Periodontal/Dental Disease

Courtesy of Brook Niemiec, DVM, DAVDC:

Dental Disease

(by Fraser Hale, DVM, FAVD, Diplomat ACVD

Most people are very aware of their own teeth. We are subject to a constant barrage of information regarding plaque control, cavity prevention, and the catastrophic effects of bad breath. Many of us also visit our own dentists regularly. Despite this awareness of human dentistry, many pet owners still do not realize that their pets are subject to the same dental concerns.

Why is it important to care for your pet’s teeth?

For exactly the same reasons it is important to care for your own. The most common disease in pet animals is periodontal (gum) disease. It affects at least 90% of dogs and 70% of cats over the age of 5 years. Periodontal disease is the result of bacterial infection of the structures that support the teeth. As it progresses, these structures weaken, leading to loose and lost teeth. While this is going on, the animal is fighting a constant battle with the bacteria in the mouth. As the animal chews its food, the infected and inflamed gums bleed, and a shower of very aggressive bacteria enters the blood stream. These germs are carried throughout the body and can cause infection in many areas. Among the diseases that have been documented as associated with periodontal disease are kidney infection and failure, liver infection and failure, heart valve infection and failure and arthritis. With the immune system constantly challenged by oral bacteria, it is less able to respond to other invasions. Mouths with advanced periodontal disease are sore so animals do not chew their food as well and may have a hard time digesting it properly so can suffer from malnutrition. The overall effect is that the quality and quantity of life suffer dramatically.

What can you do about dental disease?

Plenty. The first step is to look in your pet’s mouth. If the gums appear red or inflamed, if there is a foul odor, if you see pus at the gum line or if you see loose or broken teeth, arrange to have your veterinarian do an oral examination as soon as possible. The problem will be assessed and a treatment plan formulated. This will usually involve a professional cleaning and polishing of the teeth and may include extraction of unsalvageable teeth. Once the teeth are clean you will be instructed in home-care. As with your own teeth, plaque and tartar will start to accumulate very rapidly unless you brush regularly. If you have a young pet and you and your veterinarian can find no signs of dental disease then you can start home-care right away, to prevent severe problems from developing. It is suggested that you start training your pet to accept having its mouth played with as soon as you bring it home. There is no need to brush kitten and puppy teeth, as they will be lost and replaced in the first year, but if you can get them to enjoy having their teeth brushed when they are young, it will make it much easier to carry out your home-care program when the permanent teeth come in. It is suggested, however, that when your pet is teething, (losing baby teeth in favor of permanent teeth) that the gums will be sore and so it would be best not to be playing around with the mouth at that time. When you brush your pet’s teeth, you cannot ask them to rinse and spit. Therefore, it is important that you use a brushing agent that is safe to swallow. Do not use human tooth paste as it will foam and distress your pet and when swallowed, it can cause stomach upset. Baking soda is also to be avoided, as the very high sodium content can be dangerous, especially to older patients. There are now several products specifically formulated for use on dog and cat teeth. There are, of course, many other oral and dental diseases that do occur and require treatment. Dogs and cats are very prone to fractured and traumatically injured teeth leading to tooth root (endodontic) abscesses. As well as being constant sources of infection, these teeth are painful. With many pure bred animals, elective breeding has resulted in orthodontic problems. This can lead to teeth hitting each other in abnormal and painful ways. These conditions are best treated in the young animal, and some can even be prevented by early intervention. Cats are prone to a cavity-type of problem that starts at or below the gum line, making it difficult to detect until it is well advanced. These ‘Neck Lesions’, as they are called, are extremely painful. Fully snesthetized cats show no pain response with an abdominal incision but will react when a neck lesion is probed. Many owners will say that their pet does not exhibit signs of pain, even when there is an obvious problem. This is not surprising when we think about how dogs and cats act in the wild. As predators, they will often select a weak or distressed animal as an easy meal. If they reveal to the world that they are in pain, or ill, they stand a good chance of being eaten themselves. Also, if they allow dental pain to keep them from eating, they soon grow too weak to hunt and then starve. So, instead, they tend to put up with the pain and carry on. Studies have shown that dogs and cats have pain thresholds and tolerances almost identical to human subjects. This means that if something hurts you, it would hurt your pet to the same degree and in the same way. If you have every had a tooth ache, you know the meaning of pain. As veterinary dentists catch up to their human counter parts, more treatment options become available. No longer must we extract all diseased teeth, as many reparative and restorative procedures are now available. Some veterinarians will be able to provide these services in their own hospitals. For those veterinarians who choose not to make the large investment in time and money to equip themselves to offer advanced dental services, referral options are available.

One final point, dogs and, cats, use their mouths for many of the same essential and recreational functions that we use our hands. It follows that their teeth are as important to them as our fingers are to us. A pet with a sore mouth and missing teeth faces both physical and emotional challenges. Fortunately, with an increasing emphasis on preventative medicine, veterinary dentistry is starting to get the attention it deserves. The keys to a healthy mouth and a happier pet are, be aware of what problems can arise, watch for them, take steps to prevent them and treat them as soon as they are noticed.

The following is copy written by the American Veterinary Dental College:

Periodontal Disease

Periodontal disease is the most common clinical condition occurring in adult dogs and cats, and is entirely preventable. By three years of age, most dogs and cats have some evidence of periodontal disease. Unfortunately, other than bad breath, there are few signs of the disease process evident to the owner, and professional dental cleaning and periodontal therapy often comes too late to prevent extensive disease or to save teeth. As a result, periodontal disease is usually under-treated, and may cause multiple problems in the oral cavity and may be associated with damage to internal organs in some patients as they age.

Periodontal disease begins when bacteria in the mouth form a substance called plaque that sticks to the surface of the teeth. Subsequently, minerals in the saliva harden the plaque into dental calculus (tartar), which is firmly attached to the teeth. Tartar above the gum line is obvious to many owners, but is not of itself the cause of disease.

The real problem develops as plaque and calculus spread under the gum line. Bacteria in this ?sub-gingival? plaque set in motion a cycle of damage to the supporting tissues around the tooth, eventually leading to loss of the tooth. Bacteria under the gum line secrete toxins, which contribute to the tissue damage if untreated. These bacteria also stimulate the animal?s immune system. The initial changes cause white blood cells and inflammatory chemical signals to move into the periodontal space (between the gum or bone and the tooth). The function of the white blood cells is to destroy the bacterial invaders, but chemicals released by the overwhelmed white blood cells cause damage to the supporting tissues of the tooth. Instead of helping the problem, the patient?s own protective system actually worsens the disease when there is severe build-up of plaque and tartar.

Periodontal disease includes gingivitis (inflammation [reddening] of the gums) and periodontitis (loss of bone and soft tissue around the teeth). There is a wide range in the appearance and severity of periodontal disease, which often cannot be properly evaluated or treated without general anesthesia for veterinary patients. Effects within the oral cavity include damage to or loss of gum tissue and bone around the teeth, development of a hole (?fistula?) from the oral cavity into the nasal passages causing nasal discharge, fractures of the jaw following weakening of the jaw bone, and bone infection (?osteomyelititis?). Bacteria from the mouth can enter the bloodstream and are carried around the body. Studies in dogs have shown that periodontal disease is associated with microscopic changes in the heart, liver, and kidneys.

Studies in humans have linked periodontal disease to a variety of health problems including poor control of diabetes mellitus and increased severity of diabetic complications. Additionally, it has been shown that diabetes is a risk factor for periodontal disease.

Fig 1. Stage 4 periodontal disease in a dog.
Treatment of periodontal disease is multi-faceted. If your pet has tartar or large amounts of plaque present, professional dental cleaning is required, which includes a thorough oral examination, scaling and polishing. Abnormalities found are recorded on a dental chart. Dental radiographs are required to correctly diagnose and assist in treatment of patients with extensive disease. When periodontitis is present, several treatment options may be employed to save the teeth. The patient?s overall health, the cost of specific treatments, and the owner?s willingness to provide home oral hygiene must be taken into account prior to performing periodontal therapy – without likelihood of diligent homecare subsequently, periodontal therapy is not indicated, and severely involved teeth should be extracted.

Fig 2. Professional dental scaling in a cat.

Home oral hygiene can improve the periodontal health of the patient, decrease the progression of the disease and decrease the frequency of or eliminate the need for professional dental cleaning. Implementing home oral hygiene at a young age can help the pet accept life-long oral care. Consult your veterinarian about proven home oral hygiene strategies that can be employed to help maintain your pet?s dental health. Be cautious about miracle remedies advertised on the internet or sold in pet stores. Many of these are unproven and may be worthless – like many other things in life, when something seems too good to be true, it usually is. When properly cared for, teeth can remain in healthy condition in the mouth, and the risk of associated health complications can be reduced.

The following is copy written by the American Veterinary Dental College:

Pain and Dental Disease in Dogs and Cats

Most pets with painful dental conditions do not show clinical signs that are obvious to the owner, but this does not mean that they are not feeling pain. They cannot tell you about the pain. In the wild, animals tend to hide signs of illness or weakness – dogs and cats posses this instinct.

Many painful dental conditions develop gradually, and are more common in middle-aged and older pets. As a result, behavior that the owner interprets as “acting grumpy” may be the result of dental pain. Owners often observe that their pet acts “years younger” following dental treatment.

Be sure that your veterinarian examines your pet’s mouth every time your pet visits the veterinary hospital! An AVDC veterinary dental specialist can be consulted to examine your pet for conditions that cause oral pain.

Some dental treatment and oral surgery procedures such as extraction, or even deep scaling of teeth may cause pain. AVDC veterinary dental specialists are trained to treat and prevent discomfort your pet could experience as a result of treatment. These steps include use of general anesthesia and local anesthetic blocks during the procedure, and post-operative medications when indicated. A pain-free mouth encourages prompt recovery of appetite and other activities following treatment.