating a broken tooth: extraction or root canal with a crown needed in some cases. In this case, the owner chose extraction which we did today.  This dog will go home with oral pain medicine for 4 or 5 days and then should be on her way to a painfree mouth.

Now I don't think that all pain needs treated in all animals (although we probably should be treating pain more often then we do).  If I bang my knee and it turns all black and blue and sore, I don't go reaching for the bottle of Advil right off the bat.  But I do think that animals hurt the same way you and I hurt.  I think different individuals have different pain tolerances too just like in people.  So while not 100% of pain needs treated, just know that even if they an animal is not acting painful, if you see something or feel something on your pet that looks like it should hurt, well, then it does hurt.  If you have any doubts, ask your veterinarian.

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