Is dental disease really a big deal?

Dental disease is a HUGE deal. Periodontal (gum) disease is the number one diagnosed problem in dogs and cats. By the age of just two, 80% of dogs and 70% of cats have some form of periodontal disease. In addition, 10% of dogs have a broken tooth with pulp (nerve or root canal) exposure. This is extremely painful until the nerve dies, at which point the tooth becomes infected! Infectious oral diseases affecting the gums and root canals create systemic bacteremia (bacteria in the blood stream, which can infect other parts of the body). Periodontal inflammation and infection have been linked to numerous problems including heart attacks, strokes, kidney disease, emphysema, liver disease, osteoporosis, pregnancy problems and diabetes. Therefore, oral infectious diseases are known as "the silent killer."

In addition to systemic effects, oral disease can also cause inflammation to the eye, resulting in blindness. Furthermore, jaw bone loss from chronic infection can lead to a jaw fracture known as a pathologic fracture, and these have a very hard time healing. Finally, infectious oral disease can result in osteomyelitis (an area of dead, infected bone), nasal infections and an increased risk of oral cancer. Speaking of oral cancer, the oral cavity is the fourth most common place for cancer. Unfortunately, by the time that most are discovered, they are too advanced for therapy. Early treatment is necessary for cure. That's why you, the pet owner, need to check your pet for oral growths on a regular basis. Anything suspicious should be shown to your veterinarian promptly.

In cats, a very common problem is feline tooth resorption lesions, which are caused by normal cells called odontoclasts eating away at the cat's own teeth. Approximately half of cats over 6 years of age have at least one. They are similar to cavities in that once they are advanced, they are VERY painful and can become infected. They are first seen as small red areas along the gumline.

Other oral problems include bacterial cavities, painful orthodontic problems, dead teeth (which are commonly discolored), and worn teeth. Almost every pet has some form of painful or infectious oral disease that needs treatment. Unfortunately, there are few to no obvious clinical signs. (See below, What are the warning signs of periodontal disease?) Therefore, be proactive and ask your veterinarian for a complete oral exam, and perform regular monitoring at home.

What is periodontal disease?

Periodontal disease is defined as the destruction of tooth attachment (periodontal ligament and jaw bone), caused by bacteria. It begins when bacteria form on teeth in a substance called plaque. If plaque is not removed immediately, two things occur. First, the plaque is calcified by the minerals in saliva to become calculus (or tartar). This is the brown substance on teeth that many people mistakenly equate with periodontal disease, but the truth is that calculus does not result in periodontal disease.

The other thing that occurs with chronic plaque formation is that it will start to move under the gumline. Once the plaque gets under the gum, it starts causing inflammation, which is called gingivitis. Gingivitis is the initial, reversible form of periodontal disease. If this inflammation is not controlled, the bacteria within the gingiva change to a more virulent type. These more virulent species create more severe inflammation. Eventually, the body responds to this inflammation. Part of this response is bony destruction, which continues until the tooth is lost. However, in most cases periodontal disease causes problems long before this happens. (See above, Is dental disease really a big deal?)

What are the warning signs of periodontal disease?

Unfortunately, there are no obvious outward signs of periodontal disease until it is VERY advanced. The earliest sign is inflammation (redness or swelling) of the gums. This is generally accompanied by buildup of plaque and calculus on the teeth, but unless you are looking for these changes (see above, Is dental disease really a big deal?), they are not noticeable.

As periodontal disease progresses, the infection will worsen. The next signs within the mouth are receding gums or loose teeth. This increased infection may result in bad breath or blood on chew toys; however, this should NOT be relied upon for diagnosis. If your pet has bad breath or you see blood on toys, it is almost a sure sign of advanced periodontal disease requiring a trip to the veterinarian.

Late signs of periodontal disease include nasal discharge (blood or pus), eye problems, facial swelling or a jaw fracture.

Why is it important to have my pet's teeth cleaned regularly?

There are two main reasons for routine cleanings. First, they help prevent periodontal disease. Second, and possibly more importantly, a cleaning allows for a COMPLETE oral examination. Only with general anesthesia can most oral health problems be noted. This includes screening for oral cancer, broken teeth, cavities, and in cats, tooth resorption. Finally, general anesthesia is required for periodontal probing, which is the method of diagnosis of periodontal pockets.

My dog eats hard food. Isn't that like brushing his teeth?

NO! This is a myth, which came about from the surface of the teeth being slightly cleaner in pets fed dry food. Typical dry food does not protect against periodontal disease. This relates to the root cause of periodontal disease, which is subgingival plaque (plaque below the gumline). Supragingival (above the gumline) plaque accumulates and causes local changes in the gum tissue that allow attachment and growth of subgingival bacteria, however after this has occurred; supragingival plaque has little to no effect on periodontal disease. Traditional dry foods break apart at the tip of the tooth and have little to no dental benefit.

There are specially formulated and processed dental foods that effectively clean a pet's teeth as the pet chews and are an excellent adjunct to routine tooth brushing. Look for the VOHC Seal of Acceptance on the dental food you choose.

How do I brush my pet's teeth?

Start with a soft toothbrush and veterinary toothpaste. The malt flavor from Virbac appears to be the favorite of my dog and cat patients. Do not use human toothpaste, as it contains detergents that may cause stomach upset. Also, I do not recommend the fingertip brushes for two reasons. First, the bristles are not very effective at cleaning. Second, they put the pet owner's finger at risk for a bite, from even the most placid animal.

Go slowly and be very positive, using food treats if necessary. Place the brush at a 45-degree angle to the gumline. Brush in a circular motion, with a firm stroke away from the tooth. Try to reach all tooth surfaces, but concentrate on the outside surface.

The hardest part is getting started. It's best to start young, because the earlier you introduce brushing, the easier it will be for your pet to accept it. I recommend handling your pet's mouth from the time you bring him home. For puppies and kittens, introduce the brush at around 6-7 months. Be consistent; animals like routines, so if you make it a habit it will be easier on both of you.

For further information visit dogbeachdentistry.com and click on "Home Care."

My veterinarian has recommended a dental cleaning. What is involved?

The first step is to place the patient under general anesthesia. Anesthesia-free dentistry is NOT recommended (see below, Why does a dental cleaning have to be done under anesthesia?), and is even illegal in some states. Don't be fooled by "sedation" dentistry. In my opinion, sedation dentistry is more dangerous than general anesthesia for two main reasons. First, in sedation dentistry (or any other anesthesia-free dentistry), the trachea (windpipe), and therefore the lungs, are not protected from the particles generated during a dental cleaning. These particles are full of bacteria and, if inhaled, can result in pneumonia.

The other difference between anesthesia and sedation is the length of effect. Most practices today employ relatively short-acting agents to put the patient under anesthesia, and then a gas to keep the patient under anesthesia. If a problem occurs under anesthesia, the veterinarian can turn off the gas and the patient will recover quickly. But under sedation, the effects generally do not go away until the drug is cleared by the system, which can take too long. General anesthesia is very safe today, thanks to advances in anesthetic drugs, training and monitoring equipment.

A true dental prophylaxis consists of several steps, some more critical than others. The required steps that must be performed include:

  1. Supragingival scaling: This is the removal of the plaque and calculus above the gumline (what you can see).
  2. Subgingival scaling: This is the thorough cleaning of the area under the gumline to remove disease-causing bacteria. It is typically performed by hand and is time consuming, but it is the most important step of a dental prophylaxis.
  3. Polishing: Scaling slightly roughens the teeth. This promotes plaque and calculus attachment and reduces the lasting effect of the cleaning, so the teeth are polished afterward. There has been some controversy about this in human dentistry, due to the loss of enamel with many cleanings over time. However, in veterinary dentistry, with relatively fewer cleanings in an animal's life, this is not a concern.
  4. Sulcal Lavage: Cleaning and polishing results in debris being caught under the gumline, which must be thoroughly rinsed out.
  5. Oral exam, periodontal probing and dental charting: This is a critical and often misunderstood part of the dental prophylaxis. There are teeth that cannot be thoroughly examined in a pet who is awake, when periodontal probing is not possible. With the patient under anesthesia, the mouth is thoroughly and systematically examined, and all findings are noted on a dental chart. Any diseased teeth or tissues are then properly treated.

Optional steps include fluoride therapy or using a barrier sealant.

Make sure you ask that all of the above five steps are performed, or you are likely getting a poor cleaning. Ask to see the veterinary hospital's dental chart system if you have any concerns.

Why does a dental cleaning have to be done under anesthesia?

It is impossible to do a thorough cleaning and definitive oral examination (including periodontal probing) on a pet who is awake. Your veterinarian can provide the appropriate pre-anesthetic protocol and treatment plan to provide your pet with the best care.

When is a pet too old to have a dental cleaning?

NEVER. Healthy pets, even when they're older, handle anesthesia quite well. Age does increase the possibility that the patient will have some degree of organ malfunction, and those with systemic problems will be at an increased risk. Therefore, we recommend pre-operative testing on all patients prior to anesthesia. The important organs include the liver, kidneys, heart and lungs. Recommended tests include a complete blood panel and urinalysis in all patients. Thyroid testing and thoracic radiographs are recommended in all patients over 6 years.

As a pet owner, what can I do at home to prevent periodontal disease?

The gold standard of home care is tooth brushing. To be effective, however, it must be performed at least three times a week; daily brushing is ideal. See How do I brush my pet's teeth? (above) or visitdogbeachdentistry.comfor directions.

Another form of home care consists of rinsing with an antiseptic agent. CET® Oral Hygiene Rinse (Virbac) is an excellent antiseptic rinse for veterinary patients. The active agent (chlorhexidine) impregnates the teeth and gums, and its antibacterial effect lasts up to six hours. Additionally, Maxiguard® (Addison Biologics) has been shown to decrease gingivitis. It is also very palatable, making it an excellent choice for feline patients. Both of these are excellent ways to decrease gingivitis and periodontal disease in your pet.

It may be challenging for some pet owners to make the commitment to daily tooth brushing for their pets, or to teach their pets to tolerate handling of their mouths. When frequent brushing is not practical, feeding an effective dental food provides a convenient solution. There are numerous products touted as "dental" foods or treats. Pet owners must be careful, as these typically only clean the tip of the teeth, not the areas that are necessary for control of periodontal disease. Of the dental foods available, only Hills® Prescription Diet® t/d® is clinically proven to reduce gingivitis, plaque and calculus. A combination of brushing and feeding the right dental food is best for oral disease control.

What should I look for when I examine my pet's teeth?

Look for anything that appears abnormal. The first sign of periodontal disease is redness of the gums. No matter how minor it seems, if this is present, disease is present. The pet needs veterinary care in order to treat the disease and avoid all the problems associated with it. (See above, Is dental disease really a big deal?) If periodontal disease is not treated early, advanced signs of disease include swelling of the gums, calculus on the teeth, receding gums, and mobile teeth. Any of these is a sign of advanced periodontal disease, and immediate medical attention is required.

Other things to watch for include swelling or masses, broken or worn teeth, and discoloration of the teeth. Any of these things should also be brought to the attention of a veterinarian right away.

What should a pet chew on?

There is a fine line between being too easy to chew up and swallow, and being too hard, possibly damaging the teeth. Many commercial chew toys are far too hard and can break the chewing teeth. There are two guidelines I recommend using:

  1. If you cannot make an indentation in it with a fingernail, the treat or toy is too hard.
  2. If it would hurt to hit yourself in the knee with it, the treat or toy is too hard.

Pets who are prone to quickly swallowing large pieces of chew toys should be monitored during their use, to avoid an obstruction.