In addition to systemic effects, oral disease can also cause inflammation to the eye, resulting in blindness. Furthermore, jaw bone loss from chronic infection can lead to a jaw fracture known as a pathologic fracture, and these have a very hard time healing. Finally, infectious oral disease can result in osteomyelitis (an area of dead, infected bone), nasal infections and an increased risk of oral cancer.
Speaking of oral cancer, the oral cavity is the fourth most common place for cancer. Unfortunately, by the time that most are discovered, they are too advanced for therapy. Early treatment is necessary for cure. That’s why you, the pet owner, need to check your pet for oral growths on a regular basis. Anything suspicious should be shown to your veterinarian promptly.
In cats, a very common problem is feline tooth resorption lesions, which are caused by normal cells called odontoblasts eating away at the cat’s own teeth. Approximately half of cats over 6 years of age have at least one. They are similar to cavities in that once they are advanced, they are VERY painful and can become infected. They are first seen as small red areas along the gumline.
Other oral problems include bacterial cavities, painful orthodontic problems, dead teeth (which are commonly discolored), and worn teeth. Almost every pet has some form of painful or infectious oral disease that needs treatment. Unfortunately, there are few to no obvious clinical signs. (See below, What are the warning signs of periodontal disease?) Therefore, be proactive and ask your veterinarian for a complete oral exam, and perform regular monitoring at home.
The other thing that occurs with chronic plaque formation is that it will start to move under the gumline. Once the plaque gets under the gum, it starts causing inflammation, which is called gingivitis. Gingivitis is the initial, reversible form of periodontal disease. If this inflammation is not controlled, the bacteria within the gingiva change to a more virulent type. These more virulent species create more severe inflammation. Eventually, the body responds to this inflammation. Part of this response is bony destruction, which continues until the tooth is lost. However, in most cases periodontal disease causes problems long before this happens. (See above, Is dental disease really a big deal?)
As periodontal disease progresses, the infection will worsen. The next signs within the mouth are receding gums or loose teeth. This increased infection may result in bad breath or blood on chew toys; however, this should NOT be relied upon for diagnosis. If your pet has bad breath or you see blood on toys, it is almost a sure sign of advanced periodontal disease requiring a trip to the veterinarian.
Late signs of periodontal disease include nasal discharge (blood or pus), eye problems, facial swelling or a jaw fracture.
There are specially formulated and processed dental foods that effectively clean a pet’s teeth as the pet chews and are an excellent adjunct to routine tooth brushing. Look for the VOHC Seal of Acceptance on the dental food you choose.
Go slowly and be very positive, using food treats if necessary. Place the brush at a 45-degree angle to the gumline. Brush in a circular motion, with a firm stroke away from the tooth. Try to reach all tooth surfaces, but concentrate on the outside surface.
The hardest part is getting started. It’s best to start young, because the earlier you introduce brushing, the easier it will be for your pet to accept it. I recommend handling your pet’s mouth from the time you bring him home. For puppies and kittens, introduce the brush at around 6-7 months. Be consistent; animals like routines, so if you make it a habit it will be easier on both of you.
The other difference between anesthesia and sedation is the length of effect. Most practices today employ relatively short-acting agents to put the patient under anesthesia, and then a gas to keep the patient under anesthesia. If a problem occurs under anesthesia, the veterinarian can turn off the gas and the patient will recover quickly. But under sedation, the effects generally do not go away until the drug is cleared by the system, which can take too long. General anesthesia is very safe today, thanks to advances in anesthetic drugs, training and monitoring equipment.
A true dental prophylaxis consists of several steps, some more critical than others. The required steps that must be performed include:
Supragingival scaling: This is the removal of the plaque and calculus above the gumline (what you can see).
Subgingival scaling: This is the thorough cleaning of the area under the gumline to remove disease-causing bacteria. It is typically performed by hand and is time consuming, but it is the most important step of a dental prophylaxis.
Polishing: Scaling slightly roughens the teeth. This promotes plaque and calculus attachment and reduces the lasting effect of the cleaning, so the teeth are polished afterward. There has been some controversy about this in human dentistry, due to the loss of enamel with many cleanings over time. However, in veterinary dentistry, with relatively fewer cleanings in an animal’s life, this is not a concern.
Sulcal Lavage: Cleaning and polishing results in debris being caught under the gumline, which must be thoroughly rinsed out.
Oral exam, periodontal probing and dental charting: This is a critical and often misunderstood part of the dental prophylaxis. There are teeth that cannot be thoroughly examined in a pet who is awake, when periodontal probing is not possible. With the patient under anesthesia, the mouth is thoroughly and systematically examined, and all findings are noted on a dental chart. Any diseased teeth or tissues are then properly treated.
Optional steps include fluoride therapy or using a barrier sealant.
Make sure you ask that all of the above five steps are performed, or you are likely getting a poor cleaning. Ask to see the veterinary hospital’s dental chart system if you have any concerns.
Another form of home care consists of rinsing with an antiseptic agent. CET® Oral Hygiene Rinse (Virbac) is an excellent antiseptic rinse for veterinary patients. The active agent (chlorhexidine) impregnates the teeth and gums, and its antibacterial effect lasts up to six hours. Additionally, Maxiguard® (Addison Biologics) has been shown to decrease gingivitis. It is also very palatable, making it an excellent choice for feline patients. Both of these are excellent ways to decrease gingivitis and periodontal disease in your pet.
It may be challenging for some pet owners to make the commitment to daily tooth brushing for their pets, or to teach their pets to tolerate handling of their mouths. When frequent brushing is not practical, feeding an effective dental food provides a convenient solution. There are numerous products touted as “dental” foods or treats. Pet owners must be careful, as these typically only clean the tip of the teeth, not the areas that are necessary for control of periodontal disease. Of the dental foods available, only Hills® Prescription Diet® t/d® is clinically proven to reduce gingivitis, plaque and calculus. A combination of brushing and feeding the right dental food is best for oral disease control.
Other things to watch for include swelling or masses, broken or worn teeth, and discoloration of the teeth. Any of these things should also be brought to the attention of a veterinarian right away.
- If you cannot make an indentation in it with a fingernail, the treat or toy is too hard.
- If it would hurt to hit yourself in the knee with it, the treat or toy is too hard.
Pets who are prone to quickly swallowing large pieces of chew toys should be monitored during their use, to avoid an obstruction.