Dental post op complications...decision to make

If you have seen my other thread then you know some of what is going on. Now that I have some answers, and have a serious decision to make, I thought I would make a fresh thread explaining everything, and updating as time goes on.
Maddie had a dental procedure on Thursday and he had two extractions. One of those being an upper canine tooth. He was doing great the day after the procedure, but over the weekend (and of course the holidays) he started to go downhill. He was in pain and not himself.
I finally got him in to see a local doctor (his regular clinic was closed an extra day after the holidays) and found out that Maddie had the following complication from the surgery:
When the tooth was extracted the surgeon created a flap out of the gums to fold/suture over the extraction site, so it was a closed site and not an open one.
However the flap failed to take, meaning Maddie refused to heal that way, leaving him with an open site. This open site then got a whole bunch of food stuck up in the opening.this is what was causing the pain and irritation, also leaving possibility of infection.
So the tech cleaned out what she could from the socket. He was then given an injection of buprenorphine for the pain that will last three days, and sent home with antibiotics to prevent infection. We now need to follow up with the doctor who performed the surgery, for her to see what happened and to make a plan with her regarding treatment.
Basically I will have two options. Have the surgeon go back in and suture it closed again and hope it takes this time. Or let it heal on its own while keeping him on antibiotics and continuously cleaning out the socket and check ups every week.
If anyone has any advice or opinions on which would be the better option I would really appreciate it. I have an idea of what I would prefer based on what I can handle but I'm still open to both and I would love some outsider input. So please any suggestions are welcome.
I will update as things progress, and I hope to receive some helpful feedback. Thanks in advance.

Are you hesitant to go back to the previous vet because you think he may have done something wrong?  I can't say if he did or not, but if that's not the issue, I'd ask for his opinion about what he wants to do, as long as you're still confident in his work.

Either way, I'm glad you were able to get your cat into a vet sooner than the post-op you had scheduled!

So, essentially it was a dry socket and an infection?  If the flap failed before, then it might fail again.  If it were me, I'd opt for staying on the antibiotic (don't forget to also put him on a probiotic too, given several hours after the antibiotic) and clean out the socket after giving him buprenorphine, which might make it easier to do after doping him up.  

It was not technically a dry socket because that would be a dislodged blood clot. It was that the closure opened up leaving it open. The pain and inflammation was coming from it being filled with food. There was no infection yet, but antibiotics were given to prevent it because it's an open site now.

I'm honestly leaning towards surgically closing it again, only because it can take 3-5 months to close on its own. That's a long time of being on medication, and cleaning it out everyday all on my own for that long while also attending school is a lot to deal with. However surgery is only an option if there is enough tissue left to make a new flap.

I meet with his regular doctor on friday and will update you then based on the plan we make together.

I just want to note that I fully trust the original surgeon. This is not something that was done incorrectly, it's just an unfortunate complication that we could not have predicted. Even the doctor that we went to yesterday said that everything looked beautifully done, and the socket itself was clean and healthy. They wanted to remove a price of the dead flap but they couldn't because it was sutured in so well. I have full confidence in his original surgeon.

Ginny said:

 If it were me, I'd opt for staying on the antibiotic (don't forget to also put him on a probiotic too, given several hours after the antibiotic).  

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Can you elaborate on the probiotic? I don't have experience with them but I would like to look into it if he needs to be on antibiotics long term. How safe are they? Do they interfere with the antibiotics? And do you have any reccomended products? Thanks in advance!

Maddies Momma said:

 

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Can you elaborate on the probiotic? I don't have experience with them but I would like to look into it if he needs to be on antibiotics long term. How safe are they? Do they interfere with the antibiotics? And do you have any reccomended products? Thanks in advance![/quote]
There's a good thread here on TCS about probiotics: http://www.thecatsite.com/t/262587/probiotics-search-human-grade-and-cfus

And one on using Human probiotics vs pet specific ones: http://www.thecatsite.com/t/327724/human-vs-cat-probiotics-please-help

A great read with suggestions for Human probiotics and recommended doses is http://www.rawfeedingforibdcats.org/probiotics-for-cats---why-and-which-ones.html

Probiotics are "good bacteria" that live in the gut and replaces what antibiotics kill off as they work. Probiotics are safe to use. I don't think the pet specific ones go through any rigorous testing and safety assurances like Human ones do. They may come in pet-approved flavors like chicken and fish while the Human ones are unflavored and undetected by cats when mixed into food (you open a capsule and sprinkle the powder into canned food).

Maddies Momma said:

 

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Can you elaborate on the probiotic? I don't have experience with them but I would like to look into it if he needs to be on antibiotics long term. How safe are they? Do they interfere with the antibiotics? And do you have any reccomended products? Thanks in advance![/quote]
First of all,  to what @LTS3  said!  

Antibiotics either kill gram positive bacteria or gram negative bacteria or both in the gut.  The problem is that when good bacteria are killed off, the bad ones and opportunistic ones can then over grow, like yeast.   So probiotics are used to repopulate the gut flora that protects the necessary mucosal lining that protects the intestinal surface.  That lining prevents bad guys from getting from the intestines out into the peritoneum (which is supposed to remain sterile) or worse into the bloodstream where you can get an overwhelming infection.  Here's a good link I just found.  This is for humans though so keep this in mind.  But our pets get similar diseases that we do because they live with us, and we feed them processed foods.  

http://www.globalhealingcenter.com/natural-health/4-toxins-that-are-destroying-your-gut-health/

It's been said that good bacteria that live in our gut comprise up to 70% of our immune system.  I guess that's comparable in a cat as well, but I don't know how to extrapolate the info to apply to them.  Their intestinal tract is shorter and the transit time is much quicker than ours.  For right now I've been using Jarrow's Petdophilus for my kitties.  I do not have product loyalty though.  I'm always looking for something better  I use this product with every meal, to help their immune systems.  It seems to help them.  Others here speak highly of Bene-bac.  

I agree that maybe the surgery would be better since you wouldn't want to keep him on an antibiotic for months while the hole closes slowly.  Wish there was another option though.  I hope it works this time!

My  Mr. Grimsby got a raging infection after the vet pulled an infected tooth. He'd tried several antibiotics before the procedure, but Mr. G threw up every one of them. I noticed that he was spending a lot of time on a receiver that was plugged in and stayed warm all day. When I finally got him back to the vet, he had to be put on intravenous antibiotics in the clinic for a week! And when he came home, he was on a course of oral antibiotics that he also threw up for a week. The vet gave me something that smelled like bananas to help him keep the medicine down.

Honestly, if I had a choice of sending him through surgery again or going the antibiotic route, I'd opt for the surgery. I know how much Mr. G suffered on that medicine and I wouldn't wish it on any other cat :-(

Good luck with Maddie. We hope all goes well!

PHarber-Murphy said:

My  Mr. Grimsby got a raging infection after the vet pulled an infected tooth. He'd tried several antibiotics before the procedure, but Mr. G threw up every one of them. I noticed that he was spending a lot of time on a receiver that was plugged in and stayed warm all day. When I finally got him back to the vet, he had to be put on intravenous antibiotics in the clinic for a week! And when he came home, he was on a course of oral antibiotics that he also threw up for a week. The vet gave me something that smelled like bananas to help him keep the medicine down.

Honestly, if I had a choice of sending him through surgery again or going the antibiotic route, I'd opt for the surgery. I know how much Mr. G suffered on that medicine and I wouldn't wish it on any other cat :-(

Good luck with Maddie. We hope all goes well!

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Thank you for your support! I'm so sorry you had to go through that with your boy! Is everything okay with him now?
So far Maddie seems to be fine with the antibiotics, but he is on a very minor antibiotic as a preventative. I still wouldn't want him on it long term.
I'm hoping we will be able to choose the surgery, but it all depends on Wether there is enough healthy gums to create a new flap to close it. We will see what the surgeon says!

No, I'm sorry to say that we had Mr. G put down in February this year. It wasn't the tooth or the infection that finally got him - it was just plain old age. He was somewhere between 17 and 20 years old. The rescue where we got him told us he was three; the vet who saw him a few days later said he was at least seven. That's why we don't know how old he was in the end.

He was one tough kitty cat, though! After we got him, he had several teeth pulled (besides the one that was pulled with an active infection and gave him septicemea (sp?); a radioactive iodine injection because he couldn't handle Tamazole in either pill or cream form; another tooth extract with the resulting septicemea; and several weeks of intravenous fluids before he finally crossed the rainbow bridge.

I loved him dearly and think about him every day, but we adopted Albert a few months later. He's been a terrific addition to our little family and it brings me joy to see our Bertha, who's about 10 now, playing with him. She got a new lease on life herself.

I'm glad that your fellow is doing well on the antibiotics. Be sure to get some pre- and probiotics into him, as someone else suggested earlier. Keep us informed on your progress.

Good luck

UPDATE: hey everyone, I just wanted to say thank you so much for all of your advice and support! I have some good news to share.

Maddie had an appointment with his regular doctor today and it's good news. Although there is still a large opening in his gums because such a large tooth was removed, the actual wounded area has healed over nicely. She said it is all healthy tissue now. The actual extraction hole is fully covered in normal healthy "mucosa". It will still be a very long time before the opening shrinks and closes in, but there is no longer any open wounds. All we need to do is keep an eye on it and keep it clean, but it should be just fine. She had no concerns about needing to reclose it or keep him on long term medication. She said everything is covered, there is no bone exposure or dry socket so he should not feel any pain. We will finish the antibiotics that the other vet prescribed, but other than that no meds required. He is not on any pain meds now and he is happy and playful. I'm sorry I can't explain as well as the doctor, but I hope you get the general idea. Long story short, maddie is doing well and all I need to do now is keep it clean and keep an eye on it.

Just heard the good news that Maddie will be okay.  Again, thanks for sharing

We are so happy to hear that Maddie is doing well I know it was quite a scare, but she will be fine now. It's a tremendous relief. Best regards to you both!

Phyllis

One thing I forgot to ask the doctor is when will he be allowed to have hard/dry food again? The post op instructions said 7-10 days, but I'm sure those didn't take into account the complications he would have. I would imagine play it safe and feed canned for a few weeks to allow the newly healed tissue to strengthen/harden. He got so many nice treats for Christmas and I'm super tempted to let him have some, but I don't want to hurt his mouth. Any thoughts?

Maddies Momma said:

One thing I forgot to ask the doctor is when will he be allowed to have hard/dry food again? The post op instructions said 7-10 days, but I'm sure those didn't take into account the complications he would have. I would imagine play it safe and feed canned for a few weeks to allow the newly healed tissue to strengthen/harden. He got so many nice treats for Christmas and I'm super tempted to let him have some, but I don't want to hurt his mouth. Any thoughts?

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When you cross that bridge with complications if there are any, then

just follow the post op instructions which should have indicated what

can or cannot be fed to your kittie Maddie who should come through this

with flying colors.  When in doubt, pick up the phone and call the

vet.  

jimmycatlover said:

When you cross that bridge with complications if there are any, then
just follow the post op instructions which should have indicated what
can or cannot be fed to your kittie Maddie who should come through this
with flying colors.  When in doubt, pick up the phone and call the
vet.  
:heart3:

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He has already had complications leaving him with an open extraction site, that's why I am unsure.

Maddies Momma said:

One thing I forgot to ask the doctor is when will he be allowed to have hard/dry food again? The post op instructions said 7-10 days, but I'm sure those didn't take into account the complications he would have. I would imagine play it safe and feed canned for a few weeks to allow the newly healed tissue to strengthen/harden. He got so many nice treats for Christmas and I'm super tempted to let him have some, but I don't want to hurt his mouth. Any thoughts?

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You could always put the hard food in a blender and crunch it up fine, or put it in a bag and take a hammer to it. You could use it as a topper to his canned food.  I'd still wait though the longer he can wait the better.  

Maddies Momma said:

He has already had complications leaving him with an open extraction site, that's why I am unsure.

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Thanks for sharing.  Did you call the vet for assistance.

Hope it gets better and your Maddie is not in any pain.

I thought the open extraction site was healing as per

your vet.  

jimmycatlover said:

Thanks for sharing.  Did you call the vet for assistance.
Hope it gets better and your Maddie is not in any pain.
I thought the open extraction site was healing as per
your vet.  :heart3:

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Yes the site is healing and he has recovered from the complications. The earlier update still stands. However the confusion about feeding is that he still has a large opening where the tooth was. It is healing tissue but it's still an open extraction site. It will take months to close in and maybe not even all the way. It's not painful anymore because it's healthy tissue. The post op feeding instructions were in regards to a closed extraction site not an open one.