Update on tooth extraction

Birker2020

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My horse went into the vets on Monday morning to be dropped off for the day following diagnosis by my EDT of fractured upper first premolar (106). The vet spoke to me and said she would have to stay in overnight to keep an eye on her. I'd not been made aware of this before and had to go to work, so didn’t have spare hay, rugs or feed for her, but they looked after her really well and did all that for me even turning her out on a paddock both days for a couple of hours.

The vet text me later the same day to say he’d had chance to look at her and said unfortunately the majority of the tooth was healthy (healthy not unhealthy) and the roots were firmly in place so he had removed the fractured fragment for now and would repack with putty and antibiotics the following day.

I rang him later that day after work to see if he wanted me to take anything up to the hospital for her and he said that I didn’t need to. He said that he had put forceps on the tooth and she had shaken her head and the forceps and fractured loose part of the tooth had flown off. He then said she would have to go back in at some point in the future when he had the appropriate tools to remove the rest of the tooth as the roots were deep, i.e. on a dentistry day. When I asked how far in the future the answer was a bit vague but I was told a few months. I am not sure how I or he can determine when the horse will be uncomfortable enough for this to happen as the symptoms of this tooth were so vague in the first place. As well as this I am worried she will have to go through all this stress again, I have to lose time from work (worked out around £40 in lost earnings) to take her and then leave early to pick her up and the stress I went through worrying about it all, never mind the financial burden I will have to endure a second time round. The vet kindly text me later that evening to say my horse was fine in the stable, they had wanted to keep her in for possible colic following the deep sedation.

Unfortunately the following day my vet wasn’t there to speak to when I collected her but I got discharge papers from another of the vets saying that she had had a slab fragment removed (106) and I was to syringe her mouth twice daily with a salt solution. Bute x 2 daily. Got to ring up in a week. No syringe supplied but luckily I had a spare unused one. Would have been handy for someone to have shown me how to go about this on a horse who isn't taking kindly to having her mouth messed with anymore.

Bill so far although not checked yet is around the £300 mark. So the upshot of it is that she has to go in again to have the rest of the tooth removed at some point and presumably another stay, where I can assume that the bill is most likely to be double this.

I am distinctly worried about the situation. Although this is an excellent practice, I feel that the whole tooth should have been removed at the time and more time should have been allotted to have carried this out. To not have the right tools to carry out the procedure is a bit poor in my opinion, although they did right by her by removing the wobbly bit of the tooth. I am not sure where I want to go with this, I feel like I should dispute the bill yet on the other hand I am also glad she’s had the loose fragment removed to be made more comfortable. I feel intimidated by the vet who can sometimes get a little upset with me, I’ve been in tears before following a similar time when I chose to speak about something so quite frankly I am dreading the conversation. I feel very upset about the whole business and this makes me too emotional to have any real exchange of opinion. Tried to make contact earlier with vet, but phone ringing out. Friends have suggested seeing another vet practice, or finding an EDT to take it out (but sedation/pain relief will still need to be carried out by a vet from some practice somewhere) and I feel it really is a vet job. Also moving practices and getting vet history will be a total nightmare. And of course I doubt that can take place until I have cleared the balance of the account. I feel a certain amount of loyalty towards my vet practice as they have always been very good with her in the past especially in an emergency situation and have been first class in the service they have offered previously. I don't really know what the point of this post is, other than to just update those who were kind enough to reply to me and to share my feelings and worries which helps.
 
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Unfortunately when you get a non specialist vet this is what can happen. The whole thing costs more and takes longer than if you'd gone to a more experienced vet in the first place.

I think in a previous thread someone recommended a dental specialist not too far from you, at 3 Counties vets IIRC? Get a referral to there?
 
I am not sure what you can do now but I would be extremely unhappy to have been told they didn't have the appropriate tools for an extraction when that was what she was sent in for, it sounds to me as if the loose part came away rather easily and that your dentist probably could have done that without sedating, keeping in in case of colic is fair enough but still seems a bit OTT especially as you were not told and they didn't even carry out the procedure they were supposed to, could any part of your conversation when booking in have been misinterpreted?
 
could any part of your conversation when booking in have been misinterpreted?
Hi BP. No definitely not as the EDT left a voice mail with the vet at the time he saw the horse. I followed this up with a long winded voicemail of my own. I also spoke to the surgery prior to leaving the voicemail and booked her in for the procedure. I think they have a lot of horses who are booked in and left for the day as there were wagons arriving when I'd unloaded. Then they have limited time to get through them all, I've noticed this more and more lately (over the past 3 - 4yrs). So if they come across something that they have no time to reach a conclusion on they have to go back in again. :(
 
Unfortunately when you get a non specialist vet this is what can happen. The whole thing costs more and takes longer than if you'd gone to a more experienced vet in the first place.

I think in a previous thread someone recommended a dental specialist not too far from you, at 3 Counties vets IIRC? Get a referral to there?
Hi TP - yes I think I need to take a copy of the discharge note and ring around and see if someone can have a look at her in a few weeks. This was one of the practices I was considering contacting. I understand that vets only specialize in certain things, I think I was surprised my EDT wasn't going to assist my vet, I hoped he would have.
 
Hi BP. No definitely not as the EDT left a voice mail with the vet at the time he saw the horse. I followed this up with a long winded voicemail of my own. I also spoke to the surgery prior to leaving the voicemail and booked her in for the procedure. I think they have a lot of horses who are booked in and left for the day as there were wagons arriving when I'd unloaded. Then they have limited time to get through them all, I've noticed this more and more lately (over the past 3 - 4yrs). So if they come across something that they have no time to reach a conclusion on they have to go back in again. :(

I am now using a small equine practice with 2 partners and one or two employed vets, I took a horse in a couple of years ago for SI injections and was pleasantly surprised to see 1 partner just finishing with a horse pop in to see what was going on with mine and a young vet having time to watch while the other partner did the work, they communicated constantly, discussed what was going on and nothing was rushed, they are extremely busy but take time to do the job well and I like they way they work.
They meet in the office most mornings and talk about their work, are there to take calls from clients until about 8.45 unless on emergency calls and although they are only small they have good facilities and will bring in a specialist as and when required for anything they cannot deal with, I think they are unusual in that the clients seem to be put first and they listen.
 
Unfortunately when you get a non specialist vet this is what can happen. The whole thing costs more and takes longer than if you'd gone to a more experienced vet in the first place.

Yes, this.

This happened to my OH a few years back (not by a vet I'd like to add!) He needed an emergency skin graft after a mountaineering accident, so signed the consent form and had it done. The graft didn't take, was done incorrectly etc etc... We found out afterwards that an orthopedic surgeon had carried it out, and not a plastic surgeon. We didn't know at the time, and were only acting on the advice given by the professional looking man in a white coat! Apparently, OH should have asked for the plastics team to do the procedure... which would have taken a bit longer and been done correctly. Not helpful!! We now ask a LOT of questions, whether it is for human family members, the dog, horse... A specialist is always better!
 
I would be dissapointed and challenging the bill, they should have had the tools for tooth removal avaliable if that's what the horse was booked in for. Yes it was more involved than they thought but that's nothing unusual.
Moving vets is easy you just phone up and register somewhere else, the new vets phone your previous vets and request a history is sent. Most vets will send it even if there is an outstanding balance as it is not in the animals best interest to withhold it.
Good luck whatever you decide to do
 
If the horse is in for a tooth extraction, the least they can do is have the damn tools available on the day, and if they can’t for an unforeseen reason then reschedule.

I’d be having words to be honest and then kick myself for not using a specialist.

I’ve just had a horse hobdayed. I used a specialist who only does wind work. In & out in a day, £400 cheaper than using my very good orthopaedic vets who don’t specialise in wind (but could have done it).

Vets will always take your money if they can, you just need to know when it makes more sense to go elsewhere.
I’d also be questioning an overnight stay for a routine tooth extraction!
 
Thanks for your comments. To be honest it wasn't until I arrived on the morning of the procedure that I found out that something I had taken as routine could be potentially a lot more complicated. When the vet said this could occur, or that could occur, the xray might show x,y and z that I found out potentially how difficult it might be. I hadn't realized that the vet would have limited time, because he'd agreed to it I thought he would have time and equipment to see it through. I never even considered that there would be specialist dental vets, I thought that was what EDT's were for. So if I can find someone willing to take this tooth on then that's great. I think the overnight stay was because mare can be colicky and when deep sedation takes place it can slow the digestive system and they wanted to keep an eye on her. I'm sure they had her best interests at heart. Just tried to speak to vet again but not available but will ring me later. Difficult situation. Not sure if the dentistry day he mentioned I might have to bring her back to involves an EDT or not in which case this might be better.
 
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I am now using a small equine practice with 2 partners and one or two employed vets, I took a horse in a couple of years ago for SI injections and was pleasantly surprised to see 1 partner just finishing with a horse pop in to see what was going on with mine and a young vet having time to watch while the other partner did the work, they communicated constantly, discussed what was going on and nothing was rushed, they are extremely busy but take time to do the job well and I like they way they work.
They meet in the office most mornings and talk about their work, are there to take calls from clients until about 8.45 unless on emergency calls and although they are only small they have good facilities and will bring in a specialist as and when required for anything they cannot deal with, I think they are unusual in that the clients seem to be put first and they listen.
It sounds like a horse Utopia BP
 
Why did they not have kit that they will have on a dentistry day? It sounds a bit to me as they maybe bring someone else in to help with/do those?

I would be pretty cross that all they had managed to do was allow the horse to lose a tooth with some forceps attached to it. Though they presumably did xray too to determine the quality of the tooth?
 
It sounds like a horse Utopia BP

I am sure it is not perfect but being small and owning it themselves does mean they are not being put under pressure all the time financially so can take a few minutes to watch a procedure or chat to a client, I don't see vets very often fortunately but did go through a patch where I saw too much of them and ended up falling out with two practices in quick succession ending up with these who have been much more efficient as well as being competent and caring.
 
Why did they not have kit that they will have on a dentistry day? It sounds a bit to me as they maybe bring someone else in to help with/do those?

I would be pretty cross that all they had managed to do was allow the horse to lose a tooth with some forceps attached to it. Though they presumably did xray too to determine the quality of the tooth?
Yes I believe an xray was taken. My horse is now qualifying to be a dentist seeing as she did such a good job removing her tooth herself. That's another thing, if a horse is under heavy sedation how does it shake its head? Someone could have been clobbered over the head with a flying forcep. :)
 
I've just spoken to the vet who has rung me whilst driving to another appointment and answered some of the questions I had. He says that the majority of the tooth was healthy and the rooms are firmly in place so he removed (or rather my horse did) the fractured fragment to make her more comfortable. He said the tooth fragment that came out was diseased but the body will lay down dentrine to cover the hole, with the remainder of the tooth being very strong. The fragment that came out was triangular shaped 1cm x 2cm. When I queried why he didn't have the equipment he said that the message he had from the EDT was that the tooth needed looking at ASAP which is what he did by fitting her in asap. He said he'd explained to me that the job might be much larger than anticipated or cost more than expected which he had done although it was only when I was parked in his car park at the hospital on the day and not beforehand and it would have been nice to have been prewarned.

Then he started to get defensive which he tends to do without realizing it I think and started talking faster and I could hear from his voice he was annoyed with me for questioning him. I find it all very intimidating. He said that they were very fond of the horse and of me and they had done their best and how well they had looked after her to which I replied I hadn't doubted they had for a minute but the point was that it would have been nice/decent/appropriate/sensible for him to have been present when she was discharged but he said I'd called to collect her earlier that he expected and was driving back and was sorry he had missed me. I said I was frustrated as I'd not even been supplied with a syringe or clear instructions on how to carry out the task I'd been asked to do. It sounds simple but in reality with a horse who is very wary of its mouth being touched it is hard and I'm sure I could have been told some tips or given advice on how to do this better.

I could hear he was annoyed with me questioning him which I had anticipated as I know from past experience this is the case. He seems to think I am making a big deal out of it all which I find a bit patronizing and this made me upset and a little peed off so I suppose I came across as a bit defensive too although me being defensive is not what most people would call defensive, as I won't say boo to a goose normally. He said that if it caused further problems it would have to come out on dentistry day and would be anything between £900 to £2K. I said it was ok for him to say I was making a big deal out of it but its a lot of money to me, we've already had to cut back on so much at home with partner losing job through ill health and the real threat of us losing the house, etc, etc. I don't have a few thousand pounds to fling around on such things. I know that's not his problem but the point is I haven't gone thousands to spend on a job which I had believed initially would have taken a few minutes at most. I've got to ring him on Friday, quite frankly its the last thing I feel like doing at the moment. He's offered to speak to me if I want to come over the surgery and show me the fragment of the tooth if its not been thrown away which was decent of him but I don't think I can control my emotions so I have passed on that invitation. I said I'd checked the invoice with the staff and could he please make sure it was correct and he said he'd do it tomorrow it was just he was incredibly busy at the moment. I am so tempted to cease my custom now - I've been with this vets for around 16 years, the vet I used to use who I got on like a house on fire and who was brilliant with my girl left a couple of years ago now and I just think their prices are going up and their service down which is a real shame.
 
I would be very unhappy about this. Why is it necessary for the horse to go in on a 'Dentistry Day'. Sounds to me like they have another vet coming in to do this sort of work armed with the appropriate tools. Why did the horse shake its head having the fragment removed if it was under sedation?
My horse had a tooth removed under standing sedation. He was a big, 17hh, strong boy and they managed fine taking the whole tooth out. He remained at the vets for a few days to be monitored.
If it were possible, I would ask to be referred to an equine hospital where they can deal with this sort of thing easily as they have the experience and all necessary equipment. Sometimes, local vets faff about trying to do their best but their best just isn't good enough. You waste time and money with them instead of going straight to the experts (could have said straight to the horse's mouth!).
 
An equine tooth removal if the roots are healthy is actually a massive job -it would be common for it to referred to a 'dentistry'day for a specialist to come in with tools and sometimes it has to be done under GA.
It's not inappropriate to investigate and treat what they can and re evaluate if they find more problems - that is not their fault just the nature of the disease. Would you rather they did a sloppy job and didn't do it properly? However I would normally get oral problems like this dealt with/assessed by a vet with a dentistry specialism - EDT is not qualified for this job. Some slab fractures grow out.
 
it might be better also to book in for an examination with the vet in person rather than doing it by text or voicemail - you will have to pay for the consultation obviously but would then allow you to fully involve yourself in the decisions and ask any questions so you feel fully informed.
 
I would be unhappy with the lot of them, EDT and vets, tbh.

Why would the whole tooth, with a healthy root need to come out, on Dentistry Day, or at any time? Horses teeth grow all the time, so eventually the broken part should grow out. We had a mare with a split tooth, long before EDTs were ever heard of. The vet (general mixed practice) brought a human dentist to advise. We had to wash her mouth out with Corsodyl every day, which we did for what felt like a long time but was certainly not forever.
 
Nine years ago my horse was found to have a fracture back tooth. He was under local anaesthetic for some hours while the vet tried to take it out. He wasn't able to take it all out but it hasn't caused any problems since although I have to have the equine dentist out every six months to file the one opposite. It cost about £1200.

My daughter's horse had to a have a front tooth out last year as he was booted in the mouth, the tooth fractured and then came infected. This, again was done under local but was all done fairly quickly (we watched) and was much cheaper, about £300, I think.

Neither horse stayed overnight and I'm very surprised your horse was able to move its head while under. I know the second vet was a dental expert and he explained everything along the way.

Not sure I like the sound of your vet!
 
I'd be changing vets as well, sod being intimidated by someone.
My aged WB has a fractured upper back tooth. The vet who looks after him is an equine dental expert, but he wouldn't tackle the extraction. Horse would have to go the Dick Vet and they would go in from the face, as the roots are so deep. Cost in the region of 2k. It isn't bothering him at the moment, both it and it's opposite tooth are kept shorter to take the pressure off.
 
Does the tooth NEED to come out? My horse from very, very many years ago got kicked and split a tooth. The EDT spotted it during a routine float and the vet had to get involved to sedate and x-ray. There was a wobbly bit and it was all planned to have it removed under standing sedation but by the time that was arranged it turned out it had broken off and vanished (probably swallowed!). The rest of the tooth was fine and was left intact.

I wonder if you could get a second opinion from the specialist mentioned above?
 
Look away if easily offended by a bit of gore. Here is the offending piece of tooth (tooth fragment). This is the bit that was loose, measuring around 2cm x 1cm.
 

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