Dental Disease

 

According to the American Veterinary Dental Society, more than 80% of dogs and 70% of cats show some signs of gum disease by age three. In spite of this important statistic, oral hygiene is one of the most overlooked areas of medical care for animals. As we increase our knowledge of animal health we realize that proper dental care does not just make your pet’s breath smell better; it is mandatory for your pet’s long term quality of life. Dental disease is prevalent in almost every adult dog and cat we examine.

Prevention is the key, and in addition to professional cleaning which we provide, the most important thing you can do is to brush your pets teeth. If started at an early age this “bonding time” is an enjoyable time for all. Start the brushing when the adult teeth are in, which is around 5 months of age. We can tell you when to start if you are not sure, and show you how to do it.

People sometimes wonder why pets need their teeth professionally cleaned by us, and then brushed by you, when they have memories of growing up with dogs and cats and never doing this. It doesn’t take much to answer this question. Pets nowadays eat diets that makes them prone to plaque. They also live longer, and just like in people, are more prone to disease as time goes on. A big reason is because we did not have the knowledge decades ago to understand how dogs and cats lived lives of chronic pain because we did not know, or could not diagnose, the periodontal disease that is occurring below the gum line. With the advent of digital radiography and our current body of knowledge we realize that we did not treat dental disease anywhere near as thoroughly as needed.

This is the crux of the problem. When you look at the teeth and see some tartar it doesn’t seem like much of a problem. Just scrape the tartar off and the teeth will look better.

Here is the same tooth as it is being removed while this pet is under anesthesia. The root on the right is rotten, compare it to the normal root on the left. We find these rotten teeth only by probing under anesthesia or taking x-rays. A rotten root is painful. In this pets case it felt significantly better when removed.

Cats get a unique dental problem, called neck lesions (also called FORL- Feline Odontoclastic Resportive Lesions), that are painful. When we encounter these problems we need to remove the bad tooth. The short video below is an example of how painful this is on a cat. This cat is completely anesthetized, yet when we tap its premolar teeth it moves it jaw in obvious pain.

Anesthetized Cat with Painful Teeth

It is the periodontal disease that is occurring out of sight and below the gum line that causes the most problem. This is the area we thoroughly need to address when we clean a pets teeth under anesthesia.

Dental disease is a treatable and preventable problem, and since your pet cannot tell you how it feels, it is up to all of us, as members of your pet’s health care team, to address this problem. Most people wait too long to get their pets teeth cleaned professionally. Teeth cleaning should be considered a preventive measure, not a way to treat a problem that is already present. Good dental care revolves around the control of bacteria under the gumline where it is not visible. We will teach you how to prevent it and how to treat it.

Dental disease is such a rampant problem, and is so easily prevented, that February of every year is designated as National Pet Dental Health Month. Please ask one of our receptionists for additional information. This page has detailed information on dental disease in dogs and cats. We have a summary page on dental disease if that suits your needs better. There are short videos on this page. You will need Quicktime from www.apple.com to be able to view them.

This page has an extensive amount of information that will inform you of this serious and overlooked problem. Please set aside the time to fully understand it due to its importance regarding your pets quality of life.


Normal Tooth Anatomy & Development

The diagram below illustrates some of the structures of the normal tooth. It also shows Stage III periodontal disease, which you will learn more about later. On the left side you can see the bone of the jaw and the blue periodontal ligament. It is this ligament that keeps the tooth attached to the bone in the socket. You can also see the blood supply and nerves to the tooth. They are the vertical finger-like projections in the center of the tooth.

On the right side we have illustrated what happens in gum disease. The brown area between the tooth and gum is tartar and its associated bacteria. This tartar is intert, is not causing any significant gum disease, and removing only this tartar does nothing to the bacteria that are below the gum line. It is the bacteria surrounding and within this tartar that we are after. Notice how a significant amount of tartar is below the gumline, and thus cannot be seen. Also, notice how the gum is pulled away from the tooth leaving a pocket.

As the bacteria progresses further down the tooth, the gum is pulled further and further away, the jawbone literally erodes away, and the periodontal ligament can no longer hold the tooth in the socket. The tooth rots out, or is removed when we clean the teeth. The bacteria that eventually causes this erosion enters the bloodstream and can cause disease in other organs. It is this bacteria below the gumline that is causing all the trouble, and is the bacteria we remove when we professionally clean the teeth.

After the teeth have been professionally cleaned we can use non anesthetic dental from Pet Dental Services to prevent the problem from recurring. You are fooling yourself if you think you can take your pet somewhere to have them scrape the tartar off once gingivitis is present. The teeth look nice, which means you have done something cosmetically nice for your pet, but you haven’t touched the medical problem.The teeth need to be cleaned by trained professionals from our hospital or Pet Dental Services.

This radiograph of a tooth shows the same anatomy as above. We will show it again later when we show radiographs of diseased teeth. Notice how tightly the roots of the tooth fit into the healthy jaw bone. When we show you radiographs of diseased teeth later this jaw bone will be partially gone.

Dogs have 28 deciduous (temporary or baby) teeth and 42 permanent teeth. Anatomically they have 4 different types of teeth: Incisors (I), canines (C), premolars (Pm), and molars (M).

This is an x-ray of the lower jaw (mandible) of a dog. You can see how deep the roots go.

In comparison to dogs, cats have 26 deciduous teeth and 30 permanent teeth. They have the same types of teeth that dogs do, but in different proportions. They lack premolar #1 found in dogs due to a different evolutionary path.

The deciduous teeth start being replaced by the permanent teeth (in this picture they are the 2 large central incisors marked by the arrows) at 4 months of age. The puppy teeth that were there were probably swallowed.

Dogs seldom have problems with teething, although they do tend to chew things during this period. It is advisable to supply them with synthetic bones for this purpose, or else some of your personal items might get recycled! By 8 months of age all the permanent teeth have appeared.


Congenital Abnormalities

Small breed dogs tend to have dental problems more often than large breed dogs. This may be due to the fact that they have smaller oral cavities and the teeth are forced closer together. Cats get comparatively few congenital problems regarding their teeth. Any condition where the teeth are not normally positioned is called a malocclusion.

Malocclusions are corrected only if there is a problem with mastication (chewing). Undershot jaw (lower jaw protrudes beyond the upper jaw) is seen on occasion, and is prevalent in small dogs and in breeds like Bulldogs, Shih Tzu’s, and Lhasa apso’s. Overshot jaw (upper jaw protrudes beyond lower jaw) is similar to buck teeth in people.

Occasionally, a dog will not shed a deciduous tooth when a permanent tooth starts to come through the gums in the same location. These retained deciduous teeth, along with any extra teeth, should be removed because they will result in displacement of the permanent teeth. Problems of this nature are discovered by our doctors on routine exams. This enforces the importance of bringing in young pets for vaccines and exams at an early age.

Biofilms

So what is it that causes dental disease? It all boils down eventually to bacteria. When it comes to dental disease, because of the unique environment of the mouth, we measure bacteria counts in the billions (yes billions)! Bacteria that adhere to the enamel of teeth colonize and begin synthesizing molecules, the most important of which are carbohydrates. These carbohydrates are sticky and act as a glue to attract more molecules on the teeth, eventually forming plaque. As time goes on calcium carbonate deposits on the plaque, hardens, and then becomes calculus. This is the hard material deposited on teeth people sometimes call tartar.

Tartar is made up of calcium salts, food debris, bacteria and other organic matter. It is orange to brownish in color and although soft when deposited, it quickly hardens. It collects primarily on the cheek (buccal) side of the premolars and molars, although it can occur in any tooth. Periodontal disease results when the bacteria at the center of this plaque move under the gumline. There are many different bacteria in the mouth that start the process of plaque development. Some are aerobic, and live off the rich oxygen supply in the mouth (can you guess why the mouth has a rich oxygen supply?). As mentioned above, some of the bacteria in the plaque that migrate under the gumline go to an area of no oxygen, and are called anaerobic. The anaerobic ones tend to cause the most problem. Here is a list of some of their scientific names (warning-they are tongue twisters, so you better brush up on your Latin):

  • Actinobacillus actinomycetemcomitans

  • Bacteroides asaccharolyticus

  • Fusobacterium nucleatum

  • Eikenella corrodans

  • Porphyromonas gingivalis

  • Actinomyces viscous

There is no oxygen under the gumline, so the main type of bacteria to colonize there is called an anaerobe. The anaerobic bacteria cause an inflammatory reaction, and break down the periodontal ligament. The end result; the tooth rots out. Also, as these bacteria invaded deeper into the tooth cavity they reach the blood supply to the tooth and can enter the bloodstream where they cause significant damage to the liver, kidney, and heart. It can even predispose to diabetes mellitus (sugar diabetes).

The problem does not end there when it comes to periodontal disease. It can also lead to spontaneous jaw fractures, deep seated bone infection, cancer (neoplasia) at the affected tooth, Since bacteria are the main culprit in periodontal disease, it makes sense that antibiotics will be used to treat the problem. The two main ones we use are Clavamox and Antirobe. In select cases, where it is impossible to clean the teeth professionally, we will sometimes use one of these antibiotics in what is called pulse therapy. They are given for one week each month indefinitely. They are reserved for cases where the heart or other internal organs are seriously diseased and unable to withstand the sedation needed for professional teeth cleaning. Antibiotics are certainly no replacement for professional cleaning, but have a place in some select cases. How do you prevent these bacteria from starting the problem all over again after the teeth are professionally cleaned? Brush the teeth, or use the enzymes, chew toys or sprays on the teeth to minimize plaque buildup.

Symptoms

Symptoms of dental disease can range from subtle to extreme. One of the most common symptoms is bad breath (halitosis). Sometimes a pet with dental disease will cry in pain when you touch it anywhere near its muzzle. Another symptom is a partial or complete inability to eat (anorexia). A pet that has this problem may eagerly go to the food bowl, and either just look at the food or drop the food out of its mouth after only a few bites. Other pets might drool from one or both sides of the mouth. Unfortunately, many pets are stoic (do not show outwards signs of pain when it exists on the inside) do not show any symptoms until the problem is well entrenched and we have a difficult time correcting the problem.

The important point to remember is the fact that once you notice any of these symptoms, your pet’s dental disease is already causing discomfort or pain, and even affecting other body organs. Therefore, it is important for you to be aware of the existence of this problem, to learn how to perform a basic oral exam at home, learn how to brush its teeth or use gels or sprays, and to bring your pet in for regular (every 6-12 months) dental exams by one of our veterinarians. Every 6-12 months seem like a lot to some people. Compared to the typical lifespan of a dog or cat, it is not very frequent. Your pet cannot tell you its mouth hurts, it is up to us, as a team, to ensure that this inevitable problem is properly monitored and treated before it causes discomfort and pain, and sometimes premature organ failure.

Stages of Gum Disease

Before we show you diseased gums and teeth, lets get some perspective and show you some healthy teeth and gums. This is an example of the teeth and gums we want to see for the rest of your dog’s life.

There are 4 stages of periodontal disease. The first stage occurs when bacteria cause an invisible film of plaque to form on the teeth. The bacteria react with minerals and other debris that accumulate in the oral cavity, eventually causing tartar. You learned about his already in the biofilms section.

Gingivitis appears prior to tartar formation. It is seen as the reddened gum along this canine tooth. Since the gingiva are the first line of defense for the tooth against bacteria, any gingivitis is considered significant. This pet should be treated now before the problem progresses to more advanced periodontal disease, an all too common diagnosis in our hospital.

If we treat the gingivitis now, when it is at Stage I, we can reverse the process in many cases. As the periodontal disease progresses it becomes increasingly difficult to reverse this process.

Dent2

Here is another example of canine Grade I periodontal disease. It doesn’t look like much of a problem, and is easily ignored at this stage, which is a mistake because it is now that we can do the most good in preventing progression to other stages of periodontal disease. This is the time to professionally clean the teeth, not when it progresses as you will see in the next slides.

A tooth that starts with the tartar of the teeth shown above will rapidly progress to this more advanced state, which is Stage II periodontal disease in the dog. The underlying gum is more inflamed and is pulled further away from the tooth.

As the periodontal disease progresses tartar buildup also continues. The underlying gum is pulled further away from the tooth, and Stage III periodontal disease is present. The pocket of bacteria under the gumline in this tooth is significantly weakening the periodontal ligament and weakening the bone of the jaw.

Untreated Periodontal Disease

Stage III periodontal disease eventually progresses to Stage IV periodontal disease. This tooth shows advanced periodontal disease as evidenced by the ulcerated gums (blue arrow), pus along the gum line, and severe tartar. When this happens your pet will experience pain and will become internally ill from the bacteria spreading to internal organs via the bloodstream. Pet’s with this problem are in jeopardy of internal organ failure.

Here is another dog with a similar problem. The tartar is so thick that it is literally holding the teeth in place! Notice how far up the inflamed gums are. In Stage IV periodontal disease the tartar can be so extensive that it is the only thing holding the teeth in the socket in some cases. When we remove the tartar the teeth literally fall out.

In some cases the infection under the gumline has eroded away the gum tissue that normally covers the root. If the tooth has 2 roots it will cause a hole to appear between the roots where the gum has eroded- this is called a furcation lesion. The cat in the picture below is well on its way to getting this problem.

Its hard to believe that someone would let their dogs teeth progress this far. Unfortunately, this is not an uncommon situation.

stageIV

This is one potential outcome when pets with periodontal disease are not treated. The teeth in this cat literally rotted out of its mouth. This situation is completely preventable. Fortunately, pets that have no teeth can still eat well, but that is small consolation for this cat. The years of chronic bacteria that were released into this cats bloodstream when the periodontal disease progressed from Stage I to Stage IV can seriously affect the internal organs and cause this cat to have premature organ failure.

This is another potential outcome for a pet that has periodontal disease. This dog’s lower jaw (mandible) is fractured at the chin because of long term periodontal disease. You can see this fracture (the arrow points to it) as a separation where the two lower jaw bones meet at the chin.

This jaw had to be wired back together after the teeth were cleaned. It will also need to be on long term antibiotics. Unfortunately, the problem might get worse as time goes on. The wire (marked by the arrow) can be visualized just to the right of the tongue at the very center of the picture. It is wrapped all the way around the jaw and anchored under the chin. It will need to stay in place at least one month.

Here is another cat with the same problem, click on the picture to enlarge it.

There are other serious complications that can occur when proper oral hygiene is neglected. This dog had a seriously infected tooth that created a fistula (arrow) into its upper jaw. Food will go into the passage and end up in the nasal cavity, which is not a place where food belongs. This dog will have chronic infections because of this, which can even lead to life threatening pneumonia.

Complications of Dental Disease

The heart is one of the internal organs that can be affected in advanced dental disease, because bacteria from the mouth infection can readily deposit on the heart valves (especially the mitral valve). Our heart page has extensive information if you would like to learn more. This picture is from our heart page. The top arrow points to a normal valve leaflet. The bottom arrow points to a thickened valve leaflet, which could be the result of chronic bacteria from the mouth. The thickened and rounded lower leaflet causes the problem.

The thickened valve can malfunction and leak blood backwards through one of the chambers of the heart, instead of forward like intended. This turbulence of blood as it flows through this leaky valve can often be heard as a heart murmur. The result of this back pressure is a buildup of fluid in the lungs (pulmonary edema) eventually. Fluid in the lungs will cause your pet to start coughing and feel very ill- it is a serious sign that requires immediate veterinary care.

In addition to heart (cardiac) problems, dental disease can affect the kidneys and the liver. These are both vital organs, and require a pet free from dental problems if they are to function properly. Some pets do not live a full life due to the chronic affect the bacteria has on their internal organs, leading to premature organ disease.

Diagnosis

Since there are numerous diseases and conditions that can mimic dental disease, the diagnosis of dental disease must be performed by a veterinarian. During a routine physical exam we will be be performing a complete examination, including the oral cavity. As with any illness, the diagnostic process is carefully followed so that a correct diagnosis is actually made and other problems that are a result of the dental disease (ex-heart murmur), or are occurring simultaneously (ex-kidney disease), are not overlooked. Our doctors will gladly point out what problems (if any) your pet is having with its teeth and gums.

We will also show you how to perform a basic oral exam so that you can monitor your pet’s progress at home. The oral exam is not complete until we exam your pets mouth (the medical term for the mouth is oropharynx) under anesthesia. Only then can we check for tumors, ulcers, gum disease, foreign bodies, and infections, and enlarged tonsils.

Pre-anesthetic Preparation

The first step in the process is yearly exams by one of our doctors, and more often if there is a medical problem of any kind or you pet is on chronic medication. Many people will have this yearly exam performed when their pet comes in for yearly vaccines. We will look inside the mouth and determine if any oral disease is present. If there is enough gum disease to warrant professional cleaning, pre-anesthetic tests will be ordered. We will also try to identify teeth that might need removal if there is an obvious problem.

For pets under 5 years of age a routine in-house blood panel will suffice in most cases. For older pets, or those with other problems, a more thorough blood panel will be ordered. These blood panels will let us know if your pet is ready for anesthesia, will check your pets health in general, and will allow us to assess any damage to the liver or kidneys from the chronic bacteria in the bloodstream. In addition, our doctors will sometimes recommend other tests prior to anesthesia. These tests commonly include radiographs of the lungs or abdomen, along with an electrocardiogram to assess the heart.

Our pre anesthetic diagnostic tests page covers these tests in more detail. Our doctor will analyze the results of the pre-anesthetic diagnostics tests and customize an anesthetic protocol for your pet. In many cases Intravenous fluidswill be given prior to and during the professional cleaning. These fluids, when used in combination with pre-anesthetic tests, dramatically minimize the risk of anesthesia. as a final preparation prior to professional teeth cleaning one of our doctors might put your pet on antibiotics.

Anesthesia

When significant gingivitis is present proper dental care involves more than just scraping tartar off the teeth. Just scraping the tartar may temporarily make the teeth look better, but it is not addressing the real problem that occurs under the gumline. Thorough dental care involves scaling, probing, radiographing, flushing, measuring, fluoride and polishing. You will learn more about these in the next section. These treatments can only be accomplished on an anesthetized pet. It is not realistic to think that all of this can be accomplished on an awake pet, and be as thorough as we can on an anesthetized pet.

When these procedures are performed properly we can reverse the periodontal disease in some cases, and keep the teeth and gums healthier for a longer period of time. Since the risk of anesthesia is negligible with the precautions we take and the precise method available to administer and monitor anesthetic, it is well worth the negligible risk in order to clean the teeth and gums properly. In reality, the risk of disease occurring by not cleaning your pet’s teeth professionally is greater than the risk of anesthesia. We have extensive experience in anesthetizing pets, especially the geriatric pets that so commonly have advanced dental disease. To minimize any anxiety you have over anesthetizing your pet, one of our doctors will personally discuss our anesthetic protocol with you and set up an anesthetic plan that is specific for your pet’s condition. Our anesthesia page has extensive detail on how we anesthetize animals.

Professional Cleaning

Oral Exam and Charting

The first aspect of the cleaning process is an examination of the complete oral cavity. It is only when a pet is sedated can this be completed thoroughly. The arrow is pointing to a cyst in the mouth of this dog that was not seen until it was sedated. The owner did not know it was present, nor did this dog show any symptoms. We were able to remove it before it became a problem.


After our thorough oral exam we chart the problems encountered.


Dental Unit

The equipment you will find in our hospital is the most advanced available. It will allow us to provide a wide array of dental services.


Radiology

Radiography is an important part of dental care and is commonly performed as the next step after the oral exam. During your pet’s oral exam under anesthesia our staff will measure the depth of the pocket on the teeth that have disease. If the depth is 4 mm or greater we might take a radiograph of the tooth to make sure the underlying jawbone and root are healthy. If the root or jawbone are not healthy the tooth needs to be removed or a root canal at a specialist needs to be performed.

Our dental x-ray machine is made specifically to radiograph animals


The machine is automated, allowing us to rapidly take high quality radiographs


The high definition of these radiographs allows us to see problems that are not apparent during the oral exam. Here is the normal tooth radiograph you saw at the beginning of this page.


This radiograph shows a problem around the root. Do you see the dark, semicircular area around the root of the tooth in the very center of the picture? Compare it to the other root of this same tooth just to its right. This dark semicircular area radiographically is called lucency, and is an indication of deep seated infection in the tooth. It is painful and needs removing.


In this radiograph the jaw bone has been eroded down to expose parts of the roots on both teeth. This is the furcation lesion shown earlier.


Calculus Removal aboveand Below the Gumline

If the tartar is extensive, as it is with this dog, a special dental instrument is used to crack off large pieces of tartar before we use the scaler. This enables us to clean the teeth faster, another method to minimize anesthetic time. It also reduces wear on the ultrasonic scaler tip.


Scaling teethis greatly facilitated by a special instrument called an ultrasonic scaler. By vibrating tartar off the teeth with the scaler we cause minimal trauma to the tooth enamel. In addition, the rapid manner in which it removes the tartar minimizes anesthetic time. The gentle nature of the scaler allows us to clean under the gumline and not irritate the gums.

These teeth belong to Socrates, a dog that was brought to us for teeth cleaning. The tartar is obvious. Do you see the inflamed gums also?


We use a specialized ultrasonic scaler that is made for animal teeth


The tip vibrates 18,000 times per second, and literally vibrates tartar off the teeth. It does not harm the enamel, and lets us clean the teeth faster than doing it by hand. It continually sprays water to minimize heat buildup which could irritate the gums.


Socrates’ tooth just after it has been scaled. Notice the small amount of blood at the gumline. This is gingivitis, and needs to be addressed.


Probing and Measuring

Here is a close-up of the probe. Each of the notches is 1 mm, the total length being 10 mm. Anything more than a 3 mm pocket under the gums in dogs, and o.5 mm in cats, is significant.


Lets have a little fun and show you just how small 10 mm is, courtesy of Uncle Abe


When we measured the depth of the pocket on this tooth it was obvious from the bleeding and the depth of the probe that Socrates has Grade II periodontal disease.


If we think the bone loss seen on the radiograph is manageable, and the gum pocket is not too large, we can place a long acting local antibiotic, called Doxirobe®, under the gumline. This will continually kill the bacteria causing the gingivitis. The ultimate goal is to save the tooth from advanced periodontal disease and the need to remove a rotten tooth. If the problem is too advanced for this treatment, we will remove the tooth.


The Doxirobe is placed under the gum, where it will harden and release continual amounts of tetracycline antibiotic. We are trying to prevent further periodontal disease leading to removal of the tooth in the future.


We checked Socrates other teeth for gum problems and found out they are just fine. We plan on checking Socrates in 3 months to see how his healing is progressing.


In some pets the tooth problem is so severe that removal of the tooth is necessary. After we remove the tooth we place a special bone graft in the opening called Consil.

Here it is being applied to the opening where a tooth was removed


Root Planing

This is probably the most critical step in the professional cleaning proces. By scraping the bacteria under the gumline with this special instrument we take care of the problem at its core. This can only be done on your pet when it is under anesthesia.

We use a specially designed instrument that is gentle

Flushing the Gums

After the teeth are scaled and probed, and the roots have been planed to remove the originating bacterial cause, we spray them with chlorhexidine to further help eliminate the bacteria that are causing gingivitis. It is only after this point in the professional cleaning process that we have significantly decreased those billions of bacteria.

Polishing

Polishing the teeth makes them look whiter. It also smoothes off the enamel surface and makes it more difficult for bacteria to adhere. Once bacteria get reestablished, the cycle of plaque leading to tartar and eventually gingivitis gets started all over again.

Fluoride Treatment

One of the final steps in the cleaning process is the application of fluoride to prevent cavities. We bathe the teeth in fluoride for a few minutes, then rinse it off. It has a very nice smell, too bad we can’t transmit smells over the Internet. We even put fluoride on the teeth of pets when they are spayed or neutered to help protect their teeth when they get older.

Prevention

Just like in people, routine preventive care is critical to proper dental hygiene. This saves your pet from extended periods of pain and unnecessary tooth loss, and can save you the expense of the veterinary care needed to treat advanced dental disease. Your pet’s teeth should be checked every 6-12 months by one of our doctors, especially if it has already had gingivitis and had its teeth cleaned. Any pet that has had periodontal disease should be checked every 3 months. One of these check ups can be accomplished when your pet is brought to our hospital for yearly booster vaccinations.

One of the most important things you can do to slow down the recurrence of dental disease is to brush your pets teeth. This will help keep the gums healthy and prevent tartar buildup on the teeth on the cheek side (buccal) of the mouth, although it does not work as well on the teeth on the tongue (lingual) side of the mouth. Even though this may sound like an impossible feat for an uncooperative pet, or even a ludicrous idea, it is one of the best ways to prevent dental disease. Even though the teeth will eventually need professional cleaning again in the future (most people get their teeth cleaned several times per year), proper brushing will decrease the amount of dental disease that occurs and the number of times we will have to clean your pet’s teeth over its lifetime.

Due to the short life span of pets in relation to people, proper home care of your pet’s teeth becomes an important health measure. When brushing the teeth there are some common sense things to do to make the process go smoother. One of our technicians will demonstrate some of these techniques with one of our hospital cats (they love the attention). It is important to remain calm and patient, since for most pets having something put into their mouths is a new experience. With a little tincture of time, the procedure progresses smoothly. also, it is highly advantageous to start the brushing process at an early age.

Patience is the key! Try to do something positive (feeding it, playing or walking)  with your pet just after brushing to condition the behavior for the future. Try to make the whole process fun, and don’t ever let on that you are doing something good for your pet (kinda like child psychology- if its good for them they won’t do it). With your pet near you or on your lap, maybe while watching TV, let your pet get used to your finger near its mouth. Dipping your finger into a food or liquid your pet has acquired a taste for helps start the process smoothly. When it is comfortable with your finger, use a soft gauze to massage the gums and gently rub the teeth. a cotton tipped applicator can also be used. Eventually you want to progress to a toothbrush.

In smaller pets, especially cats, proper restraint is important. There needs to be a proper balance between too little and too much restraint, a balance that varies with each pet. This is especially true with cats. For smaller pets, placing them on a table will make the process go smoother. Larger pets can also be placed on a table, if feasible, or can be restrained on the ground. Only one or two people should be involved in the cleaning process, usually without children present. We have a complete page demonstrating this restraint technique. Eventually, introduce a soft bristled toothbrush.

These toothbrushes are available in our dental kits. A rubber finger brush can be used but a toothbrush is preferred. You should not use your personal tooth paste to brush your pet’s teeth because the taste can upset their stomachs. Our dental kit has toothpaste that is specially made to be palatable to animals. These kits also have suggestions to make it easier to brush your pets teeth. If you consider daily tooth brushing a chance to enhance your bond with your pet, you and your pet will find it more enjoyable. Brush the teeth in a slow and circular motion with a small amount of toothpaste. Its important to brush the outside of the teeth (the teeth up  against the lips and not the teeth up against the tongue) since that is where the plaque is most prevalent. If your pet is cooperative brush the insides next. Your goal is to brush at least 3 times per week. This will decrease plaque by 90%. If you encounter resistance on a pet that normally lets you brush, or see blood or there are blood tinges on the toothbrush, smell any odor, see any inflamed area or swelling, or a buildup of tartar or inflamed gums, you should bring your pet in for an exam. If the tartar is significant it is time for a professional cleaning.

The brown staining at the top of this tooth is plaque.  The reddish gumline just above the plaque is gingivitis. It is time for a professional cleaning when you see this.

In some cases brushing is just not feasible. In these situations you can use sprays, gels and chew toys to control the buildup of bacteria. Another excellent way to prevent the tartar buildup that leads to gingivitis is the food called T/D. It is particularly useful for small breed pets, which are prone to significant dental disease. Just like in people, routine preventive care is critical to proper dental hygiene. This saves your pet from extended periods of pain and unnecessary tooth loss, and can save you the expense of the veterinary care needed to treat advanced dental disease. Your pet’s teeth should be checked every 6-12 months by one of our doctors, especially if it has already had gingivitis and had its teeth cleaned. Any pet that has had periodontal disease should be checked every 3 months. One of these check ups can be accomplished when your pet is brought to our hospital for yearly booster vaccinations.

Non Anesthetic Dental from Pet Dental Services

For many people the most convenient way to prevent dental disease is with a professional technician scraping the tartar off the teeth before the problems starts. This means it should be started when your pet is 6-12 months of age, and continued at least every 3-6 months for the rest of your pets life. This non anesthetic technique is not used for pets that have gingivitis or periodontal disease, since as you already learned, these problems needs to addressed with professional cleaningand root planing. After the teeth are cleaned we recommend the non anesthetic dental, usually anywhere from monthly to every 6 months, to prevent the problem from ever recurring again.

We have contracted with outside licensed technicians from Pet Dental Services to perform non anesthetic teeth cleaning on the 4th Monday and Wednesday of every month. You can make an appointment and wait while it is being performed, or you can drop your pet off and pick it up later. They will give you a chart of the teeth cleaned, and let you know of any problem areas to watch for. All legitimate non anesthetic dental people are licensed by the state of California to perform this technique. This can only be performed legally in the state of California under the direct supervision of a licensed veterinarian. This law is obvious for your pets protection. Many unscrupulous people perform this procedure because they tell you they are saving you money and fooling you into thinking they are actuallly doing something medical for your pet. They prey upon the irrational fear people have of anesthesia. In reality, all they are doing is setting up the stage for the bacteria that is under your pets gumline to to wreak havoc later on.

Miscellaneous Dental Problems

Carnaissal Tooth abscess

The carnaissal tooth (upper 4th premolar) may become infected and result in the formation of an abscess around the root. This is a very painful condition and is often accompanied by fever, loss of appetite and depression. a classic symptom of the problem is discharge through the face below the eye. This tooth needs to be removedfor the problem to be corrected. It has a deep root and needs careful extraction to correct the problem.

Lymphoplasmocytic Gingivitis

This disease, seen almost exclusively in cats, is a specific inflammation of the the gum tissue. It is a painful and debilitating condition that is controlled but not cured. It is treated in various ways, including surgery with a laser.

Cracked Teeth

It is very common for pets, especially dogs, to break or loosen their teeth while playing or chewing. This can cause significant discomfort and predispose your pet to dental problems later on in life. Injured teeth are usually removed, under general anesthesia, to ensure that the whole tooth is removed, including the root. If the root is not removed there will be a continual problem. In some cases we will refer you to a specialist that will determine if the tooth can be saved.

This dog fractured its tooth by chewing rocks


It was so badly traumatized it had to be removed. This tooth has 2 deep and strong roots, so it has to be split in half with a high speed drill.


The tooth just after removal


Cavities (caries)

Due to the nature of their enamel dogs and cats do not routinely develop cavities. If they do, the cavity looks like a black area on the tooth, usually seen at the gum line or on top of the molars. Cavities can lead to pain and difficulty in chewing. The usual treatment is extraction of the tooth, although we can refer you and your pet to a specialist in veterinary dentistry to fill the cavity and save the tooth.

Discolored Teeth

Discolored teeth are seen in some pets. This can be caused by diseases like Distemper, the administration of certain antibiotics during the first few months of life, or trauma. If you notice discolored teeth please bring your pet in for an exam to determine the cause of the problem and if treatment should be instituted. Teeth that are red stained or red tinged have internal bleeding and need dental care.Antibiotics like tetracycline, if used when your pet is young, can stain the teeth permanently

Worn Down Teeth

Worn down teeth are usually caused be chewing rocks, chains, and fences. This is a behavioral problem that should be corrected to prevent long term problems. also, dogs that continually chew or bite at the skin due to allergiesor fleas will cause the incisor teeth to be worn down, sometimes all the way to the gum line.

This problem can be detected during a routine exam and corrected by prevention of chewing on itchy skin before the teeth get worn down too far

At this stage there is no way to correct the problem without extensive dental work with a specialist

Growths

Pets can get growths in the oral cavity, some of them can be benign, some malignant. Any growth or inflamed area in the mouth should be biopsied.

A benign gum growth that occurs usually in older dogs is called an epulis.The growth of the gum sometimes become so large that it covers a tooth almost completely

This is the same growth as above 1 week after removal using the laser

What is the next step?

If one of our doctors feels your pet needs to have its teeth professionally cleaned there are several steps you should take:

1. Make an appointment to have the teeth cleaned before you leave our office. This will give you greater flexibility in your scheduling and allow us to accommodate you as much as possible. One of our receptionist’s will give you a written price estimate based on the doctor’s written instructions.  An estimate will be given that covers all anticipated costs. Even though our estimates are very accurate, there may be slightly greater, and more often lesser, charges on the final bill. This might be because some teeth need removal or medication needs to be sent home, or even finding something on the oral exam while under anesthesia that was not readily visualized during the initial exam. If there is any significant change in the price we will call you before proceeding. Please leave a phone number where you can be reached.

2. If one of our doctors feels your pet needs pre anesthetic diagnostic tests, have them obtained while you are here, or drop your pet off and return to pick it up later when the tests are complete. Any test samples sent out to our outside laboratory will be available the following morning. Please call our office after 10 AM the next day for these test results.

3. The night before the teeth cleaning take away all food and water before you go to bed, and make sure your pet does not eat anything in the morning. Our office opens up at 7:30 AM for drop offs. We appreciate having your pet in for its teeth cleaning by 8 AM.

4. We will anesthetize your pet and clean its teeth sometime in the morning or early afternoon. One of our doctors will call you as soon as the procedure is complete.  It is very rare for a pet not to go home on the same day its teeth are cleaned. Your doctor will let you know if he plans on keeping your pet overnight. This might be because your pet is older or has a medical problem that requires us to monitor its progress in the hospital for an additional night. The best time to pick up your pet is in the late afternoon or early evening.  We are open until at least 9 PM every night for your convenience.

You will be given written post dental instructions when you pick up your pet. If you have any questions after reading these instructions please let us know. Your pet may be groggy the first night. This is not because of the anesthesia, it is because of the pain injection many pets are given after their professional cleaning.

5. Contact with children and other pets should be supervised by an adult the first night. Give it a small amount of water and soft food an hour after getting home. If it eats and there is no vomiting, give it some more food and water. It might experience some grogginess that evening because of the pain shot we give (some people welcome this, especially with young and active pets), but should be back to normal by the next morning. Please call us the next morning if you have any questions or you feel there is a problem (ex.-not eating, very lethargic).

6. If we send your pet home with pain medication or antibiotics use them exactly as prescribed.

7. Call us if your pet does not resume its normal activity and eating habits within 24 hours.