REVIEW OF PET DENTAL DISEASE, PART 3

Due to ongoing family concerns back in Pennsylvania, Desperado and Helpful Buckeye are still a little bit out of the loop as far as publishing a new issue of Questions On Dogs and Cats. For that reason, this issue will be a continuation of our review of Pet Dental Disease. Enjoy!

1) Helpful Buckeye has received a lot of e-mails about our continuing series of articles on dental health care of dogs and cats. Most of you have become more aware of how widespread dental problems can be. There are still two weeks remaining in National Pet Dental Health Month and there are just enough questions and answers from Dr. Brook Niemiec left to take care of the next two issues of Questions On Dogs and Cats. Dr. Niemiec, you will recall, is the board-certified veterinary dentist, in San Diego. Here is the second portion of those questions:

Why is it important to have my pet's teeth cleaned regularly?

ANSWER: There are two main reasons for routine cleanings. First, they help prevent periodontal disease. Second, and possibly more importantly, a cleaning allows for a COMPLETE oral examination. Only with general anesthesia can most oral health problems be noted. This includes screening for oral cancer, broken teeth, cavities, and in cats, tooth resorption. Finally, general anesthesia is required for periodontal probing, which is the method of diagnosis of periodontal pockets.

My dog eats hard food. Isn’t that like brushing his teeth?

ANSWER: NO! This is a myth, which came about from the surface of the teeth being slightly cleaner in pets fed dry food. Typical dry food does not protect against periodontal disease. This relates to the root cause of periodontal disease, which is subgingival plaque (plaque below the gumline). Supragingival (above the gumline) plaque accumulates and causes local changes in the gum tissue that allow attachment and growth of subgingival bacteria, however after this has occurred; supragingival plaque has little to no effect on periodontal disease. Traditional dry foods break 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 as the pet chews and are an excellent adjunct to routine tooth brushing. Look for the VOHC Seal of Acceptance on the dental food you choose.

How do I brush my pet’s teeth?

ANSWER: Start with a soft toothbrush and veterinary toothpaste. The malt flavor from Virbac appears to be the favorite of my dog and cat patients. Do not use human toothpaste, as it contains detergents that may cause stomach upset. Go slowly and be very positive, using food treats if necessary. Place the brush at a 45-degree angle to the gumline. Brush in a circular motion, with a firm stroke away from the tooth. Try to reach all tooth surfaces, but concentrate on the outside surface.The hardest part is getting started. It’s best to start young, because the earlier you introduce brushing, the easier it will be for your pet to accept it. I recommend handling your pet’s mouth from the time you bring him home. For puppies and kittens, introduce the brush at around 6-7 months. Be consistent; animals like routines, so if you make it a habit it will be easier on both of you.

My veterinarian has recommended a dental cleaning. What is involved?

ANSWER: The first step is to place the patient under general anesthesia. Anesthesia-free dentistry is NOT recommended (see below, Why does a dental cleaning have to be done under anesthesia?), and is even illegal in some states. Don’t be fooled by “sedation” dentistry. In my opinion, sedation dentistry is more dangerous than general anesthesia for two main reasons. First, in sedation dentistry (or any other anesthesia-free dentistry), the trachea (windpipe), and therefore the lungs, are not protected from the particles generated during a dental cleaning. These particles are full of bacteria and, if inhaled, can result in pneumonia. The other difference between anesthesia and sedation is the length of effect. Most practices today employ relatively short-acting agents to put the patient under anesthesia, and then a gas to keep the patient under anesthesia. If a problem occurs under anesthesia, the veterinarian can turn off the gas and the patient will recover quickly. But under sedation, the effects generally do not go away until the drug is cleared by the system, which can take too long. General anesthesia is very safe today, thanks to advances in anesthetic drugs, training and monitoring equipment.A true dental prophylaxis consists of several steps, some more critical than others. The required steps that must be performed include:
Supragingival scaling: This is the removal of the plaque and calculus above the gumline (what you can see).
Subgingival scaling: This is the thorough cleaning of the area under the gumline to remove disease-causing bacteria. It is typically performed by hand and is time consuming, but it is the most important step of a dental prophylaxis.
Polishing: Scaling slightly roughens the teeth. This promotes plaque and calculus attachment and reduces the lasting effect of the cleaning, so the teeth are polished afterward. There has been some controversy about this in human dentistry, due to the loss of enamel with many cleanings over time. However, in veterinary dentistry, with relatively fewer cleanings in an animal’s life, this is not a concern.
Sulcal Lavage: Cleaning and polishing results in debris being caught under the gumline, which must be thoroughly rinsed out.
Oral exam, periodontal probing and dental charting: This is a critical and often misunderstood part of the dental prophylaxis. There are teeth that cannot be thoroughly examined in a pet who is awake, when periodontal probing is not possible. With the patient under anesthesia, the mouth is thoroughly and systematically examined, and all findings are noted on a dental chart. Any diseased teeth or tissues are then properly treated.

OK, since this is the last Sunday in February, National Pet Dental Health Month, Helpful Buckeye will present the third and final portion of the questions and answers from Dr. Brook Niemiec. Dr. Niemiec is the board-certified veterinary dentist from San Diego. For the final questions and answers about pet dental health:

Why does a dental cleaning have to be done under anesthesia?
ANSWER: It is impossible to do a thorough cleaning and definitive oral examination (including periodontal probing) on a pet who is awake. Your veterinarian can provide the appropriate pre-anesthetic protocol and treatment plan to provide your pet with the best care.

When is a pet too old to have a dental cleaning?
ANSWER: 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.

As a pet owner, what can I do at home to prevent periodontal disease?
ANSWER: The gold standard of home care is tooth brushing. To be effective, however, it must be performed at least three times a week; daily brushing is ideal. See How do I brush my pet’s teeth? (above) for directions. Another form of home care consists of rinsing with an antiseptic agent. CET® Oral Hygiene Rinse (Virbac) is an excellent antiseptic rinse for veterinary patients. The active agent (chlorhexidine) impregnates the teeth and gums, and its antibacterial effect lasts up to six hours. Additionally, Maxiguard® (Addison Biologics) has been shown to decrease gingivitis. It is also very palatable, making it an excellent choice for feline patients. Both of these are excellent ways to decrease gingivitis and periodontal disease in your pet. It may be challenging for some pet owners to make the commitment to daily tooth brushing for their pets, or to teach their pets to tolerate handling of their mouths. When frequent brushing is not practical, feeding an effective dental food provides a convenient solution. There are numerous products touted as “dental” foods or treats. Pet owners must be careful, as these typically only clean the tip of the teeth, not the areas that are necessary for control of periodontal disease. Of the dental foods available, only Hills® Prescription Diet® t/d® is clinically proven to reduce gingivitis, plaque and calculus. A combination of brushing and feeding the right dental food is best for oral disease control.

What should I look for when I examine my pet’s teeth?
ANSWER: Look for anything that appears abnormal. The first sign of periodontal disease is redness of the gums. No matter how minor it seems, if this is present, disease is present. The pet needs veterinary care in order to treat the disease and avoid all the problems associated with it. (See above, Is dental disease really a big deal?) If periodontal disease is not treated early, advanced signs of disease include swelling of the gums, calculus on the teeth, receding gums, and mobile teeth. Any of these is a sign of advanced periodontal disease, and immediate medical attention is required. Other things to watch for include swelling or masses, broken or worn teeth, and discoloration of the teeth. Any of these things should also be brought to the attention of a veterinarian right away.

What should a pet chew on?
ANSWER: There is a fine line between being too easy to chew up and swallow, and being too hard, possibly damaging the teeth. Many commercial chew toys are far too hard and can break the chewing teeth. There are two guidelines I recommend using:
If you cannot make an indentation in it with a fingernail, the treat or toy is too hard.
If it would hurt to hit yourself in the knee with it, the treat or toy is too hard. Pets who are prone to quickly swallowing large pieces of chew toys should be monitored during their use, to avoid an obstruction.

This concludes the 3 weekly installments of questions and answers about pet dental health. The AVMA has provided this review of pet dental care:

Dental Care

Pets At Risk: Bad Breath Isn't Funny Anymore
Frisco caught the guest by surprise in the living room. He planted a big, breathy smooch on her face. "Ugh! Dog breath!" The room erupted in laughter.
It wasn't so funny the next day when Frisco had his yearly check-up. The 2-½-year-old dog was diagnosed with gum disease, and he was in danger of losing a tooth if he didn't begin a regular dental care program.
According to the American Veterinary Dental Society, Frisco's case is not unique. Studies show that more than 80 percent of dogs by age three and 70 percent of cats by age three show some signs of gum disease. Bad breath could be an early warning sign of the dangerous gum disease gingivitis.Pets Need Dental Care, Too!
During National Pet Dental Health Month each February, pet owners are reminded that dogs and cats need good oral care. An educational campaign to consumers, sponsored by the American Veterinary Medical Association and the American Veterinary Dental Society with an educational grant provided by Hill's Pet Nutrition, Inc., helps pet owners understand the importance of regular dental care for their pets.
Particularly at risk are small dog breeds, such as Pekingese and Shihtzu. Experts say these breeds are more likely to develop tooth problems because their teeth are crowded into small mouths. This can create a haven for plaque buildup.
Cervical line lesions (CLL) are the most common dental disease of domestic cats. Studies show that about 28 percent of domestic cats that veterinarians examine have CLL. Because the lesions often begin beneath the gumline, owners usually are unaware that there is a problem until the tooth is seriously damaged. Prevention is the key to helping pets maintain good oral health. The American Veterinary Dental Society recommends that pet owners follow three important steps:
Visit Your Veterinarian
Just as dental visits are the cornerstone of a human dental program, visiting a veterinarian is the key to ensuring the health of your pet's teeth. A veterinarian will conduct a thorough physical examination of your pet as part of the dental evaluation.
Start a dental care routine at home
Removing plaque regularly from your pet's teeth should be part of your pet's home dental care routine. Ask your veterinarian about the procedure for brushing your pet's teeth. Dog owners also may feed specially formulated dietary foods that help reduce the accumulation of plaque and tartar from teeth when the pet eats. Your veterinarian can offer more information on dietary options.
Get Regular Veterinary Dental Checkups
The family veterinarian needs to monitor the progress of your pet's preventive dental care routine much the same way a dentist monitors your teeth. Regular dental check-ups are essential.
Once a pet's teeth display the warning signs — bad breath, a yellow brown crust of tartar around the gumline, pain or bleeding when the pet eats or when you touch its gums — gum disease may already be present. For a professional dental check-up, call your veterinarian today!