Just Ask the Experts: Further advice on tooth extraction to treat aggression

Dr. Tynes welcomes behavior questions from veterinarians and veterinary technicians.

E-mail: vm@advanstar.comWith the subject line: Behavior questions

Q. I am caring for a 4-year-old Westie that has become aggressive. The owner has requested extraction of all four canines or euthanasia. What are your thoughts?

A. Dr. Daniel T. Carmichael gave a reasonable and thorough answer to this question from the veterinary dentist's point of view , and I would not disagree with any of his comments or suggestions. However, tooth removal as a form of treatment for aggression is complicated medically, behaviorally, and as a welfare issue. In order for practitioners to best be prepared to respond to this question when posed by a client, a veterinary behaviorist's perspective is helpful as well.

Valarie V. Tynes, DVM, DACVB

DON'T FORGET THE UNDERLYING CAUSE OF THE AGGRESSION

Clinicians faced with questions such as this one tend to focus on the clinical signs of the problem (i.e. aggression) rather than the clinical problem itself. This focus is understandable—it is the sign that is of most concern to the client (their safety or the safety of others is at risk), and I would never underemphasize our responsibility for keeping people safe. However, a veterinarian should consider a behavior issue the same way as any issue that has an impact on an animal's health and welfare.

Consider this example: A client presents a dog to you for evaluation of constant coughing for several days and nights. The client is exhausted and begs you to stop the coughing so he can sleep. As medical practitioners, we understand the importance of diagnostics to first determine why the dog is coughing before we administer medications that may or may not include cough suppressants. A behavior problem should be addressed the same way.

Pain and discomfort are frequently overlooked as an underlying cause of aggression. The pain or discomfort can be mild enough that it is not obvious to the veterinarian and may be missed by our diagnostic techniques. After all, our patients cannot tell us what they are feeling. Nevertheless, experiencing even mild pain or discomfort can be enough to lower the threshold for aggression. Any patient presenting for aggression needs a thorough behavioral history as well as a physical examination to recognize and rule out the possibility of pain being the underlying cause of the aggression. Understanding the dog's motivation is critical to successful management of any behavior problem.

Removing a dog's teeth to combat a clinical sign, without having a thorough understanding of the underlying motivation for biting, can result in a dog that is still suffering. Once the dog can no longer bite, the client often feels no need to avoid the stimuli that were causing the dog to bite in the first place. These stimuli are usually causing fear and anxiety in the dog, both of which are profound emotions that, when unrelieved, can result in a great deal of stress and suffering.

Unfortunately, many people continue to cling to outdated theories suggesting that dominance is the underlying cause for most dog aggression. The fact is—and most anyone educated in the field of behavior would agree—most dogs exhibiting aggression toward people are suffering from some degree of anxiety, fear, or conflict. In all cases, the first and most important recommendation for an aggressive dog is to identify and avoid—or eliminate when possible—the stimuli that lead to aggressive responses. Examples include the following:

• A dog growls, snaps, or bites when you attempt to take something away from it; owners are educated to understand the importance of no longer trying to take items away from the dog.

• A dog growls, snaps, or bites when someone attempts to move it from the furniture; again, clients are taught not to do that.

Of course, these recommendations are also likely to include instructions for not allowing the dog on furniture anymore or not giving it highly favored objects that it is likely to guard. Nevertheless, these are common and simple initial instructions intended to keep the client safe until additional exercises can be initiated that help the dog to understand that it no longer has to fear these interactions. In addition, teaching clients to recognize body postures and facial expressions that indicate the underlying emotional state of the animal allows them to change the situation, often before an increase in aggression occurs.

Armed with this basic understanding of how to create a safer environment and better interactions with their pets, most clients willingly initiate this part of the treatment plan. Most are relieved to find that improving the situation can be this simple and never follow up with additional behavior modification. Clients also need to know that when they stop forcing compliance on their pets through confrontation, they can begin to teach their pets appropriate responses in situations that previously caused anxiety and perhaps aggression. For example, instead of physically pulling a growling dog off the furniture and giving it a leash correction (as some trainers may suggest), a client could call the dog to him or her in a cheerful, enthusiastic manner and offer it a toy or treat for complying. The dog can then be encouraged to follow to another location where it does not have access to the furniture and again be rewarded for compliance. In the end, this creates a stronger human-animal bond and better welfare for the pet.

It is true that some forms of dog aggression are more difficult to predict and avoid than others, but these are usually the exception and not the norm. Clients should at least attempt to avoid provoking a dog's aggression before considering tooth extraction. Clients must also be informed that a dog may continue to suffer from fear or anxiety if they stop following the treatment protocol after the dog's teeth have been removed. Putting the dog in the situation in which it continues to experience fear or anxiety results in suffering and subsequently leads to poor welfare for the animal.

CONSULTING A BEHAVIOR EXPERT

Dr. Carmichael said that he would consider extracting a patient's teeth after all attempts at behavior modification had failed and, ideally, there had been a consultation with a veterinary behaviorist. While Dr. Carmichael specifically recognizes the qualifications of the veterinary behaviorists, many veterinarians who do not have a veterinary behaviorist in their area come to rely on nonveterinarians to deal with behavior problems in their clients' pets. Unfortunately, anyone can call himself or herself a behaviorist, and many do, whether they have an education in the field or not. It is common for clients to tell their veterinarians, and even to tell veterinary behaviorists, that they have tried everything and nothing worked, when, in fact, they have never been given accurate information by a qualified behaviorist.

If general practitioners refer their clients to trainers or other lay people, it is their responsibility to be familiar with the knowledge level of those individuals as well as their training protocols so that the practitioners have some idea as to whether a client will be given accurate and appropriate information.

If a veterinary behaviorist is not available to the client, veterinarians should consider a telephone consultation with a veterinary behaviorist before recommending tooth extraction. The practitioner can then be certain that extraction is the best next step to take (see the sidebar "Behavior resources").

In the phone consultation, the veterinarian should be able to describe the history and the clinical signs the animal displays, as well as the treatment protocol that was recommended and what parts of it the client was able to implement. If, in fact, a client has seen a qualified behaviorist and was taught to avoid stimuli leading to aggressive responses, as described above, then the questions remain: why hasn't the client been successful, and will removing the dog's teeth lead to further suffering as the owner continues to put the dog in those provocative situations? Removing a dog's teeth to treat aggression should only be considered after all other efforts at treatment have failed. In addition, primary care veterinarians should only recommend teeth extraction in cases in which they feel certain, based on their experiences with the clients, that the clients will continue to try to avoid putting the pets into the situations that may provoke aggression.