I recently received a question from a person whose dog experienced a complication after dental work at the vet’s office:
Our older Dachshund (he is 12 to 13 years old) had his teeth cleaned over six months ago. The vet decided a few teeth were too far gone to save, and extracted them. One of these was a carnassial tooth. The extraction site has never closed, leaving a gaping hole in the roof of his mouth. Now, when he eats, food gets in the hole and up into his nose, causing some pretty violent sneezing jags. I will admit when I saw this huge hole in his mouth post-surgery, I was frustrated with the vet for not stitching it closed.
The vet now tells me my dog needs to be on antibiotics the rest of his life! I know antibiotics can cause havoc with the human body — how safe is it for a dog of his advanced age? Does he truly need to be on this forever?
Tomi, it sounds like your dog has an oronasal fistula. This nasty-sounding development is an uncommon complication of dental work.
The roots of the teeth are embedded deep in the bones of the face and reach almost into the nasal cavity. In rare instances, when a tooth is removed (or falls out on its own), a permanent hole can develop between the nasal cavity and the mouth. When dogs with oronasal fistulas eat, food can pass from the mouth through the hole and into the nose. Once in the nose, the food can cause irritation (manifested in your dog’s case by sneezing) and chronic sinus infections.
Improper extraction, especially of the canine teeth (the big fangs in the front), can damage the bones of the face and cause a fistula. Alternatively, infection associated with severe dental disease can eat away the bone and progress all the way into the nasal cavity. This, in my experience, is a more common cause in the rear teeth (such as the carnassials, which are the biggest, most stressed, and generally most problematic of the teeth in the back).
About two-thirds of the fistulas I have seen have been in Dachshunds.
Tomi, I am not convinced that your vet did anything wrong. There is a good chance that deep infection corroded the bone surrounding the tooth root, leading to the problem. If the tooth was severely infected, it would come out one way or another (either through extraction or through the process of falling out on its own after years of pain) and the fistula was going to form. Remember that it is the defect in the bone that is the big problem here — even if your vet had closed the gum tissue with sutures, it probably would have re-opened.
I disagree, however, that your dog needs a lifetime of antibiotics. Antibiotics, as you mentioned, do sometimes wreak havoc on the body. However, the much bigger problem is that long-term antibiotics can cause the bacteria in the body to become resistant to the drugs and therefore much more dangerous.
The good news is that oronasal fistulas can be repaired. Although the underlying bone probably can’t be replaced or repaired, a special procedure using “flaps” of gum or cheek tissue can effectively close the hole in most cases. Some general practice vets are comfortable performing this procedure, and others (I’m guessing your vet is in this group) refer patients to specialists in veterinary dentistry.
If I were in your shoes, I would have the fistula repaired before I’d even consider antibiotics.