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.