One of the more common things an owner will mention to me as I am performing a physical examination is that they have noticed bad breath (halitosis) coming from the mouth of their beloved pet. Nobody wants a kiss from a stinky mouth! This foul odor is generally the result of bacterial accumulation tarter build-up, if we are lucky. If we are not, tarter may only be the start of it. Halitosis may signify a broken or diseased tooth, an oral abscess (infection), disease or infection of the gums and tissues surrounding the tooth, or even an oral tumor. These conditions are painful, even if Fido isn’t telling you directly. Dogs and cats, like their wild counterparts, are generally very effective at hiding any pain or discomfort. This is why regular veterinary examinations (every 6-12 months) are crucial to detecting dental disease, as well as other conditions. Owners can be a tremendous help to this process by regularly lifting the lip of their dog or cat to peek inside. Is there any visible tarter or a bad smell? Any discolored, chipped, broken, or loose teeth? Are the gums red, swollen or bleeding? Owners can also watch for subtle signs that may indicate mouth pain including decreased appetite, changes in eating habits, difficulty chewing, or dropping food. If an owner is unable to examine the mouth closely enough, or has questions or concerns, the pet should be scheduled for a check-up with his regular veterinarian.
When your pet is presented for examination, the veterinarian will perform an entire physical examination, and if the pet allows, will thoroughly examine the entire oral cavity. If the pet does not allow, or if more advanced examination is necessary, the pet may need anesthesia to properly probe each tooth. This allows for checking for pockets in the gum line around each tooth, assessing any spots, discoloration on the tooth enamel, any chips or fractures of the teeth and checking for any mobile teeth. Dental x-rays are necessary to assess any problems inside the tooth as well as below the level of the gums (for example, the tooth roots and the skull and jaw bone encasing the teeth). The veterinarian will use all of these diagnostics to determine the best course of action for the tooth. General practice veterinarians are trained to be able to identify dental concerns and perform thorough dental cleanings, tooth extractions, and general oral surgery. However, a board-certified veterinary dentist may be consulted to perform advanced treatment procedures such as crown placement, root canals, orthodontics, implants and caps.
For many owners, the most pressing concern about dentistry is the anesthesia. This is a natural concern, however, the anesthetic protocols and anesthetic monitoring that are now available have made the overall risk of complications very significantly lower than the risk of chronic infections. If left untreated, oral infections can also spread to the liver, kidneys and heart, which have the potential to become life-threatening. Pre-anesthetic blood work will also be performed, in addition to the physical examination, enabling the veterinarian to tailor the anesthetic protocol to the patient. Proper anesthesia also includes pain management, which may involve a combination of pain injections, local nerve blocks and pain medications to go home for a few days after surgery. While there is no guarantee for the outcome of any anesthetic procedure, the overall risk is extremely low and most patients are awake and sitting up 15-20 minutes after the procedure.
A routine dental cleaning (prophylaxis) begins with a thorough sedate veterinary exam, ultrasonic (power) and hand scaling to remove tartar and plaque, a low-speed (power) polish with flavored polish, rinsing to remove any debris and finally, an optional plaque deterrent sealant may be applied. If there is evidence of periodontal disease, additional, tailored treatments will be administered.
Several studies have demonstrated that by three years of age, up to 85% of dogs and cats have periodontal disease. This is bacterial infection of the tissues surrounding the teeth (gums, ligaments, bone). It begins when plaque starts to accumulate on the surface of the teeth. Next, minerals in the saliva start to harden the plaque into tartar, which is very firmly adhered to the teeth. This is visible above the tooth, but owners are unable to see the bacteria and tartar spreading underneath the gum line and tooth root. This can lead to periodontal disease which includes swelling and redness of the gums, loss of soft tissue and bone around the teeth, the development of fistulas (holes between the oral cavity and nasal sinus), and weakening the of the jaw bones due to infection which can then lead to fractures. Treatment of periodontal disease is multi-faceted and depends on the severity of the disease, and also the willingness of the owner to perform oral hygiene at home, as well as the pet’s overall health.
An owner can significantly help decrease the incidence of periodontal disease by maintaining good oral hygiene at home. Keeping in mind that dogs and cats aren’t generally keen on having their teeth brushed and flossed daily, so don’t be discouraged if tartar does accumulate to some degree! The idea is to minimize the overall number of dentistries that are required over the life-span of your pet. It is rare for a dog or cat to never require at least one dental cleaning in his lifetime.
Most dogs and many cats will tolerate tooth brushing, particularly if introduced to this as puppies or kittens. There are a variety of toothbrushes and flavored pet toothpastes available for your pet. Do not use human toothpastes as they contain abrasives and are high-foaming which are irritating if swallowed. There are also a variety of chlorhexidine-based dental wipes, oral rinses, oral gels for dogs and cats, and rawhide chews for dogs. Chlorhexidine is an excellent antiseptic for plaque, however if does have a taste which some animals do not like. Others accept the products readily. There are treats for both dogs and cats that are marketed for dental health and rely on enzymatic agents to prevent plaque accumulation, or structure to help break down existing tartar. There are also several foods available which use this kibble-structure principle to promote tartar break-down. In general, avoid chew toys that are made of hard materials, like cow hooves and hard nylon. These can cause fractures of the teeth, and tend to cause more harm than good. Daily chewing of firm rubber toys is ideal. Consider smearing butter on or in the toy to promote chewing. However, as with any toy, use caution if your dog tends to tear toys into small pieces so that he does not ingest them! With any pet, but especially with cats, remember that patience when starting a new routine is essential. And especially when trying diet changes or adding new flavors, allow your pet a little latitude as she adjusts. In time, your pet will be on his or her way to a healthy mouth.
Robin Paterson, D.V.M.
Cerbat Cliffs Animal Hospital
4110 Stockton Hill Road
Kingman, AZ 86401