Dental Disease in Pets

 People are often surprised to learn that animals get the same aliments that humans do- from heart disease to diabetes to cancer. Among the other conditions that animals can develop are dental and periodontal disease. Gum erosion, inflamed gums, tooth decay, tooth root infections and fractured teeth with pulp exposure- dogs and cats are at risk for all these.

Since animals can't brush their own teeth, tartar and plaque accumulate to cause problems. Besides causing bad breath and pain (note that animals will tolerate more pain than humans before manifesting obvious signs of discomfort such as reluctance to eat), the plaque build-up also harbors bacteria that is shed into the blood stream to affect other organs of the body.

While tartar accumulation and gum inflammation can be minimized by feeding dry foods and giving chew toys and tartar control treats, there is often individual and breed predisposition to developing dental disease. Some dogs and cats, despite being on a 100% dry food diet, will still get plaque. Certain dog breeds, especially toy and miniature dog breeds are especially prone to periodontal disease. These breeds are also prone to retaining their baby teeth. These extra teeth which can lead to problems often necessitate removal.

Certain cat breeds such as Siamese and Abyssinians seem to be particularly prone to gingivitis (inflamed gums). In cats, stomatitis (inflamed mouth) can signal certain diseases such as infection with the feline immunodeficiency virus (FIV).

What can a dog/cat owner do? The most important part in managing dental disease is, as for ourselves, daily brushing. While some cats and dogs will simply not tolerate this, most can be taught to deal with a finger brush or small toothbrush in the mouth with pet toothpaste (not human products). It may take time and patience to train your pet to accept brushing and it's best to start with puppies and kittens to let them get used to gentle massaging of the gums and teeth. By starting with a bit of baby food, the pet learns that the brush is tasty and will tolerate this. Then chicken or beef flavored toothpaste can be introduced. The toothbrush is applied to the outside of the front teeth (incisors), the fangs (canines), and the back teeth (premolars and molars), working between the cheek and the outside of the tooth where plaque build up occurs. This can be done without having to open the animal's mouth but by simply lifting up the lip and moving the brush between the cheek and teeth.

Most animals will cooperate with this technique but are less tolerant of having their mouth opened wide. Fortunately, less buildup occurs on the inside of the teeth. If inflamed gums are more of a concern without the presence of tartar, chlorohexidine based gels and solutions can be helpful to swab on gum and minimize oral bacteria. Dental brushing on a regular basis, ideally every day, but even 3 times a week, makes a difference.

For dogs and cats that already have considerable dental tartar and/or periodontal disease, a more thorough cleaning is necessary. Cleaning the teeth is not just for cosmetic purposes, although your pet's breath will undeniably smell better afterwards. It is beneficial for the pet's health since the bacteria harbored in the mouth systemically affects all the organs of the body. In some cases of inflammation of the liver or kidneys or heart murmurs, bacteria often play a contributing role.

A dental prophylaxis is best done under anesthesia by your veterinarian. There are facilities, usually pet stores and grooming salons, that will offer "anesthesia-free dentals" or "standing dentals" or "hand scaling". While this seems ideal since it avoids anesthesia for the pet and is less expensive, there are many drawbacks. While a superficial cleaning leaves the teeth looking apparently clean, deep cleaning is not possible, and an extensive amount of plaque can be left under the gum line. When a compromised tooth is encountered that necessitates extraction or other procedure (i.e. root canal), this cannot be addressed. In scaling the teeth, either by hand or with a cavitron, small scratches are made on the tooth's surface and unless the teeth are polished, this roughened surface provides a foothold for bacteria to build up again. Also, in the process of cleaning the teeth, bacteria are liberated and go into the blood stream. Outside of a hospital setting, antibiotics are not given to eliminate these bacteria that systemically affect the animal nor are painkillers administered.

For this reason, at veterinary hospitals, an injection of antibiotics is given at the time of the dental prophy, and if there are extractions and/or the presence of periodontal disease, antibiotics and painkillers are dispensed. Dental prophies done at the hospital also provide the occasion to remove minor lumps as well as to do other procedures that the animal may not tolerate in an awake state - thorough ear cleanings, toe nail trims and radiographs of limbs or back. Note, however, dental prophies are not done at the same time as major surgeries such as abdominal or orthopedic procedures. This is to avoid contamination of the sites with the oral bacteria released with cleaning teeth.

Most hospitals can do prophies and do extractions, but not all do certain techniques. These include "flaps" with extractions, a technique that allows the hole to be closed over and sutured with absorbable sutures and dental radiographs which allow a more thorough evaluation of tooth and bone damage. These more specialized procedures are usually done by veterinarians and technicians who have undergone additional training in veterinary dentistry.

Still, there are some procedures that necessitate referral to a veterinary dentist, that is, a specialist who can do more difficult procedures such as root canals. This technique is done to preserve fractured major teeth such as the canines (the fangs) or carnassials (the big molar teeth) rather than extracting them.

There are always concerns about anesthetizing an older animal, and it is often the middle-aged or older pet that has significant dental disease. However, there are ways that this can be done safely. Your veterinarian will recommend doing blood work and urinalysis before anesthetizing your pet. It is important to get a "picture" of your pet's body's function, and this is best done by analyzing liver and kidney enzymes, electrolyte levels and red blood cell and white blood cell counts.

If there are significant problems noted beforehand, a dental cleaning may be delayed and further testing such as radiographs and ultrasound or treatment with continued monitoring may be recommended. If no problems are found in the blood and urine samples, a "baseline" or what is normal for your pet has been established. This is an important point of reference in the future as your pet ages and helps your veterinarian determine significant changes in your pet's health as your animal gets older.

There are several precautions that are taken on the day of anesthesia for a dental prophy. These include:

* A physical exam (even if one was just done the day before; like us, an animal's status can change overnight)

* Antibiotics to eliminate bacteria liberated during a dental prophy

* Pain killers to minimize any pain associated with the procedure

* Use of an intravenous catheter for administration of fluids (which allows for the perfusion of organs and control of blood pressure)

* Monitoring blood pressure with a Doppler

* Monitoring the patient's oxygen content with a pulse oximeter * An EKG that monitors the heart's electrical activity

* Close supervision by a veterinary technician who monitors the animal's depth of anesthesia, breathing pattern, heart rate and body temperature

It is ideal after a dental prophy to commit to keeping the bacteria at a minimum with regular brushing. This needs to be done 3-7 times per week to be effective. But even if this is not feasible, you have taken a significant step in improving and extending your pet's life.

If you have questions regarding dental disease, don't hesitate to contact your veterinarian.

The above is general veterinary information. Do not begin any course of treatment without consulting your regular veterinarian. All animals should be examined at least once every 12 months.

About the author:

Linda Mar Veterinary Hospital and its cat-only affiliate, Coastal Cat Clinic, are small animal practices located in Pacifica, California.

 Linda Mar Veterinary Hospital