- Rory Colville, Clinical Director.
The most common disease that our pets suffer from is gum disease, correctly named periodontal disease. Over 80% of pets over 3 years of age will have this disease.
We see many pets younger than this with gum disease at our clinic. It’s not uncommon to see some dogs and cats affected as early as 6 months old but it’s usually as pets become older that it becomes worse. That’s why, at Bruceview, we would prefer we are proactive and address gum disease in the early years by encouraging good preventative oral home care (more on this in a minute) and by timely professional dental treatment (which this document is mostly about).
We all know that if we, ourselves, have swollen gums (gingivitis) it’s painful, so just because our furry friends are still eating does not mean that they are not in pain. If the gingivitis progresses to become a deeper inflammation and starts to affect the tooth sockets, bone infection and further pain will result; we call this periodontitis. Dogs and cats are very good at hiding slow burning pain. This stoicism is an evolutionary advantage because hiding their pain means they don’t show weakness in the wild. Pet owners and veterinary professionals are the only advocates that animals have; they cannot speak to us as we would to our dentists. This is why, at Bruceview, we offer free of charge dental check-ups, as well as taking the time during routine vaccinations and health checks to exam your pet’s mouth. As a pet owner you may see blood on your pet’s toys/chews/food bowl, facial swellings, decreased self-grooming, reluctance to play with toys and you may smell bad breath but often times it’s not until you or we look into their mouths that the gum disease is apparent and not until dental treatments are performed and we see generalised improvements that we realise that our pets were, in fact, suffering in silence.
Gum disease isn’t only painful; it also affects the rest of the body. In humans, the fact that gum disease causes disease elsewhere in the body is beyond doubt and many studies have linked periodontal disease to kidney, liver, heart disease, diabetes and stomach ulcers, to name but a few. There are fewer studies performed in pet animals but there is clear evidence to show a link does exist. The reverse is also true: other diseases, for example kidney disease and diabetes, and of course, stress can make gum disease worse.
The major problems with gum disease if left untreated are:
- tooth loss
- disease elsewhere
- reduced quality of life
So, home care is what we all call toothbrushing!
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 ownership so that it becomes normal for them. Care is required to ONLY use dog and cat toothpaste. Human toothpastes are not suitable (for many reasons) for pets. Some may even contain xylitol which is potentially fatal to dogs. The most important factors in choosing a toothpaste and toothbrush are:
- 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 crazy pet parents’ actions. Therefore, toothbrushing should be a joy and a treat. My dog wags his tail and his wee 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 may just 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 we 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. Dental chews such as Greenies and Dentastix will help but nothing is as good as toothbrushing.
Veterinary Dental Cleaning and Dental Surgery
At the start of the disease process, we call 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 lost.
So what are the treatments that may be necessary?
• 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 pain relief required without a general anaesthetic being given. Even dental cleaning (scale and polish) 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 quite often are 2 to 4 hours long.
• So, you can see that because we always need a GA, 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 and if we need to perform any extractions it is now considered 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 conditions identified upon full dental X-rays. We quite often pick up on conditions in this way, that must have been causing conditions for our pets, but they simply couldn’t tell us.
Dental x-rays showing bone loss
• We then chart the mouth, which is what your dentist is doing when they shout out all 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 quite some time, much longer than it takes dentists with our mouths, 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 more gentle 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 achieve this. Dental cleaning below the gum line is the most important part of this step. Our dental ultrasonic scaler can be safely used below the gum line (in pockets) but most are not safe to be used in this way. We also have to clean out these pockets with special instruments called curettes. This is an act of surgery and whilst our highly trained veterinary nurses usually do most of the dental cleaning, this aspect needs to be performed by a vet and can take quite some extra time.
• We run an antiseptic solution called CLS through our scaler to treat the mouth as we clean.
• We split our dental cleaning charging in two. We have a lower price, we call Grade 1 Cleaning or “Special Offer”, which reflects that it is a quicker procedure, involving a lighter, quicker anaesthetic, that we use to treat early gum disease, when it is reversible. In some other countries, this is done yearly so that pets get a full dental check-up under GA, X-rays and cleaning. When you think about it, that’s the equivalent of our check-ups at the dentist: the opportunity at lower and fixed costs to prevent problems from escalating into more painful and more expensive treatments. We hope this becomes more common in our country.
• 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.
• Our other, higher, dental cleaning fee reflects that we are dealing with more than just gingivitis and thus we suspect that it will be a longer procedure to chart and clean the mouth; we simply call this fee “Dentistry”. Often this procedure will take 2 hours and we have to charge for the extra anaesthetic time even though no surgery was necessary; some of our dogs’ mouths simply take that long to clean; this never happens in human dentistry.
Can you see why dental treatments are therefore difficult to fully estimate for?
Most of the info 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/xrays and this allows us to cap the costs for this first stage. We can show you the X-rays 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 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, very rarely, we simply 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 very 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 for ourselves but we can’t ask our dogs and cats to do this and they don’t know to avoid trying to eat with area 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 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.
So, this all takes considerable skill and time, hence why dental surgery is costed out as it is. I hope this document helps with your understanding of dental disease and treatment. If not, do please ask one our nurses or vets for more information.
Remember, Pet Health Club members get 10% discount on dentistry at our clinic.