dvm2 (16)What is periodontal disease?
Periodontal (gum) disease is a bacterial infection that affects the structures (periodontal ligament and jaw bone) that hold our teeth firmly in place. Plaque is first formed by the accumulation of bacteria on the teeth. Plaque, if not removed, is than calcified by minerals in the saliva to become tartar (brown substance on teeth). Chronic plaque formation results in inflammation (gingivitis), when the plaque moves under the gumline. Gingivitis is the first, reversible form of periodontal disease. If this inflammation is not controlled it becomes more severe, and the body responds resulting in bone destruction, and eventually tooth loss. In most cases, periodontal disease causes other problems long before this happens.

Do I have to worry about dental disease in my pet?
Periodontal (gum) disease is the most common ailment in dogs and cats. Examination is the key to diagnosis and helps determine the type of treatment needed. By just the age of two, 70% of cats and 80% of dogs have some form of periodontal disease. By this age, 10% of dogs also have a broken tooth with pulp (nerve or root canal) exposure. This is extremely painful up until the nerve dies, at which point infection of the tooth occurs. Bacteria is created with these oral diseases,which infects the bloodstream, and can infect other parts of the body. These infections from periodontal disease have been linked to problems such as diabetes, liver disease, kidney disease, heart attacks, strokes, emphysema, osteoporosis, and pregnancy problems.

In addition to these sytemic infections, oral disease can also cause many other major issues. It can cause blindess, as a result from eye inflammation. Jaw bone loss from chronic infection can lead to fractures which have a hard time healing. Finally, this disease can result in osteomyelitis (an area of dead, infected bone), nasal infections and as increased risk of oral cancer.
In cats, it is very common for half of cats over 6 years of age to have at least one feline oral resorptive lesion. These eat away at the cat’s own teeth, similar to cavities, and are very painful and can become infected. They are first detected as small red areas along the gumline.

Unfortunately, there are very few obvious clinical signs. It is best to take preventative measures by asking your veterinarian for a complete oral examination, and perform regular checks at home.

What are the warning signs of periodontal disease?
A pet owner can help by examining their pet’s teeth and oral cavity at least monthly. If you sense a disagreeable odor, gum disease may be present. The other earliest signs are inflammation (redness/swelling) of the gums. This is generally also seen with plaque buildup and tartar, which can be less noticeable, and loose teeth. Pain may also be present; any changes in eating or chewing habits can be the result in an oral problem. When your home examination reveals dental issues or if you are still uncertain, a trip to the veterinarian is in order.

When a pets teeth and gums hurt badly enough, they could stop eating. The vast majority will find some other tactic to keep eating (chew on the other side, swallow kibble whole). Animals have an extremely strong survival instinct, no matter what discomfort they feel. Some other signs are excessive drooling, bleeding mouth when eating/playing with toys, reluctance to hold their toys in their mouths, be less playful, or having a hard time sleeping. Often, after dental treatment, clients notice a huge change in their pet, including acting more energetic and playful than they have in years.

Is it important to have my pet’s teeth cleaned regularly?
A cleaning allows for a complete and total oral examination. Only with general anesthesia can most oral health problems be noted. These exams include screening for oral cancer, periodontal pockets, broken teeth, cavities, and tooth resorptions (in cat’s).

Does hard kibble do the same thing as brushing their teeth?
Typical dry food does not protect against periodontal disease. The root cause of periodontal disease is subgingival plaque, or plaque below the gumline. Traditional dry kibble breaks 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. Pet owners should be aware that numerous products labeled as “dental” foods/treats, typically only clean the tip of the teeth. Specific dental formulas (Royal Canin Dental or Hills Prescription Diet t/d) have enzymes which bind to those minerals in the saliva that would cause the accumulation of tartar, and get swallowed instead of binding to the teeth. These products have been clinically proven to reduce gingivitis, plaque and tartar. Ask your veterinarian what the best choice of dental food is for your pet.

What should a pet chew on?
There is a fine line between being too hard, possibly damaging the teeth, and being too easy to chew up and swallow. Many commercial chew toys are far too hard and can break the chewing teeth. There are two general guidelines to follow when buying chew toys: if you cannot make an indentation in it with a fingernail, the treat or toy is too hard, and if it would hurt to hit yourself in the knee with it, the treat or toy is too hard. Pets should always be monitored while they chew, especially those that are prone to quickly swallowing large pieces.

As a pet owner, what can I do at home to prevent periodontal disease?
Brushing the teeth is the gold standard of home care. Daily brushing is most ideal, however to be effective, it must be performed at least three times a week. Another way to decrease gingivitis and periodontal disease in your pet is using a rinse with an antiseptic agent. CET Oral Hygiene Rinse is an excellent antiseptic rinse; the active agent (chlorhexidine) impregnates the teeth and gums, and has antibacterial effects. It may be difficult for some pet owners to make the daily commitment of tooth brushing, or to teach their pets to be tolerant of mouth handling. When this is not practical, feeding an effective dental diet provides a convenient solution.

How do I brush my pet’s teeth?
It is important to go slow and have lots of patience when teaching your pet to tolerate brushing of their teeth. The owner must take care for their own safety; never put yourself in harms way or push your animal to the point of aggression. One can start by giving daily examinations of the mouth. This will build trust between owner and pet, so the animal feels safe. You can work up to using a small soft toothbrush and veterinary toothpaste. Human toothpaste should be avoided becuase the detergents can cause stomach upsets. Finger toothbrushes can be used at first as well, but be wary that your finger could be at risk for a bite, even from the most placid animal. Take little steps, and reward (with food/low cal treats) the desired behaviour you wish to continue to see. It is best to start young, because it will be easier for your pet to accept it. Be consistent and have a routine, because animals will find this easier to accept.

What is involved in a dental cleaning?
General anesthesia is absolutely necessary to do a thorough cleaning definitive oral examination. Your veterinarian can provide the appropriate pre-anesthetic protocol and treatment plan to provide your pet with the best care.

There are several reasons why general anesthesia is necessary. In “sedation” dentistry or anesthesia-free dentistry, the trachea (windpipe) is not protected from the particles generated during a dental cleaning. These particles are full of bacteria and if inhaled, they could lead to pneumonia. Veterinary practices put a tube down the trachea and inflate a cuff, to prevent any inhalation of particles, and to prevent water dripping down into the lungs. Also, most veterinary clinics use short-acting agents to put patients under anesthesia, and than keep them on a maintenance gas. The gas can be turned off and the animal recovered quickly, should any problems occur. Under sedation, the effects of the agent last until the drug is cleared from the system, which can take a long time. General anesthesia is very safe today, because of the advances in medicine, training, and monitoring equipment.

Dental prophylaxis consists of several steps: supragingival scaling (removal of plaque/tartar above the gumline), subgingival scaling (thorough cleaning under the gumline), polishing (smooth over the rough edges created by scaling; these rough edges promote plaque and tartar attachment and reduces the lasting effect of the cleaning), sulcal lavage (flushing debris from gingival crevice), thorough oral examination, periodontal probing for pockets, dental charting, and at the end, fluoride therapy.

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.

Why is cleaning my pet’s teeth more expensive than cleaning my teeth? Why is it more expensive than the last time his teeth were cleaned a few years ago?
The cost of dental care for pets has certainly increased as the quality of anesthesia, cleaning, and services have increased. One example of this is our ability to provide dental radiography, or x-rays, which allows us to see the roots and bone surrounding each tooth. We want to provide safe anesthesia and a service that proactively helps treat pain and prevent the progression of disease. To accomplish this we require modern, specialized equipment like a blood pressure monitor, a fluid pump, and an ultrasonic scaler. Most of this equipment is not necessary when human teeth are cleaned because we are not undergoing anesthesia. Also, remember that usually our oral hygienist is performing a routine preventative cleaning before hardly any tartar has built up on our teeth. Pets rarely get dental care this early and thus their cleaning is not a true preventative it is a treatment.

The doctor has recommended extraction of some of my pet’s teeth but will he still be able to eat without these teeth?
Yes. Our goal in veterinary dental care is for our patients to have mouths that are free from infection and pain. It is much healthier to have no tooth than to have an infected tooth with a root abscess or a painful broken tooth. We have many dog and cat patients that are able to eat a regular diet with few or even no teeth! In some cases a veterinary dental specialist can offer root canals or more advanced therapy to save teeth. Our doctors will always offer referral if there is a possibility of saving teeth. Please let us know if this may be an option for you.