Ask the Vet - Dental Health for Pets

Welcome to the second Ina Road Animal Hospital video blog. Today’s topic is pet dental health – a timely topic since February is Pet Dental Health month.

Let’s start with the basics. Dogs and cats have what many refer to as “baby teeth,” also known as deciduous teeth, when they are young, just like we do. These teeth will eventually fall out and be replaced by adult, or permanent, teeth. Dogs have a total of 28 deciduous teeth and 42 adult teeth. Cats have 28 deciduous teeth and 30 adult teeth. These teeth include incisors, canine teeth, premolars and molars.

Average Eruption Times for Teeth in Dogs:


 Deciduous teeth
Permanent teeth
 Incisors
4-6 weeks
3-5 months
 Canines
5-6 weeks
4-6 months
 Premolars
6 weeks
4-5 months
 Molars

5-7 months

Average Eruption Times for Teeth in Cats:


 Deciduous teeth
Permanent teeth
 Incisors
3-4 weeks
3-5 months
 Canines
3-4 weeks
5-6 months
 Premolars
6 weeks
4-5 months
 Molars

5-6 months


These teeth are made of several parts. The crown of the tooth (the part above the gum line) contains enamel, the hardest substance in the body, which is the white outer surface of the teeth that we can see, and the inner aspects known as dentin (a softer, bonelike material), and pulp (which contains the nerve, lymph, and blood supply to the tooth). The root of the tooth contains dentin, pulp, cementum (a calcified connective tissue) and is held in place by the periodontal ligament which is attached to the alveolar bone (the bone of the socket of the tooth root).

tooth_definitions.jpg

Some Definitions:

Enamel: a porous, calcified substance made of crystalline calcium phosphate; the hardest substance in the body

Dentin: the bulk of the substance of the tooth that lies just beneath the enamel of the tooth; this calcified tissue contains tiny tubules and covers the pulp

Pulp: the central portion of the tooth that contains the blood supply, lymphatics, connective tissues, and nerve supply of the tooth; this provides sensory function, produces the dentin, and nourishes the tooth

Plaque: a soft, sticky film consisting of bacteria and mucous that forms on dental surfaces

Calculus: hardened form of plaque that contains organic secretions, food particles, calcium phosphate and carbonate. Its surface is rough and facilitates further accumulation of plaque and additional calculus.

Gingivitis: inflammation of the gums

Periodontitis: Inflammation of the tissues surrounding the teeth affecting the gums and tooth roots associated with bacterial plaque and calculus on adjacent teeth leading to bleeding from the gums, infection of the tissues, pain and gradual loss of the bone and supportive tissues of the affected teeth.

Dental Disease:

Just like us, dogs and cats are prone to the development of dental disease. They will form plaque and calculus (also known as tartar) on their teeth, which, if left unchecked, will eventually lead to periodontal disease/periodontitis.

Plaque is a clear to light yellow, thick, sticky substance composed of saliva, bacteria, and food particles. This can form as quickly as 6-8 hours after brushing. It will adhere itself to the enamel surfaces we can see, as well as the dental surfaces that are just under the gum line. If not removed, it will eventually harden into mineralized calculus which has a rough surface making further accumulation of plaque easier. The accumulation of plaque and calculus can eventually lead to gingivitis as well as infection of the dental structures (periodontal disease). Unlike plaque, once formed, calculus (or tartar) cannot be removed with regular tooth brushing.

There are four stages of dental/periodontal disease.

Stage 1 – gingivitis, inflammation of the gums, is the primary symptom noted in this phase. Halitosis, or bad breath, can also be present. It is associated with chronic plaque accumulation along the dental surfaces. The bacterial populations trapped in the plaque leads to chronic inflammation of the gingiva. With a veterinary dental cleaning and regular home care, this stage is reversible since there has not yet been any loss of the attachment of the tooth. This stage is usually not painful to the pet.

Stage 2 – Halitosis is typically present, gingivitis has progressed, and the inflammation has spread and infection of the superficial dental surfaces is now noted. In this stage, up to 25% of the bony dental attachment has been lost and early periodontitis is present. Use of a dental probe often reveals a class one furcation. This means that the separation between the roots can be felt with the probe, but very little bone loss has occurred between the roots. The periodontal pocket is usually 3mm or less. With proper veterinary dental cleaning, including subgingival cleaning, and diligent home care, this stage can also be reversible. Mild oral pain can be associated with this stage.

Stage 3 – Halitosis, advanced gingivitis, and now gingival recession are present. The gingival tissues are tender, painful, and usually bleed easily. Periodontal pockets are at least 3mm deep and between 25-50% of periodontal bone loss is present. Stage two furcation is typically felt with a dental probe. In this stage, the probe can feel the furcation (separation between the roots), but still cannot pass through and through between the roots to the other side of the tooth. This stage may be irreversible depending on the degree of bony attachment still present. If the tooth is still solid, regularly scheduled veterinary dental cleanings, including subgingival cleanings, and diligent home care, may reverse this stage; however, if the bone loss has advanced far enough and the tooth is loose, extraction is recommended.

Stage 4 – Marked gingivitis, halitosis, and pain are present. The infection has caused significant bone loss (>50%) and the tooth is loose. Stage three furcations are present – this is where the dental probe passes easily between the roots. Tooth root exposure is noted and periodontal pockets are advanced. This stage is irreversible. The infection can extend past the tooth root and the surrounding alveolar bone to affect additional teeth and the surrounding bone of the jaw. Extraction of the affected teeth is necessary to help control the infection and pain.

In addition to pain, inflammation, gingivitis, tooth root infections, bone loss around the affected tooth/teeth, and tooth loss, periodontal disease can also lead to painful fractures of the jaw bone(s) if the bone destruction around the tooth/teeth is severe.

Periodontal disease can not only cause pain and infection in the mouth, but the bacteria residing in the mouth can spread to other areas of the body. This can lead to heart, liver, and kidney disease as well.


Prevention of dental disease:

Regular dental care is the best defense in the prevention of dental disease in pets. This is best when started at a young age. Acclimating your puppy or kitten to brushing their teeth when they are young can facilitate caring for their teeth as they grow older.

Brushing your pet’s teeth is one of the most important methods of home dental care and prevention of dental disease. To maximize the benefits of tooth brushing, it should be performed daily. Unfortunately, if done less frequently than every other day, there is little to no benefit to this form of prevention. This is a result of how quickly plaque is able to form on the dental surfaces.

There are several types of tooth brushes that can be used and finding what is most comfortable for you and your pet to use may take some trial and error to find the one that works best for you and your furry friend. Soft, finger tip tooth brushes may work well for young animals, pets with smaller mouths, and in the early stages of acclimating your pet to having his or her teeth brushed. Straight and angled tooth brushes with different sized heads are also available.

It is important to use the appropriate type of toothpaste when brushing a pet’s teeth. Our pets cannot rinse and spit the way we do and will swallow the toothpaste in the process of having their teeth brushed. Therefore, it is essential that the toothpaste is safe for them to ingest is used. Human tooth pastes contain too much fluoride for our pets to swallow and also foam when used. A pet safe, enzymatic toothpaste should be used. Many brands are available and they come in multiple different flavors to encourage your pet to allow you to brush his or her teeth.

In the situations where brushing your pet’s teeth is not possible, additional options are available, though they will not yield the same benefits that brushing regularly can. These options include water additives and oral rinses, which can slow the accumulation of plaque formation, as well as dental chews and dental diets, which helps remove plaque as your pet chews the treat or food.

Just like we need to make regular trips to our dentist for cleanings, our pets should also receive regular veterinary dental cleanings as an essential part of maintaining good oral health.

What happens during a veterinary dental cleaning?

The first step of this process is a physical examination of your pet which includes an examination of your pet’s mouth to determine the stage of dental disease present. This will help us give you an idea of what to expect during your pet’s dental cleaning. Unlike us, our pets are unable to undergo a proper dental cleaning while awake, thus general anesthesia is used to allow us to have full access to a pet’s mouth and properly examine the oral cavity, scale and polish the teeth, perform any necessary extractions, and apply fluoride treatments or other therapies to the dental surfaces.

Prior to anesthesia, we will perform preanesthetic blood work to help gauge your pet’s overall organ health. This will give us the opportunity to tailor the anesthetic protocol to your pet’s specific needs. If concerns are found in this blood work, we will discuss them with you prior to proceeding and give appropriate recommendations (which may include postponing the dental procedure). We will also place an intravenous (IV) catheter and start IV fluid therapy prior to starting the dental and will continue this fluid therapy throughout the anesthesia and anesthetic recovery of your pet. IV fluid therapy is an important part of any anesthetic event. This allows to help maintain the fluid needs of an anesthetized patient, maintain normal blood pressure while under anesthesia, and allows us to have venous access should additional medications need to be administered to a pet while they are under.

Once under anesthesia, an endotracheal tube is placed to allow administration of gas anesthesia and oxygen to the pet. This also serves to protect this pet’s airway during the dental procedure as there is a fair amount of water used during a dental cleaning. A veterinary team member is assigned to monitor anesthesia on the pet and will stay with him or her throughout the procedure and during his or her recovery. Our hospital utilizes monitoring equipment similar to that which is used in human hospitals. This equipment allows us to continuously monitor heart rate, ECG, respirations, oxygenation and CO2 levels, as well as blood pressure while a pet is anesthetized further allowing us to customize each patient’s anesthetic requirements during the procedure.

We will then use an ultrasonic scaler to remove the calculus and plaque from the patient’s teeth. A thorough examination of the mouth, including probing periodontal pockets, will be performed to assess the health of each tooth and determine if any other oral abnormalities are present. Should extractions be necessary, we will use local anesthetics to provide localized pain control at the site of the extraction prior to removal of the diseased tooth. Subgingival scaling is performed with the use of hand scalers after the crown of each tooth has been ultrasonically scaled. Each tooth is then polished. Once cleaned and polished, the pet’s mouth is thoroughly rinsed with a dental rinse and a fluoride treatment is applied. Once the procedure is complete, the pet is then allowed to recover from anesthesia and will usually go home a few hours after the procedure is complete and he or she is fully awake.

Depending on the severity of the dental disease, some pets will need to be on oral antibiotics for a period of time, sometimes started prior to the scheduled dental procedure and continued for a length of time after the procedure has been completed. If extractions were necessary, we will also prescribe pain medications to help these pets have as comfortable a recovery from the procedure as possible.

We will follow up with each dental patient to see how at home recover is going and usually schedule an in office visit within one to two weeks to assess healing and further discuss home dental care. We will recommend regular monitoring of oral health and gladly assist in helping each pet owner tailor a home dental care plan to fit the specific needs of their pet.

What about anesthesia-free dental cleaning?

It is natural for pet owners to have concerns about the general anesthesia necessary to perform a veterinary dental cleaning as described earlier and this can lead some to seek alternate types of dental cleaning.

Grooming facilities will often tell pet owners that they cleaned or brushed their pet’s teeth during the grooming process. While this sounds beneficial, it is ineffective in prevention or treatment of dental disease in pets. A single brushing only removes the plaque present at the time of the grooming and does not remove any calculus that may be present, nor is it able to treat any underlying periodontal disease below the gum line.

Owners will also hear about anesthesia-free dental cleanings in which the calculus is chipped or hand scaled from the crown surfaces of the teeth. Unfortunately, while providing a pleasant cosmetic outcome, these techniques fail to treat the problems which may exist below the gum line. Thorough subgingival cleaning around each tooth cannot be accomplished in even the most cooperative awake pets. Access to the lingual surfaces of the teeth (the side next to the tongue) cannot be obtained in this type of cleaning and proper polishing of these dental surfaces after the calculus has been chipped away is not possible. While visibly appealing in the short term, the source of the halitosis that is often present in these pets is not properly addressed and calculus often reforms quickly in these pets.

In summary, the best ways to care for your pet’s dental health include: Regular daily or every-other-day tooth brushing with an enzymatic toothpaste designed for use in pets, the use of dental chews and/or oral rinses and water additives, and regular dental checkups and cleanings by your veterinarian.