Doctors treating facial trauma will throughout the span of a career see a wide variety of injuries, from an amazing number of sources. Dog bites represent one of the more common sources of traumatic facial injuries. These injuries can produce terrible damage that leaves severe scarring of both a physical and psychological nature. According to data from the U.S. Department of Health and Human Services, the number of hospitalizations from dog bite injuries has increased by 88 percent over the past 16 years.
According the Centers for Disease Control and Prevention in Atlanta, approximately two percent of the population of our country will be bitten by a dog each year. This represents millions of injuries and unfortunately the victims are most frequently children. In the United States we can expect as average of about 15 deaths each year from dog bite injuries and historically about two-thirds of these are children. One study found that almost 70 percent of the victims of facial dog bite injuries are under the age of five.
The relationship between dogs and humans is an ancient one. The oldest fossils indicating an association between dogs and humans are approximately 33,000 years old, but fossils showing close association between humans and wolves may be as much as 100,000 years old. The domestic dog (Canis Lupus Familiaris) is the direct descendent of the grey wolf (Canis Lupus) resulting from thousands of years of selective breeding.
Although the domestic dog has been bred to be very different from its ancestors, it is important to realize that even the smallest variety of domestic dog carries within its genes instincts passed directly from the first wolves willing to share their lives with humans. Pack behaviors, territorial instincts and defensive behaviors are still an instinctual characteristic of man’s best friend. Obviously these instincts manifest themselves in very different ways, but they are fundamentally connected to the DNA of the grey wolf.
Dogs that have been bred and trained to maximize aggressive characteristics receive an inordinate amount of media attention. However, experts agree that a vast majority of dog bites occur as a result of inappropriate human expectations of dog behavior and inadvertent provocation of either a fear or protection response from the dog. The vast majority of dog bites I have encountered in my career have resulted from a child or adult simply being in close proximity to a dog that no one expected to bite.
Humans all too often force dogs to interact socially with people they do not know well. The reality is that dogs need time to get to know people, and they need to be allowed to do so at their own pace.
Although the majority of very serious injuries or deaths can be attributed to pit bulls, rottweilers, and wolf-dog hybrids, it is a mistake to be any less concerned by the risk posed by a breed with a more docile reputation. In my personal anecdotal experience, labs and golden retrievers have been responsible for a majority of injuries. I believe this results from a cavalier attitude humans assume around traditionally less aggressive breeds. In 2000, a 4-pound Pomeranian in a seemingly unprovoked attack, killed a child in Los Angeles.
Many dog bite injuries can easily be avoided by making responsible decisions about when and how it is necessary for a dog to meet and interact with unfamiliar humans. If a dog is to live in relationship with an adult, it should be given time to get to know the person at the dog’s pace. Forcing physical contact or proximity, putting hands in the dog’s face, and worst of all putting your face in a dog’s face are all a recipe for disaster. A frightened or nervous dog may display a wide range of behaviors appearing excited, happy, or even sleepy. Human assumptions about the mental state of another species often are the next step down the road to tragedy.
If it is necessary for a dog to establish a relationship with a child, this should be done very slowly with the dog under the physical control of a familiar handler at all times until the dog makes it very clear that the relationship has his endorsement. Even then, if the child cannot be trusted to avoid behaviors the dog is not familiar with, a handler should be present and in control at all times. If unfamiliar children are around a dog that does not need to be in a long-term relationship with the dog, the dog should simply be put away out of contact with the child. Frequently dog bites result when a dog familiar with his “own” children is expected to be just as friendly with little strangers. The American Veterinary Medical Association has produced resources available to the public to help prevent dog bites, and specifically to help teach children appropriate behavior around dogs. Excellent information can be found at: https://www.avma.org/public/Pages/Dog-Bite-Prevention.aspx
If a dog bite occurs it is critical to get appropriate care. Even a seemingly inconsequential wound from a dog’s mouth can result in a life threatening infection. In particular, if the background of the dog is unknown, rabies prevention protocols must be followed. Although rare in the United States due to immunization of most domestic pets, rabies infection is universally fatal if not treated before any symptoms appear.
It is a myth that dogs’ mouths are somehow cleaner than humans. The reality is that the dog’s mouth is filled with potential disease causing microbes. The most common infectious problems associated with dog bites include a relatively short list of bacteria. Areas of the body with minimal blood supply like a finger are at greater risk for infection than highly vascular areas like the face. In particular the elderly, individuals who have weakened immune systems and people who have previously had their spleen removed are at risk for serious infectious complications. Even a seemingly inconsequential wound can be very dangerous and medical advice should be sought.
Emergency medicine physicians or primary care doctors manage the majority of dog bite injuries. Facial bites can however be very complex and require specialized skills to repair both soft tissues and fragile underlying bones. The surgeons of the Cosmetic Surgical Arts Centre, with offices in both Missoula and Hamilton, have a combined experience of over 50 years in the management of all types of facial trauma. We are pleased to be on call to help manage facial injuries, which are of course always unanticipated. The most valuable skill in the management of bite injuries is however prevention.