Straight Talk about Dental Disease
We usually notice that our pet has bad breath. Almost always this is because of diseased teeth and gums in our pet’s mouths. The problem with dental disease is that it is life shortening and painful for the pet. The worse it is, the shorter your pet’s life is likely to be and the more chronic pain there is. Animals tend to suffer in silence, which lulls us into thinking that the only real problem is the resultant bad breath. Even this halitosis can be enough to cause us to interact with and enjoy our pets much less than we otherwise might. Since our pets do not complain, they can end up suffering in relative isolation and we do not experience the fulfilling relationship with the pet that it and we originally wanted.
The most devastating dental disease tends to occur in the smaller breeds of dogs. They have less jaw bone to support their teeth, they tend not to gnaw and can be generally uncooperative about having their teeth wiped or brushed unless these pups are trained with rewards to cooperate with your efforts from puppy-hood. Such training is well worth the effort and is an investment in sparing your pocketbook and in your pet’s long term health (be they dogs or cats). Encouraging puppies to gnaw on safe chew toys and providing these toys frequently are the other parts of the healthy mouth equation.
As with people, removal of soft plaque prior to mineralization of this plaque is the key to reducing the frequency and degree professional intervention. We believe that nightly wiping/brushing of your dog’s teeth (after all food/treat consumption for the day), is very effective in dogs. We also believe that as little as 30 seconds (total) can be enough. Keep it simple, short and consistent. A little effort regularly is a whole lot more effective than an enormous effort occasionally.
Periodontal disease is a preventable disease. If dental disease is allowed to progress, the whole process snowballs and advanced disease of the gums and supporting bone ensues. (Cavities, fortunately, are rare in dogs and cats). As the gums become inflamed and retract, the roots of the teeth become accessible for bacterial colonization and the disease process accelerates, sometimes with irreversible consequences. Before we know it, we have a much older pet with a very seriously diseased and painful mouth (Grade III and IV periodontal disease). Such pets have the most need for care, but are at the most risk for complications trying to provide the necessary care. This is the situation that we really need to try to avoid by providing adequate home care coupled with proper professional dental prophylaxis, preferably by the time grade I or at most grade II disease has occurred. If the gums are even beginning to get red and/or swollen, then it is time for professional attention and treatment.
Grading and Treatment of Periodontal Disease
Grade I PDDZ (periodontal disease):
In Grade I PDDZ, sufficient soft plaque has accumulated and mineralized to create a “foundation” of calculus upon which an even faster build up of plaque/calculus then occurs. There is little to no gum or bone involvement generally, however many times some of the teeth are being more affected than others. Grade I will often advance to:
Grade II PDDZ:
Building upon the foundation of calculus, even more calculus accumulates and the beginnings of gingivitis (inflamed gums) may be noted. The calculus is starting to extend under the gums. Grades I and II involve primarily the outsides of the teeth surfaces, however the inner surfaces have begun the process of accumulating calculus. Treatment is done by scaling the calculus away from the obvious areas, followed by gentle scaling of the tooth just under the gums to remove advancing calculus. Occasionally this process can be done awake if the dog is cooperative (the more dental home care that you practice with your dog, the more likely that this professional scaling can be performed awake). Otherwise, fast acting anesthesia (dog is awake within minutes of the completion of the procedure!) is necessary. Most cats will cooperate with an awake scaling, oddly enough.
If there is no intervention to halt Grade II periodontal disease, then the situation progresses to the more painful and life-shortening:
Grade III PDDZ:
Bacterial build up (abcess formation) causes the gums to swell and turn a deep red color. The dental calculus spreads further under the gums along the root surface and a vigorous scraping of the root surface (root planning) is required to restablish attachment of the gum to the tooth root. Serious discomfort, pain and bad breath set in; bacterial movement from the mouth to the heart valves and kidneys becomes more likely (shortening the animal’s life span) and gum retraction progresses to expose the jaw bones themselves to the unchecked progression of bacterial infection and boney destruction and root abcessation which is:
Grade IV PDDZ (low):
Grade IV PDDZ (heavy):
This is a crisis situation. The pet’s mouth becomes unbearably painful and stinky. The pets whole body bears the stress of this ongoing infection, inflammation and destruction. Crisis management: chronic pain management, chronic antibiotic use and extractions of abcessed teeth under anesthesia (which is made more risky by Grade IV dental disease) is necessary. In addition to root planning, curettage, which is the removal of not only calculus but the underside of the diseased gum is necessary to effect reattachment. Ignoring such a situation is not an option. Dental X-rays are indicated to identify which teeth need extraction due to excessive bone loss or root tip abcessation. Antibiotics and powerful pain meds are needed during the pet’s recovery from anesthesia.
What We Can Do:
Some dental treatment/scaling of grade I or even grade II calculus build-up (PDDZ) may be able to be adequately addressed with your pet awake and with you present. Other cat or dog patients will require sedation or anesthesia to provide a professional treatment/scaling for their dental problems. We perform pre-operative EKG’s (and other blood tests as indicated) and use only the safest premedication, induction and maintenance anesthetic agents (as recommended by board certified cardiologists that study your pet’s pre-operative EKG) as well as contemporary methods of anesthetic monitoring for your pet. In addition, we have sophisticated digital dental X-ray equipment and modern facilities and equipment for performing oral surgery, including dental extractions and gum surgeries as indicated by the oral exam and dental X-rays.