As a small-animal general practice veterinarian, one of the most frequently asked questions I hear from clients in the exam room is, “How do I get my dog or cat to live a long, healthy life.” There are a lot of answers to that question. That being said, one of the top specific answers to this question and the one I want to focus on today is dental health in our dogs and cats. If I could categorize one area of health that effects the quality of life and overall health of a patient it is their oral health, so today I want to focus on this topic, answering ten of the most common questions I get asked in the exam room.
What is periodontal disease?
Oral disease is one of the most prevalent diseases we see in veterinary medicine. A recently published statistic proved over 80% of our dogs and cats are currently living with dental disease. Compare that to a recent study by the American Veterinary Medical Association (AVMA) that published less than 7% of our conversation in the exam room is discussing dental health. This was a very concerning statistic to hear, seeing that these numbers do not correlate.
Why does oral health matter?
Companion animals have increasingly become considered primary members of our family. Periodontal disease can affect other parts of the pet’s body. If oral health is left unrecognized, this can impact the overall health and longevity of our pets. Because of this dental care is equally as important of a topic in the exam room as vaccines and heartworm preventative. The heart and liver are especially prone to developing inflammation from dental disease.
There is evidence that dental disease is linked to cardiopulmonary diseases like endocarditis, according to the World Small Animal Veterinary Association (WSAVA). This evidence is supported by cultured bacteria from infected heart valves being the same as those also identified in the mouth. Similarly, diabetic dogs tend to have higher rates of dental disease. The inflammation and infection affecting the blood glucose levels of these patients in what ends up being a vicious cycle. Often times, once the teeth are addressed, we can see improvement in these patient’s numbers, overall energy, and quality of life.
Why oral health is ignored?
Failure to address dental health is often due to a combination of difficulties both in and out of the exam room. One reason it has been difficult over the past couple of years is due to the patient-to-veterinarian ratio crisis we have been dealing with in the COVID era, particularly in the DC area. Long gone are the days of chatting with my clients about last weekend’s UGA game. Now routine Wellness Care is being sacrificed with an overburden of emergency ear infections, UTI’s, and gastroenteritis cases. Veterinarians simply do not have as much time as we would like, making routine care more and more difficult to discuss. Reinforcing the need to have a good relationship established with your veterinary team.
Another reason is cost. My least favorite question in the exam room is, “how much is this dental going to cost, doc?” There are 42 teeth in the adult canine mouth. This is 42 opportunities for us to find something during a routine dental procedure. A pet insurance plan can be crucial to the financial impact of these procedures throughout your pet’s life. Also, working with a veterinary hospital who offers a dental package as part of their Wellness Plan can be a way to spread the cost of a dental procedure out throughout the year.
A third reason oral health is ignored is the concern behind anesthesia. Anesthesia makes dental evaluation and treatment safer and less stressful for your pet. During your pet’s dental procedure, veterinarians use sharp, sterilized instruments. Animals don’t like to hold still while X-rays are taken and these sharp instruments are used to clean their teeth. Placing your pet under anesthesia during the procedure allows your veterinarian to make a more accurate diagnosis and decrease the chance of complications and missed concerns such as an oral mass that could otherwise go unnoticed. Your pet will rest comfortably while the veterinary team safely performs a thorough and proper dental cleaning. Anesthesia is much safer than you may think. Before anesthesia, your pet will be carefully screened with bloodwork and other tests to ensure she is free from underlying disease. During the dental procedure, a trained professional will be dedicated to continuously monitoring, recording vital signs, and communicating the findings to the veterinarian.
At what age does dental disease typically present?
Dental disease begins early in life. By the age of two, most dogs and cats have some degree of dental disease. The early signs of dental disease in pets include bad breath, yellow tartar buildup on the teeth, and red and swollen gums. Early, thorough care during these years can add years to a patient’s life and preserve healthy teeth and bone in the oral cavity.
What if my dog or cat has a broken tooth?
If you can see that your pet's tooth is actively bleeding, this means that the pulp of the tooth has been exposed. Pets usually have quite a strong food drive and do not want to show signs of illness, so do not be mistaken into thinking your pet has no pain from the fracture. Your pet feels a similar level of pain to what you would if your tooth was broken and exposed, so it is important to seek immediate treatment for them. If you see the break actually happen or know when the break occurred, options may be available to preserve the integrity of the tooth, but there is a very short window for this treatment to be effective, so you should immediately contact your veterinarian. Root canal therapies or extractions are the two treatment options for teeth with old fractures and pulp exposure. Once the pulp is exposed it is a matter of time before the tooth will become infected, then the tooth will die and eventually a painful abscess with develop around the root. This is an emergency, and is a much more invasive and expensive procedure that could be prevented with early detection through routine dental care and x-rays.
Does dental disease cause my dog or cat to have pain?
Dental disease causes significant, chronic pain in pets. When dental disease is discovered later, after years of tartar, plaque, and bacteria buildup have caused infection, inflammation, and diseased teeth, your pet has already experienced significant, chronic, life-changing pain. But animals are experts at hiding signs of pain, so the pain often goes unnoticed by you. Instead, you may see that your pet is increasingly irritable and lethargic and has a decreased appetite. Changes you may attribute to your pet’s advancing age or other lifestyle factors. But after a proper and thorough dental procedure, many pet owners report the emergence of “a whole new pet.” One who is happier and more active.
Dogs rarely show signs that they’re in pain, and if they’re behaving and eating as usual, it may appear as if nothing is wrong. That’s an incorrect assumption because appetite is a strong drive. It is easy to avoid biting on a painful tooth. Dogs may display signs of dental trouble such as drooling, a lack of appetite, swelling or bleeding, but these do not show up in every case. Most families only notice the bad breath caused by plaque, and that alone is reason enough to have your veterinarian examine your dog’s teeth. Usually by the time serious signs come up, it is too late to the save the tooth, and there is a high likelihood the pet has been living quietly in pain for quite some time. Most pets continue with their daily routine and it is not until we have the opportunity to address the wiggly pre-molar or the fractured canine that families will notice a difference in their pet.
Is the tooth the only thing affected by dental disease?
Dental disease can lead to a broken jaw. Unfortunately, we see this all too common in veterinary medicine. Smaller breeds are particularly prone to this complication. Infection to these dogs’ mouths can weaken their relatively small jaws, and something as simple as jumping off the bed can lead to jaw fracture. Jaws that fracture due to periodontal disease present an extra challenge due to the lack of good quality bone in the area as well as lack of teeth. Sometimes fractures can even happen after teeth have been removed. This is because without teeth, the lower jaw is weak. Routine cleanings can be the most critical part of maintaining the integrity of the bone in the jaw.
Does my pet need dental x-rays?
X-rays are essential for diagnosing dental disease. I can’t stress this enough. Think of the tooth as an iceberg; the majority of the tooth(approximately two-thirds) is located below the gumline, making x-rays crucial to diagnosing dental disease. A recent study showed that after examining dental radiographs (X-rays) of cats and dogs with teeth that appeared normal to the naked eye, veterinarians found 30% of dogs and 40% of cats had diseased teeth. In pets with abnormal-looking teeth, veterinarians found additional diseased teeth in 50% of dogs and 53% of cats.
What about non-anesthetic dentistry?
Non-anesthetic dentistry is stressful, unsafe, and ineffective. It is currently not recommended as the standard of care by the AVMA. It does not complete the critical parts of a dental procedure, including thorough oral exam, dental x-rays, and below gumline cleaning. Most importantly, it directly negates the leaps and bounds our field has made in encompassing a fear-free approach to the care of our companion animals over the past decade. Imagine multiple strangers holding you down and speaking a language you don’t understand. They’re shining bright lights in your face and inserting sharp, scary instruments into your mouth that pinch and poke. This is what your pet would endure during a non-anesthetic dental procedure. Without anesthesia, it’s impossible to obtain X-rays to see what lies beneath your pet’s gumline. It is also impossible to safely and effectively clean the teeth using those sharp instruments while the pet is awake. It’s simply not fair to our pets. Unfortunately, we are seeing increasingly more cases with oral conditions that went unnoticed and addressed for years due to non-anesthetic dentistry, taking sometimes years off of these patient’s lives.
What can I do at home for my pet’s dental care?
Home care is a vital part of periodontal treatment. Treatments will be temporary and unsuccessful without additional home care. Consider going to your dentist twice yearly for a cleaning and never brushing in between visits. Daily tooth brushing is the gold standard, but I understand this is not practical for some families. Be wary of products on the market. Similar to how we purchase our own products and groceries, researching the source of what our pets consume is equally important. Not all products that say “veterinarian recommended” are suitable for your pet. I always recommend oral health products with solid research to back those claims. The Veterinary Oral Health Council (VOHC) awards products a seal of acceptance if the companies that have applied for this seal have tested their products using strict protocols developed by the VOHC. Products that have this seal are known to have respectable science behind them and have demonstrated the product works. Additional information is available at vohc.org. There are many other chews and treats available that are efficacious but do not have the VOHC seal. Do your homework: ask the manufacturers of dental products specially formulated for dental disease to show you the research that proves the efficacy and safety of these products before purchasing these products for your pet.
In conclusion, a strong veterinary-client relationship is critical for the longevity and care of your pet. In general, it is important to have a close veterinary-client relationship established with a practice geographically close to your home. The common goal of keeping your pet as healthy as possible is crucial, and that starts with the relationship you have with your veterinarian. Think of it as a team effort; with you being the eyes and ears at home and your trusted veterinary team being your eyes and ears at your pet’s regular physical exams. Oral disease affects over 80% of our companion animals, and often goes missed or unaddressed. Early, preventative care can not only prolong your pet’s life, but it can prolong the quality years that you have with them while decreasing the impact of chronic pain, cardiac, and systemic disease. Please schedule an appointment with your veterinarian to start the conversation about your pet’s oral health.