The Truth About a Tooth

December 26, 2013

Dog smilingHands down and far away, the most common illness we see in our patients is dental disease. I diagnose it multiple times per day in my patients. It is estimated that 80 percent of domestic dogs and 70 percent of cats develop gum disease by three years of age, and most do so silently. Our patients do not brush and floss regularly (unless we are doing it for them), so they are at significant risk for dental calculus (tartar), gingivitis, loose teeth, dental abscesses and even systemic illness from oral bacteria entering the bloodstream.

Most clients are surprised when we diagnose dental disease in their pets. Many pets do not allow owners to easily look inside their mouths. Even if Fido allows us a peek at his teeth, owners may not know what oral changes may be associated with dental disease. Cats and dogs are strongly genetically programmed to hide signs of pain from us, so they often show absolutely no symptoms of dental disease. I have seen dogs with horrendously severe periodontal disease, to the point where the majority of teeth are loose or have roots exposed, and yet they are eating normally. I have seen cats with bloody, ulcerated gums who eat dry food with abandon.

cat-teethThere are some subtle symptoms of dental disease in our pets, which can be easy to overlook. Halitosis (bad breath) is often the first change that owners note; bad breath is not a fact of life in pet ownership- it is indicative of disease in the mouth! Some animals, particularly cats with dental disease, will stop eating dry food and prefer wet food instead. Pets with diseased teeth may preferentially chew on one side of the mouth, or drop crumbs out of the mouth while eating. Unexplained weight loss in older patients can also be correlated with dental disease, as can excessive drooling and pawing at the mouth.

Dental radiographOnce dental disease has been diagnosed by your veterinarian, there is only one definitive treatment for the problem: a comprehensive oral exam and thorough dental cleaning while under general anesthesia. Veterinarians perform the same oral exams, and utilize many of the same techniques and tools as our own human dentists. The main contrast between veterinary and human dentistry is that our patients cannot and will not sit still long enough for us to thoroughly evaluate, radiograph and clean teeth without being anesthetized. (Hey, there are plenty of children and even adult humans who need anesthesia to have dental work performed, so our patients are not the only ones!) The majority of dental disease occurs below the gum line; the visible parts of the teeth (called the crowns) are only the tips of the iceberg! There is simply no way to probe, radiograph and evaluate the roots of an awake cat or dog. It cannot be emphasized enough that proper, complete and medically appropriate dental cleanings cannot be performed without general anesthesia. Sedation does not work for our patients, since they often lose the swallow reflex while sedated, and this increases the likelihood of aspiration (inhaling fluid into the lungs); we anesthetize and then intubate all of our dentistry patients, to keep their airways protected.

boxer-with-toothbrush-300x200There are some groomers who claim to “clean teeth” while providing bathing and clipping services. Not only is this inappropriate, it is considered practicing veterinary medicine without a license, and it offers absolutely no health benefit to the pet. (Often groomers simply scrape off tartar from the teeth, which may damage the enamel and does not address any disease occurring below the gum line.) There are also a few veterinarians who offer anesthesia-free dentistry services, but these should be avoided at all costs for the reasons provided above. It is now considered below the standard of care in veterinary medicine to offer dentistry services without anesthesia.

dog dental radiographMany clients have concerns about Fluffy undergoing general anesthesia, and I can certainly appreciate those concerns. However, we do everything in our power to maximize patients’ safety under anesthesia. All of our patients have pre-operative bloodwork, to ensure their kidney and liver function is adequate. We place intravenous catheters, to allow ready access to veins for administration of anesthetic and emergency drugs. We monitor our patients’ heart rates and pulse oximetry, to ensure they are ventilating appropriately while anesthetized. The number of veterinary anesthetic complications is fortunately incredibly low, but the number of complications resulting from untreated dental disease is incredibly high. I strongly encourage owners to overcome their hesitations about anesthesia and proceed with a dental cleaning if Fido needs it. There is no definitive rule or guideline as to how often an animal might require a dental cleaning; toy and small breed dogs have a much higher incidence of dental disease than larger breed dogs, so they often need more regular dental care. One of the many reasons we recommend annual exams for adult pets and twice annual exams for seniors is that this is the best way to identify dental disease early, when we can hopefully intervene before extractions are needed.

Cat-with-ToothbrushWhat can be done to prevent dental disease at home? One of the best preventative measures shown to have a benefit to our pets’ oral health is daily tooth brushing. Brushing teeth once a week, or once a month, really yields little benefit. There are a variety of pet-friendly toothbrushes and toothpastes available, all of which are designed to make the experience easy for the owner, and more palatable for the pet. In the pet store, you will find an overwhelming number of products labeled for “dental health”, including pet foods and chewy treats. We have no scientific data on the vast majority of products available, so owners may be lulled into a false sense of security that a particular treat or toy can replace daily oral hygiene. The Veterinary Oral Health Council (VOHC) has given their seal of approval to a variety of products and foods; these have been tested and verified to have a benefit to your pet’s oral health. Click here for a list of products with the VOHC seal. We also have a selection of dental products and foods available for purchase at Malvern Veterinary Hospital – just ask us which may be best for your pet. Together we can work to keep your pets’ teeth healthy (and eliminate that stinky dog breath!)

 

 

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