Dentistry

We all brush our teeth daily because we have been taught by society and our elders at a young age that we need to look after our gums. Pets are no different. Ideally all pets could start to get their teeth brushed from the first few weeks of entering our lives so that it becomes normal for them. Care is required to use ONLY dog and cat toothpaste. Human toothpastes are not suitable for pets. (for many reasons). Some may even contain xylitol which is potentially fatal to dogs. The most important factors in choosing a toothpaste and toothbrush are:

• TASTE
• Availability
• Trust in the product
• Ease of use of the brush (a human brush may be ok; pet specific ones may be better)

Dogs and cats are our friends and should not be expected to put up with anything imposed upon them! Much better that our interactions with them are based on choice, that they choose to accept their pet parents’ actions. Therefore, toothbrushing should be a joy and a treat. My dog wags his tail and his face lights up when he sees me go to his toothbrush and toothpaste beaker (we keep it in the kitchen, so that we remember to do it every morning). He loves the taste of it and the fuss I make over him when we are done. We didn’t get him until he was middle aged so that’s proof you can “teach an old dog new tricks”. We started by getting him to lick the toothpaste off of our fingers. Toothbrushing needs to be DAILY or not at all. Toothbrushing once every so often is pointless and will simply cause pain. Toothbrushing removes plaque which forms every day and is the origin of gum disease. If we stop plaque, which is a bacterial film that resides over the part of the tooth next to the gums, we prevent gum disease. If humans don’t toothbrush or floss for a few days we would soon start to appreciate what it’s like for our pets. By the way, don’t try to floss your pet’s mouth; it’s not safe and not appropriate.

It is accepted that some, very lucky pets never need any oral hygiene (toothbrushing) because they carry genes that minimise gum disease naturally. There is a need to research this. Others, as previously mentioned, are very unfortunate and develop gum disease very early on and some breeds are affected much worse than others.

Some diets will act as a natural “toothbrush” but within families of pets, all fed the same diet, there will be some pets that have no disease and some with terrible problems. There is still a lot for the dental and veterinary professions to learn about gum disease but we all agree that starting to teach your pet that toothbrushing is fun, from an early age, is a good idea. Some dental chews will help but nothing is as good as toothbrushing. Check out the Veterinary Oral Health Council (VOHC) website: www.vohc.org for other products that may help.

At the start of the disease process, Periodontal Disease Stage 1, there is only gingivitis and this can be reversed by professional dental cleaning. If it progresses to Stage 2, the start of periodontitis, that means there is some attachment loss to the teeth (the bone and gums shrink away from the teeth) and it cannot be fully reversed. Any treatments are aimed at arresting further attachment loss and taking away any pain but the opportunity to return to normal, what we call Periodontal Disease Stage 0, is by and large lost.

It is inhumane to perform dentistry in animals without a general anaesthetic (GA) so says veterinary ethics and our governing body. It is simply unsafe for our patients to have sharp probes and instruments placed in their mouths when awake and it’s impossible to achieve the necessary level of compliance and pain relief required without a carefully planned pain relief and GA protocol. Even dental cleaning requires a GA as we need to work below the gum line, between the teeth and on the inside of them. It’s simply not possible to do this ethically and correctly without a GA.

A lot of our patients require pre-anaesthetic blood screening and to be on intravenous fluids during often quite long procedures.

A registered veterinary nurse will be in charge of monitoring the patient’s vital signs during procedures which are quite often two to four hours long.

So, you can see that because we always need a general anaesthetic, the starting costs are substantial to begin with.

Once anaesthetised we perform FULL mouth X-rays as what we see in the mouth with our eyes is only half the picture; if we need to perform any extractions it is best practice to have x-rayed the operation site first (we don’t want any surprises!). Studies show that 30% of dogs and 40% of cats with apparently normal mouths will have significant problems identified upon full dental X-rays. We quite often pick up on conditions in this way, that must have been causing problems for our pets, but they simply couldn’t tell us.

We then chart the mouth, which is what your dentist is doing when they shout out those numbers as they examine your mouth at check-ups. This examination is essential to allow us alongside the X-rays to decide what our treatment plan is. Bear in mind that this examination can take some time, much longer than it takes human dentists and often we need to restart it once we have removed the tartar because the tartar was hiding other problems.

Sometimes we find fractured teeth, abscessed teeth, resorbing (dissolving) roots, tumours, foreign bodies and in cats we commonly find Feline Tooth Resorptions, which are very common and usually require complex and difficult extractions.

Dental cleaning then begins. We use a state-of-the-art ultrasonic scaler that is faster to clean but gentler on the enamel of the teeth than most scalers. What we see above the gum line is obvious to all but it’s what is below the gum line that is more difficult to see, to appreciate and to treat. A combination of dental charting and X-rays allow us to achieve this. Dental cleaning below the gum line is the most important part of this step. Our dental ultrasonic scaler can be safely used in pockets below the gum line. We may have to clean out these pockets with special instruments called curettes.

We run an antiseptic solution called CLS through our scaler to treat the mouth as we clean.

We also promote the use of a dental sealant called Sanos which helps prevent gum disease. This can’t be applied at any time other than immediately after we have performed dental cleaning. It lasts up to 6 months.

We call this whole procedure a “Comprehensive Oral Assessment” as it reflects exactly that. Often these procedures will take over two hours and we have to charge for the extra anaesthetic time even though no surgery was necessary; some of our patients’ mouths simply take that long to assess and clean. This is very unlikely ever to be the case in human dentistry.

Most of the information we need to allow us to decide what we need to do is gathered after we have performed a GA. We can of course do things in stages, the first stage being the dental cleaning/ dental charting/ x-rays and this allows us to cap the costs for this first stage. We can show you the X-rays, take photos and discuss the next part of the plan, the second stage, and give you a new estimate at discharge.

Unfortunately, because gum disease commonly results in bone loss from the tooth socket and gum recession (gum die back), we often find that there is need to extract teeth, often multiple teeth.

If a tooth can’t be saved and it’s causing pain, it needs to be extracted. Sometimes, especially in older pets, we will make tactical decisions to remove teeth that whilst they might be ok a little longer, we really don’t feel that they will, and are not happy to have to put the pet through another procedure. Likewise, if tooth brushing is simply not going to happen (for any of a variety of reasons) or we are dealing with a patient that is super responsive to plaque, we may need to remove affected teeth earlier than we hoped.

If you prefer, and if the vet who performed the dental check-up advised you that they feel that dental surgery may be necessary, we can phone you on the day to discuss the surgery we wish to perform and any attendant costs. If you give us permission and if we can perform all that we need to do, we can get everything done on the same day. Sometimes we run out of time or the anaesthetic has gone on too long, and thus we have to book for another procedure. Whether we plan to get everything done on the same day or to do in stages, we pride ourselves in communicating well with our clients.

Extracting dog and cat teeth is much more technical and time consuming than human teeth. The nearest equivalent in human dentistry would be a wisdom tooth extraction under GA in hospital.

Dog and cat teeth may have up to 3 roots that diverge in different directions meaning that we need to split the tooth with a dentist’s drill and remove them in 3 parts.

Sometimes we need to take out many teeth.

Their roots break very easily compared to our teeth, therefore more time and care are required.

Often times the roots require what we call open extractions, meaning that we need to remove some jaw bone to allow safe access to deeply buried roots or roots that have partly bound themselves to the bone of the socket.

We may need to lift gum flaps to allow us to close the socket over. We try wherever possible to close the extraction site over, for patient comfort and to improve healing. Humans can perform saline mouth rinses after an extraction but we can’t ask our dogs and cats to do this and they don’t know to avoid eating with the areas of the mouth operated on. Closing the gum over the sockets is much preferable to leaving open sockets in most cases.

It can take 45-60 minutes (or longer) just to remove one tooth in some instances.

We usually need to use magnifying, operating glasses called loupes, especially with small dogs and cats, to allow us to see what we need to do. Our instruments’ working tips range in size from 6mm down to the size of a tiny hypodermic needle point.

As mentioned earlier, not only is all this work highly skilled (a lot can go wrong if the surgeon does not work methodically and is not skilled), it can take considerable time. We usually won’t go beyond 4 hours for any one procedure though.