WHY IS MY DOCTOR MAKING SUCH A BIG DEAL ABOUT MY PET’S TEETH?

Dental disease is the most common, most diagnosed, most often-recognized health problem we see in our companion animals.

As in people, plaque and tartar build up on the teeth in all animals. This plaque is formed by food particles and bacteria which, combined with salivary secretions, attach where the teeth rise above the gum line. If this plaque is allowed to accumulate unchecked, it eventually causes a variety of dental conditions that range from mild discomfort and bad breath, all the way to root abscesses, tooth loss and difficulty eating.

Eighty-five percent of all dogs and cats three years of age and older have some degree of dental disease that requires treatment and/or preventative care. If left untreated, periodontal disease can lead to systemic disease, showering the lungs and other internal organs with bacteria. This can cause heart, liver, and kidney disease resulting in a shortened life for your pet.

The majority of pet owners are unaware of the severity of their pets’ dental problems and therefore do not view the teeth cleaning procedure as necessary. Pet dentistry should not be an elective procedure, but rather a required component of routine preventative care similar to physical examinations, vaccinations, intestinal parasite exams, heartworm testing and annual wellness blood work.

HOW CAN I KNOW IF MY PET NEEDS TO HAVE HIS TEETH CLEANED?

Gently lift a lip and look at your pet's teeth (Yes, especially if your pet is a cat!). Gum problems occur when bacteria accumulate at the gum line and in time will appear as a yellow or brown accumulation of tartar on the teeth. Soon, the gum will become red or swollen (gingivitis) and a disagreeable odor (halitosis) will be present in your pet's breath. If left untreated this will progress to eventual tooth loss. Other common problems are chips or fractures on the tooth's surface. Chewing on items harder than your pet's teeth (e.g. bone, rocks, and chew hooves) may break teeth. Superficial chips usually cause no problems; however, tooth fractures that expose the pulp or root canal (you may notice a red or black spot on the tooth) allow bacteria to travel up the tooth, eventually leading to an abscessed tooth.

The leading sign of dental disease is bad breath. Dogs and cats should not have disagreeable mouth odor. Bad breath comes from infection. If your pet's breath does not smell like roses, let us examine his mouth and advise care.

WOULDN’T I KNOW IT IF MY PET’S TEETH WERE PAINFUL?

Most pet owners do not realize that there is a problem with their pet’s teeth until the pet stops eating or when their pet gets a swelling under his eye. This swelling is due to an abscessed upper fourth premolar tooth. Dogs and cats instinctively will hide any signs of discomfort or illness as long as they can. Unlike people, who realize quite soon that they have an abscessed or infected tooth, dogs and cats will suffer low grade, chronic pain from tooth root abscess for years before the problem becomes painful enough to be clinically obvious.

DO I HAVE TO TAKE MY PET ELSEWHERE IF THERE IS A PROBLEM WITH HIS TEETH?

Dental procedures are performed at Claws & Paws Veterinary Hospital® daily. Dental x-rays, ultrasonic scaling and polishing, fluoride treatment, polymer bonding and periodontal surgery are some of the procedures we offer to our patients. For more in-depth procedures, such as root canals, we refer our pets to Specialists. Twice each year your pet will receive an oral examination as part of his semi-annual well pet examination. A complete oral examination is necessary in identifying abnormalities and forming a treatment plan. Many of the problems are quite apparent at this time while others must be evaluated when the pet is under anesthesia.

DOES MY PET REALLY HAVE TO BE SEDATED TO HAVE HIS TEETH CLEANED?

Anesthesia allows us to evaluate each tooth without your pet feeling any discomfort or pain. Our dental suite has a centrally located gas anesthetic machine and patient monitoring system. As you can imagine, not too many of our pets would sit still in a chair and let us clean and probe their teeth while awake! We use a safe anesthetic protocol, one gentle enough to allow your pet to recover and return home the same day that the procedure is performed.

General anesthesia is required for the majority of dental procedures we perform in pets. This allows us to immobilize the patient and to prevent any pain. Anesthesia is the primary concern most pet owners have in considering dental care for their pets. It should be noted that in the majority of patients, the benefits of a dental procedure far outweigh the risks of anesthesia. In fact, untreated periodontal disease will result in far more complications than anesthesia.

An anesthetic protocol is selected based on physical examination, diagnostic lab work results, the pet's age and medical history, and length of the procedure. Every patient receives pre-anesthetic pain medication when indicated. The pet is then anesthetized with a short acting intravenous anesthetic to allow placement of an endotracheal tube into the pet's windpipe (trachea). This is important to protect the airway during the teeth cleaning and flushing of the mouth as well as allowing a gas anesthetic to be used. The anesthetic is mixed with oxygen in a vaporizer. The vaporizer controls the amount (%) of gas anesthetic mixture a pet receives. Isoflurane is the anesthetic we use and is considered to be one of the safest gas anesthetics available. After the procedure, your pet is placed on 100% oxygen and recovers quickly by exhaling the anesthetic gas.

Each pet is constantly monitored during the procedure. The veterinary technician will evaluate the pet's heart rate, respiration rate, reflexes, gum color and jaw tone to evaluate the depth of the anesthetic. Each patient will also have a patient monitor. These monitors measure heart rate and oxygen saturation. EKG and blood pressure monitoring are also available if warranted. Some elderly pets or those with heart or kidney disease may also have an intravenous catheter and IV fluids administered during and after the procedure.

WHY DOES MY PET NEED TO HAVE PRE-ANESTHETIC BLOOD WORK?

Whether your pet is 6 months or 16 years old, a proper pre-anesthetic work-up will help to identify any hidden health problems that may not be detected from a physical examination alone. This may include comprehensive blood chemistries, complete blood cell count, urine analysis, EKG or chest X-rays. Based on these results, an anesthetic protocol is selected or it may be determined that the teeth cleaning procedure should be held off until any detected health problems are under control.

IF I AM ABLE TO SCRAPE THE TARTAR OFF OF MY PET’S TEETH WHEN HE IS AWAKE, DO I STILL NEED TO HAVE HIS TEETH CLEANED BY MY VETERINARIAN?

Some pets are wonderful about letting their owners manually scrape/remove the tartar from their teeth. While this improves your pet’s appearance, unfortunately it is not adequate dental care. Tooth infection and decay and bad breath occur because of the bacteria below the gum line. This can only be removed with sub-gingival scaling which is performed as part of your pet’s teeth cleaning. Without this sub-gingival scaling, the teeth cleaning process is worthless. Also, dental x-rays are included with every dental cleaning. These can reveal hidden abscesses and tooth decay.

WHAT HAPPENS DURING THE TEETH CLEANING PROCESS?

A skilled veterinary technician uses an ultrasonic scaler and hand instruments to remove all the tartar and calculus from above and below the gum line. Once the teeth are clean, a fluoride paste is used to polish the teeth smooth, making them more resistant to future tartar development. Then a periodontal probe and explorer are used as part of a post cleaning examination. If a probe depth (pocket around the tooth) is greater than 2mm in dogs or 1mm in cats, this indicates that periodontal disease is present and additional treatment may be necessary to save the tooth. A comprehensive oral examination and charting is performed at the time of the teeth cleaning. Dental x-rays show the inside of the tooth and root. Our hospital uses the same dental radiograph machine found in your dentists' office. Charting a patient's mouth is the recording of abnormalities in a pet's medical record for future reference or to design a treatment plan. Cats have 30 permanent teeth and dogs have 42 to keep track of. Probing in our cat patients will identify feline odontoclastic resorptive lesions (FORL’s). These dental resorptions are commonly referred to as cavities or cervical neck lesions. These are common in cats over 5 years of age (although they can and do occur at any age), occur at or below the gum line, and can be quite painful. Although not as common, cavities also occur in dogs.

WHAT IS MEANT BY THE TERM FORL OR CAT CAVITIES?

Many cats get painful lesions at the gum line that invade the teeth. These lesions are referred to as feline odontoclastic resorptive lesions (FORLs). Recent research indicates that in cats over 5 years of age there is a 72% chance he or she may have one or more teeth with FORL.

WHAT IS NORMAL TOOTH ANATOMY FOR THE DOG AND CAT?

Dogs have 28 primary (baby) teeth and 42 adult teeth. Cats have 26 primary teeth and 30 adult teeth. The primary teeth erupt between 3-12 weeks of age. These teeth are replaced by permanent teeth between 4-6 months of age. Incisors are the small teeth in the front of the mouth between the large canine teeth. Dogs and cats have six upper and six lower incisor teeth. The canine teeth are the large (fang) teeth located next to the incisors on either side. The incisors and canine teeth are used for grasping food and toys as well as directing the tongue in the mouth.

Next, the premolars are located on either side and in back of the canine teeth. Dogs have four upper and four lower premolars while cats have three upper and two lower premolars. Behind these teeth are molars. Premolars and molars serve to shear, cut, and grind food. The way teeth align with each other is called occlusion. Normal occlusion occurs when the upper incisors just barely overlap the lower incisors. For some dog breeds (such as Boxers and Bulldogs), an underbite (the lower incisors are in front of the upper incisors) is normal.

HOW EXACTLY ARE MY PET’S TEETH CLEANED?

A dog or cat teeth cleaning means different things to different people. At our animal hospital the teeth-cleaning visit is a lot more than removing tartar from teeth. Our goal is to restore your pet's mouth to its normal, fresh, healthy state. Having your pet's teeth professionally cleaned is the single most important medical treatment you can give that will result in long-term health. We are serious about keeping your pet's teeth as healthy as possible. Listed below are the steps we take to ensure the best for your dog or cat.

1. A general physical examination is performed by your Doctor before anesthesia, including evaluation of the bite, identification of abnormal wear patterns, gum infection, oral cancer and pre-anesthetic blood profile along with any other necessary diagnostics.

2. A second oral examination is performed under anesthesia.

3. Supragingival (above the gum line) plaque and tartar removal.

4. Subgingival (below the gum line) scaling, root planning, and curettage where indicated. Removing tartar from the tooth crowns may improve the appearance of teeth, but the majority of dental disease is below the gum line.

5. Tooth polishing with fluoride.

6. Irrigation of periodontal pockets with chlorhexidine solution.

7. Post cleaning exam and teeth radiographs.

8. Dental charting for the medical record. Charting records missing, fractured and discolored teeth, feline oral resorptive lesions, periodontal pocket depths, gum recession, as well as any other abnormalities or lesions noted.

9. Any indicated therapy which may include tooth extraction, gingival resection, dental polymer bonding, etc.

10. The last step in the teeth cleaning process before your pet wakes from anesthesia involves application of a barrier sealant (Oravet) that prevents plaque and tartar forming bacteria from attaching to the teeth.

11. Upon release of your pet to go home, home care instructions on oral hygiene will be detailed. Our dental technician will meet with you to review tooth brushing techniques and your pet's custom-designed oral hygiene program, which is based on conditions found and your pet's willingness to be treated. When performed regularly, brushing, CET chews, weekly Oravet applications and a tartar control diet will greatly increase the intervals between teeth cleaning appointments.

IS THE TEETH CLEANING PROCEDURE PAINFUL?

Untreated dental disease in our patients is a chronic source of pain. In veterinary dentistry, we use pain prevention at each step of a patient’s treatment (pre-operative, intra-operative, and post-operative). All patients undergoing a potentially painful procedure receive pain medication before beginning the procedure. Local nerve blocks are used as needed to stop pain transmission during the procedure. Post-operatively, a pet may receive another pain control injection and many will have 3-5 days of pain relief medication dispensed depending upon the procedures performed during the procedure. This pain prevention approach greatly limits the discomfort a pet may experience from the necessary dental treatment. Pain control also improves the pet’s recovery time and speeds the healing process.

ARE DENTAL RADIOGRAPHS REALLY NECESSARY?

Intra-oral x-rays (radiographs) are a standard in human dentistry. Recently they have become an essential tool in the maintenance of our pets’ oral health. Each dental patient will benefit from oral charting and radiographs. These allow us to obtain a diagnosis and formulate a treatment plan allowing the necessary therapy to be performed during the pet's anesthetic procedure. Radiographs serve as a medical record of the patient's dental disease and are shared with you. This way you can better understand the state of your pet's dental disease, the need for the treatment performed, and the importance of follow-up visits or home care programs.

Dental x-rays show the inside of the tooth and root. These radiographs are important because much of tooth pathology lies below the gum line and is not obvious on physical inspection alone. The only way to evaluate the root structure, the inside of the tooth and the supportive bone is to take radiographs. Many treatment decisions are based on these radiograph findings. The frequency of dental prophylaxis varies between each pet and is dependent on the stage of the disease and ability of a pet owner to offer preventative home care.

We like to compare dental radiography's usefulness in a patient with a 6 mm periodontal pocket to our routine use of standard radiology in a patient with a swollen paw. Each instance requires that we use some imaging tool (x-ray & film) to diagnose the problem/cause, periodontal disease or broken bones, and decide upon the best therapy.

The x-ray machine we use in veterinary dentistry is the same as in your dentist's office except the presets on the technique chart are of dog and cat teeth. Use of digital x-ray technology improves fine detail of the image and also significantly decreases anesthetic time for your pet.

While a set number of dental x-rays are taken with each teeth cleaning procedure, there will be some cases in which full mouth x-rays or additional x-rays will be needed.

1. Mild to moderate periodontal disease. We x-ray periodontal pockets that are greater than normal (>3mm in dogs, >1mm in cats) depth. This allows better treatment planning and follow-up care if we know what is happening below the gums.

2. Advanced periodontal disease. A radiograph will show the extent of the disease and prevent root or jaw fractures during extractions.

3. Extraction cases to evaluate for root fractures, tooth root abscesses, as well as assisting in the removal of fractured root tips.

4. Attrition (tooth loss), or abrasive wear (worn teeth), discolored teeth and teeth with pulp exposure (open pulp canal).

5. Persistent primary dentition (baby teeth) when found with adult counterpart.

6. Resorptive lesions (cavities) in our cat patients. Therapy is dependent on root structure and presence or absence of infection.

7. Stomatitis or markedly inflamed gums.

8. Oral masses, tumors, and facial swellings. Oronasal fistula (infections of the oral cavity and nasal cavity) diagnosis and treatment planning.

9. A painful mouth, chronic sinus infection, and foul smelling breath.

10. Missing or impacted teeth.

In our dental practice, most feline patients (due to the high frequency of resorptive lesions) will receive full mouth radiographs. Moreover, about ½ of our dog patients will need 4-6 radiographs based on their worn or broken teeth or the identification of periodontal pockets found during their cleaning procedure. Overall, radiographs greatly enhance the quality of dental service we offer to our patients.

HOW OFTEN WILL I NEED TO HAVE MY PET’S TEETH CLEANED?

It depends on the degree and rapidity of plaque and tartar accumulation. Examine your pet's teeth monthly. Look for an accumulation of yellow or brown material at the area where the tooth meets the gum line. Pay particular attention to the cheek teeth and canine teeth. Once you notice plaque or tartar accumulation, it is time for a professional cleaning. Do not wait. Attached to the tartar are bacteria that are irritating to gum tissues. When treated, inflammation (gingivitis) will be resolved. When gingivitis is left untreated, it will progress to periodontitis, which is nonreversible. Time between dental cleanings is also breed specific. Small breed dogs and cats will need to have teeth cleanings much more often than will large breed dogs. The intervals between teeth-cleaning procedures will depend on how often you can brush your pet's teeth. Once daily is optimum. If you cannot brush your pet's teeth consider use of gels or rinses, chews, and a dental diet.

WHAT CAN BE DONE WITH A BROKEN TOOTH?

If your dog or cat breaks its tooth, there are two treatments: root canal therapy to save the tooth or extraction. Leaving the tooth alone with an exposed nerve is not a humane option. In addition to pain, infection will develop, which can spread to vital organs.

HOW MUCH DOES IT COST TO CLEAN MY PET’S TEETH?

It is difficult to accurately quote what the procedure will cost prior to the teeth cleaning because we do not know what state your pet's teeth and gums are in until your pet is anesthetized, the tartar and plaque are removed and x-rays are taken. The fees are based on weight of your pet, pre-operative testing, anesthesia, and any necessary therapy and medications that are indicated. The Doctor or veterinary technician will be happy to give you an estimate once you bring your dog or cat in for an examination. However, please be aware that findings due to x-rays and a more thorough oral examination once your pet is asleep, may necessitate further treatments that will add to the cost of your original estimate.

WHAT IS PERIODONTAL DISEASE?

Periodontal disease is the most common infectious disease seen in veterinary medicine. Periodontal disease is a process in which bacteria and plaque induce an inflammatory process of the gums and supporting tissue of the tooth. The signs we notice are bad breath and reddened gums. Gingivitis is a term used to describe inflammation limited to the gums. Gingivitis is reversible and responds well to professional cleaning. Untreated gingivitis will progress to periodontitis; the inflammatory responses that involve the supporting bone and tooth root. The end result of periodontitis is loss of the tooth (teeth) due to loss of supporting bone. Inflamed gums also provide bacteria with easy access to the blood stream where they can travel to infect major organs. While gingivitis is curable, periodontitis is not. Pets who develop periodontitis will need more frequent teeth cleanings with periodontal treatments. The aim of treatment is to prevent progression of gingivitis to periodontitis.

In the beginning stages, cleaning above and below the gum line as well as removal of calculus attached to the tooth will help restore periodontal health. In advanced cases, either periodontal surgery or extractions are performed, at which time periodontal disease is managed but not cured. Antibiotics given on a monthly basis also help to control the progression of periodontal disease. Smaller breeds are more prone than larger because the teeth are closer together in small dogs, and these dogs usually live longer. Terriers, Maltese, Schnauzer, Cocker spaniels, and Shih Tzus are especially prone to develop periodontal disease.

WHAT IS INVOLVED WITH HOME CARE?

What would happen if you stopped brushing your own teeth? Even if you only ate hard food as some dogs and cats do, there still would be problems. Your pet's teeth must be brushed daily if you can manage it. In order for brushing teeth to be of benefit, you need to brush your pet’s teeth no less than once every other day. Once daily is optimal. After this time, permanent plaque is formed on the tooth. It is not as difficult as you might imagine. What are the benefits? Brushing removes the daily accumulation of plaque from the teeth. Undisturbed plaque will result in calculus, which is a hard mineral substance that appears yellow or brown on the tooth surface. If untreated this will lead to gingivitis, pain, infection and loss of teeth. As soon as puppy or kitten teeth emerge, it is time to start brushing. Although baby teeth are replaced with adult teeth, the puppy or kitten gets used to the brushing procedure, which continues for life.

Brushing your pet’s teeth is the single most effective means of removing plaque from the visible surface of the tooth. First select a pet toothbrush. A long-handled, soft bristled brush works well for dogs, while a small specially designed brush works better in our cat patients’ mouths. Secondly, pet toothpaste needs to be used. Pet toothpastes are designed to be swallowed, taste good to our pets and contain enzymes or antiseptics that help control plaque. Human toothpaste contains too much fluoride for our pets and has detergents that should not be swallowed. Next, we want to introduce the idea of brushing in a gentle manner. Start slowly, using a washcloth to wipe the teeth. Then move to the flavored toothpaste on the washcloth. Sometimes applying a small amount something that the pet really likes on the tooth brush or wash cloth, such as tuna fish oil or peanut butter, helps your pet to more readily accept the brushing process. Once the pet is comfortable with brushing, you can then slowly convert to the pet tooth paste. Over time, you may introduce the toothbrush and soon it will become a routine. Finger-tip brushes are available for those pets who are afraid of the tooth brush. However, please keep in mind that is your finger next to those sharp teeth! The proper technique for brushing teeth is applying the bristles at a 45-degree angle to the gums. We recommend brushing the outside of the teeth (nearest to the lips) only. If possible, circular motions are superior; however, the key is the abrasive action of the toothbrush. Concentrate on the area where the tooth meets the gum line.

Tartar control diets and treats also serve to reduce plaque. Although not as effective as brushing, Royal Canin, Hills and Eukanuba special dental diets will reduce the accumulation of plaque and calculus. CET gels and rinses contain chlorhexidine for chemical inhibition of plaque formation and can also be used. Alone, these are rarely effective, but when combined with mechanical plaque control (brushing), improved results occur. Exercise toys, rawhides, and other dental treats help reduce plaque to some degree. CET chew bones are double coated with an enzyme that when mixed with your pet’s saliva helps to break down tartar (it also helps with bad breath). These items massage the gum tissue and should be used as a supplement, not a replacement, to tooth brushing. Cow hooves, bones, and hard plastic toys should be avoided as they can fracture teeth. Do not play tug-of-war games, especially with young dogs and cats, because they can move growing teeth to abnormal locations. Throwing dogs Frisbees can also cause trauma to the teeth resulting in pulpitis (discolored teeth).

Even with good home care, most pets will require professional teeth cleanings at regular intervals. Our teeth cleaning and polishing provides an environment which you can then keep clean. The more you do at home, the less we will have to do in our dental suite.

SUMMARY

Prevention of future dental problems begins at home. Caring for your pet's teeth at home certainly reduces the frequency of professional care. To help you care for your pet's teeth, we offer a variety of dental products. Our toothpaste and rawhide chews are designed to kill the bacteria associated with plaque. There are several good commercial diets available that greatly reduce plaque as it is developing. We recommend ROYAL CANIN VETERINARY DIETS. Routine home care and semi-annual oral examinations are two services you can and should provide for your companion.

Our goal is to make you aware of the benefits of regular dental care. Just as you brush your teeth and have them professionally cleaned for good overall health and appearance, your pet requires the same care. When needed, we can safely anesthetize your pet, clean and polish his teeth, take dental x-rays and perform many of the advanced procedures your pet may need.

Please do not hesitate to ask one of our helpful staff or veterinarians if you have any questions concerning proper dental care for your pet.

STAGES OF DENTAL DISEASE

Note: This article is provided by Claws & Paws Veterinary Hospital® for informational purposes only.