According to the American Veterinary Dental Society, more than 80% of dogs and 70% of cats show some signs of gum disease by age three. In spite of this important statistic, oral hygiene is one of the most overlooked areas of medical care for animals. 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. Dental disease is a treatable and preventable problem, and since your pet can not tell you how it feels, it is up to all of us, as members of your pet's health care team, to address this problem.
Dental disease is such a rampant problem, and is so easily prevented, that February of every year is designated as National Pet Dental Health Month. Please ask one of our receptionists for additional information.
Dogs have 28 deciduous (temporary or baby) teeth and 42 permanent teeth. Anatomically they have 4 different types of teeth: Incisors (I), canines (C), premolars (Pm), and molars (M).
This is an x-ray of the lower jaw of a dog. You can see how deep the roots go.
In comparison to dogs, cats have 26 deciduous teeth and 30 permanent teeth. They have the same types of teeth that dogs do, but in different proportions. They lack premolar #1 found in dogs due to a different evolutionary path.
The deciduous teeth start being replaced by the permanent teeth (in this picture they are the 2 large central incisors marked by the arrows) at 4 months of age. The puppy teeth that were there were probably swallowed.
Dogs seldom have problems with teething, although they do tend to chew things during this period. It is advisable to supply them with synthetic bones for this purpose, or else some of your personal items might get recycled! By 8 months of age all the permanent teeth have appeared.
Small breed dogs tend to have dental problems more often than large breed dogs. This may be due to the fact that they have smaller oral cavities and the teeth are forced closer together. Cats get comparatively few congenital problems regarding their teeth.
Any condition where the teeth are not normally positioned is called a malocclusion. Malocclusions are corrected only if there is a problem with mastication (chewing). Undershot jaw (lower jaw protrudes beyond the upper jaw) is seen on occasion, and is prevalent in small dogs and in breeds like Bulldogs, Shih Tzus, and Lhasa Apsos. Overshot jaw (upper jaw protrudes beyond lower jaw) is similar to buck teeth in people. Occasionally, a dog will not shed a deciduous tooth when a permanent tooth starts to come through the gums in the same location. These retained deciduous teeth , along with any extra teeth, should be removed because they will result in displacement of the permanent teeth. Problems of this nature are discovered by our doctors on routine exams. This enforces the importance of bringing in young pets for vaccines and exams at an early age.
Symptoms of dental disease can range from subtle to extreme. One of the most common symptoms is bad breath (halitosis). Sometimes a pet with dental disease will cry in pain when you touch it anywhere near its muzzle. Another symptom is a partial or complete inability to eat (anorexia). A pet that has this problem may eagerly go to the food bowl, and either just look at the food or drop the food out of its mouth after only a few bites. Other pets might drool from one or both sides of the mouth.
The important point to remember is the fact that once you notice any of these symptoms, your pet's dental disease is already causing discomfort or pain, and even affecting other body organs. Therefore, it is important for you to be aware of the existence of this problem, to learn how to perform a basic oral exam at home, learn how to brush its teeth, and to bring your pet in for regular (every 6-12 months) dental exams by one of our veterinarians. Your pet can not tell you its mouth hurts, it is up to us, as a team, to ensure that this inevitable problem is properly monitored and treated before it causes discomfort and pain, and sometimes premature organ failure.
The first stage of dental disease occurs when bacteria cause an invisible film of plaque to form on the teeth. The bacteria react with minerals and other debris that accumulate in the oral cavity, eventually causing tartar.
Tartar is made up of calcium salts, food debris, bacteria and other organic matter. It is orange to brownish in color and although soft when deposited, it quickly hardens. It collects primarily on the cheek (buccal) side of the premolars and molars.
Tartar eventually causes inflammation of the gum line, called gingivitis. It is seen as the reddened gum along this canine tooth. Since the gingiva are the first line of defense for the tooth against bacteria, any gingivitis is considered significant. This pet should be treated now before the problem progresses to periodontal disease, an all too common diagnosis in our hospital.
Untreated gingivitis eventually progresses to periodontal disease, an actual infection of the tooth root. This tooth shows periodontal disease as evidenced by the ulcerated gums, pus along the gum line, and severe tartar. When this happens your pet will experience pain and will become internally ill from the bacteria spreading to internal organs via the bloodstream. Pet's with this problem are in jeopardy of internal organ failure.
This diagram indicates how gingivitis and periodontal disease affect the tooth. You can see the red and inflamed gum on the right side, this is gingivitis. The arrow on the right is pointing to the plaque buildup, and shows the gum line separating from the tooth. Notice how a large portion of the plaque is under the gum line, which means it is invisible to us when we look at the teeth. As the plaque progress down further it disrupts the periodontal ligament that holds the gums to the root of the tooth. This is the start of periodontal disease. This diagram emphasizes the importance of removing the plaque deep under the gum line. It is too painful for a pet to do this without anesthesia.
This is a potential outcome when pets with periodontal disease are not treated. The teeth in this cat literally rotted out of its mouth. This situation is completely preventable. Fortunately, pets that have no teeth can still eat well, but that is small consolation for this cat.
This is another potential outcome for a pet that has periodontal disease. This dog's lower jaw (mandible) is fractured at the chin because of long term periodontal disease. You can see this fracture (the arrow points to it) as a separation where the 2 lower jaw bones meet at the chin.
This jaw had to be wired back together after the teeth were cleaned. It will also need to be on long term antibiotics. Unfortunately, the problem might get worse as time goes on. The wire (marked by the arrow) can be visualized just to the right of the tongue. It is wrapped all the way around the jaw and anchored under the chin. It will need to stay in place at least one month.
Pets with periodontal disease require immediate care because they are in pain and run a risk of becoming internally ill from the advanced dental disease that is present. In addition to antibiotics, they need pre anesthetic diagnostic tests. These tests are needed in order to minimize the anesthetic risk and assess the status of internal organs that may have been damaged by this mouth infection. Intravenous fluids also are necessary prior to the administration of anesthesia. It is very likely that loose teeth will have to be removed. The thorough oral exam that will be performed while under anesthesia might also reveal other problems that will be taken care of. This is another reason we anesthetize your pet for exam and treatment.
The heart is one of the main internal organs affected in advanced dental disease, because bacteria from the mouth infection can readily deposit on the heart valves (especially the mitral valve). After a variable period of time, the valves can malfunction and leak blood backwards through one of the chambers of the heart, instead of forward like intended. This turbulence of blood as it flows through this leaky valve can often be heard as a heart murmur. The result of this back pressure is a build up of fluid in the lungs (pulmonary edema). Fluid in the lungs will cause your pet to start coughing and feel very ill- it is a serious sign that requires immediate veterinary care. This problem with the heart valves is one of the main reasons we use antibiotics before and after the teeth are cleaned.
In addition to heart (cardiac) problems, dental disease can affect the kidneys and the liver. These are both vital organs, and require a pet free from dental problems if they are to function properly.
Since there are numerous diseases and conditions that can mimic dental disease, the diagnosis of dental disease must be performed by a veterinarian. During the physical exam we will be checking more than just the teeth, we will be performing a complete examination. As with any illness, the diagnostic process is carefully followed so that a correct diagnosis is actually made and other problems that are a result of the dental disease (ex-heart murmur), or are occurring simultaneously (ex-kidney disease), are not overlooked.
Our doctors will gladly point out what problems (if any) your pet is having with its teeth and gums. We will also show you how to perform a basic oral exam so that you can monitor your pet's progress at home.
To correct the gingivitis that is present it is important to gently clean under the gum line. This can only be accomplished thoroughly and gently if your pet is under anesthesia. Anesthesia will make it impossible for your pet to experience any anxiety from having instruments placed in its mouth, or discomfort when the tartar is actually removed. This is why we anesthetize every pet to clean its teeth and perform a proper oral exam. Since the risk of anesthesia is negligible with the precautions we take and the precise method available to administer and monitor anesthetic, it is well worth the negligible risk in order to clean the teeth and gums properly. We have extensive experience in anesthetizing pets, especially the geriatric pets that so commonly have advanced dental disease. To minimize any anxiety you have over anesthetizing your pet, one of our doctors will personally discuss our anesthetic protocol with you and set up an anesthetic plan that is specific for your pet's condition.
The primary way to clean under the gum line, remove tartar and restore your pet's gums to optimum health, is to scale them using our ultrasonic scaler. First, the large pieces of tartar are removed with special instruments to crack the tartar off. Then, using precise instruments and our ultrasonic scaler, the gums are gently cleaned under the gum line. After they are scaled we polish the teeth to make it more difficult for bacteria to adhere to them and start the cycle of plaque, tartar, and gingivitis all over again. Then floride is applied to harden the enamel.
Cleaning can restore the gums to a healthy state, which can then be controlled with brushing at home, feeding hard food, and routine monitoring by us every 6-12 months. If you follow this preventive program your pet will not encounter advanced dental disease and have a much better quality of life.
Just like in people, routine preventive care is critical to proper dental hygiene. This saves your pet from extended periods of pain and unnecessary tooth loss, and can save you the expense of the veterinary care needed to treat advanced dental disease. Your pet's teeth should be checked every 6-12 months by one of our doctors, especially if it has already had gingivitis and had its teeth cleaned. One of these check ups can be accomplished when your pet is brought to our hospital for yearly booster vaccinations.
One of the most important things you can do to slow down the recurrence of dental disease is to brush your pet's teeth. This will help keep the gums healthy and prevent tartar buildup on the teeth on the cheek side of the mouth, although it does not work as well on the teeth on the tongue side of the mouth. Even though this may sound like an impossible feat for an uncooperative pet, or even a ludicrous idea, it is one of the best ways to prevent dental disease.
Even though the teeth will eventually need professional cleaning again in the future (most people get their teeth cleaned twice per year), proper brushing will decrease the amount of dental disease that occurs and the number of times we will have to clean your pet's teeth over its lifetime. Due to the short life span of pets in relation to people, proper home care of your pet's teeth becomes an important health measure.
When brushing the teeth there are some common sense things to do to make the process go smoother. It is important to remain calm and patient, since for most pets having something put into their mouths is a new experience. With a little tincture of time, the procedure progresses smoothly. Also, it is highly advantageous to start the brushing process at an early age.
The first skill to master when cleaning your pet's teeth is proper restraint. There needs to be a proper balance between too little and too much restraint, a balance that varies with each pet. This is especially true with cats. For smaller pets, placing them on a table will make the process go smoother. Larger pets can also be placed on a table, if feasible, or can be restrained on the ground. Only one or two people should be involved in the cleaning process, usually without children present.
Start the process by getting your pet used to having your finger in its mouth. Dipping your finger into a food or liquid your pet has acquired a taste for helps start the process smoothly. When it is comfortable with your finger, use a soft gauze to massage the gums and gently rub the teeth. A cotton tipped applicator can also be used.
Eventually, introduce a soft bristled toothbrush. These toothbrushes are available in our dental kits. A rubber finger brush is even easier to use than a toothbrush. This finger cot is also available in our dental kit. You should not use your personal tooth paste to brush your pet's teeth because the taste can upset their stomachs. Our dental kit has toothpaste that is specially made to be palatable to animals. These kits also have suggestions to make it easier to brush your pets teeth. If you consider daily tooth brushing a chance to enhance your bond with your pet, you and your pet will find it more enjoyable.
The carnaissal tooth (upper 4th premolar) may become infected and result in the formation of an abscess around the root. This is a very painful condition and is often accompanied by fever, loss of appetite and depression. A classic symptom of the problem is discharge through the face below the eye. This tooth needs to be removed for the problem to be corrected. It has a deep root and needs careful extraction to correct the problem.
This disease, seen almost exclusively in cats, is a specific inflammation of the the gum tissue. It is a painful and debilitating condition that is controlled but not cured. It is treated in various ways.
It is very common for pets, especially dogs, to break or loosen their teeth while playing or chewing. This can cause significant discomfort and predispose your pet to dental problems later on in life. Injured teeth are usually removed, under general anesthesia, to ensure that the whole tooth is removed, including the root. If the root is not removed there will be a continual problem.
Due to the nature of their enamel, dogs and cats do not routinely develop cavities. If they do, the cavity looks like a black area on the tooth, usually seen at the gum line or on top of the molars. Cavities can lead to pain and difficulty in chewing. The usual treatment is extraction of the tooth, although we can refer you and your pet to a specialist in veterinary dentistry to fill the cavity and save the tooth.
Discolored teeth are seen in some pets. This can be caused by diseases like Distemper, the administration of certain antibiotics during the first few months of life, or trauma. If you notice discolored teeth please bring your pet in for an exam to determine the cause of the problem and if treatment should be instituted.
Worn down teeth are usually caused be chewing rocks, chains, and fences. This is a behavioral problem that should be corrected to prevent long term problems. Also, dogs that continually chew or bite at the skin due to allergies or fleas will cause the incisor teeth to be worn down, sometimes all the way to the gum line.
This problem can be detected during a routine exam and corrected by prevention of chewing on itchy skin before the teeth get worn down too far.
At this stage there is no way to correct the problem without extensive dental work with a specialist.
Pets can get growths in the oral cavity, some of them can be benign, some malignant. A benign gum growth that occurs usually in older dogs is called an epulis.
The growth of the gum sometimes become so large that it covers a tooth almost completely. These are treated by surgical removal under anesthesia.
If one of our doctors feels your pet needs to have its teeth cleaned there are several steps you should take:
1. Make an appointment to have the teeth cleaned before you leave our office. This will give you greater flexibility in your scheduling and allow us to accommodate you as much as possible. One of our receptionist's will give you a written price estimate based on the doctor's written instructions. Even though our estimates are very accurate, there may be slightly greater (or even lesser) charges on the final bill. This might be because some teeth need removal or medication, such as antibiotics or analgesics for pain, need to be sent home, or even finding something on the oral exam while under anesthesia that was not readily visualized during the initial exam. If there is any significant change in the price we will call you before proceeding. Please leave a phone number where you can be reached.2. The night before the teeth cleaning take away all food before you go to bed, and make sure your pet does not eat anything in the morning. Our office opens up at 8:30 AM for drop offs. We appreciate having your pet in for its teeth cleaning by 9 AM.
3. We will anesthetize your pet and clean its teeth sometime in the morning or early afternoon. Please call our office in the mid afternoon to verify your pet will be going home the same day, which almost is the case. It is very rare for a pet not to go home on the same day its teeth are cleaned. Your doctor will let you know if he plans on keeping your pet overnight. This might be because your pet is older or has a medical problem that requires us to monitor its progress in the hospital for an additional night.
The best time to pick up your pet is between 4-6 PM to make sure he or she is fully awake from anesthesia. You will be given written post dental instructions at that time. If you have any questions after reading these instructions one of our doctors or technicians will help you, please let the receptionist know you have questions for the doctor.
4. Contact with children and other pets should be supervised by an adult the first night. Give small amounts of water and soft food an hour after getting home. If he or she eats and there is no vomiting, give some more food and water. Some grogginess may be experienced after arriving home (some people welcome this, especially with young and active pets) but should be back to normal by the next morning. Please call us the next morning if you have any questions or you feel there is a problem (ex.-not eating, very lethargic).
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