Most people are aware of the importance of taking care of their own teeth (brushing and flossing daily and regular trips to the dentist). But, do you know that your pet suffers from the same dental problems that you do? In fact, dogs and cats feel dental pain and discomfort just as we do, and yet it is far more common for them to have significant dental problems since they are not getting regular dental care. The biggest reason that pets often do not receive the dental care they need is because they rarely show obvious signs of pain or problems, which means that they suffer in silence.
Periodontal disease is caused by bacteria which attach to the teeth in a substance called plaque. Eventually this will harden and become calculus (or tartar). Once the plaque extends under the gums, it starts creating inflammation which is known as gingivitis. If gingivitis is not treated, the infection will advance deeper and start creating bone loss. The end result of this infection is tooth loss, but it will cause significant local and systemic issues long before that (see below).
Oral/dental disease is by far the number one medical problem in dogs and cats. It is estimated that more than 70% of cats and 80% of dogs have some form of periodontal (gum) disease by just 2 years of age. As shocking as these numbers are, current research suggests this actually underestimates the true incidence of dental disease. Moreover, studies are finding that periodontal disease actually starts before 1 year of age. This underscores the importance of early detection and treatment for prevention of disease. In general, veterinary dentistry has been reactive medicine (waiting for disease to occur and then treating it). However, the current trend is to prevent the disease. This means that dental care for pets – including dental exams, homecare, and professional cleanings – should be done early and often. Homecare should start at 6-7 months of age and be performed daily. Further, the first dental cleaning (with radiographs) should be at 1 year of age (especially in small and toy breed dogs). By starting early and being consistent, you can likely avoid having to perform bigger surgeries later (ultimately saving money) as well as keep your pet healthier.
To find out if your pet has periodontal disease, lift the lip and look for the presence of tartar, or redness and swelling of the gums. (Figures 1-3) Furthermore, if your pet’s breath smells, it is a sure sign of an oral infection, and in all likelihood it is very advanced. A new method for determining the level of gum disease in animals is provided by a simple technology called Orastrip. This quick and painless test can tell the level of dental disease in 10 seconds, either giving you piece of mind, or alerting you of your pet’s need for treatment. Ask your veterinarian about Orastrip, or for more information on this inexpensive service, please visit www.orastrip.com.
We now know how important oral health is, as periodontal disease in both humans and animals has been linked to many systemic disease problems including kidney and liver disease, heart failure and heart attacks, lung disease, adverse pregnancy effects, cancers, and complications of diabetes. This is due to the consistent bacterial load in the mouth entering the bloodstream through bleeding or inflamed gums. On a positive note, many of these conditions actually improve with proper dental treatment! In addition to systemic diseases, periodontal infection leads to local problems in and near the mouth such as: tooth root abscesses, nasal infection (Figure 4), eye loss, jaw fractures (Figure 5), and oral cancers (Figure 6). The bottom line is that dental disease can actually shorten the lifespan of both humans and animals.
In addition to the serious local and systemic (full body) problems associated with periodontal disease, there are numerous other painful and/or infectious conditions that occur within the mouth such as: broken teeth (Figure 7), cavities, orthodontic disease (Figure 8), and oral cancers. This means that virtually every pet has some type of oral disease.
Treatment and prevention of dental disease in our pets is very similar to the requirements of taking care of our own teeth; homecare and regular professional cleanings. Professional cleanings are very important for the health of our pets and these are generally recommended on an annual basis, but the frequency varies amongst breeds and individuals. In general, the smaller the breed of dog, the more prone they are to periodontal disease and thus more frequent dental cleanings are necessary. One important point is that a thorough dental cleaning is more than just scaling and polishing the teeth. It should include scaling and polishing above and most importantly below the gumline, a full oral exam and charting as well as dental x-rays. The oral exam and x-rays will find other painful problems as well as oral cancers, allowing for early and more effective therapy.
Furthermore, professional dental therapy can greatly benefit pets with other disease problems, such as heart disease, kidney disease, and diabetes. (For example, some cats with diabetes will no longer require insulin injections after treatment and resolution of their periodontal disease.)
It is important to note that proper veterinary dental care for pets requires general anesthesia. While it is common for people to have misgivings about general anesthesia for their pets, the truth is that properly performed anesthesia is exceedingly safe today. Advances in pre-operative work-up, anesthetic drugs, and monitoring have significantly decreased the risk of anesthesia. (See questions to ask your veterinarian) Nowadays, the exceedingly minor risk is far outweighed by the health benefits of good oral health. In addition, it is a myth that older pets should not have anesthesia. Studies have shown that healthy older pets are not an increased risk for anesthesia. Finally, patients with mild to moderate health problems still can be safely anesthetized.
“Anesthesia-free” dentistry is not only ineffective; it is stressful to the pet and it is dangerous to have sharp instruments in their mouths while they are awake. For these reasons, this practice is illegal in the state of California. The fact is that anesthesia in animal patients is very safe when performed correctly and at current standards. It also allows your veterinarian to properly clean the teeth (getting below the gum line where it really matters!) and to accomplish a thorough oral exam and treatment of any dental problems.
Ideally, homecare for pets includes daily brushing, but there are a number of diets, rinses, and treats that can also be effective preventative measures. For a list of veterinary approved products please visit www.VOHC.org. My favorite products for dental homecare are Maxiguard, 1-TDC, Greenies, and t/d diet from hills.
One concern with chew-based dental products (as well as toys in general) is how hard/firm they are. During chewing, either the product is going to give or the tooth will break. Therefore, products must not be too hard. Examples of products which commonly fracture teeth include: antlers, nylon bones, hooves, bully sticks and compressed rawhides. Chew treats and toys which are typically acceptable include: rope and sheepskin toys, kongs, standard rawhides, and Greenies. If you can make an indentation in a product with a fingernail, it is likely safe for chewing.
If you pet has broken a tooth, don’t fret, it can usually be saved. Fractured teeth with direct root canal exposure are either very painful, infected, or both and demand treatment. Just because the pet is eating and not showing signs of discomfort does NOT mean that they are not suffering. These teeth must be treated. The ideal treatment for fractured teeth with root canal exposure is root canal therapy. This will save the tooth and is much less painful and invasive than extraction. Ask your veterinarian for a referral or visit or website for more information. If the tooth is broken without direct root canal exposure, the tooth generally just needs as sealant (filling) to get rid of the sensitivity. However, even these teeth can become infected so dental x-rays should always be taken of these teeth.
Speaking of dental x-rays, they are critical for proper oral care. Numerous studies have shown that dental x-rays provide critical information in almost every case. X-ray images can show infected (and/or painful) teeth, help diagnose oral cancer and periodontal disease, and are critical for all extractions. All veterinary dentists agree that full mouth x-rays should be taken virtually every time a pet has a cleaning. The exception is that some veterinary dentists believe that large breed dogs only require x-rays when problems are found on oral exam.
If you would like to know more about dental care for pets and veterinary dentistry, please visit our website at www.dogbeachvet.com, which features educational articles and videos about periodontal disease as well as other common oral problems in dogs and cats. Dr. Brook Niemiec and Dr. Robert Furman provide specialty dental procedures at Advanced Veterinary Specialists (414 E. Carrillo St, S.B., avs4pets.com) twice a month. Call for information or an appointment 805-729-4460.