Something To Smile About Veterinary Dentistry for the Canine and Feline Patient

Does Your Pet Have A Pearly White Smile or Bad Breath? A healthy adult dog has 42 teeth, 10 more than we do. A healthy adult cat has 30. It is reasonable to say, then, that every one of your pet’s teeth is as important to his or her overall health as it is to ours.

There are various types of bacteria that reside in a pet’s mouth. With most pet nutrition low in simple sugars, only about five percent of dogs develop cavities, but that doesn’t mean they don’t need dental care. Cats get tooth cavities also, but they are not like human cavities. In people, cavities are caused by bacteria that eat through the enamel and erode sensitive dentin: outward-in. Cat-cavities are termed feline resorptive lesions; they most often occur at the "neck" of the tooth, which is where the body (root) meets the head (crown) and the tooth is a little thinner. Cat cavities originate inside the tooth and move outward; inside –out. The American Veterinary Dental Society and the American Veterinary Medical Association report that more than 85% of family dogs and 70% of family cats exhibit signs of oral disease by the time they are three years old. Some of the signs that your pet’s oral health is in need of attention include:

• Bad Breath • Yellowing or Brown Teeth • Bleeding Gums • Loose Teeth or Lost Teeth Your pet’s halitosis is a signal of something more than a nuisance; it’s a sign that your pet has bacteria in his or her mouth; a bacteria that can ultimately affect vital organs. If your pet is showing any signs of pain or discomfort when eating or he/she is finding it difficult to chew, these additional symptoms signal that it’s time for you to talk to your pet’s veterinarian about the importance of an oral exam, assessment and treatment plan. As with your own health valuation, prevention is the key to maintaining a high quality of life. This means you want your pet’s oral health treatment plan to prevent plaque and tartar buildup. This can be achieved through a combination of regular visits to your pet’s veterinarian for an oral exam, oral care at home and dental treatment by a veterinarian if your pet’s oral disease is progressing. Dogs may not like having their teeth brushed, but it should be an important step in maintaining good pet hygiene. Cats, unfortunately, are not likely to be as tolerant as dogs to allow brushing, so your cat needs to have his veterinarian check the condition of his mouth annually. Periodontal disease is the most common health problem that veterinarians find in pets. - Take your pet to the veterinarian for a dental exam - Begin a dental care regimen at home - Schedule regular veterinary checkups

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Does Your Pet Make The Grade? As we increase our knowledge of animal health, we realize that proper dental care does not just make your pet’s breath smell better; it is mandatory for your pet’s long term quality of life. Yet in spite of the overwhelming prevalence of periodontal disease in most cats and dogs, oral hygiene is often overlooked and considered unimportant or elective by pet owners. It is not. Since your pet cannot tell you how his or her mouth feels, it is up to all of us, as partners in the care of your pet’s wellbeing, to address this health problem. Most people wait too long to get their pet’s teeth professionally assessed and treated. Oral exams and treatments should be considered a preventive measure, not a way to treat a problem that is already present. Good dental care revolves around the control of bacteria under the gum line where it is not visible. It is the periodontal disease that is occurring out of sight and below the gum line that causes the most problem. This is the area we thoroughly need to address when we clean a pet’s teeth under anesthesia. Start the brushing when the adult teeth are in, which is around five months of age. We will show you how to do it. Dental disease is classified based on the severity of periodontal disease. Your pet’s veterinarian can point out the degree of tartar on your pet’s teeth, but a significant disease may be below the gum line. When bacteria adhere to the tooth surface and create plaque, the plaque will mineralize and form tartar. While brushing and proper dental hygiene can reduce bacteria and plaque, it is very difficult to safely remove tartar without professional dental treatment. Once plaque and tartar are on a tooth, bacteria are able to migrate under the gum line, where they damage the gum’s attachment to the tooth and can begin to destroy the bone that surrounds the tooth root. This leads to pain, potential tooth loss, and even kidney, liver and heart problems if the bacteria get into the bloodstream.

In veterinary medicine, there are four stages of periodontal disease. Canine Feline

Grade I Perfectly clean and white, no visible tartar or inflammation of the gums.

Grade II Attached gum may be inflamed and swollen. Visible tartar on teeth. Treatment can reverse condition.

Grade III Attached gum is being destroyed by infection and tartar. Discomfort affects eating and behavior.

Grade IV Bacterial infection is destroying the gum, tooth, and bone. Bacteria maybe spreading throughout the body.

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Oral Examinations and Dental Procedures Most small animal practices offer dental evaluations and procedures.

According to one dental expert, “The words "prophy," "prophylaxis," and "dental" are often misused in veterinary medicine. A dental prophylaxis is performed on a patient with an essentially healthy mouth, or with mild gingivitis, to prevent periodontitis. Patients with existing disease undergo dental treatment, not prophylaxis.”

Fee quotes can be given for those procedures to be performed before the dental procedure is scheduled. This assessment will include patient examination, preoperative testing, initial anesthesia, monitoring, intravenous fluids, radiographs, teeth cleaning and polishing. However, until the doctor completes a tooth by tooth examination with your pet under general anesthesia with digital x-rays, it is not possible to render an exact assessment of the entire dental procedure until the patient’s teeth and oral structures are thoroughly examined. The oral examination on a patient in the exam room allows the practitioner to design a preliminary treatment plan. Here is what the doctor will be assessing during review of your pet’s mouth which is how the doctor will assign a dental grade (discussed earlier in this book): Your pet’s veterinarian will be visually evaluating the head and oral cavity. The doctor may, at this time, palpitate this region looking for abnormal clinical signs such as: pain, halitosis, drooling, discolored or fractured mobile teeth, difficulty swallowing, inflammation and bleeding. The doctor will also assess changes in the range of motion or signs of pain in the temporomadibular joint which is the joint in the jaw often familiar to humans as TMJ. The doctor will also look for abnormalities such as oral tumors, ulcers or wounds. As part of the assessment process, the doctor will evaluate lymph nodes, nose, lips, teeth, mucous membranes, gums and the area between the gum tissue and cheeks. And when you think the doctor is just looking inside your pet’s mouth, he/she is actually assessing the conditions of the surface of the teeth closest to the tongue in both the upper and lower teeth, as well as, evaluating the characteristics of the tongue for color, texture and size in addition to looking at the tonsils and salivary ducts.

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Your Pet’s Dental Procedure Dental procedures must be performed by a licensed veterinarian in accordance with the state or provincial practice acts. Based on the findings and recommendations of the American Animal Hospital Association, general anesthesia is necessary for oral assessment because: Sixty percent of dental disease occurs below the gum line. In order to do a proper cleaning the pet should be immobilized for the procedure. Often there is calculus and bacteria-laden plaque on the teeth to be cleaned. An endotracheal tube placed in the trachea prevents debris from the scaled plague from entering the lungs. Positioning and safety of the patient is key. Radiographs are necessary for accurate evaluation and diagnosis. In one published report, intraoral radiographs revealed clinically important pathology in 27.8% of dogs and 41.7% of cats when no abnormal findings were noted on the initial examination. In patients with abnormal findings present, additional pathology was revealed via radiography in 50% of dogs and 53.9% of cats. 1 Your dental team will utilize a hand held scaler to scrape away the tartar and follow with a low speed hand held device to polish the teeth. Some dental procedures may be painful depending on the severity of the gingivitis. Anesthesia will ensure the patient will not feel pain. A technician trained in surgery will monitor your pet’s vital signs throughout the dental procedure while another technician will be performing the radiography and assisting the veterinarian during the dental procedure. The technician monitoring your pet is recording temperature, heart rate and rhythm, respiration, oxygen saturation via pulse oximetry, blood pressure and carbon dioxide levels. In addition, we provide customized fluid therapy to maintain appropriate circulation.

Before Dental Cleaning

After Dental Cleaning

1. Verstraete FJ, Kass PH, Terpak CH. Diagnostic value of full-mouth radiography in cats. Am J Vet Res

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1998;59(6):692–5.

“Dental care is necessary to provide optimal health and quality of life. Diseases of the oral cavity, if left untreated, are often painful and can contribute to other local or systemic diseases.” (Dr. Jan Bellows, D.V.M. Diplomate, American Veterinary Dental College) Dental disease doesn’t affect just the mouth. It can lead to more serious health problems including heart, lung and kidney disease, which makes it all the more important that you provide your pets with proper dental care from the start. Tartar is the first tangible sign that your pet has periodontal disease. Periodontal disease is an infection of the tissue surrounding the teeth that takes hold in progressive stages. It starts out as a bacterial film called plaque. Tartar is a solidified form of plaque. Plaque forms from a mixture of your pet’s saliva, food particles and bacteria. Initially, plaque is soft and brushing or chewing hard food and toys can dislodge it. If left to spread, plaque can lead to gingivitis, an inflammation of the gums, causing them to become red and swollen and to bleed easily. As plaque and calculus develop below the gum line, professional cleaning will be needed to help manage it. If plaque and tartar buildup continues to go unattended, infection can form around the root of the tooth.

Feline

Canine

** Images reflect severe periodontal disease, due to untreated dental disease.

Twice daily brushing for plaque and tartar control is the most essential step to helping dogs and cats keep their teeth healthy. In addition, hard chew toys also help to manage tartar control, and your pet’s veterinarian may also wish to recommend specific dental diets that have been vigorously tested for efficacy in helping maintain a healthy mouth.

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Taking a Bite Out of Dental Disease Pets have similar oral hygiene needs as humans. Do you go years without seeing a dentist? Can you imagine how your teeth would feel if you didn’t brush them everyday? By ignoring your pet’s oral health, your pet is experiencing exactly what you might envision you would experience if you answered these two questions honestly. Like humans, pets are susceptible to periodontal disease. Periodontal disease is the most prevalent disease of all diseases in cats and dogs. Periodontal disease is infectious, inflammatory and typically progressive. If you are like most owners, you are not regularly brushing your pet’s teeth every day. We somehow think, “They’re just animals,” and therefore, fail to recognize that animal health and human health have more in common than have differences. Oral health is part of overall health for humans as well as for our pets. The main cause of early tooth loss is inflammation of the supporting structures under the gum surrounding the teeth. Inflammation of the bone and tooth support structures is referred to as periodontitis. Gingivitis is the inflammation of the gums. The combination of gingivitis and periodontitis is known as periodontal disease. Signs of periodontal disease include: 

Bad breath

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Redness or bleeding along the gum line

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Drooling, which may be tinged with blood

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Difficulty chewing

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Pawing at the mouth

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Loose or missing teeth

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Facial swelling, especially under the eyes

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Nasal discharge

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Gum Recession

Food particles and bacteria collect to form soft deposits along the gum line. These deposits are called plaque. Teeth brushing will remove plaque, but because pet owners don’t routinely provide oral care to their four legged friends, plaque will harden to form tartar which, in turn, will mineralize into a substance called calculus. Calculus cannot be removed with teeth brushing. Bacteria releases toxins, and thus the affects of periodontal disease, unchecked, can be devastating. The supporting bone below the gums become infected and destroyed. Teeth become loose or fall out or an abscess may form. Further injury to major organs such as kidney, liver and heart may occur if dental disease is not treated. Treatment depends on the severity of the disease. Gingivitis can be reversed with a thorough dental polishing whereas bone loss, often referred to as loss of tooth attachment, cannot. Treatment for periodontal disease may include antibiotics, dental procedures and in worse case situations, tooth extractions

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What would you do if it were YOUR teeth? Now you are aware that 85% of dogs and 70% of cats have dental disease.

So why then, do pet owners ignore their pet’s oral health? It makes no sense, right? You now know, too, that much of the dental disease occurs below the gum line, and therefore, poor dental health is not as visible as when your pet is limping or has a wound you can see. It may be that owners aren’t treating their pet’s dental disease because they can’t see it. That is why educating pet owners like you, is vital to helping our clients appreciate that dental evaluation followed by dental treatment (if warranted) are not an elective procedures. They are necessary ones. What if it was your teeth and your dentist told you that you had dental disease or gum disease? Would you make it a priority to address these health issues in order to optimize your overall health? Our guess is that you would make an appointment to resolve the problems. It should be no different when your pet’s doctor informs you that your pet has grade 2, 3 or 4 dental disease. The sooner you treat at stage 2, the less expensive it will be to resolve your pet’s medical concerns. Dogs and cats hide pain in their mouth by chewing on the opposite side of the mouth or by swallowing their food whole. Drooling, loss of appetite or loose teeth won’t appear until oral health is severely compromised and periodontal disease is advanced. For your pet’s benefit, don’t wait this long. If your pet had a nasty, foul smelling infection in their ears, you would treat it. You should treat his mouth with the same fervor. A toothless pet is not a necessary alternative and if your pet is aging, don’t assume that loosing teeth is a natural part of your pet’s aging process. Puppy and kitten teeth fall out naturally and are replaced with adult teeth, just as this occurs in humans. However, just like in humans, adult teeth rarely fall out from natural causes. They fall out from neglect. If your pet’s doctor recommends treatment, make that appointment before leaving the veterinarian’s office. Your pet deserves the best care that together, we can give!

Give your pet a reason to smile; oral health matters.

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We are extremely proud of the positive feedback we have received over the years from our clients, for the quality veterinary dentistry we have provided to our patients. Our strong commitment to our patients ensures our clients that our goal is to maintain a healthy and prolonged quality of life for their companion animal.

Enhancing the human-animal bond through progressive, compassionate veterinary care. Interested in what others have to say about their pet’s dental procedure and how it has affected their quality of life?

Clinical Cases 8

Clinical Case Meet Chad and Rotunda Presentation: Rotunda, affectionately nicknamed “Tundie”, presented to the clinic for her annual physical exam and vaccines. No adverse medical symptoms per owner, seemed overall healthy upon presentation.

Previous Medical History: During previous physical examinations, Tundie was diagnosed via echocardiogram, with having irregular heartbeats.

Current Medical History: Tundie was found to be in overall good health based on physical examination. Tundie’s veterinarian did recommend that she have a dental cleaning performed in the near future due to mild tartar buildup.

Before

Diagnosis: Grade II Dental Disease.

Veterinarian Recommendations: 1. Repeat echocardiogram 2. Senior Blood work 3. Dental Procedure

Conclusion: Tundie’s repeat echocardiogram showed no significant changes in her heart condition and her senior blood work was within normal limits, both indicating it was safe for Tundie to have a dental procedure performed under general anesthesia. Resorptive lesions were seen via dental radiographs, which were not present upon physical exam. Multiple tooth extractions were needed.

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After

Clinical Case Meet Jeta Presentation: Jeta is a nine year old, spayed, daschund who is a small bundle of joy. She presented to her primary veterinarian for her annual physical exam and vaccines.

Previous Medical History: No significant previous medical history, but does have a history of previous urinary tract infection and bladder stones.

Current Medical History: Jeta was found to be in overall good health, however a new heart murmur and moderate periodontal disease with dental tartar was discovered upon physical exam.

Diagnosis: Grade II Dental Disease. Heart Murmur

Before

Veterinarian Recommendations: 1. Cardiac Ultrasound 2. Senior Blood work 3. Dental Procedure

Conclusion: Jeta’s owner’s decided to have the ultrasound performed prior to her dental procedure and it revealed mild valvular disease and pulmonary hypertension, however both conditions were mild enough that the use of anesthesia along with appropriate clinical management was determined to be safe. During her dental procedure, the dental x-rays showed that she required three extractions. The procedure included crown and subgingival scraping and root planning and polishing. Jeta’s owner is surprised at how happy and active she has become following her dental procedure. She has started to use her chew toys again.

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After

Clinical Case Meet Mittens Presentation: Mittens is a three year-old cat, who at a young age had already developed severe dental disease. Her owner Mike was originally skeptical about whether the dental work was really necessary , but the doctors were great at taking the time to explain the procedure in depth along with it’s necessity.

Previous Medical History: During Mittens physical exam she presented with early onset of gingivitis, which is severe inflammation of the gum tissue.

Current Medical History: Mittens was found to be in overall good health based on physical examination, however she did present with moderate weight loss, as well as severe tartar buildup, gingivitis, and gum recession of the upper teeth. Mitten’s appetite has been decreased due to the pain associated with her dental disease.

Before

Diagnosis: 1. Grade IV Dental Disease. 2. Weight loss (due to pain associated with severe dental disease)

Veterinarian Recommendations: 1. Dental Procedure with extractions 2. Soft food only as an interim until procedure is performed.

Conclusion: After her dental x-rays were performed and evaluated, the veterinarian decided she needed six teeth extracted however, Mitten’s owners are very happy that her dental disease did not cause her to have full mouth tooth extractions. Mittens is doing extremely well post operatively and can now enjoy eating without the pain caused by dental disease. Her veterinarian will continue to monitor her weight.

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After

Dental Procedure Checklist In order to help you make educated, informed decisions in regards to your pet’s veterinary care, we have created a detailed chart to help you compare different dental procedures. This chart will help guarantee and provide confidence that you have made the most medically beneficial decision, when comparing our dental procedures with those offered at other facilities. We are compassionate about the medical needs of our patients, as well as the needs of our clientele. Our vision is to establish a hospital where our clients and their pets would receive state of the art care in a warm and welcoming environment. We not only want our patients to enjoy their visits to us, we want our clients leaving with a strong understanding of our practice and the procedures we recommend.

Us

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Pre-anesthetic blood work Pre-operative sedation Pre-operative pain medication IV Catheter and Fluids General Anesthesia Anesthetic Monitoring:

Them

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EKG Pulse Oximeter Blood Pressure CO2 Saturation Internal Temperature

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Assigned Nurse Anesthetist Digital Dental Radiographs Dental Procedure Charting Nerve Blocks (for extractions) Post-surgical pain medications Post-surgical monitoring

You can be assured that your team is taking excellent care of your pet during the procedure and while some dental procedures may seem expensive, you can see the level of care, monitoring and therapy your pet receives in a surgical suite especially reserved for dental services. The cost of not treating your pet when the doctor recommends will only escalate the cost to treat later, not to mention the cost of the additional discomfort to your beloved pet. Our commitment to practicing the highest quality of medical, surgical, diagnostic, and dental care, ensures our patients comfort and client peace of mind.

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Anyone can have a job. We have a passion.