Case Study – Eye and Ear issue in a geriatric patient!
The diagnosis – Dental Disease!
The main reason Tess was brought in to see her Fur Life Vet was because she was rubbing her right eye and ear. But the final Diagnosis was dental disease! 13 Year old Tess, a bright and friendly Border Collie, presented to Fur Life Vet Echuca Clinic with fur loss around the right eye and ear and smelly breath. It later became apparent that this behaviour was linked to tooth root pain, as the behaviour soon resolved following extraction of the rotten teeth!
Tess is a shy girl so we have used a photo of another gorgeous old Border Collie in this Case Study!
The Examination
Eyes
Examination of her eyes showed signs of cataracts, not unexpected in an elderly dog, and on the right eye, the third eyelid was exposed and coming across the front of the eye. Further examination of the right eye was performed with Fluroscein staining revealing a 5mm superficial ulcer.
Ears
Right ear hairless, red and mildly thickened. The opening to the ear canal was waxy and narrowed. Her left ear was normal.
Teeth
Strong halitosis (ie. Bad breath). Several rotten and wobbly premolars and molars. Also, severe gingivitis and gum recession around the canines.
Diagnosis
- Superficial ulceration of the right eye and inflammation of the right ear – could these injuries be as a result of her rubbing her face due to dental pain?
- Grade 4 periodontal disease (ie. Dental disease).
- Mild, non-regenerative anaemia and an elevation of mature white blood cells (ie. a stress leukogram) on the pre-anaesthetic bloods.
- These findings reflect chronic infection of the mouth, associated with the severe dental disease.
Treatment
- Antibacterial eye ointment (Chlorsig) was prescribed for the ulcerated eye. Tess was also given a Bravecto oral chew, to rule-out external parasites (such as mites) as the cause of hair loss and itching around the right ear and eye.
- Tess was booked for a dental and otoscopic examination of the right ear under anaesthetic.
However, 10 days later, despite the chlorsig eye drops and parasite treatment, Tess continued to rub at her right face and ear. The dental was then performed.
The Dental
Given Tess’ advanced age, her anaesthetic regimen was adjusted to minimise the blood pressure-lowering effects in geriatric patients: She was given premedication and maintained on a constant low-rate IV infusion in order to provide profound pain relief. Local nerve blocks were delivered in the mouth for further pain relief before extractions.
The extractions:
17 teeth were extracted. Many could be easily pulled out, due to how rotten the roots were. There was a grass seed embedded in the gums around a rotten tooth of the upper right jaw, which was extracted.
Other procedures performed under the anaesthetic:
Gentle debridement of the scarred edges of the right eye ulcer with a moistened cotton bud, to promote healing.
Otoscopic examination:
Examiniation of the right revealed a narrowed ear canal, excess wax but no foreign material. The ear drum appeared intact and healthy.
The Outcome
Recovery from the anaesthetic and extractions was rapid: Tess was bright and eating her dinner and medications within 30 minutes of waking from the procedure. Several medications were prescribed after the dental, including: oral Pain relief for 7 days, medicated ear drops for the right ear, and antibiotics for the infected gums and bones of the mouth.
Recheck: A dental recheck was conducted 12 days later. The owners were very happy with the outcome; they reported her stinky breath had cleared, her appetite had picked up and she’d stopped rubbing at her right eye and ear. Examination of the right ear revealed the wax and redness had cleared. Fluroscein staining of the right eye showed a reduction in ulcer size to 1 x 1mm, and her third eyelid was no longer exposed. Furthermore, Tess’ anaemia had resolved, with her red blood cell percentage having returned to an acceptabel level.
Nine months on: Her owner says ‘Tess is now enjoying her food, including bones. The dental surgery has made a huge difference in her quality of life. She is now a Happy Puppy.’
Conclusion
This was an unusual case of dental disease in a geriatric patient. The main reason for Tess’s vet visit was not her teeth – it was that she was rubbing her right eye and ear. It became apparent that this behaviour, the hair loss, and potentially the eye ulcer and redenned, waxy ear were linked to her tooth root pain, given the behaviour, and symptoms were soon resolved following extraction of her rotten teeth.
Looking after your pet’s teeth can help them maintain a healthy and happy life!
Did you know that Best Mates Members get a FREE Dental Scale and Polish with every year of membership*
Prevent dental disease before it starts with a Fur Life Vet Best Mates membership!
* Best Mates Membership provides for a Free Dental or Desex per 12 month membership.
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