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If you have read Dr Hale's excellent article on Feline Chronic Gingivostomatitis (FCGS) then you are aware that the treatment is whole mouth extractions. At YVC, this procedure typically goes as follows:
INITIAL EVALUATION The basic initial evaluation required before whole mouth extractions includes a review of the patient's history, an awake exam, an anesthetized exam and dental x-rays. This evaluation is usually done as a separate procedure from the extractions themselves; that is, we do this evaluation and recover the patient from anesthesia then, if the client make the decision for their cat to have the extractions, that is scheduled for another day.
Sometimes other diagnostic tests, including blood profiles and urine tests, are required or recommended for a particular patient.
(COST: the initial exam and diagnostic tests are charged for at regular YVC rates - they are not included in the cost of the whole mouth extractions. The dental x-rays are not optional, and for particular patients other tests are not optional).
THE PROCEDURE The cat is admitted to our hospital on the morning of the procedure. Water is not limited and a half-sized breakfast the day of surgery are allowed. The patient is anesthetized and the teeth are extracted. Injectable fluids, pain medication and antibiotics are administered. The patient is recovered from anesthesia, and the majority of patients go home at the end of the afternoon, the same day of their procedure.
(COST: Everything mentioned in The Procedure above, including one week of post-operative medication and special diet, are included in one fee for the whole mouth extraction procedure. As is true for any procedure, the fee does NOT include costs for unexpected problems, unusual complications or emergencies.)
POSSIBLE STAGING OF THE EXTRACTIONS It is our goal to extract all of the teeth in one procedure but patient safety and/or technical considerations might require us to stage the surgery; that is, we will extract most of the teeth in the first procedure and the remaining teeth in an appropriately timed second procedure.
(COST: If a second procedure is required in order to complete the whole mouth extractions, it is charged for at the usual YVC dental surgery rates. This will usually amount to one half or less of the fee for first stage of the procedure. Unfortunately the need to stage the extraction procedure is not predicatable, so whether or not there will be this extra expense is not predictable.)
POST-EXTRACTION CARE Of course, this is a major dental surgery, and cats will require some time and special care to recover. Patients have pain medication and special food for about two weeks after whole mouth extractions.
Most cats will start eating at least reasonably well on their own beginning within 24 hours of the procedure. It is possible that a cat would be so persistent, significant loss of appetite that we will need to place an esophageal feeding tube. This tube requires a brief general anesthesia to place, is easily maintained and used, and is removed (without anesthesia) once the patient is eating on their own. (As of 2013 we have never had the need to place a feeding tube in a cat because of whole mouth extraction surgery, so the possibility that this would be needed, in our experience, is very slim.)
(COST: Medication and special diet required aftet the first week post-operatively are charged for at usual YVC rates. If a feeding tube is needed, this is also charged for at usual YVC rates.)
PROGNOSIS As Dr Hale notes in his article, the longer the cat's mouth is inflamed before extractions, the longer it will remain inflamed after extractions. It is also vitally important to note that THERE IS NO KNOWN CURE FOR FCGS, including whole mouth extractions. Most cats do extremely well after the procedure, eventually requiring little or no medical care, but a few cats will remain inflamed enough that they require considerable treatment.
Yarmouth Veterinary Center
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