Collaboration at The COVE is like a well-oiled machine. Monti Tortolini is a Labrador Retriever who provided us with a perfect example of the care that we strive to provide to each and every patient. While it may seem redundant that great care should be provided anywhere, we truly reach for the gold standard, the only standard that we would want for our very own pets.
Monti came to The COVE in 2019 as an 8-week-old puppy. He presented for an oral examination with Dr. Colleen Fox, DVM, CSAVP Dentistry, with a Class 2 Malocclusion. This means that Monti’s lower jaw was shorter than his upper jaw. While you may think this just made him look a little different, in Monti’s case, his baby canines and incisors came into contact with his hard palate, causing painful defects and infection. To relieve his pain and to allow his jaw to grow to its maximum potential, the baby teeth causing trauma and pain were removed the following day under general anesthesia.
He went home the same day following surgery with some mouth restriction (no toys), pain medication, and instructions to eat softened food until his recheck oral examination with Dr. Fox two weeks later. At that time, the extraction sites were healed. Monti returned to his normal diet, and an oral examination was scheduled for when he was almost six months of age to evaluate his occlusion and how the adult teeth were coming in.
Upon Monti’s return to The COVE in early 2020 as a 5-month-old puppy, Dr. Fox performed a preoperative examination and occlusion check. There were hopes that the lower jaw would grow to a more appropriate length and allow the adult mandibular canine teeth to erupt in a comfortable position. While Monti’s jaw-length may never be normal, the goal is to have a comfortable and hopefully functional mouth. Unfortunately, Monti’s lower jaw was not able to grow enough for the adult canine teeth to erupt into a comfortable position. Monti would need another procedure to alleviate his oral pain.
Within a month of his examination, Monti was scheduled to undergo general anesthesia to address the adult mandibular canine teeth with a procedure called crown shortening and vital pulp therapy. This procedure would allow Monti to maintain his mandibular canine teeth, since they are indeed a large structure in the jaw. The procedure would also shorten the crowns of those teeth so they would no longer cause trauma and pain to the palate. Since shortening the crowns would then expose the pulp chambers of these teeth, a vital pulp therapy (modified root canal procedure) is performed to allow the teeth to continue to mature as they should while sealing the pulp chamber to prevent infection and tooth death.
Still wondering where the collaboration of services comes in? We are just about there. Monti presented the morning of his dentistry procedure as a wild, happy puppy. As with every patient preparing to undergo general anesthesia, our anesthesia technician worked to obtain baseline vitals, which included electrocardiogram (ECG) monitoring to check the heart rate. Once hooked up to the ECG, we noticed significant abnormalities. At that time, the Tortolini family was contacted, and Monti’s procedure was postponed pending evaluation with our board-certified veterinary cardiologist, Dr. Merilee Small. Before leaving that day, Monti was sccheduled for a cardiac evaluation.
When Monti returned the following week for his exam with Dr. Small, she diagnosed him with dilated cardiomyopathy (DCM), a condition in which the heart becomes enlarged and unable to squeeze or contract appropriately. DCM has recently been linked to grain-free and boutique diets. Upon further investigation, we learned that Monti had been on a grain-free diet. Monti’s condition did require medication and he has continued regular recheck examinations with Dr. Small.
By the end of 2020, Monti’s cardiac function had improved, and he was doing very well. Dr. Small had cleared Monti to undergo general anesthesia with Dr. Fox so that the mandibular canine teeth causing trauma and pain to his palate could be addressed. Although cleared for anesthesia, we made sure that Dr. Small would in fact be in the building during his dental procedure, just in case any complications arise. Thankfully, with the collaboration of our anesthesia, cardiology, and dentistry teams, Monti did well under anesthesia and went home the same day following his procedure. He recovered well and had a recheck examination with Dr. Fox one week following surgery.
Monti’s next recheck was with Dr. Small, six months following the dentistry procedure. Monti continued to do well, and sedation was planned for the following week with Dr. Fox to take recheck radiographs of the mandibular canine teeth treated with the vital pulp therapies. These recheck radiographs are necessary to confirm the vital pulp therapy did not fail and that the teeth are continuing to mature as they should. Again, good news for Monti, those radiographs revealed the teeth were continuing to mature and no problems were indicated at that time.
While this is just an example of collaboration across our services, we continuously work together to provide the gold standard of medicine to every pet that walks through our doors on a daily basis. If you have questions about our Cardiology or Dentistry departments, give us a call at (757) 935-9111.