February is approaching, which the veterinary profession has designated “Dental Health Month” in primary care practices across the country. Here at Daniel Island Animal Hospital, we want to put a special emphasis on the importance of dental care for your pets. In the next few blogs through the month of February, we will be addressing oral health and preventative care for dogs and cats.
Like many of my clients, I grew up with many dogs and cats and we never paid much attention to their dental health. I couldn’t tell you whether they had dental tartar or not. If dental care came up, it was a reaction to horrible breath, not eating, or bleeding from the mouth. Since those days, the veterinary profession has come a long way in recognizing the importance of dental health to the well being of our canine and feline companions.
What is dental disease?
Dental disease in pets is no different from that found in people. It all starts with plaque bacteria that colonize the tooth surface just as they do in our mouths. Without regular bacterial removal by brushing or chewing, eventually the bacteria develop into a hard cement called calculus or tartar. This cement grows on itself, and eventually the constant presence of bacteria causes inflammation of the gums, known as gingivitis, also generally called periodontal disease. If the inflammation and bacterial infection continue to progress, they cause the gums to pull away from the teeth, causing deep gingival pockets around the teeth. Eventually, the gums recede from the teeth and the infection proceeds to destruction of the bone that holds the teeth in place, eventually causing them to fall out. Gingivitis and periodontal disease are a significant source of discomfort for many pets, and there may be other potential health risks associated with a constant bacterial infection in the mouth.
What’s involved in a “Dental”?
Unfortunately, many pets, ESPECIALLY pets that have sensitive or painful mouths due to dental disease, don’t really let us get a good look around in their mouths during a routine visit, much less allow us to do anything about a problem that we may see. This is why veterinary practices have developed the basic protocol for what is called a dental prophylaxis treatment, often referred to as a “Dental” for short. Although preventative care is implied in the name, the process usually involves both the prevention AND treatment of dental disease.
If you think back to the last visit made to your dentist, hopefully you experienced a comprehensive evaluation of each tooth, measuring the gingival pockets, scraping away tartar, taking dental x-rays, doing treatments as needed, followed by thorough cleaning and polishing. Your dentist should have also evaluated your mouth as a whole, including the gums and tissue of the insides of the cheeks, lips, hard palate, throat and tongue. The veterinary dental prophylaxis is no different – we have 30 (adult cats) to 42 (adult dogs) individual little tooth patients that need to be thoroughly evaluated and treated appropriately.
Why is it so expensive?
Unfortunately, our pet’s reluctance to voluntarily submit to a tooth-by-tooth evaluation makes anesthesia necessary for effective dental prophylaxis treatment. Which leads to the biggest obstacle to pet dental prophylaxis treatment for most people - the cost. Inhalant anesthesia, done properly with pre-anesthetic blood screening, appropriate premedication, temperature, circulatory, and respiratory system monitoring throughout the procedure (including ECG, blood pressure, carbon dioxide and tissue oxygen levels), intravenous fluid support, and post-anesthetic monitoring, adds a significant cost. However, it also adds a significant value to the procedure.
Removing calculus when pets are awake, or even performing “sedation” dentistry, where animals are placed in a mild version of anesthesia and tartar is removed by hand, is unequivocally rejected by the members of the American Veterinary Dental College as being inadequate (see http://www.avdc.org/dentalscaling.html). Removing the tartar you can see only addresses the visible part of the problem for pets with dental disease, but it doesn’t deal with the bacteria under the gum line, which is what leads to painful periodontal disease. Unfortunately we just cannot safely and effectively remove tartar above and below the gum line, check for and treat periodontal disease, get full dental radiographs and thoroughly examine the mouth for other oral problems with an animal in an unpredictable state of sedation. It’s unsafe for the patient, personnel and equipment and it is not providing the level of medical care that your pet deserves.
Now I will be the last person to ingnore or underplay the risks of anesthesia. It is ALWAYS a risk, for any person or pet, to undergo. However, when all the necessary precautions are taken and it is carefully monitored, anesthesia carries a fairly low risk for even older pets with other underlying medical conditions. When compared to the increase in welfare that can be achieved by removing a constant source of inflammation and infection that is present in the mouth of pet with dental disease, it is usually a risk well worth taking.
How do you “treat” dental disease?
In general private practice, we rely on removal of plaque bacteria and calculus and topical and/or systemic antibiotic therapy to resolve most of the dental disease we see. In cases where the disease is severe, especially if there has been significant bone loss or there is an abscess at the tooth root (which we can see with our digital radiographs), then dental extraction may be necessary. Since our dogs and cats aren’t out chewing up carcasses to survive, the loss of teeth is generally well tolerated and a much better alternative to continued pain and disease. In some cases however, advanced techniques such as periodontal surgery, root canals, crowns and even orthodontic treatments may be the best option for your pet. At this time, we refer cases such as these to a board certified veterinary dental specialist on an individual basis.
How can I prevent dental disease?
Once the teeth and gums have been evaluated, cleaned and treated, we move on to the most important step – taking care of your pet’s teeth at home. Home dental care, especially brushing to remove plaque accumulation, is the best way to extend the amount of time between necessary dental prophylaxis treatments under anesthesia. It is so very critical to your pet’s well being, that it has become one of my preventative care soapboxes, as my clients will attest to ;-)! In an upcoming blog I will go step by step through the process of brushing my own dog’s teeth, cat dental care and give tips on how to work on getting them to accept it.
Your job between now and then is to email us with ANY questions you have about dental care in your pets. In our final dental blog I will address any questions that come up directly, so that we can help all of you better take care of your pet’s teeth at home.
As you are considering New Year's resolutions for yourself for 2012, make sure to include your pet! The most common resolutions we make seem to be centered around better physical and mental health so why not try and focus on these things for your pet as well!?
First Resolution: Measure food!
How about having the goal of helping your pet to achieve his or her ideal weight? Obesity is the one factor that can take away years of quality life from your pet faster than any other. One of the most common mistakes that we see is owners free feeding their pets. This is when the bowl is filled without regard to measuring quantity. Find out how much your pet should be eating (FYI yourveterinarian can calculate a recommended caloric intake based on age, activity level and body condition) and adapt him/her to a scheduled, measured feeding routine! (Check out Dr. Rainwater's articles on dog and cat weight loss for more information.)
Second Resolution: No more table scraps!
I can't tell you how many times I hear owners confess the junk food that their pets get - ice cream, fast food hamburgers, chips, etc. There are also junk food pettreats such as Pupperoni and extra large Milk-Bones (read: king size Snickers bar) that are just as bad. Believe me; I understand how much joy it brings to see your pet indulging in a special treat! Instead of the "junk food" though, how about trying raw carrots, green beans, or homemade baked sweet potato slices to name a few healthy options? My dogs still get their chew treats once or twice weekly, but we give vegetables as their daily rewards and my dogs LOVE them! They act just as excited for the vegetables as they did for the store bought treats! Give it a try!
Third Resolution: Exercise your pet more!
Not only will this resolution benefit your pet's physical health, but it will benefit their mental health as well. Take your dog on daily walks or runs depending on his/her ability. Play a daily game of fetch or Frisbee in the back yard! Try a new toy for your cat (ideas: remote control mouse, laser light, or feeding toy) and play with it daily. As you exercise your pet, you are helping their mental health as well. We see so many behavior problems that most likely stem from lack of mental stimulation!
Fourth Resolution: Train for life!
Adopt an attitude that training your pet is a lifelong goal: training is NEVER over for a pet! Have you resolved to put your dog away when strangers come over as opposed to teaching him/her good manners? Have you resolved to let your cat use the sofa as a scratching post because "the sofa's old and we want to get rid of it anyway"? Have you resolved to allow your dog to jump on you to demand attention? Pets thrive when they know what behaviors are expected of them and when they are positively rewarded for those behaviors. I recommend all new puppy owners adopt the philosophy: "nothing in life is free." This means, ask basic commands before rewards such as getting them to sit before they are fed, let outdoors, or before you pet them. Adult dogs and cats can also be taught these behaviors to help treat and/or prevent a few of the behavior problems that are common in adult pets. Try and teach your dog or cat better manners this year! Everyone will benefit!
Well, it has finally come to fruition that I suffer from a disease I readily see in our canine patients.Fortunately, it is not infectious (so no quarantine needed!) and it can be corrected. Unfortunately, I have had to learn the hard way the degree of discomfort some of our four-legged friends have had to deal with (and quite admirably, I might add) What is this often debilitating problem? Intervertebral disc disease (IVDD). Some big words for a relatively little, but much needed and ungraciously overlooked (at least in my case) cushion in our bodies.
What is IVDD
Intervertebral discs are the cartilage pads that connect the vertebral bones of our spinal column. The disc's job is to act like a shock absorber and spread out the compressive forces we subject our vertebrae to every second of every day and night. Interestingly, they account for 16 percent of the length of the articulated column in dogs and about 25 percent in humans! They are also one of the organs in our body that consistently show degenerative changes with advancing age. Each disc is composed of two parts: the nucleus pulposus (central part) and an outer anulus fibrosus. The nucleus is a semi-fluid tissue that is maintained under pressure by the encircling bands of fibrous tissue of the anulus fibrosus.
Insidious changes occur to both the nucleus and anulus relatively early in life. Calcification of the nucleus can occur which decreases its shock absorber abilities which imparts less flexibility of the spine. In humans and pets this is noted by a stiff, and possibly guarded, gait. Pain is not uncommon either, often from surrounding muscles that spasm. Mircofragmention of the anulus may also occur which allows the nucleus to bulge or escape completely ("bulging or herniated disc"). The nucleus most commonly escapes in the direction of the spinal cord where it may compress nerve roots (nerves that innervate our peripheral body) - usually termed "pinched nerve" - or it may cause inflammation or, worse, compression of the spinal cord. Let me tell you from personal experience a herniated disc HURTS!!! Besides pain, it can also cause muscle fasciculations (not visible to the eye), tingling, numbness, paresis (weakness), or even paralysis. Degenerative changes can occur in any disc, but the effects are most severe in the regions that are most mobile: the neck and the lumbosacrum.
Who is Predisposed
There are particular breeds of dogs that are genetically predisposed for developing IVDD and they typically fall under the category "chondrodystrophic breeds". Some of these are: dachshunds, beagles, Pekingese, basset hounds, and shih tzus. These breeds have a genetic disorder with their cartilage and bone development, hence abnormally developed discs may form. However, any breed can develop a disc problem, so any abnormal gait ("stilted walk", "holding neck funny"), PAIN!, or any weakness or nonuse of a leg or legs should prompt an immediate visit to your veterinarian.
How it's Treated
Diagnosing a pet with IVDD is often straight-forward with information gleaned from the physical exam and, often, survey radiographs. Many cases are mild and can be managed with anti-inflammatory medication (often steroids, since they are POTENT at reducing inflammation), pain control, muscle relaxers, and most importantly, STRICT REST - ideally, the pet is crated. More severe cases are referred to a veterinary neurologist or orthopedic surgeon where surgery may be indicated to extrude the herniated disc material and then fusion of the 2 adjacent vertebrae. Many of these pets recover remarkably well following spinal surgery.
After my recent disc herniation, I have a renewed and deeper empathy of the pets we see for neck and back pain. Neurologic-related pain is INTENSE and should not go untreated. We are here to help diagnose and treat the ones that can be managed medically, and we also have 2 specialty groups, Veterinary Specialty Care and Charleston Veterinary Referral Center, in the Charleston area that provide surgical care for those cases that need it.
We are celebrating all of our technicians and assistants this week for National Veterinary Technician Week! Last year, I wrote an article about the credentials and skills our LVTs possess. This year, I'd like to focus on the other half of our patient care support team, our amazing assistants!
In our hospital, a technician's assistant's primary role is to keep the day running smoothly by helping our veterinarians and technicians wherever needed. You'll often find our assistants checking in appointments, restraining patients, preparing lab samples and vaccinations, and keeping our hospital ship-shape!
We're also honoring our hard-working groomer's assistants this week. These ladies pamper the dogs and cats visiting Teri for their spa day by helping with walking, bathing, brushing, drying, trimming nails, and cleaning ears. They also are in charge of keeping the groom room tidy and tackling all that pet hair!
A big thanks to all of our assistants - Erin, Mary, Vyonne, and Michelle - we couldn't do it without you!
Monday, February 6, 2012 at 12:54PM | 
