The Meowing Vet wishes you a Happy 2017! What are your pet’s New Year’s resolutions? Getting in shape? Getting braver about taking daily medications? What about a bright new smile? This article answers some of the common questions that pet owners have about their dog or cat’s dental health, what happens during a veterinary dental cleaning, and what things can be done at home to keep their pet’s teeth and gums healthy.

---

For more in-depth information on a variety of dental disorders in dogs and cats, check out the free veterinary educational resources from Animal Dentistry & Oral Surgery, a specialty dental practice for pets located in Leesburg, Virginia, USA.

---

Q: Why is my pet’s dental care so important?

A: In addition to tooth decay and fractured teeth, periodontal disease is of special concern in dogs and cats (as well as humans). Periodontal disease is disease of the gums and other structures surrounding the teeth. Its milder form, gingivitis, involves only the gumline but can progress to disease of the nearby ligaments attaching teeth to the underlying bone, known as periodontitis (the more severe form of periodontal disease).

Both disorders can cause discomfort, oral bleeding, and halitosis (bad breath). Furthermore, periodontitis can cause painful tooth root abscesses (including those which can even push up underneath the eye!), facial swelling, draining tracts between the roof of the mouth and nasal passages, loose teeth, and underlying bone destruction, which can progress to possible jaw fractures. Plaque is the accumulation of a sheet of bacteria (not food debris!) across the surface of teeth. It may initially be an invisible, transparent layer, but can harden (or mineralize) in time, forming the hard colored calculus (or tartar) that can build up on your dog or cat’s teeth. This bad plaque bacteria and their released toxins trigger an inflammatory response along the gumline, causing swelling and bleeding. Periodontitis has been linked to low grade systemic inflammation as well as potential damage to the heart, liver, kidneys, and brain in some animal patients secondary to inflammation and the showering of the bloodstream with bacteria released from oral plaque. Canine cognitive dysfunction (dementia) may be partially caused by or exacerbated in certain dogs suffering from periodontal disease.

If you’ve ever had a toothache, you know what agony it can be. None of us want our pet to be uncomfortable, so good dental hygiene is of utmost importance (as important as keeping up-to-date with your dog or cat‘s vaccines and other preventative care). Periodontal disease can be prevented with good prophylactic attention (including regular at-home brushing or dental treats as well as regular veterinary dental cleanings). However, once periodontal disease has started, it is rarely curable and must be intensely managed by you and your vet to prevent progression.

Q: When should I be concerned about my pet’s oral health?

A: Some degree of periodontal disease can be detected on physical examination in up to 70-90% of dogs and cats seen by your veterinarian. Therefore, scheduling an annual check-up for your pet is key to monitoring your dog or cat’s dental health. Regular physical exams also provide your vet the opportunity to detect oral tumors, which account for 6% of all cancers in dogs and 3% in cats. Consult your vet sooner if you observe oral bleeding, swollen or red gums, excessive drooling, decreased appetite (your pet’s mouth may hurt, causing him or her to avoid chewing), oral or nasal discharge, facial or eye swelling, or very bad breath in your pet.

Q: What if my juvenile or adult dog still has some baby teeth? What if he or she has an underbite or overbite? What about a broken tooth?

A: If your dog never fully lost all of his or her baby teeth (usually by 7 months of age), I highly recommend that they are pulled by your veterinarian. Retained baby teeth (or deciduous teeth) cause crowding of permanent teeth, which can affect the normal “bite” of a dog (or how the top and bottom rows of teeth should fit together), resulting in uneven tooth wear as well as gum irritation. This can progress to gingivitis. Toy breeds (such as miniature poodles, Yorkshire terriers, and Chihuahuas) are more likely to retain baby teeth, primarily their incisors and canines. If your juvenile pooch hasn’t lost all of his or her baby teeth, ask your vet if they can be removed at the same time as your dog’s spay or neuter.

An English bulldog’s cute underbite is certainly iconic and adorable, but bulldogs and other brachycephalic (or flat-faced) dog breeds are at increased risk of periodontal disease due to this signature jaw formation. Normally, a dog’s top and bottom rows of teeth should fit together like scissors, allowing for even wear when chewing food. However, if either the upper or lower teeth overlap one another, the “bite” is abnormal (known as malocclusion), causing uneven tooth wear and possible tooth fractures due to improper stress on the teeth and surrounding structures. This can predispose your pet to periodontal disease. Dogs with overbites are also at risk for periodontal disease due to malocclusion. (“Phteven” anyone?) Some cats may also have malocclusion secondary to retained baby teeth, underbites, or overbites, increasing their risk of periodontal disease as well.

Dogs or cats with fractured (broken) teeth should also be seen by your vet as sharp edges may cause damage to the surrounding tissues, and exposure of the root canal can lead to pain, infection (including abscess formation), and the development of periodontal disease. Depending on the severity, your vet may recommend that the fractured tooth be extracted to prevent problems down the road.

Q: What is involved in a dental cleaning?

A: Dental procedures in veterinary medicine differ slightly from those in human dentistry. For starters, you are awake during your own dental cleaning; however, our veterinary patients are asleep and pain-free under full general anesthesia. This keeps both your pet and the veterinary dental hygienist safe during the procedure. Even if your dentist gives you the “heebeegeebees,” you’re likely to cooperate and 1) hold your own mouth open, and 2) not bite your dentist. Most dogs and cats tend to be less amenable to a stranger probing their mouths or flushing them with jets of water, especially if they already have oral pain. Therefore, having your pet under general anesthesia aids everyone.

Once your pet becomes drowsy following administration of anesthetic drugs, an endotracheal tube is placed down the trachea (windpipe), partly to protect your pet’s airway during the dental cleaning to prevent water and plaque debris from entering the windpipe and possibly the lungs. If your local veterinary clinic has dental radiograph (x-ray) equipment, x-rays of the mouth may be taken to better investigate the severity of periodontal disease. Dental x-rays can be extremely valuable to your vet (and to you and your pet) since these images can display abnormalities not seen with the naked eye in up to 28% of dogs and 42% of cats that appeared to have normal mouths upon physical examination yet actually harbor dental disease.

Large chunks of plaque debris are then removed with forceps, then smaller particles are removed with both metal hand-scalers and ultrasonic scaling devices. Metal curettes clean underneath the gumline. Once visible debris is removed from the teeth, the gumline is gently probed to detect large pockets that indicate gum recession due to periodontal disease. Large pockets may be an indication that the adjacent tooth should be extracted. The teeth are then polished and rinsed, often with an antiseptic flush. Your vet may also wish to apply an anti-plaque product (such as OraVet® or SANOS®) depending on your pet’s degree of dental disease; these products act as a sealant across the tooth surface, serving as a barrier against bacterial plaque build-up.

Should your pet require dental extractions (a.k.a. having a tooth pulled), your vet will likely inject a numbing solution such as lidocaine around the tooth to be removed. An incision in the surrounding gum may need to be made in order to gain access to the base of the tooth; this incision may require sutures (stitches) to heal. The tooth is then removed, special care being taken to ensure that the entirety of the tooth’s roots are also extracted as retention of these roots can lead to pain or infection later on. Dental x-rays may be taken again following the procedure to ensure that the entire tooth root was removed.

Once the dental cleaning or extraction is complete, your pet is woken up from its anesthesia and closely monitored until ready to go home, either later that same day or the next morning.

Depending on the severity of your pet’s periodontal disease, your vet may prescribe oral antibiotics prior to your pet’s dental procedure. Your vet may also opt for injectable antibiotics as well as IV fluids to be administered during the dental procedure. Your pet may go home with a prescription for oral antibiotics or medications to reduce pain and inflammation, much like you would if you had your wisdom teeth removed or a root canal treatment.

Q: Why is a dental procedure so expensive?

A: As you’ve probably realized by now, dental cleanings and extractions can quickly become quite expensive. Between the dental equipment, medications, dental x-rays, anesthetic equipment and monitoring, and pre-anesthetic bloodwork that your vet will likely recommend to ensure that your pet is healthy enough to undergo anesthesia, you’re looking at a couple hundred dollars (at least!) for routine cases. I truly understand a pet owner’s hesitancy in scheduling a dental procedure when their dog or cat seems fine. However, for the health risks explained above (including potential damage to the heart, liver, kidneys, and brain secondary to uncontrolled dental disease), I urge you to save money and protect your pet’s health in the long-run by preventing periodontal disease before it starts. If finances are still of concern, investigate more affordable alternatives in your area such as government-supplemented low-cost veterinary services. (Please keep in mind that the overall quality of these services may differ from what you would receive at your regular veterinarian’s office since procedures such as pre-anesthetic bloodwork may not be performed in order to cut costs.) Additionally, sign up for pet insurance, as many companies may cover routine dental care.

Click here to learn how much your pet’s bloodwork results can tell your vet about your pet’s health.

Q: What risks should I be aware of involving a dental procedure?

A: As discussed, severe periodontitis can cause underlying bone destruction, weakening the facial bones and predisposing your dog or cat to jaw fractures. Though uncommon, if your pet has severe periodontal disease and requires tooth extractions, the force of pulling teeth can cause jaw fractures to occur in already weakened and diseased bone. Additionally, pain and infections (including tooth root abscesses) can occur secondary to a tooth root being left behind, requiring subsequent dental procedures in the future. Post-procedure dental x-rays aid your vet in detecting these risk factors.

Finally, many pet owners are very concerned about anesthesia. Your pet will be closely monitored while under anesthesia, but as in humans, certain anesthetic risks also exist for dogs and cats, including dangerously low blood pressure, acute kidney damage, cardiopulmonary issues, and rare sudden anesthetic death. However, appropriate precautions (including consenting to pre-anesthetic bloodwork to aid your vet in understanding your pet’s health status prior to undergoing anesthesia) can help minimize these risks. In most cases, the systemic health benefits of having a dental cleaning outweigh the overall hazards of such a procedure.

Q: Why is my veterinarian recommending that all of my cat’s teeth are pulled?!

A: In addition to periodontal disease, cats can also suffer from tooth resorption, also termed feline oral resorptive lesions (FORLs). Resorptive lesions occur when inflammation or infection of a tooth (most commonly a canine tooth) triggers the body to start destroying and reabsorbing the affected tooth. This process is quite painful, and may result in what looks like an enlarged canine tooth, which occurs during the resorptive process when the body produces more surrounding bone to try to stabilize the “dissolving” tooth. Though any age may be affected, up to 60% of cats over 6 years of age have at least one painful resorptive lesion. Kitties can be very stoic, hiding their discomfort from you. However, if you observe “chattering” like movement of their mouths at mealtimes, bad breath, drooling, or decreased appetite with weight loss, have your cat examined by your vet ASAP, who will likely recommend that the affected teeth are extracted.

Some cats may also develop gingivitis or stomatitis syndrome, which is caused by an exaggerated immune response, resulting in severe inflammation of the gums, teeth (primarily the back premolars and molars), and back of the throat. The results are a red, swollen, or bleeding gumline; thickened gum tissue or proliferative growths; as well as painful and raw oral ulcers, especially at the back of the throat, causing your pet severe discomfort when swallowing. The exact cause of feline stomatitis syndrome is unknown, yet several disease agents such as Bartonella, calicivirus, coronavirus, feline leukemia virus (FeLV), and feline immunodeficiency virus (FIV), have been suspected. Purebred cats also tend to be more likely to develop this painful condition. Stomatitis syndrome is extremely difficult to manage, so often the best course of action is teeth extraction. This initially includes all premolars and molars but may involve full teeth extraction (including canines and incisors). While the treatment may seem quite drastic, your cat will soon thank you for alleviating its discomfort.

Q: Are there veterinary dentists?

A: The term “veterinary dentist” is a bit of an oxymoron since the majority of veterinarians in general practice are technically dentists (as well as surgeons, anesthetists, radiologists, nutritionists, behavior experts, etc., etc., etc.!). In veterinary school we vets are well trained in dental cleaning and extractions, and many of us hone our skills further during annual continuing education training seminars. Therefore, your local vet is likely highly capable to perform dental procedures. Oftentimes, veterinary technicians or nurses perform your pet’s dental cleaning at the discretion of your veterinarian. Veterinary nurses, much like the hygienist at your human dentist’s office, are also well qualified at performing routine dental procedures and monitoring your dog or cat while under anesthesia.

Although most veterinarians are well educated in dentistry, some vets advance their training further by becoming veterinary dental specialists such as via the American Veterinary Dental College (AVDC). As experts in the field of veterinary dentistry, these specialists are at the forefront of dental research in veterinary medicine and can perform advanced and more complicated procedures such as fillings, dental crowns, root canal treatments, and the management of malocclusions (such as underbites and overbites). If your pet has a severe dental or other oral abnormality that may benefit from the specialization of a veterinary dentist, your general practitioner vet may refer you to a dental specialist.

In the U.S.? Search for a veterinary dental specialist near you on the American Veterinary Dental College’s Website.

Q: What can I do at home to improve my pet’s dental health?

A: In addition to advancing age and malocclusion, other risk factors that increase your dog or cat’s chances of developing periodontal disease include consuming primarily soft rather than crunchy foods and lack of at-home dental hygiene. So other than taking your pet to your vet’s office for annual check-ups and dental cleanings, what can you do at home to improve your pet’s dental health (thereby saving you money in the long run by prolonging the need of dental cleanings)?

• Routinely brush your pet’s teeth. Regularly brushing your pet’s teeth at least 3 times weekly (daily if you can manage it) is one of the best ways of reducing your doggie or kitty’s risk of periodontal disease. Read below to learn how you can accustom your pet to routine teeth brushing and what products are recommended.
• Add an antiseptic rinse. Though not as beneficial as regularly brushing your dog or cat’s teeth, antiseptic rinses such as veterinarian-approved chlorhexidine-based products can decrease oral bacteria and reduce your pet’s risk of developing plaque build-up and periodontal disease. Check out Virbac C.E.T.® and Vetoquinol Dentahex™ Oral Hygiene Rinses.
• Consider a water additive. Some owners greatly appreciate the ease of adding a product to their pet’s drinking water to cut down on dental plaque. These liquids have an enzymatic action to break down tartar buildup and freshen your pet’s breath. Consider Virbac C.E.T.® AquaDent Drinking Water Additive for cats and dogs, but please use caution by measuring the correct product to water ratio as this solution contains xylitol. Xylitol is a sweetener and has enzyme activity, yet it can be toxic to pets at high doses, potentially causing liver damage and low blood sugar, so read and follow your product label carefully. Zymox® Oratene® Brushless Oral Care Water Additive is a great alternative as it does not contain xylitol. (Ask your vet or click here to check out the entire Zymox oral care line of pet products.)
• Feed crunchy foods. Crunchy dry foods rather than predominately soft or canned diets help “scrub” your pet’s teeth when consumed, chipping off bits of tartar. You can also treat your pet with pet-safe fruits or vegetables such as raw apple slices or carrot sticks, which can naturally reduce plaque build-up. (Check out our articles on what human foods are safe to feed dogs and cats and which human foods are toxic to pets.)
• Provide dental treats and toys. In addition to crunchy pet-friendly fruits and veggies, veterinarian-developed dental treats (such as GREENIES™ for dogs and cats, those by Virbac for both canines or felines, or Twistix® for dogs) can also help reduce tartar. Additionally, some dog toys such as tennis balls or toys developed specifically for dental care help keep your pet’s teeth clean while your dog is having a blast.
  • Disclaimer: Always monitor your pet closely when consuming GREENIES™ dental chews and other similar treats as swallowing large pieces of these treats whole can pose a gastrointestinal foreign body risk to your pet. When purchasing these treats, please select the appropriate size based on your pet’s body weight.

 

Living in the U.K.? Check out VetBox Dental Care monthly subscription! 🇬🇧

Q: How can I make my dog or cat more comfortable when brushing his or her teeth?

A: As previously stated, brushing your pet’s teeth at least 3 times per week (ideally, daily) can prevent or at least slow the progression of periodontal disease. Some of you may already be brushing your dog or cat’s teeth on a regular basis. (Hooray!) However, I understand that a busy schedule or a resistant pet can get in the way of good intentions. If you have the latter, you may be wondering how on Earth you’re going to get your pet comfortable with brushing his or her teeth at home. If possible, introducing teeth brushing to your pet as a young puppy or kitten makes the process much easier. However, you can also help your adult dog or cat become more comfortable with the process with a bit more time and patience.

We don’t want to overwhelm your pet by immediately inserting a flavored toothpaste and toothbrush into his or her mouth and start scrubbing away. This can make your pet extremely fearful of at-home dental hygiene and can increase your chances of sustaining an accidental bite from your frightened pet. As displayed in the above video, start by getting your pet used to the taste of a pet-safe enzymatic toothpaste (there’s a tongue-twister for you!). Just place a small dab on your finger or on your pet’s paw for him or her to sniff and lick. Once your pet is agreeable to that, move on to acclimating your dog or cat to the feeling of a toothbrush-like object across their gums and teeth… but don’t jump straight to the toothbrush! Use just your finger with a bit of toothpaste instead. Once used to that, try a finger toothbrush. And finally, advance to a soft veterinary toothbrush only when your pet is perfectly comfortable with the previous steps. (P.S. My favorite products are by Virbac C.E.T.®) This process can take a bit of practice and patience, but going slowly with your pet increases your chances of being successful in cleaning their chompers at home.

 

The Meowing Vet had fun being your pet’s Tooth Fairy today! Convinced that it’s time to schedule a dental cleaning for your pet? Consult your veterinarian today, or ask about your pet’s dental health during his or her next annual exam. By following our tips, your dog or cat will have pearly whites as brilliant as this smiling cutie in no time:

Stay in the loop of our daily animal videos and shared news articles by following The Meowing Vet on Facebook and Instagram (@themeowingvet). And sign up for our blog mailing list in the right-hand sidebar of your desktop browser so that you never miss out on our weekly informative articles. Remember to share with your pet-loving friends!

– Maranda Elswick, DVM