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February is National Pet Dental Health Month!

The following article was written by Dr. Joyce Voss, D.V.M., Ph.D., Director of Veterinary Services & Animal Care at SICSA Pet Adoption and Wellness Center.

Did you know that pets can have many of the dental problems that humans get? As recently as 30 years ago, most people, veterinarians included, did not often evaluate pets’ teeth unless there was something clearly wrong with them.  Now we know that dental problems can not only cause pain and discomfort in our pets, but can also lead to other health problems.  The American Veterinary Medical Association has designated February as National Pet Dental Health Month to highlight the importance of dental care for your pet.  In support of this initiative, SICSA would like to share some information with you regarding pet dental health.  This first segment will discuss what happens to teeth over time.  The second will discuss at-home dental care that you can provide for your own pets.  Finally, the third portion of the article discusses what happens during a dental treatment at your veterinarian’s office.

Just like humans, puppies and kittens are born without teeth.  They grow in baby teeth, which begin to fall out and are replaced by permanent teeth at around 3 months of age.  By the time they are 6 months old, all of their baby teeth are typically gone and have been replaced by permanent teeth.  Unfortunately for the tooth fairy, most of the time we don’t find the baby teeth that have fallen out, presumably because they get accidentally swallowed.  These permanent teeth are porcelain-white at first, with pink gums that attach smoothly to the tooth.  Dogs have 42 adult or permanent teeth; cats have 30.  The development and proper growth of the permanent teeth, including appropriate location and orientation of the teeth, are some important genetic and developmental factors that can determine how susceptible an individual will be to dental problems.  For example, smaller dogs, especially those that have shorter noses or those that would have required braces had they been born human because of how crooked their teeth grow in, can be more prone to dental problems than larger dogs with longer noses.

Over time, because many of our pets don’t floss or brush their teeth, the teeth begin to yellow and accumulate plaque.  Plaque is a film that accumulates on teeth because of a combination of saliva, bacteria and debris.  The plaque eventually mineralizes and becomes tartar.  Tartar can continue to accumulate, which leads to entrapment of more bacteria and debris on and around the teeth and the gums, resulting in gingivitis, or inflammation of the gums, in a condition we call periodontal disease.  Pets start to have bad breath once they reach this stage.  While dogs and cats don’t get dental caries or cavities as much as humans do, as periodontal disease progresses and worsens, the bacteria and inflammation cause damage to the tooth, gums, and underlying bone that holds the teeth in place.  Damaged bone recedes away from the tooth and gets infected, which then results in teeth becoming loose.  Studies show that 85% of pets have some form of periodontal disease by the time they are 3 years old.  If you have ever had a tooth ache or even an infected tooth, imagine what it must feel like for our pets if they must live with dental infections and they can’t tell anyone about it to get help.

At-home dental care can decrease plaque build-up, which can then decrease the amount of tartar that develops on the teeth.  We will cover at-home dental care in our next post about pet dental health.

AT-HOME PET DENTAL CARE

One important thing that all pet owners should do is to look in your pet’s mouth and teeth regularly.  Train your pet to allow you to look at all the teeth, especially the ones in the back.  The more of this you are able to do, especially earlier on in their life, the less stressful it will be for them to have this done.  It will also increase the chances that you will be able to see mouth problems or changes earlier on when it may be easier to intervene.

Studies have proven that the most effective way to maintain healthy teeth is tooth brushing at least once daily, just as it is for us.  It is estimated that about half of pet owners don’t brush their dogs’ teeth, and less than 10% brush their dogs’ teeth daily.  Those numbers are far lower for cats. Even though brushing your pet’s teeth may sound odd or even impossible, with a little bit of training and using the correct tools, you can successfully get your pet to accept tooth-brushing.  Brushing with a pet toothbrush and toothpaste physically removes the plaque and bacteria, which helps keep the teeth cleaner better than any other form of at-home dental care.  Use of pet toothpastes will increase your chances of success because they tend to be flavored with chicken, seafood, or other flavors that they consider as treats.  Using human toothpaste for pets is not recommended because they have sudsing agents that are not meant to be swallowed.  The pets also do not appreciate their minty taste.

Other at-home ways to maintain your pets’ dental health is to provide them with dental food and treats.  Dry food tends to be better for their teeth than canned food is because crunching on the dry food scrapes away some of the plaque that accumulates on the teeth.  Dental treats often contain ingredients to help prevent plaque from turning into tartar, similar to what human mouthwashes do.  Many of these food and treat items look very large compared to non-dental foods or treats.  The size of these items encourages the dogs and cats to actually chew their food.  After all, lots of our dogs and cats enjoy their food so much that they will swallow their kibble or treats whole. I know my cats do!

Equally important in preventing dental problems in our dogs and cats is to not give them treats or toys that could break or damage their teeth.  For example, the fiber on tennis balls can be abrasive and cause damage to teeth if dogs gnaw on them.  In addition, even though many dogs really enjoy them, bones and cow hooves are too hard and can result in broken teeth.  If you’ve ever had a broken tooth, you know how painful this can be.  Teeth that are broken badly enough to have the pulp (sometimes mistakenly referred to as the “nerve”) exposed cause a lot of pain and can lead to infection of the underlying bone.  This is why broken teeth (and in humans, cavities) need either a root canal or extraction.  Because of the scarcity of veterinary dentists in the country and due to cost concerns, most pet owners elect to have these teeth extracted rather than have a root canal performed.  I can personally tell you that extracting a broken tooth that otherwise had a healthy root previously is a time-consuming and challenging process.  I highly recommend doing the best you can to avoid treats, toys, and activities that could result in broken teeth.

For more information on recommended brands of dental treats and products that have been proven to be beneficial for pet dental health, see the website for the Veterinary Oral Health Council at http://www.vohc.org/all_accepted_products.html.

Oral home care is key for keeping your teeth healthy.  It is important to remember though that even if we humans brush our teeth twice daily, floss, mouthwash, and other things to take care of our teeth, we still need to go to the dentist twice a year to get our teeth cleaned.  This is similar for our pets.  However, just like us, if we are able to maintain good oral hygiene at home, the dental visits tend to be quick and easy cleanings rather than having to go through extensive dental work.  Good dental care at home plus regular veterinary care will help your pet have a healthier mouth and live a healthier, happier life!

PROFESSIONAL DENTAL CARE

Veterinary dental care always begins with a physical examination.  During this exam, your veterinarian will look at all visible and accessible parts of your pet, including their teeth and mouth.  During this examination, your veterinarian may recommend a dental procedure under anesthesia.  The factors that will lead to this recommendation include signs of periodontal disease such as gingivitis, tartar, and loose or infected teeth, broken teeth, abnormal growths in the oral cavity, or teeth damaged by other processes such as conditions called resorptive lesions and stomatitis in cats.  It is not always possible to determine the extent of the problem during this in-office, awake animal evaluation.  While I may be able to see that there is gingivitis on the gum overlying a tooth, I cannot evaluate the condition of the underlying bone during this exam.  The condition of the bone is key in determining the likelihood that we will be able to save diseased teeth.  Often, a full and accurate evaluation can only be achieved using dental x-rays and while the pet is anesthetized.

Similar to what happens when we go to a dentist, routine full dental evaluation and cleaning includes taking dental x-rays, evaluating gum health, scraping any accumulated tartar off the surface of the teeth and beneath the gum lines, and then polishing to smooth out the teeth.  Polishing is important because it smooths micro-nicks on the teeth that occur over time or during the cleaning, which then can help make it harder for plaque and tartar to attach to the teeth.  During this time, the gums, the teeth, and their attachment to bone are evaluated for all teeth.  In a healthy mouth that just requires x-rays and a cleaning, the entire process can be completed in as little as 20 minutes.

For pets that have advanced periodontal disease or other dental concerns, the dental procedure under anesthesia can be much more involved.  If there is enough bone loss due to periodontal disease, often those teeth cannot be saved and must be surgically extracted.  Baby teeth that fail to fall out on their own after the corresponding permanent tooth has grown in require surgical extraction; retained baby teeth cause overcrowding and improper eruption of permanent teeth, which can lead to pain and worse periodontal disease earlier in life.  Broken teeth where the pulp ( “nerve”) of the tooth is exposed require either extraction or a root canal by a veterinary dentist to treat appropriately to prevent pain and infection.  Some dental problems require extraction of many or even all teeth for the pet’s longer-term comfort and health.  When pets require these types of dental interventions, the dental procedures can get to be very lengthy, which means longer anesthesia time and increased expense.  While some dental problems cannot be avoided, maintaining good oral health at home and working with your veterinarian to provide prophylactic and preventative dental care play important roles in minimizing the amount of time your pet needs to be anesthetized, which then can help minimize the cost of the dental procedures.

Although some organizations offer anesthesia-free dental cleanings, this practice is not recommended.  Tooth brushing is safe and beneficial; scraping off tartar can be risky in that there is increased chance of damage or breakage of the tooth, and a thorough cleaning is difficult to achieve, professional dental care must be done under anesthesia both for safety reasons and for effectiveness.  It can be very scary and stressful for an awake animal to have their teeth scraped with a sharp object; they certainly would not allow this process to happen below the gum line, which is where it is most critical to do if we want to halt periodontal disease.  Pets also do not tolerate the sound and vibration that accompanies the polishing that must be done afterwards.  Although there are always risks for complications for any procedure, including anesthesia, anesthetic drugs and monitoring equipment have come a long way in safety advances, and the risk-to-benefit analysis of anesthesia versus skipping a dental cleaning falls greatly in favor of proceeding with the dental cleaning in the otherwise healthy pet.

During my years working as a family veterinarian, I have counseled many pet parents regarding their pets’ dental health.  When it came time to decide on an anesthetic dental procedure, families were often hesitant due to concerns about anesthesia or cost.  When the pets do receive their anesthetic dental procedure, greater than 90% of pet parents tell me how much better their pet felt afterwards.  So many of them comment that they did not realize how much their pet’s mouth had been bothering them until they saw the difference in how they acted and seemed to feel after the procedure was done.  Even though our pets can’t verbalize and tell us when their mouth is bothering them, their feeling better and being more active after dental problems are addressed is such a great testament to how much their oral health does factor into their daily comfort and happiness!

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