Friday, 13 November 2015

BRACHY WEEK: frite bite

This is what a healthy dog mouth looks like (well, other than the chip to one canine tooth): clean, no decay, even colouring. Note in particular the spacing - between both the teeth and the ridges in the hard palate (what are called the palatal folds).

Now look at this mouth. Note the rotation of the teeth, the over-crowding, the red-raw infection evident in  the puffiness of the soft tissue around the base of the teeth.This mouth belongs to a three-year-old Pug. After surgery, this dog was sent home by veterinary dentist Fraser Hale without any instructions to brush. His reasoning: "I think this would cause undue respiratory distress (she can hardly breathe without someone poking around in her mouth)."

And how about this one - a 4-yr-old Bulldog? In this case, fur and debris has got caught between the teeth and caused a purulent discharge. This dog's breath would have flattened a warrior.

Even in the more moderate brachycephalics, the palatal folds can trap fur and debris. These pictures are of a 5yr-old Boxer.

This dog also had a problem with his lower incisors - essentially subsumed by infected puffy tissue that had to be drained.

This radiograph shows what a healthy canine jaw looks like.

For comparison, a Boston Terrier jaw. Note the crowding/overlapping.

The inside of this Boston's mouth looked like this.

This is what happens in later life for some - this is a 8yr-old Shih Tzu that ended up having to have 26 teeth extracted.

And another.

Dr Hale says some brachycephalic dogs will escape the worst of this;  also that good dental care can help mitigate some of the problems. But he also says that he has never in his whole 30-year career seen a single normal brachycephalic mouth. 

It's sobering, isn't it?

Brachy mouths are, says Hale, "accordioned". Not entirely sure that's a word - but it's very descriptive.  We have all spent (me included) so much time concentrating on the more obvious repercussions of shortening the muzzle (the breathing, the overheating, the danger to eyes), that we have neglected an area that must surely be a source of chronic, grinding pain for many brachycephalic dogs.  After all, don't we all know how head-bangingly awful it can be to have just one infected tooth?

"It is a myth that dogs don't feel pain the same way we do," says Dr Hale. "They have the same pain thresholds and tolerances as humans. They react and withdraw/defend at the same level of stimulation and have the same physiologic reactions to pain as humans. Research shows that this is true across all categories of pain, including dental pain."

Dr Hale says he frequently gets reports from owners saying that their dogs are much happier and more energetic after rehabilitation of "a sewer mouth". 

"The owners are unaware of how much their animals are suffering until we remove the problem and the improvement is there for them to see. And they smell much better so are more pleasant to be around.

"There is also a growing body of information in both human and veterinary medicine that a chronic source of inflammation anywhere in the body can have negative impacts on many body systems."

I hope people will be shocked by these pictures.  We simply cannot continue inflicting this kind of pathology on dogs simply because we think it's cute. It isn't just the brachcephalics in this case either - many toy breeds (and of course crosses) have terrible teeth, too - awry, infected, impacted or missing.

I blogged about Fraser Hale two years ago (see here), after he had spoken out very strongly about brachycephalics in an article in the Canadian Veterinary Journal. If you haven't read that piece, you can check it out here.

Earlier this year, Dr Hale followed it up with another opinion piece in the Canadian Veterinary Journal - this time addressing the  dilemma vets face when dealing with owners of breeds that are fundamentally physiologically flawed.

Here it is in full.

The Popularity Paradox

by Dr Fraser Hale

We are told that clients do not care how much we know, they want to know how much we care. In other words, being clinically competent and medically honest with our clients it far less important to them than us lavishing praise and affection and treats on their beloved pet. And this puts us all into a serious conflict of interest.

Private practice (even institutional practice) is a popularity contest. Pet owners have a lot of choices and are free to go where they please. If they find a visit to ABC Animal Hospital a cheery and happy experience, they come back. If they find the experience unpleasant in some way, they may just go somewhere else. So imagine this scenario:

Jane and John Doe have been married a year and have just purchased their very first pet, an 8 week old (let’s just pick one) English bulldog. They have had it for a week and are completely in love. They chose this breed because they saw pictures on the internet of some bully pups and videos of bulldogs riding skate boards and bouncing on trampolines. Now they are coming to you, bubbling with pride and enthusiasm, for post-purchase examination and vaccines. They chose your practice because your website features stock images including some of bulldogs, so obviously you love the breed too.

Now, you know that a bulldog is a money pit and will be prone to a host of physical and metabolic maladies, from brachycephalic upper air way issues, to horrible dental/oral anatomy/heath to orthopedic issues, skin-fold dermatitis and gale-force flatulence. Hot weather and exercise could be fatal. As the owner’s source of medical information, you have a moral and professional obligation to inform them of these issues so that they can be prepared to manage them, will know what to look for, will know what to avoid and so forth.

At ABC Animal Hospital, as soon as the Doe’s walk in with Princess Snuffles (PS), the staff start gushing about how adorable she is. During the examination, the DVM similarly expresses shared joy over the puppy and how much she is going to add to the Doe’s life together. Treats and cuddles are lavished on PS. The owners leave feeling thrilled that everyone at ABC also loves PS. But down the road as the problems start to express themselves and the visits become more frequent and expensive, the Doe’s question why you did not warn them of all these problems. Had they known, they would have returned the dog and selected a dog with a healthier build and constitution. Now it is way too late. They are deeply bonded to their fur-lemon.

In another scenario, the Doe’s go to XYZ Veterinary Clinic. After a reserved exchange of pleasantries and “Welcome to our practice” chat, the professional staff starts to evaluate PS. In so doing, they find a number of architectural concerns that are already evident and these are pointed out to the Doe’s. Then follows a list of anticipated problems, including reproductive concerns (did I mention that the Does plan on breeding PS because she is from such good lines and they are looking to make a few dollars besides?). Do you tell this naïve young couple that their precious prized (and expensive) new family member is seriously deformed in ways that are going to have a serious negative impact on its quality of life and longevity? If you spend their first visit going over all of the problems the dog has now, is going to have in the future and what they can expect this will all mean, they might leave your office feeling foolish for making this breed selection choice or angry with you for expressing your obvious disdain for their fur-child. The tone of the visit is negative and they leave feeling badly and thinking that they will not be back to see you because you obviously do not love Princess Snuffles the way they do.

Here is the conflict then. We have a moral and ethical obligation to provide our clients with accurate and valid clinical information and recommendations, including what problems to expect and how to avoid them (preventative medicine). But if we are truly honest about many of the deformed and unthrifty breeds that are so popular these days, we run the risk of alienating our clients and driving them away (to other clinics, Dr. Google or their breeder). So we may be inclined to hold our tongues and sugar-coat our interactions with our clients.
Fraser Hale


  1. Thank you for this post. Animal rescues are full of purebreeds no-one wants amongst other things because of their constant disorders and the expense and attention they require.

    1. The majority of animals in rescues are pitbulls in the US. Not bulldogs, pugs, cavaliers, etc. Not the breeds with the most health problems either.
      Also, a lot of mixes are in shelters too.

      In the UK there are a ton of Staffies, Lurchers (mix), Collie crosses, German shepherd crosses, terriers, etc.

      Here is an extremely large rescue organisation in the uk that has multiple centers across the UK.
      What are the most common dogs in these shelters?

  2. not in the USA we are importing more "rescue" dogs by the 10's of thousands to fill the need for pets .. of course all of them will live forever and have perfect teeth..none will weigh more than 15 pounds ( except the meat dogs which are Tosas which are outlawed in the UK and will weigh over 100 pounds which is even small for the breed) why because they are "rescues' and are perfect and require no special attention and will never have a health problem and they do not have any cost of care.. oh and I have a nice bridge to sell it is golden .. you can afford it because you have a "rescue" and were not foolish enough to buy a dog from a good breeder

  3. Yes, dental pathology is another serious problem that comes from shortening the snouts of canids and felids. Simply put, there are no brachycephalic carnivorans in nature, and breeding domestic ones that way damages them. This is the truth, and to state otherwise is to delude oneself and others.

    Technically, "brachycephaly" just refers to a certain length to width ratio of the skull, ie a shorter, broader skull, as opposed to moderate (mesaticephalic), or longer, narrower skull (dolichocephalic). The only really functional, healthy brachycephalics are robust molossers like Dogo Argentino, cane corso, pit bulls, etc, which is really only mildly brachycephalic; the slightly shorter, broader skull has a stronger bite, without compromising dentition, breathing, cooling, biting, etc. Anything shorter than that - anything at all (boxer, Boston, bulldog, pug, etc.) is going to be screwed up. Why would anyone allow that? Ignorance or apathy.

  4. It's unfortunate but it is I imagine often left to vets to have to educate after the fact. Maybe they should hang pictures like these in their clinics with clear explanations. Why wouldn't they, if they cared enough?

    I don't see the conflict at all. I do see why some vets would be inclined to sugar- coat interactions with clients, those are the vets to avoid!?

    Obviously not everyone thinks alike but finding the right vet is quite an important part of dog ownership.

    Obviously not all vets are alike but if they're afraid of losing customers because they tell owners their dogs will need more regular dental check ups because of their breeding they shouldn't be vets.

    It's a harsh reality for uneducated pet owners, but they will face it one way or another eventually. Maybe a somewhat delayed respect for their vet will make them go back to the vet that tells them the most truth about their dogs and how to deal with it.

    Blaming breeders might be a more diplomatic way forward, as some owners will it seems continue to buy dogs when they don't know much about them at all.

    Depends on your Google but using Google UK it wasn't until about the forth or fith page I found anything to tell me bulldogs were anything other than magnificent, courageous, British and affectionate. When I did it was for "Leavitt bulldogs", an alternative to the show bulldog though how healthy they are I don't know, looks a bit like a miniature bullmastiff.

    Besides wikipedia of course which was quite informative, so for "wikiheads" at least the info on health is reasonably good. Still "they" claim "owners can keep these issues under control by staying aware and protecting their Bulldog(s) from unsafe conditions", suppose this includes the 73.9% affected by hip dysplasia. Keep them in crates maybe!?

  5. Hey, Jemima, have you thought of putting tags onto your articles? Because I sometimes send them to people to educate them and I'd like to be able to click on, say, "pug", or "brachycephalic" or whatever and get only articles related to that topic. This way I have to search through loads of old articles to get to the info that I want to send them :)

    1. A very good idea... just started off not tagging as didn't quite understand about it at the time... Now what I need is a volunteer to go through and tag the lot... !

    2. I'll do it if I can do it tomorrow (Monday 16). I need a mindless distraction right now.

    3. Oh yes, this is vital! I just should make a big difference..

  6. here is another little opinion piece I wrote some time ago - There is a reference to "VIN", which is the Veterinary Information Network, an online forum/resource for veterinarians, open only to veterinarians by subscription.

  7. Dr. Hale, thank you for a very clear and comvincing statement. You may have heard that related to the brachycephalic issue, the Swedish Breed Club for Pugs have started a list of "brachy competent vets", i e, for pug owners to turn to.... as opposed, I understand, to those nasty brachy incompetents who signed the vets´petition. I believe that many Pug owners are ready to believe the stories of greedy vets just wanting to make money from unnecessary surgery on their beloved little dogs. I would very much like to run a translated version of your statement on my blog - along with the original in English, which many but not all can read for themselves. Would that be all right with you?

  8. I was thinking to myself after reading Fraser's "Popularity Paradox" that his "Dr Google" used properly is in fact still the most important resources for dog owners out there. Self diagnosing is one thing but very few owners would or should at least feel confident enough to actually treat their own dogs so vets still figure prominently.

    Of course Im sure many vets fear if not just find it irritating their clients second guessing them all the time. However I for one think its vital.

    If it wasn't for Doctor Google for just one example we would never have adopted triennial vaccinations. My own dogs would still be over vaccinated. Even the frequency of rabies shots had to come from my instance rather than the other way around. We don't even have rabies much like the UK.

    This issue was more or less a Doctor Google consumer led way of changing veterinary practise. And is still in the process of changing in many parts of the world, Asia for example, where the industry is still very much geared to both the income generated by annual vaccinations and the income surrounding the practise. Breaking the dependance is still an ongoing battle and you bet Dr google is still figuring prominently even if very few vets are, even European, Australian trained vets.

    One of the sites I find helpful is WSAVA, World Small Animal Veterinary Association.