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