Dentals – Why pets get to be sedated for them and we don’t.
Dental Health
We are very pleased to announce we have opened our dental program at Precision Veterinary! Oral health is just one of the many key components of your pets overall wellness, and it’s a broad topic. We wanted to compile some of the key facts to share with you, so that you can get as excited about dental health as we are!
First off, cats and dogs are somewhat different when it comes to their oral health, though admittedly they are more similar to each other than either is to their human counterparts (or human servants, as our cats like to think of us).
The Basics:
- The average dog has a whopping 42 teeth in his mouth, while the average cat (is any cat really average?!) has 30. Humans, by comparison, usually have 32. There can be both extra and missing teeth….more on that later!
- Both cats and dogs have two sets of teeth throughout their life. The deciduous (baby) teeth erupt between 2 and 8 weeks of age and then subsequently fall out as the adult teeth erupt between 3.5 months (for cats) /4 months (for dogs) and 6 to 7 months of age (for both dogs and cats). Sometimes, the baby teeth don’t fall out when they should, which can lead to problems…more on that later too!
Anatomy of a tooth
The Problems:
As dogs and cats age, their teeth can experience several different types of wear and tear that can cause them to become unhealthy, infected, painful, and even fall out.
Periodontal Disease
The most common oral health issue out there is good old periodontal disease caused by the build up of plaque and bacteria, which leads to tartar (basically mineralized, hardened plaque). Most of this blog post will focus on periodontal disease and how to prevent and treat it in your pet, though we will touch on a few other oral health topics as well. Periodontal disease includes inflammation of the gums (gingivitis) and inflammation and eventual loss of the bone and soft tissue around the teeth (periodontitis).
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Periodontal disease is an infection that comes from the build up of plaque on tooth surfaces around the gums. Plaque contains bacteria and causes irritation to the gum and eventually (if enough plaque accumulates) can lead to an infection of the bone surrounding the affected tooth. The longer the bone remains infected, the more it starts to disintegrate and disappear, leaving the tooth loose. Additionally, as the plaque comes in contact with saliva, certain minerals are deposited on the plaque and this forms tartar, also known as dental calculus. Tartar is VERY difficult to remove without dental instruments, and since it’s a rough surface, it gives new plaque something to cling onto more easily and speeds up plaque accumulation. Basically, once dental disease starts it enters a positive feedback loop and magnifies itself.
Per the American Veterinary Dental College-“Periodontal disease is the most common clinical condition occurring in adult dogs and cats, and is entirely preventable. By three years of age, most dogs and cats have some evidence of periodontal disease.” Did you hear that? That’s right…they said “entirely preventable” meaning there are things we can do to avoid this particular issue. Left untreated, periodontal disease can lead not just to pain, infection, and tooth loss, but to other health issues as well.
Consequences of Periodontal Disease in Pets
“Bad breath is the most common effect noted by owners. However, this is often only the tip of the iceberg. The gums become irritated, leading to bleeding and oral pain, and your cat or dog may lose its appetite or drop food from its mouth while eating. The roots may become so severely affected that some teeth become loose and fall out. Bacteria surrounding the roots gain access to the blood stream (“bacteremia”). Studies have shown that dogs with severe periodontal disease have more severe microscopic damage in their kidneys, heart muscle
and liver than do dogs with less severe periodontal disease.”-VOHC
Stage 4 periodontal disease in a dog (AVDC)
(Just in case the previous photo didn’t demonstrate severe periodontal disease well enough)
How fast a patient builds up plaque and tartar is based on many factors including genetics and chewing habits. Certain factors can cause plaque and tartar to build up more rapidly such as crowding or misalignment of teeth and retained baby teeth.
Retained deciduous teeth
Retained baby teeth are those that don’t fall out by the age they are supposed to. Retained teeth are a type of malocclusion, meaning the teeth are not aligned correctly in the mouth. “The most common malocclusion in dogs is persistent (retained) deciduous (primary) teeth. This is especially common in toy breeds (e.g. Yorkshire Terriers, toy poodles, Chihuahuas), and the retained deciduous teeth can force the permanent teeth to erupt in an abnormal direction. In young animals in which a permanent tooth can be seen to be erupting while the equivalent deciduous tooth is still firmly in place, the retained deciduous teeth should be extracted.”-AVDC
Persistent deciduous canine teeth
There are many other types of malocclusions as well, and there are procedures that exist for correction when the malocclusions are causing pain or causing malfunction.
Endodontic Disease
Teeth can also suffer from fractures usually from external trauma or chewing very hard objects, causing exposure of the pulp of the tooth, opening the tooth up to infection of its internal structures (called endodontic disease). “The teeth most frequently broken are the canine (fang) teeth in the dog and the cat, and the upper fourth premolar teeth (the carnassial teeth – the large upper teeth in the back of the mouth) in dogs.”-AVDC
They can also suffer from other types of trauma or injuries that cause the pulp of the tooth to die or become non-vital even without a fracture, also leaving the tooth open to infection. Non-vital teeth are frequently discolored. Treatment of endodontic disease in general practice usually consists of tooth extraction, though there are sometimes more advanced procedures available with a veterinary dental specialist such as root canal therapy and vital pulp therapy.
Less Serious Issues
Some less serious issues in teeth often seen are slow, chronic wear from long term chewing (while not ideal, not as serious as an acute fracture, as the body can usually, though not always, compensate for it) and staining of the enamel, which while it isn’t super pretty, isn’t really harmful in any way.
Cat Mouths (oh the joy!)
Cats being cats, can have all of the fun issues already discussed plus a few of their own lovely unique little quirks as well, most of which are thought to be related to the immune system. The most well-known of these issues are is tooth resorption — sometimes referred to as cavities, cervical neck lesions, or feline oral resorptive lesions (FORLs). Resorption can affect the crown of a tooth, the roots, or both. “Affected tooth roots often erode and disappear when they are replaced by bone. The lower third premolars and molars are most commonly affected; however, tooth resorptions can be found on any tooth. The specific cause for tooth resorption in cats (and dogs) is unknown, but theories supporting an autoimmune response have been proposed.”-AVDC
Side note: there are some reports of tooth resorption in dogs, but that is beyond the scope of this blog post. Tooth resorption causes inflammation of the surrounding tissues and is a painful process. Treatment most often consists of extracting the affected teeth. Cats can also be affected by stomatitis, an inflammatory condition. Stomatitis is a painful and debiltating condition that can eventually also lead to periodontal disease. Treatment often consists of a combination of frequent dental cleanings, good home oral healthcare, extraction of affected teeth, and medication.
So what can you as an owner do to prevent or slow down these issues?
- First and foremost, you can have your pets teeth checked once a year by keeping up-to-date on their annual exams. This helps diagnose dental issues early on before they get out of hand and cause more damage. Certain diseases are unfortunately out of our control, like FORLs, stomatitis (to a degree), and oral growths, but again — catching these processes early allow us to address them early and help prevent and treat our pet’s pain.
- Second, (and mostly for dogs), you can try to control what material they chew on. Harder substances tend to cause more wear and tear on the teeth. That being said of course, you need to balance these choices with the need to give your pet something he enjoys chewing on so he doesn’t chew things he’s REALLY not supposed to (like say your shoes, or the drywall). As the AVDC states “Rawhide products and chew treats can be helpful if chewed daily, and some rawhide chews and biscuits contain an anti-tartar ingredient. Palatability is important – chewing every day is the ideal… However, AVDC does not recommend cow hooves, dried natural bones or hard nylon products because they are too hard and do not mimic the effect of a dog tearing meat off a carcass. These hard products are associated with broken teeth or damaged gums.” Remember, always supervise your dog when he is chewing on chew treats or toys!
- You can participate in home oral healthcare! It is recommended by the American Veterinary Dental College to brush your pet’s teeth daily. They recommend starting very early on in life and using positive reinforcement to get them to enjoy said tooth brushing. There’s all kinds of cat and dog specific tooth brushes, and most importantly canine or feline specific toothpaste. (They can’t have our toothpaste, it makes them sick!). However, WE KNOW that brushing your pets teeth can be challenging. Luckily there are many products that maybe aren’t quite as good as brushing but can be very helpful in slowing down the buildup of plaque. These include oral health chews, oral health water additives, oral health gels….there’s a plethora. The Veterinary Oral Health Council compiles a list of products and gives their Seal of Acceptance to products that have been shown to actually work, so when you are searching for these types of products, make sure they have a VOHC seal on them. Also, there are prescription dental diets that do much of the same thing as some of the other oral health care products. Remember, none of these products will cure dental disease once it’s there, but they can definitely help slow down the progression of the buildup of plaque. In case you were curious if it’s actually possible to brush a cat’s teeth check out Cornell University College of Veterinary Medicine’s tutorial on cat teeth brushing here.
There’s also a YouTube video they recommend!
For a list of approved products, please visit http://www.vohc.org/all_accepted_products.html
How do you know when is it time to have your pets teeth checked out?
We recommend having them evaluated on an annual basis at their yearly wellness exam. However, if you note any of the following signs, these could also indicate that there is an oral health problem that needs to be checked out:
Signs of oral and dental diseases in dogs and cats:
– Bad breath.
– Loose teeth or teeth that are discolored or covered in tartar.
– Your pet shies away from you when you touch the mouth area.
– Drooling or dropping food from the mouth.
– Bleeding from the mouth.
– Loss of appetite or loss of weight (this combination can result from diseases of many organs, and early veterinary examination is important).
–AVDC
Unfortunately, even with all the dental health products and all the home care in the world, sometimes plaque and tartar get to the point where they need to be removed with a professional cleaning. A professional cleaning, when done in a timely fashion, can help prevent worsening periodontal disease in the future and can prevent the loss of teeth. Once periodontal disease is to a certain point, a patient may need not only a professional cleaning, but also treatment of any severely diseased teeth.
The Solution:
Dental Evaluation
Prior to any dental procedure at Precision Veterinary, we will evaluate your pet to assess their overall health and establish if there are any concerns for general anesthesia. This first evaluation will also serve to give preliminary assessment of your pet’s oral health to give us a better idea of what level of involvement of dental cleaning and treatments may be indicated. True story — you can never, ever know for certain what level (if any) of treatment beyond a professional cleaning a patient’s mouth may warrant until you perform a full oral exam under sedation because there are certain portions of the mouth and of each tooth that we are not able to evaluate on an awake patient. So again, the pre-dental exam can give us a very good idea of what level of treatment we are expecting, but keep in mind that it’s an estimate.
Dental Procedure
On the day of your pet’s dental procedure they will undergo general anesthesia (lots of folks inquire as to why we use general anesthesia to perform dental cleanings). The answer is multi-fold:
- Nobody likes going to the dentist, least of all dogs and cats, to whom we cannot explain WHY we are cleaning their teeth; therefore, it greatly reduces their anxiety and fear about the whole process and also makes the process safe for the people performing it, and safer for the patients too.
- We can actually do a better job at cleaning teeth if your pet is asleep because we can clean all surfaces of each tooth including UNDER the gum, which is CRUCIAL in addressing periodontal disease. In veterinary medicine, we don’t just use a hand scaler, we also use an ultrasonic scaler to scale (clean) the teeth…this instrument makes a somewhat high-pitched noise and would likely be frightening to patients while they are awake. We can also get a much more thorough oral exam all the way to the back of the mouth and on every aspect of each tooth present.
- If any teeth need to be extracted, then this is considered surgery. So a patient should of course not only be anesthetized but be given as much pain control as possible including a local anesthetic, which you guessed right, is much easier and safer to administer when they are anesthetized.
“For a thorough, safe dental cleaning in veterinary patients, anesthesia is essential, as this permits a comprehensive assessment of the tissues, allows dental radiographs to be made when indicated, followed by the cleaning (scaling and polishing procedure) itself above and below the gum-line. “Non-anesthetic or Anesthesia-free dental scaling” is not recommended by AVDC”-AVDC
Your pet will be given a complete oral exam-this includes assessing the health of each tooth in the mouth to determine treatment steps moving forward, noting any abnormalities that need to be addressed or kept track of over time, and making note of any growths or wounds in the mouth as well.
All surfaces of the teeth will be scaled, meaning tartar and plaque will be removed. The teeth will then be polished. Polishing the teeth is performed to make them smooth again and help prevent further plaque from building up. If the teeth are left roughened, it leaves lots of small crevices where bacteria and plaque can cling and start to collect.
Additionally, treatment of any teeth with periodontal disease that is too far advanced to be remedied or teeth with endodontic disease is performed. In general practice this usually means tooth extraction, which is considered oral surgery. Depending on the extraction type (simple extractions or surgical extractions where a drill is involved) absorbable sutures may be placed in the mouth. Other treatments you may see being done during this time depending on what clinic you visit might include instilling local antibiotics and dental radiographs.
In some cases, there are certain oral health conditions that need to be addressed by a veterinary dental specialist and/or may require further diagnostics. There are also other options for treatment of fractured teeth in some instances (including root canal therapy), which are available from a veterinary dental specialist. We will always discuss these options with you beforehand and can assess whether or not we would preemptively recommend referral when we see you and your pet for their pre-operative dental exam.
So there you have it!
Questions:
- What about awake dentals without anesthesia? Or scraping tartar off the teeth that I can see while my pet is awake…is anesthesia REALLY necessary?
Simply put: yes. Awake, anesthesia-free dental scalings are not recommended. It’s not recommended by us, it’s not recommended by the dental experts (check out the link below for more information). “The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because the patient cooperates, dental scaling of human teeth performed by a professional trained in the procedures can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient.“-AVDC
2. Why can’t you tell me exactly (if any) how many teeth my pet might need extracted?
At your pet’s pre-dental exam, besides evaluating their overall health and assessing if they are good candidates for anesthesia, we will do our best to give you a reasonable expectation of the level of treatment we anticipate your pet will need at the time of their dental cleaning based on the health of their gums, the level of tartar that is visible, and whether or not there are any other health issues occurring in the oral cavity. However, certain factors cannot be determined with an awake oral exam. For example, teeth at the very back of the mouth can be difficult to assess. Additionally, pockets of infection surrounding each tooth can only be detected with dental instruments once a patient is under anesthesia. Therefore, while we are able to get a fairly good idea of how involved a patient’s dental procedure will be, there may be additional teeth found on the anesthetized oral exam that end up needing treatment.
References: