Monthly Archives

February 2019

At Home Dental Care

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At home teeth brushing

Dental Home Care

By Dr. Katie Habgood

When it comes to dental disease, dogs and cats are at risk just like humans are, and often times, they are at an even higher risk.  Most humans brush and floss their teeth on a daily basis as well as visit their dentists on an annual to semiannual basis.  Despite this awareness of human dentistry, many pet owners do not realize their pets are prone to the same problems.  Just like in humans, evidence continues to mount that chronic dental disease, resulting in infection and inflammation, can have serious negative impacts on systemic health.  In order for dental care to be successful in our pets, both at home dental care and professional cleanings/COHATs must be incorporated.

Dental home care is preventative maintenance.  The most important thing to remember is that dental home care works best when starting with a disease-free mouth.  Dental home care cannot correct a problem once it has developed.  If a pet’s mouth is already diseased, dental home care such as brushing the teeth can be painful and can lead to your pet becoming sensitive to having his mouth/head handled.

Brushing

The most important aspect of dental home care is brushing.  Brushing aids in the removal of plaque on the part of the tooth that is visible above the gumline.  Brushing will not address subgingival (below the gumline) disease and will not remove calcified plaque (aka tartar).  Brushing is most effective when performed at least 4 times/week, ideally daily.  The reason for this is because plaque will form on a tooth within hours of brushing the tooth and will start to form tartar within a few days.  Even after we brush our own teeth the night before, our teeth often feel “fuzzy” when we wake up in the morning.  This “fuzzy” feel is biofilm on the tooth which is composed of bacteria that is specifically known as plaque.

It is best to incorporate brushing when your pet is young (8-12 weeks is the best time to start), but brushing can be started at any age.  It is important to start slow to let your pet get used to brushing.  By starting slow and by incorporating lots of positive reinforcement, most pets will actually enjoy having their teeth brushed.  Pick a finger toothbrush or a small soft-bristled brush (an actual pet toothbrush is best because it is designed for the unique shape of dog’s and cat’s teeth but a child’s toothbrush can also be used).  Just make sure your pet doesn’t try to swallow the finger toothbrush!  Next, get a toothpaste from your veterinarian.  Do not use human toothpaste because they contain enough fluoride to be toxic if swallowed daily and some brands contain Xylitol which is an artificial sweetener that is harmless to humans but quite toxic to dogs.

If you would like information on how to brush your pet’s teeth, please contact your veterinarian or you can access many different videos on tooth brushing on YouTube.

Dental Chews and Wipes 

Unfortunately, there are a number of dental products over the counter that claim to be effective for one thing or another yet have no credible evidence to back that claim.  So how does a pet owner know which dental product to choose?  We highly recommend looking for dental products that have been awarded the Veterinary Oral Health Council (VOHC) Seal of Acceptance and specifically products that have the seal for helping to control plaque.

The VOHC is an independent body of veterinary dentists who evaluate dental products made for pets to determine whether they are effective for what they claim to be.  It is up to the company who makes the product, though, to seek the approval of the VOHC.  The approval is based on testing and clinical trials of the product.  The VOHC does not perform any research itself therefore the manufacturer must perform scientific trials based on the VOHC standard protocols.  The VOHC will review the data once the company submits their report to them.  If the VOHC is satisfied that the protocols were followed and that the results indicate a significant beneficial effect, the product is granted the Seal of Acceptance.  An example of this is Tartar Shield Soft Rawhide Chews which we carry at our clinic.  Visit vohc.org to learn more about the VOHC and to see their list of accepted products.  Just like with brushing, it is best to give your pet a dental chew daily.

Other important factors in choosing dental treats are taking into account how hard the product is and making sure your pet is not going to choke on the product.  Unfortunately, there are many products that you can find in pet stores that are way too hard to be chewed.  If you can take the product and can either bend it or take your fingernail and scratch pieces of it off, it is soft enough for your pet to chew on.  Products to avoid include cow and horse hoofs, bones, hard Nyla bones and antlers.  We see too many pets with fractured teeth as the result of chewing on products that are too hard.  Also keep in mind that dental chews must be the proper size for the pet to avoid a choking hazard.

Dental wipes can also be effective in removing plaque but just be sure to wipe the area of the tooth that meets the gumline.  Some animals will not tolerate brushing but will tolerate the wipes.  Wipes are considered the next best thing to brushing and work best when used daily.

Oral Gels, Water Additives and Sprays

Several companies make oral gels that are designed to be applied to the outer surface of the tooth with a swab on a routine basis.  An example is OraVet Plaque Preventive Gel which is designed to be applied once weekly.  OraVet is a wax-like substance that makes it more difficult for plaque to adhere to the tooth.  Just like brushing, this product works best as a preventative in a clean, disease free mouth.

There are several companies who also make products that are designed to be added to your pet’s water to help reduce plaque formation and sometimes freshen the breath.  Sprays can be used as well.  Visit the vohc.org website to see which products have received their Seal of Acceptance.

Dental Diets

Hard food is ideal over canned food because it can help remove plaque from teeth.  It is a common misconception, though, that simply feeding a kibbled diet will prevent dental disease from developing, especially with cats who tend to inhale rather than chew most of what they eat.  There are a few pet food companies who make special dental diets to help control plaque and/or tartar but just like with brushing, diets should not be used without addressing underlying disease first.

One of the diets we carry is Science Diet t/d.  This product comes in a large kibble size designed to scrub the entire tooth surface when chewed and has been awarded the Seal of Acceptance by the VOHC for helping to control both plaque and tartar in dogs and cats.  This diet is high in fiber which helps prevent the kibble from shattering when chewed, instead allowing the tooth to “sink into” the kibble allowing plaque to be scrubbed away.  Purina also makes a diet called DH which has been awarded the Seal of Acceptance by the VOHC for helping to control tartar in dogs and plaque and tartar in cats.  It is important to remember that these diets are helpful only in cleaning the molars and premolars and not the incisors or canine teeth.

By incorporating at dental home care into your pet’s daily routine, you can greatly improve your pet’s dental health which may mean fewer professional cleanings and decreased tooth loss.  Please contact your veterinarian with any questions regarding at home dental care.

FAQ’s About Dental Cleanings

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Frequently Asked Questions About Dental Care

By Dr. Katie Habgood

Below are some of the most common questions that each of us veterinarians get asked on a weekly basis.  There are several differences between veterinary dentistry and human dentistry.

Dr. Dill during a dental procedure

 Will my pet be able to eat without teeth?

Yes.  When I get asked this question I follow up with a question of my own, “How can your pet eat now with a painful mouth?”  The goal of professional dental care/COHATs is to address and treat underlying disease and pain.  Pets do surprisingly well with little to no teeth.  Depending on your pet, he may choose to eat canned food or dry food.  I have had several pets with no teeth continue to eat a dry only diet.  There are some instances where a veterinary dental specialist can offer a root canal or other more advanced therapy to save the teeth.

My pet doesn’t seem to be in pain so why does he need a dental cleaning/COHAT?

Pets are good at hiding pain and disease, especially cats.  Some pets will stop eating completely when there is mouth pain but that is rare.  Pets have a strong instinct to survive no matter how painful they are.  It is common for pets to compensate for their pain by chewing on the opposite side of the mouth that the pain is on.  Also, cats tend to inhale about 80% of what they chew which makes identifying dental pain even harder.  It may be difficult for pet owners to notice subtle signs of oral pain as well and it is not unusual for pet owners to notice differences in their pets that they attribute to old age.  We often have pet owners tell us how much more energetic and playful their pets have become after removing broken or diseased teeth.

Does my pet really need to have those teeth extracted?  Can my pet have a root canal instead?

Because our pets can’t talk to tell us they are in pain, they rely on us to identify and treat underlying disease.  If there is significant disease to a tooth, extraction is often the only treatment option.  Significant disease includes deep pocketing between the tooth and the gumline, mobility of the tooth, fractures with pulp exposure, discoloration of the tooth indicating pulp/tooth death, etc.  During a professional dental cleaning/COHAT, full mouth x-rays are taken which helps us identify disease below the gumline which might not be readily apparent above the gumline.  This will help us determine if a tooth needs to be extracted.  We are doing your pet a disservice if we leave diseased teeth in place.  The whole goal of professional dental care is relieving your pet of disease and pain and this cannot be accomplished if diseased teeth are left in place.  How would you feel if you had a painful tooth that your dentist addressed only by cleaning the tooth?

There are instances where a root canal can be performed instead of removing a tooth but this is based on the health of the root of the tooth.  If there is already evidence of root disease or abscessation, a root canal cannot be performed and instead the tooth must be extracted.  If a root canal can be performed, referral to a board certified veterinary dentist is needed.  The cost difference between extracting a tooth and a root canal can be significant.  A full COHAT with tooth extraction can cost several hundred dollars while a root canal can run upwards of ~$2700.  The closest board certified veterinary dentist is in the Minneapolis area.

Why must my pet have a professional cleaning under anesthesia when my groomer can just scrape the tartar off of my pet’s teeth and/or brush my pet’s teeth?

First, when tartar (calcified plaque) is “scraped” or scaled off of the teeth, this creates a rough surface to the tooth which actually increases the adherence of plaque and bacteria to the tooth.  This is why polishing the teeth after scaling is so important.  If your groomer is not polishing the teeth afterwards, your pet will be at increased risk of dental disease.

Secondly, when tartar, which is composed of bacteria, is removed from the teeth, small pieces can be inhaled by the patient leading to a lung infection.  When professional cleanings are performed under general anesthesia, the patient is intubated (tube placed into the windpipe) not only to provide oxygen and gas anesthetic support but also to protect the airway from inhalation of bacteria and pieces of tartar.

Lastly, the most important part of cleaning your pet’s teeth is removal of plaque and tartar below the gumline.  This is not possible in an awake animal and is not safe.  Dogs and cats have much longer roots on their teeth than humans, therefore tartar and plaque buildup below the gumline can be excessive.  The scalers we use to clean the teeth are sharp and can cause trauma to a pet that is able to move.  Brushing aids in the removal of bacteria and plaque on the part of the tooth that is visible above the gumline.  Brushing will not address subgingival (below the gumline) disease and will not remove calcified plaque.  Brushing works best as a preventative either before dental disease has developed or after dental disease has been addressed with a professional cleaning/COHAT.  Also, if your pet has advanced dental disease, brushing may be painful.

My pet is older and I am worried about anesthesia.  Is my pet too old to anesthetize? 

Old age is not a disease.  Older pets can be more prone to disease but age alone is rarely a factor when dental care is needed.  Fortunately, anesthesia is much safer now than it was in the past and we always tailor our anesthetic plan to the patient.  Your older pet will have a different anesthetic plan than a younger pet.  Having bloodwork performed before anesthesia can lower the risks of anesthesia by screening for underlying diseases.   Also, all of our geriatric or senior pets have an IV catheter placed prior to anesthesia and a balanced electrolyte solution given in the vein during the anesthetic event.  This helps minimize the risks of complications from the anesthesia by helping to stabilize the cardiovascular system (helps maintain the blood pressure and heart rate).  Modern inhalant gas anesthesia is also much safer than injectable anesthesia which had been used in the past.  With gas anesthesia, the patient has a tube placed into the windpipe to administer the gas and oxygen and to also protect the airways from harmful bacteria.

Why is cleaning my pet’s teeth so expensive and why is your estimate more expensive than *insert name* Veterinary Clinic down the street?

The majority of dental cleanings on people are not performed under anesthesia.  Anesthesia is needed not only for the safety of your pet but also for the safety of the staff members who are working in your pet’s mouth.  As with everything else, the cost of dental care for pets has increased over the years as the quality of anesthesia, monitoring and other services have increased.  One example is dental x-rays.  Performing dental x-rays is the standard of care in diagnosing disease that would otherwise be missed on exam alone.  Dental x-rays allow us to identify disease below the gumline and will help us determine which teeth can be saved and which must be removed.  Our clinic employs several certified veterinary technicians who closely monitor your pet under anesthesia.  In order to monitor your pet safely, we need special equipment like a blood pressure monitor, pulse oximetry, IV fluid pump, esophageal stethoscope, electrocardiogram monitor, etc.  Not all veterinary clinics have dental x-rays or special monitoring equipment which is often reflected in the cost of the estimate.  Lastly, unlike human dentistry, there are very few pet owners who have medical insurance to cover the costs of their pet’s care.

I hope this helps answer some of the more common questions that you may have about veterinary dental care.  If you have any additional questions, please contact myself or one of the other veterinarians at our clinic.

-Dr. Katie Habgood

Professional dental care for dogs and cats

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Lita is a 4-year old Maltese/Yorkie. Before dental.

Lita’s teeth after the dental cleaning.

Professional dental care for dogs and cats

By Dr. Katie Habgood

Dental disease is encountered every single day in veterinary practice and is one of the most common diseases in our companion pets.  More than 75% of dogs and cats over the age of 3 years old have some degree of dental disease.   Left untreated, dental disease can cause a myriad of problems including painful gum disease, tooth root abscesses, and in severe cases weakening and even fractures of the jaw.  Fortunately for our pets, “dental cleanings” or COHATs can be performed not only to address disease that is present but also as a preventative along with at home dental care.  COHAT stands for Comprehensive Oral Health Assessment and Treatment.

One question often asked is, “Why are you recommending a dental cleaning when I can just brush my dog’s/cat’s teeth at home?”  Brushing works best as an at home preventative before your pet develops dental disease or after a COHAT has already been performed.  Unlike brushing the teeth, which aids in removing bacteria and plaque from the tooth surface that is visible above the gumline, there are many more steps involved in a COHAT.  So, what exactly is a dental cleaning/COHAT?  The first step occurs during your pet’s exam.  Your veterinarian will examine your pet’s mouth as thoroughly as your pet allows to determine the degree of dental disease present and then come up with a treatment plan.  A drop-off appointment is then scheduled for the COHAT.

  • On the morning of your pet’s COHAT, you will first meet with a technician to go over necessary paperwork and to discuss preanesthetic testing. The technician will then set up a pick-up time later in the day for when your pet is ready to be discharged.  If preanesthetic testing is elected, the technician will perform this.
  • Your veterinarian will then perform another exam on your pet and review any preanesthetic tests. A preanesthetic sedative is then given, an IV catheter is placed to administer fluids and your pet is anesthetized.  Anesthesia is needed when performing teeth cleanings.  Anesthesia immobilizes your pet to allow thorough cleaning below the gumline, it provides pain control, it allows placement of a tube into the wind pipe to secure the airway and to prevent bacterial products from entering the airway, and it allows treatment of disease especially when extractions are needed.  While under anesthesia, your pet’s heart rate and rhythm, respiratory rate, blood pressure, oxygenation and temperature are all closely monitored.
  • A technician then performs full mouth x-rays of your pet’s teeth. This allows us to visualize the roots of the teeth to identify disease that may not be readily apparent above the gum surface, as well as to identify any abnormal bone changes, such as fractures or masses.  X-rays will determine if the teeth can be saved or need to be extracted.
  • Next, the technician will examine each tooth, use a periodontal probe to check for pockets between the tooth and the gumline and chart any abnormalities. An ultrasonic scaler is then used to clean the teeth above and below the gumline.
  • While the technician is cleaning your pet’s teeth, your veterinarian will review the x-rays. Once the cleaning is finished, your veterinarian will perform a thorough oral exam and come up with a revised treatment plan which may include extractions.  If extractions are necessary, your veterinarian will determine what dental blocks are needed.  A dental block is an injectable anesthetic that numbs the area around whichever tooth needs to be removed.  After extracting any necessary teeth, whenever possible, the extraction sites are sutured closed with an absorbable/dissolvable suture.
  • The technician then rinses your pet’s mouth and polishes all remaining teeth. After polishing, fluoride is applied.  Your pet is then allowed to wake up from anesthesia.
  • When your pet has fully recovered from anesthesia, a dental chart is created by the technician, and your veterinarian will create an at home treatment plan. If your pet had any teeth extracted, pain medications will be sent home to administer for a certain amount of days.  Your veterinarian may also prescribe an antibiotic.
  • When you pick up your pet later in the day, a technician will go over at home instructions, including medications, special feeding plans such as feeding a softened diet and at home dental care.

So how often does my dog or cat need a dental cleaning?  It all depends on the degree of plaque and tartar accumulation.  If your pet allows, get in the habit of examining the mouth at least once a month.  If you are noticing red gums, bad breath, yellow or brown material on the teeth, broken teeth, mouth soreness, etc., it is time for a professional cleaning.  Unfortunately, our pets can’t always tell us when a tooth is bothering them!  If you have any further questions about any of the above steps of a COHAT, please contact your veterinarian.