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Dental Care - posted 02/11/2013
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
Average Eruption Times for Teeth in Cats:
| Deciduous teeth
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.
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.
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
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
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.