Dental Extractions - concerns after surgery

hummys

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Hi all,
My 11 year old cat finally had some long overdue dental work done. This would have been done sooner, but he had difficulties with diabletes that we seem to have in remission. We delayed treatment because of his vets concerns over infection. Turns out he needed some teeth removed due to resorption. This past Thursday he had 10 teeth removed. He was sent home with Clindamycin and two pain meds - Buprenorphine oral suspension 0.5mg to be given every 8 hours for 3 days and Onsior oral suspension 20mg to be given every 24 hours for 3 days. After 2 doses of the Buprenorphine, he was acting weird - almost like he was hallucinating, fearful to walk down the hallway, very skittish and not sleeping for almost 24 hours after returning home. Spoke to the vet dentist and he said to stop the Buprenorphine because he thought that it was too much medication for him and that was causing those problems. We were directed to continue the Onsior. He’s scheduled for his last dose of Onsior today. He’s better than he was, but still having problems. He’ll be fine for a few hours and then he‘ll have odd behavior… running away from us, hiding, that sort of thing. Liter box habits and eating are mostly normal (although I know he misses his crunchy treats). The vet dentist indicated that this was behavior not usual during recovery. Can anyone share their experiences with this sort of dental surgery. Part of me feels like he should be further along and more himself. I’m worried sick and would appreciate any input. Thank so much.
 

mrsgreenjeens

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It could be that he's running away, hiding because he doesn't want to get his medicine, OR he's in pain. There's no way for us to know for certain. But it's only been a few days so I would give it until tomorrow and if he's still acting strange, give your Vet a call again and perhaps they will want to see him to make sure everything is ok. Can you check his mouth to see if it looks ok? I'm guessing if he's eating fine things should be pretty good in there (his mouth :wink:), but it's never a bad thing to take a look.

My boy had four teeth removed when he was eleven for the same reason as yours. We never used any pain meds on him because when he first came home he was clearly over medicated and I was freaking out about that and wondered why they released him to come home when he was stumbling and falling down, etc. Thankfully by the next morning he was much better and even ate without much prompting, which is highly unusual for him. He never exhibited any signs of pain, so I didn't give him anything. I was kind of leery about sticking something in his mouth knowing he'd had extractions on both sides, and on upper and lower teeth. I just wasn't sure that wouldn't hurt more than to leave him be.

Hoping your guy will be fine after today's final dose.
 
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hummys

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Thanks so much for the response. Will try to look closer at his mouth. He won’t eat the food with his final Onsior and I won’t force him. Happily, right now he’s in one of his favorite chairs sleeping (not hiding!) - I‘ll try to get a look when he gets up.
 

silent meowlook

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Sounds like pain to me. Ask the vet about Gabapentin. If used in conjunction with the buprenex it might help.
When I worked at the cat hospital we would keep these multiple extraction cats in Hosp for 3 days on a fentanyl cri because it is really painful.
if you have ever had one too the removed you know how much it hurts. But 10. That has to be painful.
 
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hummys

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I thought that he’s in pain makes me sick to my stomach. Will check again with the vet. Thank you.
 

silent meowlook

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I am sorry. I am not trying to upset you. He probably is feeling somewhat better by now. It is so hard when veterinarians don't seem to take that into account.
 
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hummys

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Happy for the input. It’s so frustrating to not know how to comfort him. Good news - he seems to be better this morning. Jumping on the bed, purring some and following me around a bit. Certainly not 100%, but better than yesterday. Still doesn’t have his full appetite back, but he is eating. He doesn’t eat kibble, but in addition to his wet food, he also eats freeze dried raw. His treats are freeze dried as well and he can’t have any of those for a few weeks. A good sign was that he was looking for them this morning. He must be confused that he’s not getting them yet. I’m hopeful that he seems to be feeling better, but I will call the doctor once they open to discuss any possible lingering pain. Thank you.
 

mrsgreenjeens

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My guy eats freeze dried raw for treats also. I just added a drop or two of water to each treat to soften them up a bit before giving them to him. Not enough to rehydrate them, just enough to soften them.
 
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hummys

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I thought about doing this, but thought that they would still be too course. They weren’t! Probably the best thing he’s eaten since surgery. Thanks!

He seems to be doing better, no more hiding or weird behavior. Purring and for the most part, following me around. He is on gababentin for any lingering pain and still on antibiotics. Have a few more questions if you all don’t mind -

He was eating more the day of surgery and the next few days after. He seems to not be eating as much now. I’m assuming that may have something to do with the lack of heavy pain meds and maybe now he’s feeling discomfort in getting used to his new mouth plus the ongoing healing. Also, I’ve noticed that sometimes not always his mouth is slightly open… ever so slight, but I can see that his lips aren’t tight. I can’t tell that his mouth is swollen, but I assume that it still might be with 10 teeth removed. I keep telling myself that it was 10 extractions and that surgery was only 5 days ago I feel like I need to be sure that he’s as comfortable as possible and just let him be to relax and heal, but I don’t want to ignore anything that may be out of the norm. Is this all a part of the healing process? Thank you again.
 

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I have had cats with extractions, none were given pain meds, just antibiotics, and all recovered fine. Your boy was most likely skittish and fearful because it WAS a horrible experience for him. My cats even ate kibble the next day after returning because it was there for the other cats. Cats with NO teeth still eat kibble. Most cats and dogs swallow kibble without chewing when eating anyway. If it hurt, they didn't show it. As long as a cat eats some, is normal in litter box habits, and is drinking water, everything is good......
 

mrsgreenjeens

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I know with my guy after having four extractions at one time, he ate well the first day or two, then really slowed down too. But he has always been a very picky eater and I think he only ate well because he didn't get to eat for basically two days because of the dental! Then I did notice he seemed to be having trouble figuring out the new arrangement in his mouth :lol:

As far as him hanging out with his mouth slightly open, why not give your Vet a call and ask if that's normal? I just can't recall if that happened or not. I do remember every once in awhile I notice my guys little tongue sticking out, even now, but can't remember about the other.
 

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Hi hummys hummys !

About this:
After 2 doses of the Buprenorphine, he was acting weird - almost like he was hallucinating, fearful to walk down the hallway, very skittish and not sleeping for almost 24 hours...

The prescribed dosage you noted was .5ml...........that's more than double the amounts that I've ever used, and I'm confident the high dose accounts for those particular reactions you observed. A more appropriate dose is likely .1-.2ml and can be safely used with Gabapentin (each of those uses different pain pathways, the combination providing better pain management) - in your position, I'd resume the bupe at low-dose, being particularly careful manipulating his mouth when inserting the syringe. I also hope they told you that it should not be swallowed, just allowed to be absorbed by the gums and mouth tissues.

The healing period for these surgeries is generally ~2 weeks, and the 'gold standard' calls for an automatic recheck appointment "built in" to their planning.....I'd be asking for that now.

Keep posting! (pics would be nice too!)
.
 
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hummys

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He does have a follow-up appointment scheduled for October 4, two weeks and a few days after his surgery. I am giving him Gabapentin, so hopefully he doesn't have pain. He does seem to be a bit better each day, his personally almost back to normal - he's following me around everywhere, even waiting by the bathroom door for me to get out of the shower. Not eating fully, but eating, so I'm not worried about that (yet).

I spoke with the vet earlier (and sent a few pictures) about his mouth being slightly open at times. I explained that the opening was slight, but there and when he was doing it, I could see his bottom teeth showing and that it never happened before the surgery. He doesn't think that the issue is anything mechanical from the surgery. He thinks that it's so slight that it's most likely either still some swelling in the back of his mouth or the sutures bothering him. He wanted me to bring him in if that would make me more comfortable, but my boy being a former feral doesn't do well in the carrier or with doctors (actually most people in general). An extra trip would give him unnecessary anxiety. He asked me to keep an eye on it and call him on Friday with an update. We'll can decide then if an office visit is appropriate.

white shadow - I doubled checked the Buprenorphine thinking that I made a typo, but I didn't. It is what was prescribed. Then I did some research and saw that was too high a dose. Thank you for that. No wonder he seemed like he was hallucinating. I have no words. I try to be so careful when it comes to his care. I thought about the medicine, but not the dose.

I've attached two pictures (I think) - one before surgery and one trying to show his mouth open. It's very difficult to capture. Since it isn't all of the time, I only seem to be able to get a photo when it's darker in the room. If you are able to expand it, you can see it better. Hope you don't think I'm out of my mind... it's slight, but there. Thanks again.
 

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silent meowlook

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The buprenorphine can be different strengths. I have seen it 0.6mg/ml, 0.3mg/ml, and 0.15 mg/ml. The usual dose is 0.02 to 0.04 mg/kg. So if you have a 5kg cat which would be the average large adult cat, and you were giving the 0.04mg/kg it would be 0.2mg. So if the veterinarian has the standard buprenorphine 0.3mg/kg it could easily be 0.66 mls. If they had the 0.6 mg/ml it would be half of that. 0.33 ml. Or with the 0.15mg/ml it would be 1.3ml. So it wasn’t necessarily the wrong dose.
Also, I have give double even triple the dose without adverse effects when needed.
 

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Ten extractions could take the full two weeks to resolve. He may have some pain. He may have some discomfort. He may just have some awkwardness with sutures and a new mouth. It’s hard to know. If you give a little bupe, does his appetite improve? I would double check the numbers and the dose and see about putting him back on the bupe. When he was odd, almost hallucinating, was he still eating well? Maybe a little short term oddness might be needed just to get him through this episode.

Another thing to consider is whether the extractions were symmetrical. In most cases, this doesn’t matter. But the fangs, the canines, that’s a different story. If he had asymmetric extractions of canines, the remaining canines that are missing their opposite may bite into the opposing lip or gum.

I would find yourself a veterinary dentist. Not just a general vet but a dental specialist. Most general vets can do extractions well enough. And that’s about it. If you need corrections and proactive extractions eg the remaining canine when it’s opposing match has been removed, you’ll likely need the specialist. General vets don’t have the training and they would prefer not to extract healthy teeth. Even if canines are not an issue (all removed or symmetrically removed), I recommend the dentist because tooth resorption is often chronic. You could consult with the dentist before it becomes a critical issue about possibly proactively removing his remaining teeth rather than waiting for them to be resorbed. I had to go this route with my last kitty, Krista who got to the point where general vets no longer wanted to work in her mouth because too many teeth were already removed and they didn’t feel comfortable taking anymore. I appreciate their honesty. But it put us in quite a bind. We lucked out and got a cancellation appointment in two weeks. This is not typical. Dentist consultation appointments can have two to six MONTHS lead time. Schedule that dentist appointment now when he maybe doesn’t need it so that you’ll be able to jump the line when he does. That first appointment is always the hardest to get. Once you’ve been seen, it’s usually a lot quicker to get a procedure appointment. If you wait until he needs to see a dentist, you’ll still have to wait that two to six months for the initial consultation.

For now, I would consider resuming the bupe for a day or two and see if his eating improves. You may need to trade off the short-term side effects to keep him comfortable until those sutures dissolve and/or he gets used to his new mouth.

For the medium to long-term, assume you’re not done with tooth resorption as long as his mouth still has teeth to resorb. Get that initial dentist consultation scheduled as soon as you can get it whether he needs it or not. Have the vet who performed his extractions send along his records to the dentist including X-rays that were taken.

If you’re in North America, you can find a dentist off the AVDC website. Otherwise I would call up the emergency animal hospitals. Many of them double as specialty hospitals.

AVDC.org | American Veterinary Dental College
 
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hummys

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His surgery was done at dental only specialty practice (they are on the AVDC website). We're lucky enough to live in an area where there are several practices within a 45 minute drive. We were in luck, scheduling wasn't a problem. He was at his regular vet for an annual (diabetes in remission - we always like to have updated blood work for him) a week and a half before we knew he had an infection. His regular vet said nothing about his mouth/teeth. Nothing. A week and a half later, I noticed that his mouth looked sort of swollen and kind of like he had marbles in his chin. Went to the vets office for an emergency visit. His regular vet wasn't available that day, so we saw another. She's the one that informed us of his mouth infection - large lesions on his gums, red areas on his back teeth, gingivitis. Makes me sick to think of it, since it had to have already started when we had our first visit. Being a former feral, he's a sweetheart, but there's no way he lets us have at it in his mouth. We never noticed anything going on and no difference in his eating or personality. BTW, his regular vet called to apologize, saying that she was so preoccupied with getting his blood, that she didn't pay enough attention to his mouth (!). No words. They scheduled us for the dental procedure there, but by the time we got home, I had already decided to see a dentist. If I can't trust your practice to see the issues, I surely don't trust you to do the procedure. The practice that we went to has great reviews, and more important we know friends and neighbors who have used them with glowing reports. And glowing reports for the dentist we used in particular. But, there have been a few things that have upset my confidence in this practice. They call themselves a concierge care practice, but our experience so far hasn't been that. I'm happy to go into more detail, but this is already lengthy and I want to be respectful of your time. I can't go so far as to say that they did anything wrong, but once there have been a few things that just don't sit right, it makes it difficult to to trust anything. Right now I'm really worried about the opening of the lips. It isn't an all the time thing, only noticed a few times during the day. I'm hoping that it's either the sutures or that he has some swelling still. Perhaps it is just him getting used to the new mouth. The extractions aren't symmetric for the most part, but both the canines were removed so that part of his mouth is. He did eat more when he first came home on the bupe and onsior. He was so out of sorts and frightened, I hate to drug him again. I'm hopeful since his eating picked up a bit today. Perhaps some of it may be because he's not getting his usual food. Because of his diabetes, I watch his diet carefully, so no kibble for him. He likes to snack on freeze dried raw and his treats are freeze dried as well. They seem to be crunchy enough for him. He can't eat that just yet. I've mixed it with water to soften it, but he wants no part of that. I've put his regular food in a blender to make it more familiar with a pate consistency, but he wants no part of that either. I found a few pates that he does like and I'll watch him to see if that helps with his appetite.

Thank you all for the ongoing advice and encouragement. I can't put into words how grateful and appreciative I am.
 

mrsgreenjeens

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With my guy (who only had four extractions but NO pain meds afterwards) I ended up giving him quite a bit of freeze dried raw, but he absolutely will NOT eat it if it's rehydrated. As I mentioned above, I did put just a drop or two of water on each piece of food to slightly soften it the first day or two, and that worked, but have you tried breaking the pieces up until their pretty small? Most cats don't really chew their food anyway, so if the pieces are small enough, all he will need to do is pick them up with his tongue and then swallow them.
 
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hummys

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I tried wetting the freeze dried chicken treats just enough to soften. He doesn’t want anything to do with them! He’s alway been a very picky eater. Likes his food, but doesn’t like anything different. Anything new and he’ll let it sit there all day until dinner time. I’ll try wetting his dehydrated raw tonight and see what he thinks. Thanks!
 
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