October is Dental Awareness Month
Over 70% of all dogs and cats over five years of age suffer from periodontal disease, which means that they have loss of the supporting structures of the teeth. In most cases this process is uncomfortable, and it will eventually lead to problems such as loose teeth, bacteria in the blood stream, and damage to the kidneys, heart and liver. The majority of dogs and cats seen at this practice over the age of 5 have one or more painful teeth in their mouth.
Most pets with painful dental conditions do not show obvious signs of any problems. This does not mean that they are not feeling pain, but rather are not acting in a manner that we recognize as “painful”. Studies have shown that dogs and cats have the same basic anatomy and sense pain much as we do. You know how you feel when you have a painful dental problem. Why should a dog or cat feel any different?
In the wild, if an animal shows weakness, they can become singled out to be eaten by predators, or be moved down the chain of authority within their group. Wild animals tend to hide any sign of illness. I believe that dogs and cats both posses this innate instinct to not show any sign of “weakness”. Because the painful condition comes on gradually, most owners of pets with painful mouths think that their pet is just” acting a little older”, or is a “little grumpy due to age. When the painful condition is removed, the improvement is usually very noticeable and rapid. Many owners tell us that their pet is acting “years younger” following treatment. In my opinion, the most common reason for a dog or cat to act older is because of painful dental disease. This usually goes unnoticed by the owner, and in many cases by the general practitioner.
In fact, dental problems occur with great regularity in wild animals. Studies on African Wild Dog skulls around 100 years old showed that very similar numbers and types of dental problems occurred with the skull specimens as occur with pet dogs and cats. Keep in mind that these wild animals only live to be a few years old, while many domestic dogs and cats are living well into their teens. The wild animals do not have as much chance to “outlive their teeth”, while domestic pets, like man, are now living long enough to show significant dental problems.
Indications that your pet might be in need of a dental care would include the presence of a red stripe along the gum line, unpleasant odor from the mouth, reluctance to chew, change in chewing behaviors, inability to see the teeth due to calculus accumulation, reluctance to allow home care, broken teeth, discolored teeth, loose teeth, draining or swelling around the face or jaw, decreased appetite, swellings or enlargements of the oral tissues, difficulty swallowing, rubbing the face with a paw (sometimes resulting in eye irritation), rubbing the face on the carpet, and other signs as well. Consult a veterinarian knowledgeable about dental care in your area to see about the possibility of dental problems in your pet.
This varies tremendously from individual to individual. Factors affecting the frequency of professional care include the presence of pre-existing disease, individual physiology, the degree of homecare that is provided, diet, and individual habits. In general, most pets need their teeth cleaned between every 6 months to every four years. The safest thing is to have a veterinarian knowledgeable about dental care examine your pet and give you their recommendations.
Unfortunately, some lay people have tried to make a business out of cleaning pet’s teeth without anesthesia, playing on the owner’s fear of anesthesia. In my opinion, this is worse for the pet than doing nothing at all. Removing the visible tartar from above the gum line is only one of the twelve steps involved in a proper dental cleaning, and is not even the most important part. This is the only part of the cleaning that can be done in an “awake” animal, and it cannot be done very well.
Think of the degree of cooperation that you give the hygienist when you have your teeth cleaned. For 45 minutes you remain reasonably still while they scrape away at your teeth, having you spit out periodically. Imagine if someone tried to do this to you without explaining the process? Imagine if you had a painful area in your mouth as most dogs and cats do? Imagine how involved the cleaning would be if you did not ever brush your teeth, like most pets? How complete could the job possibly be? These people have no training in identifying or treating dental problems in pets. All they can do is remove, painfully, some of the tartar in your pet’s mouth. They cannot clean under the gum line (the most important part of the cleaning) or obtain any dental radiographs of problem areas. The reason it is worse than doing nothing is that it gives an owner a sense that their pet has been well cared for, in addition to leaving a very rough surface that actually promotes future dental disease.
Proper dental care in animals requires general anesthesia, period!
There is always some risk of complications when anesthesia is used. The safety of anesthesia depends primarily on the skill and training of the person responsible for the procedure. In veterinary medicine, this varies a great deal from practice to practice. In some practices, the nurses are responsible for anesthesia, while in others the doctors are directly involved. At animal Dental Care, the doctor administers and constantly monitors the anesthetic episode.
There are newer injectable and inhalation (gas) anesthetic agents that can significantly decrease the effects of the anesthetic episode. These newer agents tend to be more expensive, but the patients “wake up” much faster. Other factors that make a big difference are the use of pre-anesthetic blood work to identify problems with your pet’s internal chemistry, the use of IV fluids during the procedure (can you imagine a person being anesthetized without an IV), anesthetic monitoring that includes blood pressure and blood oxygenation, general patient care, and attention to individual needs.
Many of our patients are 10-15 years of age, and are ready to go home, acting normally, less than one hour after completion of a procedure lasting several hours. If managed properly, the anesthetic risks are very minimal. Ask questions about the type of anesthesia that will be used on your pet, how they will be monitored, and who will be administering the anesthesia.
The Twelve Basic steps for dental care are as follows:
. Step 1. General Physical exam
. Step 2. Initial oral survey
. Step 3. Remove calculus above the gum line
. Least important part
. Most visible part of the cleaning to owners
. This is all a you can perform without anesthesia
. Step 4. Remove calculus below the gum line
. This is the least part of the cleaning visible to owners
. This is the most important part of the procedure for the patient
. Three possible steps may be involved
. Subgingival scaling (calculus removal)
. Root planing (smoothing rough surfaces)
. Subgingival curettage (soft tissue debridement of the inside of the gingival pocket)
. Step 5. Polishing
. Removes defects and irregularities
. Step 6. Irrigate all debris from under the gum line.
. Step 7. Flouride application
. Strengthens enamel
. Desensitizes exposed dentin and/or cementum
. Decreases the incidence of caries
. Step 8. Complete charting
. Almost all patients will have problem areas
. Note all abnormalities on the chart
. Pockets over 3mm in dogs and 1 mm in cats
. Furcation exposures
. Fractures/ exposed dentin
. Loose teeth
. Root exposure
. Step 9. Dental radiographs
. All suspicious areas should be radiographed
. 80% of dental anatomy is not visible to the eye
. Step 10. Treatment Plan
. Decide what treatment is needed
. Decide what medications are needed
. Step 11. Home care
. Give owners their options
. Demonstrate products on the owner’s pet
. Step 12. Schedule the next appointment
. Re-check Exam
. Time for the next professional care appointment!
Spending 2-3 minutes a day caring for your pet’s teeth can save you money, improve your pet’s health, improve their breath, and make them more comfortable. Studies have shown that pets with periodontal disease have damage to their liver, kidneys, and heart. Studies in humans have shown an association between periodontal disease and a variety of illnesses.
Most pets readily accept home care once they are trained. Please see the section on home care.
Brushing a pet’s teeth removes only the soft plaque. Once the plaque is mineralized, forming calculus (“tartar”) it cannot be removed by brushing. The calculus then serves as a rough surface upon which more plaque can readily form. Brushing is not very effective below the gum line, where most problems occur. Brushing along with periodic professional care is the best bet for maintaining your pet’s mouth in a comfortable condition.10. Are broken teeth a problem?
Broken or fractured teeth occur commonly, especially in dogs that are very aggressive chewers or in those that have access to hard chew toys. Cats frequently have fractures of the tips of their fangs.
At the very least fractured teeth expose the dentin located under the enamel, which is painful for the animal (have you ever had a painful chipped tooth?). Frequently, bacteria migrate along the exposed dentin via microscopic tubules, and invade and destroy the inside if the tooth. This leads to an abscessed tooth, which may “last” uncomfortably for years before it becomes loose and falls out. The infection inside the tooth may not occur for months after the initial fracture, so an owner may not make the connection between a broken tooth and altered behavior in their pet.
Fractures that result in exposure of the inside of the tooth (the area with the nerves and blood vessels) always result in the death and infection of the inside of the tooth. Frequently an owner will notice a small amount of bleeding from the fracture site, or a pink spot in the middle of the fractured area. These require immediate attention, and can also take years to loosen and fall out, causing discomfort the entire time.
Even when teeth are painful, most owners will not be aware that there is any problem.
Fractured teeth should be examined and radiographed. Smoothing the fracture and applying a sealant can decrease the chances of eventual infection and make your pet more comfortable. Dead or infected teeth should be treated or extracted. Do not depend on your pet to let you know if their mouth is painful.
Discolored teeth can occur from many causes. A recent study showed that 92.8% of all discolored teeth have dead tissue in the pulp chamber. Usually teeth that are discolored tan, gray, or pink have dead tissue inside them, which serves as an area for bacteria to grow. These teeth can have inflammation around the roots and destruction of part of the root. Discolored teeth should be evaluated and treated as indicated.
Even when painful, most owners will not be aware that there is any problem.
When multiple teeth have a roughened surface and brownish discoloration, the cause is frequently improper development of the enamel. These teeth will benefit from smoothing, sealants, and occasionally from restoring the lost surfaces with a composite restorative material.
Bad breath is usually associated with bacteria in the mouth that produce sulphur containing compounds such as hydrogen sulfides and methyl mercapatans. These compounds not only smell bad, but they also are damaging to the oral tissues. Professional cleaning along with home plaque control (see home care) gives the best results. Bad breath that returns very shortly after a cleaning indicates that there may be some deep-seated problems that may have been overlooked.
Bad breath is occasionally seen with medical conditions such as kidney failure and diabetes.
Anything that increases abrasive action in the mouth is of some benefit, but feeding dry food exclusively has a minimal effect in preventing dental problems. Imagine if you only ate dry food, but never brushed your teeth or had your teeth cleaned. Most people would agree that you would still develop problems.
Certain dry foods are formulated to have a significant effect on the prevention of dental problems. See the “home care” section.
“Double teeth” usually occur as a result of the baby teeth not being shed normally when the permanent teeth erupt. The permanent teeth usually come in between 3 and 7 months of age. If the baby tooth is not shed in an orderly fashion, this can lead to displacement of a permanent tooth into a painful position, or formation of pockets of infection at an early age. Usually the retained baby teeth can be extracted, making sure to remove the entire root.
There should never be two teeth of the same type in the same place at the same time. If you suspect that your pet has any double teeth they should be evaluated for possible problems.
In my opinion, it is not possible to perform proper dental treatment without dental radiographs. Most of the important dental anatomy is under the gum line and cannot be seen or accurately evaluated without radiographs. Without radiographs, you will miss the majority of painful dental conditions present in an animal. Anatomy of the dental structures varies a great deal from patient to patient. With radiographs, you can modify your treatments to meet these anatomic differences. Radiographs also allow us to identify problems much earlier and treat them while they are easier to treat, there is no evidence that the amount of radiation from dental radiographs causes any problems in veterinary patients.
This can be due to improper training, individual resistance, or because there is a painful area in the mouth that was missed. See the section on home care on the home page for tips on introducing your pet to regular home care.
Swollen areas in the oral cavity can have a number of causes. A variety of benign and malignant tumors occur in the oral cavity. Gums may become overgrown for a variety of reasons. A person familiar with oral disease should critically evaluate any oral enlargement. Enlarged areas that continue to grow, are ulcerated, painful, or bleeding deserve special attention.
If dental problems are found early enough, teeth can be saved with minimal treatment. Certain teeth are very critical for chewing function or for working animals, and so are more important to maintain. Additionally, extractions of certain teeth require aggressive removal of bone that can weaken the jawbone, or cause discomfort for some time afterward. Each patient and each tooth should be evaluated individually, and the owner made aware of the options for treatment.
Veterinary dentistry deals mainly with discomfort. Aesthetic considerations are important, but the focus of veterinary dental care is on making our patients comfortable, so they can enjoy life. Frequently, saving a tooth is less painful for the patient, and adds to their function and enjoyment of life.
Anything that increases chewing can be of some benefit in improving dental health. “Natural type diets” of bones, raw meats, and vegetables are not generally effective in preventing dental disease. I think that any benefit gained by feeding of bones and pieces of meat with bones in them is offset by an increase in the number of fractured teeth. Wild animals, consuming a “natural-type diet”, have similar numbers of dental problems when compared to domestic animals.
In Europe, zoo cats such as lions and tigers have a lower incidence of the cavities that occur at the gum line in most feline species. It has been suggested that this may be due to the fact that they tend to be fed more raw food and fewer prepared foods. This has not been proven.
In my opinion, natural diets are nutritionally adequate as long as they are well formulated, but do not provide substantial long-term benefits for oral health.
Reddened gums, or “gingivitis”, is not a problem by itself, but frequently is associated with periodontal disease. Since we cannot tell which cases of gingivitis will progress to periodontal disease, we consider a “red stripe” along the gum line to be an indication for a dental cleaning procedure. If periodontal disease exists, causing damage to the supporting structures of the teeth, this can be identified and treated appropriately while the patient is anesthetized.
Although the trend is slowly changing, most veterinarians receive very little dental training while in veterinary school. You need to ask questions to find out their level of dental expertise. Ask what additional training they have obtained, and what courses or wet labs they have attended. Have they attended the Veterinary Dental Forum that is held annually? Are they a member of the American Veterinary Dental Society? Do they read the Journal of Veterinary Dentistry? Do they have and use a dental X-ray machine? Most veterinarians will welcome your questions and concern, and will let you know if they are comfortable treating your pet’s dental problems.
Although some pain may occur, we take steps to minimize any discomfort your pet might experience. We regularly use local anesthetic blocks (“Novacaine”) like a human dentist. We also will typically give pain medication as part of the anesthetic protocol, administer an injection of a long acting anti-inflammatory at the end of the procedure, and send home pain medication as indicated for each patient. Most patients eat as soon as they get home. If you feel your pet is experiencing discomfort after a procedure, call and let us know. We want our patients to be comfortable as soon as possible.