Dental Disease

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The PetStuff Online Newsletter
Volume 1 Issue 12  December 17, 1999


Sponsored by PetStuff Online Store

Produced by Dr Dan

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"Dental Problems in Dogs & Cats: The Nuts & Bolts"

Ever wonder what's the "Number One" problem seen by veterinarians in dogs and cats ?   Nearly 75% of the dogs and cats we examine have Gum Disease, Dental Calculus and often times Abscesses, Loose and Missing Teeth!   Unfortunately, we can't see the whole picture or I'm sure we'd all be a little more concerned over our pets dental health. The brown calculus you see on your pets' teeth is only the "tip of the iceberg"!  Calculus accumulations can cause changes inside the body that may result in organ dysfunction and a shortened lifespan. To my belief, "That's Important!"

Another brief question?  Can you imagine what it would be like to go through life without thumbs?   Pets' have no thumbs and after they lose teeth how can they remove a mat or burr in the fur? How can they catch a biting flea? What would chewing hard food be like?  I'm sure if our dogs and cats could talk, they would be telling us, "All I want for Christmas is my Two Front Teeth..."  Teeth are of primary importance to and an invaluable tool for healthy dogs or cats.

How can I tell if my pets have dental problems?

It's very easy...  Lift the lip and take a peek and a good sniff.  If your pet has horrible breath this is an early and sensitive indicator that bacteria are being harbored in the mouth. With a very mild buildup of dental calculus the breath starts smelling foul.  

You also can very easily see the calculus. Normal teeth are white and shiny all the way to the gum-line. If you see yellow or brown deposits, especially near the gums, there is a problem. As a dog or cat chews their food the calculus is rubbed off the tips of the teeth. It is very rare to ever see calculus on the tips of the teeth, but since the cone-shape of the tooth breaks the food they are chewing the abrasive action never reaches the gum-line.  Calculus builds up and the bacterial toxins damage the gums.

Look at your pets' gums.  They should be pale rose in color and taper down to a knife edge where they meet the tooth. If there is a bright red line where the gum meets the tooth or if the knife edge has become rounded the pet is starting to have gum disease. Abscessation and tooth loss are usually soon to follow.

Notice the brown calculus, red gums and loss of the knife edge on the following pictures of diseased pet teeth.

DENTALCALCDG copy.JPG (115832 bytes)  DentalDogHeavyCalculus.JPG (103788 bytes)CatCalculus.jpg (12918 bytes)

The progression of Dental Disease

When we brush our own teeth we remove the soft white substance called tartar.  Tartar is a by-product of bacterial action on sugars and other remnants of food which remain in the mouth after eating. Some of this tartar accumulates just under the knife-edge of the gumline. If it is left there, eventually it takes up minerals and it becomes hard and a yellowish-brown in color.   Ever wonder why we have our own teeth cleaned professionally when we brush twice a day?  It's to remove this hidden calculus before it can cause damage.  We don't see calculus because it's hidden beneath the edges of the gums.

What would happen if we didn't brush our own teeth? The tartar would continue to harden and form larger deposits of calculus along the gums.  If left long enough calculus will eventually move down, covering most of the tooth. This is the situation we have in many of our pets! (See the picture on the right above)  

Calculus is filled with bacteria. The bacteria constantly release toxins that eat away at the peridontal ligament that holds the tooth in the gum. You can see early stages of this irritation in the red line and slight rounding of the gum where it meets the tooth (See the photo on the left above). What you can't see is how deep the destruction of the ligament has progressed.  When the destruction continues beyond the gum-line "pockets" are formed.  Food particles pack into these pockets and carry the calculus accumulation and infection deeper. Soon, pus-filled abscesses can form.   Eventually, the entire root is infected and the peridontal ligament is destroyed allowing the tooth to fall out.

Something we all need to be aware of is that this tooth and gum disease is permanent! Once the peridontal ligament is destroyed it won't return to health after cleaning. We are experimenting with a neutriceutical drug (Coenzyme Q10) which is showing promise in partially restoring gum health and tightening diseased loose teeth, but for the most part once the damage is done the tooth will be lost.

You might wonder how disease in the mouth can cause systemic illness and early organ dysfunction which can lead to an untimely death of the pet.

Bacteria, Bacteria, Bacteria...  

Loads of bacteria find their way into the circulation every day. These bacteria can form cute little cauliflower-like growths on the delicate valve leaflets in the heart.  I see so many old Poodles with rotten teeth and heart murmors.   I can't see inside, but I often summise that these aquired valve leaks are the result of the bacterial threat from their chronic dental disease. Unfortunately, open heart surgery to repair the valves isn't in my line of expertise or the usual pet owners' budget.

Second problem...  If bacteria are constantly causing a threat to the body the animals immune system has to fight them off or die of overwhelming bacterial septicemia.   While fighting off the bacterial invasion from the teeth, globulins are formed (a protein) by the animals' immune system. Excess quantities of globulins (or proteins) can plug the tiny filters in the kidneys and cause a condition called amyloidosis.   Kidneys are an essential organ needed to maintain life. Once they are destroyed there is no regeneration! Without a kidney transpant the animal will die.

Normal Teeth

felineteeth.JPG (42840 bytes)  canineteeth.JPG (50019 bytes)

Abnormal Teeth

felineabnormalteeth.JPG (50857 bytes) 

How do veterinarians clean the teeth?
Unfortunately, dental calculus is tough stuff!  It is as hard as stone and sticks very well to the enamel surface of the tooth.  It is also unfortunate that dogs and cats won't sit still and let us work on their teeth.  For that reason we have to administer an anesthetic. This scares many pet owners and causes them to forego proper dental care for their pets. A little explaination about anesthetic protocols is in order.

There are many levels of anesthesia ranging from:

Mild sedation    --  Unconsciousness  -- Surgical Anesthesia  -- Coma  --    Death

On dental procedures we maintain a level of anesthesia between sedation and unconsciousness.    The lighter the anesthesia the safer it is. We try to keep the animal just brely asleep. At our hospital we use gas anesthesia exclusively for several reasons.

Number one is that it is safer and more controllable than injectible anesthetics.  We use a compound called Isoflurane mixed with oxygen and nitrous oxide. When we turn off the gas our patients recover and are sitting upright in less than 10 minutes.  It is this rapid recovery that you don't have with injectible anesthetics. Also with injectible anesthetics once you give the drug you can't take it back. When using gas anesthesia if the patient gets a little too deep, you can very easily back down on the quantity of anesthetic being administered. It costs a little more, but our patients are safer and they go home wagging tails rather than staggering like a drunk.

A second reason for using gas anesthesia is that we don't want our patients inhaling all the bacteria we are cleaning off the teeth. With this technique the windpipe is intubated with a tracheal tube which is connected to the anesthesia machine. You can see it in the pictures shown above and below. On the end of the tube is a little balloon which is inflated once the tube is placed inside the windpipe. This seals off the windpipe so that no liquid or bacteria can enter the lungs. Intubation also creates a safety factor. If the pet should slow down on respiration, we can very easily assist breathing until any excess anesthetic is flashed from the system and the patient is stabilized.

AnesthesiaMachineSm.JPG (16978 bytes)  TrachTubeSm.JPG (13535 bytes)  IntubatedCatSm.JPG (20749 bytes)

Sorry to get sidetracked on anesthesia, but it is important.  Ask your veterinarian what type of anesthesia he or she uses. In today's world there is no reason to opt for anything less than Isoflurane Gas Anesthesia. It is much safer than injectible anesthatics.  We are proud that our clinic death loss from anesthesia stands at less than 1 in 10,000 animals anesthetised.

To continue, once we have the pet happily sleeping, we are ready to go to work on the teeth. As I mentioned above, calculus is hard and sticks. For that reason we need something to break it away from the tooth. We use a machine called a cavitron.  The cavitron has a tiny wand with a metal tip that vibrates at very high frequencies and sprays cooling water mist. When the cavitron probe is touched to the calculus, the material breaks into tiny pieces and flakes away from the tooth. We only use the cavitron to remove the big pieces of calculus. Once the teeth appear clean we take a hand dental scaler and scrape the remainder of any calculus away.   You can actually feel calculus on the tooth with a hand scaler.  It has a rough, gritty feel.  Once the tooth is free of calculus the hand scaler slides up and down the tooth surface without any grating feeling. Since the cavitron can cause damage to the gums from heat buildup we keep it away from the gum-line.  This is where the hand scaler works best and gives us a tactile feel to make sure all the calculus has been removed.

Since ANY cavitron puts microscopic pits in the enamel surface of the tooth our last step is to polish the teeth.  We use an abrasive paste and tiny rotary polisher with rubber buffing cups.  This imparts a nice shine to the enamel and slows the future accumulation of calculus.  Without a good polishing to remove these microscopic pits calculus accumulation on the tooth could be accelerated after a dental cleaning.

When everything is clean and shiny, it is time to look at the condition of the teeth. Any teeth with deep pockets, abscesses, severe root exposure or extreme loosness are usually extracted. Cavities are extremely rare in dogs but occasionally we see them in cat teeth.  Why?   Maybe it's because pets don't eat sugar like we do! When we are sure everything is ok we turn off the anesthetic.

Within minutes the animal begins stirring.  As soon as we see signs of consciousness, we deflate the balloon in the tracheal tube and remove the tube. The patients are dried and wrapped in a warm towel.  This is a good time for us to trim nails, check ears, clip or comb out mats and any other little tasks that the animals don't care for and are so easy when they are not totally "with it". Once the patient is up and talking to us we return them to a recovery cage and call the owners to tell them how the procedure went. The pet will be ready to go home in an hour or two.

 

DentalDogCavitron.JPG (95359 bytes)  DentalDogPolish.JPG (96622 bytes)

HandscaleCatSm.JPG (14074 bytes)  ClawScraper2.jpg (11238 bytes)  GraceyScraper.jpg (10916 bytes)

Home Care for the Teeth

We commonly hear, "My dog eats plenty of bones and dry food, why does he have calculus". The answer is simple. The bones and dry food don't get up along the gumline where calculus forms and causes the gum damage. There are just hundreds of foods, chews, toys, biscuits, sprays, etc. on the market.  All fast and easy for the owner, but put plain and simply -- they DON'T WORK!  The only way to slow the formation of calculus on your pets teeth is by brushing them with a soft brush and a pet dentifrice paste.  Sorry - nothing else works.   If you are serious about keeping calculus off your pets' teeth you are going to have to learn to brush them. Actually it is not that hard.

Brushing the teeth...
Start out with several pet toothpastes.  Find one that your pet likes the taste of. Some like chicken. Others like beef or malt or mint.  Just give them a little taste and see what happens. If they like the taste, half the battle is won. As soon as your pet has found one that it likes,try putting a tiny bit of the paste on a moistened cloth (I use gauze pads wrapped around the finger tip) and just wipe one or two teeth on the outside surface in the front of the mouth where it is easy to reach. Stop and give a treat and lots of praise.  The next day try wiping a few more teeth. Don't try to do the whole mouth.  Just a few at a time accompanied by lots of praise, treats and petting. Eventually your pet will let you get further back to the molars. You don't have to worry too much about the tongue side of the teeth.  Calculus rarely collects on this side of the teeth. Once your pet gets used to you working on the teeth and associates it with fun you can graduate to a very soft bristle, baby tooth brush.  When you make this change, once again go easy.  Just a tooth a day with lots of praise and treats. Believe it or not you will soon be able to brush your pets teeth and have them enjoy it. I have a friend who adopted a nine year old poodle who had never had its' teeth brushed. With a little patience and praise, this dog now looks forward to this attention each day.    How often?  As often as you can.  Once a day is ideal.  The more you brush, the less often you will need to have the teeth scaled professionally.   Without any brushing, your pet should have its' teeth cleaned once or twice a year to remove the calculus. I have a client who religiously brushes her dogs teeth each day.   After two years, I can barely detect any buildup of calculus.  Brushing works!

Home Hand Scaling

I know of many people who are fairly successful at scaling their pets teeth with hand scalers at home.    In fact I do the same procedure on my own Toy Poodles' teeth from time to time.   You need to be extremely patient and have a good quality "sharp" scaler.   Scalers come in several forms:  There is one which is shaped like a little hoe on each end of a metal shaft. This is great for breaking large pieces of calculus off. There is also one shaped like a claw on the end.  It also is fairly good at getting the big pieces of calculus off, plus it can get up along the gum-line a little better. The third type is like a little curvy wire thing on the end.   It is very stiff and good at getting the small stuff along the gum-line.  I like and use all three.  What I do is work on one or two teeth a day.  You can take the little hoe and hook on the brown calculus near the gum and pull towards the tip of the tooth.  After some pressure is applied the calculus will crack off. You can then use a finer instrument and keep scraping away at it until the scaler slides up and down the tooth without feeling any grittiness.  If the tooth feels smooth the calculus is gone.  One thing you must face is that if a tooth is extremely diseased and loose you might pull on the calculus and end up with the whole tooth falling out.   If the tooth was that loose, it is better to be out of the mouth than left to fester and abscess.  Once again, keep sessions extremely short and accompanied by lots of praise and treats. Before closing out on this section, I might mention that hand scalers need to be kept sharp to work well. The scalers are all scrapers and need a sharp corner on them to effectively grap the calculus and remove it.  If the edges are rounded and dull or the instrument is of poor quality, the scaler will slide right over the calculus and make it difficult to remove.

ClawScraper.jpg (9535 bytes)   HoeScalerSm.JPG (14832 bytes)  GraceyScraper.jpg (10916 bytes)

Parting words...
I once went to a dentist who had a little sticker on his exam light that you were forced to look at while he did his work.    The sticker read, "Prevention Pays - Neglect Costs". The phrase stuck with me and is a constant reminder.  If you let your pets teeth go, sooner or later it will have tooth loss or worse...  "Prevention Pays - Neglect Costs"   Dental damage is permanent. There is no second chance. Your pet can't tell you when it has a toothache - You need to lift that lip and look!

Next Week
December 24th - Christmas Eve - Closed for Family & Faith
December 31st - New Year Eve - Closed for Y2K
January 7th - "Anesthesia In Pets - Differences You Should Be Aware Of"

Joke of the Week by Mary T.

A burglar broke into a house late one night. He shone his flashlight around the room until it illuminated the object of his desire--a cd player. As he started to reach for it, a voice from the dark said, "JESUS is watching you!"

The burglar froze in his tracks and quickly switched off the flashlight. After a few moments of heart-pounding anxiety, nothing happened, so he cautiously turned the flashlight back on and again reached for the cd player. Just as before, a voice from the dark said, "JESUS is watching you!"

This time, instead of switching off the flashlight, the burglar scanned the room with it. Finally, the light revealed a parrot in a cage in one corner of the room. The burglar breathed a sigh of relief and asked the parrot, "Are you the one who was talking?"

"Yes," the parrot said, "My name is MOSES."

"MOSES!" scoffed the burglar. "What kind of stupid person would name a bird MOSES?

The parrot replied, "Probably the same stupid person who would name a Rottweiller JESUS!"

Credits
Some of the images used in this publication taken from Hill's Atlas of Clinical Anatomy, Published by Veterinary Medicine Publishing Company, Inc. A publication donated to veterinarians by the Hill's Pet Food Company to teach clients about their dogs and cats in sickness and in health. Hill's Pet Food Company produces Hill's Prescription Diets and Science Diet Premium Pet Food.

Have A Very Happy Holiday Season

Later if Y2K allows it,  Dr Dan