Dentistry

How can I tell if my pet has a dental problem?

You probably will NOT know if your pet has dental disease. Dogs and cats are experts at masking pain and discomfort.  Bad breath, however, is the first indicator of dental disease and should not be ignored. Just as in humans, the best way to determine if you pet has dental disease is to see the doctor and have your pet’s mouth examined under anesthesia. Your veterinarian will do a cursory exam when your pet is in the exam room, but in order for your pet to have a complete and thorough exam he/she will have to be anesthetized to have their mouth thoroughly examined and have x-rays taken. In some pets (especially cats) tooth disease often occurs below the gum line or under the tartar which cannot be seen without anesthesia and x-rays. After dental cleanings, most owners report overall increase in activity in their pet and overall improved quality of life after dental work. 

Why dental care?

The American Veterinary Dental Society reports that 80 percent of dogs and 70 percent of cats show signs of oral disease by age three. As in humans, preventative care is paramount to good oral care. Ideally we should be brushing our pets’ teeth daily and our pets should have dental cleanings yearly to every other year depending on the breed and age of the dog.  Dental disease doesn’t just affect the mouth. The bacteria in the mouth can easily gain access to the blood stream through the inflamed gums and seed in other parts of the body such as liver, lung, heart and kidneys. 

Dental disease is painful to your pet and can lead to erosion of the jaw bones that support the teeth and sometimes jaw fractures can occur. Cats can experience tooth resorption, which is an extremely painful condition in which lesions erode the tooth enamel and eventually attack the dentin and the pulp canal containing the tooth’s nerves and blood vessels. This can happen under the gum line or on the tooth itself and the only treatment is to extract or remove the diseased tooth.

It is important to note that a non-anesthetic teeth cleaning, what groomers sometimes offer, is not comparable to the veterinary dental cleanings and it is illegal if groomers use anything other then a toothbrush, because its considered practicing medicine with out a veterinary license. It is impossible to perform a total cleaning on a pet without general anesthesia. Cosmetic cleanings do not address periodontal disease where it occurs; under the gum line.  

What is dental disease or periodontal disease?

Periodontal disease is an infection of the tissue surrounding the teeth. It starts out as bacterial film called plaque. The bacteria attach to the teeth and form a biofilm which calcifies by calcium in the saliva in 24-48 hours. This forms a hard rough substance called tartar or calculi which then allows for more plaque to accumulate.  Initially plaque is soft and brushing or chewing hard food and toys can dislodge it. If left to spread plaque and tartar can lead to gingivitis, which is inflammation of the gums, causing them to become red, swollen and bleed easily. If the plaque and tartar is not addressed with veterinary dental cleanings, infection can form around the root of the tooth. In the final stages of periodontal disease the tissues surrounding the tooth are destroyed and the boney socket holding the tooth in erodes and the tooth becomes loose. Unlike gingivitis, periodontal disease IS NOT reversible. This is a very painful process for your pet. This can be avoided by brushing the teeth daily and seeing your veterinarian regularly. 

What is involved in a veterinary dental cleaning?

At Ada Hospital for Animals, a dental cleaning itself is similar to a human dental cleaning. The major difference is your pets will always be given pain medications as part of their anesthetic and they will always be anesthetized. There are two major components to your pet’s dental care under anesthesia: a thorough oral examination and the dental cleaning itself. In order to do a proper oral exam your pet needs to be anesthetized. Veterinarians can only do a very basic exam on your pet when he or she is awake. When your pet is anesthetized, it allows for a complete and thorough exam where there will be sub-gingival assessment of pockets, examination of the inside of teeth and the back of the mouth.  Anesthesia is also necessary because it would be unethical (dangerous, stressful and painful for the patient) and what pet would hold still with an x-ray in its mouth?

1)     Pre-anesthetic exam: whenever anesthesia is required your veterinarian at Ada Hospital for Animals will thoroughly examine your pet to make sure he or she is healthy enough to undergo anesthesia. All pets should have blood work done within six months to check liver, kidney and complete blood count to reduce any risks possible prior to anesthesia. Depending on the age and physical exam findings the doctor may also recommend an electrocardiograph, x-rays or other tests. Though there is always some risk with any medical procedure, modern anesthesia is safe even for older pets as long as they are in good health and their labwork is good.

2)     Anesthetic monitoring: At Ada Hospital for Animal your pet will ALWAYS be given pain medications prior to the procedure (morphine type drugs and an anti-inflammatory injection). During anesthesia your pet’s vital signs (blood pressure, respiratory rate, heart rate and temperature) will be monitored. This helps ensure the safety of your pet while undergoing anesthesia.

3)     Dental radiographs: Radiographs (x-rays) are taken on any suspicious teeth (gingival pockets, fractured teeth etc). X-rays allow the veterinarian to look for disease and bone loss below the gum line which cannot be detected by oral examination alone. In some cases x-rays can confirm the need for extraction of teeth that are badly infected or diseased.

4)     Subgingival curretage and polishing: Veterinarians use the same tools and instruments as human hygenists & dentists to remove plaque and tartar from your pets teeth. The tartar under the gum line is also cleaned removed. To smooth out any scratches on the tooth enamel, your pet’s teeth will be polished with a special paste.

5)     Periodontal treatments: If diseased gums are noted and if the gum is starting to detach from the tooth as a result of periodontal disease, an antibiotic adhesive substance called Doxirobe will be inserted under the gum line. Other periodontal treatments may be done depending on the case and situation.

6)     Fluoride: Application of anti-plaque substance such as fluoride treatment is done. This can help strengthen and desensitize teeth as well as decrease future plaque formation.

7)     Professional charting and recording: Professional notes are taken on a dental chart, noting abnormalities on each of the dog’s 42 teeth, or the cat’s 30 teeth.

Is it painful to have a tooth removed?

Thankfully your pets will be anesthetized and have pain medications on board during the procedure Your Veterinarian at Ada Hospital for Animals also performs regional pain relief in the form of nerve blocks for pain control (similar to what human dentists do).  Some of your pet’s teeth contain 3 roots and in order for the tooth to be removed your pet may need a gum flap, gum sutures and the tooth may be sectioned using a drill.  All of our patients always go home with at least one sometimes two or three different pain medications.  

How often should I be brushing the teeth and how often should I have a dental cleaning?

Just as in humans, ideally teeth should be brushed daily. Home care of the teeth, while great, does not replace the need for professional cleaning. The cleaning performed by your Veterinarian’s dental hygenists is done while under anesthesia and includes many steps as described above. Cosmetic cleanings do not address periodontal disease where it occurs; under the gum line and does not remove the calcified plaque, tartar.

The frequency of dental cleanings performed by your veterinarian depends on the patient. Small dogs tend to do less recreational chewing that may help prevent plaque buildup.  Smaller dogs also have proportionally larger teeth compared to their head size and thus they have more tooth crowding above the gum, which creates more pockets for tarter and bacteria to accumulate.  Flat-nosed dogs, such as Pugs, Boston Terriers, French Bulldogs, and Boxers, have even more tooth crowding than small breeds. Their teeth are stacked on top of each other and rotated and they are at a much greater risk for periodontal disease and often need to have dental cleanings every six months to a year.

Below are pictures of a before and after of a typical dental cleaning. 

Before:

After:

An abscess shows up as a black halo around the tooth root in an x-ray, which just goes to show the importance of dental x-rays because we could not see this on a normal dental exam.  

Below is a picture of the progression of periodontal disease.  Arrow #1 shows the normal tooth root.  Arrow #2 shows progressive destruction or loss of the tooth root through the process known as resorption.  Arrow #3 is the complete loss of tooth roots, leaving only a small tooth fragment that was not visible above the gum line and only showed up on x-ray.

Tooth resorption is a very painful but somewhat common phenomenon in cats. It is where the the tooth starts to dissolve away. This can occur at the crown (tooth above the gum) and or in the roots. Often gum tissue grows over and the tooth is eaten away by the same cells that take away the baby teeth. We don’t know why this happens in cats, and there is no way to stop or reverse this process. The treatment is removal of the tooth.  The x-ray below shows a resorptive lesion in a cat.  The red arrow shows a lesion in the crown of the tooth and the white arrow shows the lack of normal roots.