Dental diseases are the most common diseases of dogs and cats, yet remains the most undiagnosed and untreated disease in veterinary medicine.  Eighty five percent of all animals have severe disease by the time they are 4 years old.  Only a small number of these pets are being treated safely and effectively.  Below are some frequently asked questions regarding dental care for pets. 

 

Why does my pet have bad breath?

Bad breath is NOT normal.  It is a sign of disease.  This could range from simple gingivitis to advanced periodontal disease.  Other possibilities include foreign bodies, abscessed teeth, oral tumors or other body system disease.  Bad breath should be investigated and treated safely and effectively as soon as possible!

 My dog eats really well, could he still have dental problems?

It is absolutely possible to have a good appetite and have major dental disease.  Animals cannot talk so they have no choice but to live in pain and discomfort.  Not eating in the wild would make them more susceptible to predators, lower their place in the pecking order and lead to their eventual demise.

Do dry foods prevent dental disease?

It depends on the brand of the food involved.  In general, there may be less dental disease with dry foods versus canned food.  The difference is not significant, however there are dry foods that are specifically formulated to reduce the accumulation of plaque which have passed specific tests to prove their label claim.  The diets and treats are clearly marked with the Veterinary Oral Health Council (VOHC) seal.

I had a dog when I was a kid that didn’t have dental care and he seemed OK.  Why is dental disease an issue now?

Dental disease has always been present in our pets.  However, in recent years there has been a change in a pet’s role from an outside dog that ate leftover food to our faithful companion that sleeps in the house or even our beds.  These pets are often times considered to be members of the family or even like a child.  This has increased the level of care many people expect for their pets.  We suspect animals with good oral health would live longer and have a better quality of life.  We believe every animal is entitled to a pain free mouth.

What can I do to control dental disease?

Daily brushing is the most effective prevention and only takes 1 minute per day once your pet is trained.  There are also some special foods that reduce calculus formation as well as rinses and special treats.  Also, there is a barrier sealant that can be applied to your pet’s teeth and followed with once weekly home applications and another that is applied immediately after a professional dental cleaning that is designed to reduce periodontal disease for 6 months  It is necessary to start with clean teeth regardless of the method you choose.

My groomer brushes my dog’s teeth at each visit, is that helping?

Brushing must be performed with good technique at least every other day to be effective.  Brushing the teeth once every 4-6 weeks only gives a perception something is being done when it is really of no value.  Another consideration is the discomfort caused by using a toothbrush on inflamed gums which could be torture to your pet.

I have heard of anesthesia free dentistry, is that OK?

This is currently the most divisive topics in veterinary dentistry today and maybe of all time.  Dental radiographs are essential to accurately diagnose conditions in the mouth.  In order to take diagnostic films and prevent equipment damage and pain or anxiety to your pet, general anesthesia is performed.  Once a mouth has been cleaned and all disease treated, it MIGHT be possible to have the teeth cleaned on a regular basis as more of a preventative measure.  Keep in mind, dental radiographs will need to be performed at intervals based on your pet's history.  

In general, non-anesthetic dental care is dangerous to the patient as well as ineffective for a full diagnosis and appropriate treatment of painful or infected teeth.  Unfortunately, there are many non-anesthetic providers who take advantage of pet owners' fear of anesthesia.  There are reputable companies who provide non-anesthetic dental services under the care of a licensed veterinarian as a preventative measure.  Sometimes, pet owners will feel more comfortable trying a non-anesthetic method before consenting to a more thorough anesthetized procedure.  This allows an experienced technician to get a closer look in the mouth to document disease.  This thought process seems logical on the surface, however in the only publish study on non-anesthetic dentistry, the technician recommended dental radiographs in 100% of the cases which makes the non-anesthetized cleaning with disease present less valuable.  More information and my opinions will be available in the future.
 
How long does it take to clean my pet’s teeth?

All dental cleanings are not equal!  In some clinics, a dental cleaning only takes 15 minutes.  These cleaning barely clean the surface of the teeth, leaving much bacteria and calculus under the gumline where you cannot see it.  This would be similar to you washing your car when it really needs the transmission serviced.   They may not do any harm, but at the same time, did not do much good.

A professional dental cleaning procedure which includes a thorough cleaning above and below the gum-line, a tooth-by-tooth exam and charting of important findings, full-mouth dental radiographs and before and after pictures can take 1.5 hours in a dog and 1 hour in a cat.   Once the mouth is fully evaluated, treatment can be performed which may be 15 minutes or multiple hours in cases of severe disease.  It is extremely important to have a veterinarian who likes providing dental care, has the necessary equipment and training, and a dedicated support staff to help ensure a successful outcome that will help your pet.  Most of the time, patients will be at the clinic for most of the day and go home that evening.  My clients have access to my personal cell phone for any questions or concerns that may arise.

I am concerned about the need for anesthesia, is it safe?

Anesthetic safety is our primary concern.  All anesthetic procedures carry some level of risk.  However, in most cases the risk of well balanced general anesthesia is much lower than the risk of untreated dental disease.  We take many precautions to decrease anesthetic risks in our patients including, but not limited to, a thorough pre-anesthetic physical exam, pre-anesthetic blood work, individualized anesthetic protocols, IV fluid support, and an assistant dedicated to anesthetic monitoring and support.

How do you monitor anesthesia?

Anesthetic monitoring is a combination of physical observations and measurement of vital signs such as blood pressure, heart rate, respiratory rate, eye position, jaw tone and body temperature.  Once we have this information, it is then necessary to make adjustments to maintain safe anesthesia.  This is best accomplished by utilizing a trained assistant who is constantly present during the procedure to make observations and pass the information along to the doctor.  Most anesthetic complications are a result of too much anesthesia and inappropriate monitoring.  With good technique, complications are very rare.  You likely face much more risk each day driving your car.

Why is it so much more expensive then my visit to the dentist for a cleaning?

Your dental hygienist is performing a prophylaxis, which is a preventative procedure.  Most animals have advanced disease that need much more involved therapy.  The two procedures are not even in the same category of service.  The procedures on pets would be a combination of services rendered at the general dentist, periodontist, endodontist and oral surgeon.  At least half of the expense is due to anesthesia or anesthetic related issues such as pre-anesthetic blood work, IV fluids, and monitoring.  The rest of the expense is related to the removal of calculus, full-mouth dental x-rays (compared to much fewer views in human patients), a detailed examination of each tooth and surrounding tissue followed by treatment of disease.  Also important to consider is many people have dental insurance where the premiums cover the cost of the visit and provide a discount on treatment up to a point.  These premiums may come out of your paycheck with little recognition of the true cost.

Why are there so many differences in what veterinarians offer?

I believe veterinarians are doing the best they can based on their current level of knowledge.  Dentistry has not been commonly taught in veterinary schools until recently (and is still limited).  I used to despise dental cases until I received advanced training.  Now dentistry and oral surgery is my favorite, and most rewarding discipline in veterinary medicine.  With this being said, I think it is very important to seek the best care you can for your pet and find someone who is passionate about excellent dental care.  It is very important to recognize there are differences which affect the cost of care provided.  With that in mind, the old saying, "you get what you pay for" is true.  Anyone can buy equipment and claim to provide dental care, but you should educate yourself and determine what you feel is best for your pet based on interviews with doctors and staff and on-site tours to see what goes on behind the scenes. 

As a veterinarian who has a practice limited to dentistry and oral surgery, I work mainly on a referral basis and deal with more involved or complicated cases where additional training and expertise is useful for a good outcome.  I feel that every pet owner should know their options when it comes to dental care.

Why is there such a large range in prices for dental procedures from different veterinarians?

This is pretty much a follow up to the previous question.  Most of the time there is a HUGE difference in the level of services offered.  One clinic may just anesthetize the pet, clean the tartar off the teeth, and wake them up.  Others will perform a more in depth cleaning and polish the teeth to help reduce (but not stop) further accumulation of plaque.  Still another clinic may do this plus have the equipment and training to take x-rays, diagnose disease, and offer treatment for these conditions.  You must compare apples to apples, which can be challenging for a client with little knowledge of animal healthcare.  You should be able to ask as many questions as you like and make sure you feel comfortable with what you are getting for your pet. 
It is true you get what you pay for.  If you want effective, safe therapy you will end up paying for it and your pet will appreciate it!

How effective are the lower level cleanings?

When we talk about lower level cleanings, we are talking about just a cleaning or maybe a cleaning with limited dental radiographs or minimal veterinary oversight.  I think these cleanings have some value, I am really reluctant to say they are worth the risk of anesthesia and the cost associated with them.  As an example, if the teeth are cleaned and loose teeth are removed, I estimate 75% of disease is left behind.  If you consider the less expensive nature of the procedure it seems reasonable, however, your pet will still have pain and infection.  This does NOT represent value and can create a false sense of security because you thought everything was OK.  You must remember your pet, most likely, did not show you any indication they were painful before.  In the end, there is no significant and log lasting benefit.  Many times the breath will smell better for a few weeks then returns to nasty dragon breath.

Consider that most of the disease issues are below the gums.  If only the visible parts of the teeth are cleaned, this is nothing more than a cosmetic cleaning which will not decrease discomfort or bacterial absorption.  You allow your pet to be put under anesthesia and only make their teeth look OK on the surface yet the disease is raging beneath the gums.  That is risk without benefit.

Once established disease is diagnosed and treated, some patients may be able to have a lesser level cleaning as a maintenance procedure in the future, especially if you are committed to diligent

home care.  This is more likely to be the case in really young animals or follow up cases when severe disease has been treated.

 What happens if I elect not to treat my pet’s dental disease?

Most conditions, if left untreated, will be a source of pain and infection which allows bacteria into the bloodstream, potentially leading to organ dysfunction and a shortened life span.  Many pets will suffer in silence and “slow down” as if they are just getting old.  Once the pet is treated properly they usually become a more youthful version of themselves.  Most pet owners, even the most astute, rarely pick up on subtle signs of disease.  It is only after treatment that clients will recognize what they thought was "normal" was actually evidence of pain or infection.

How many teeth does my dog or cat need to survive and be healthy?

Zero!!  A domestic dog or cat does not need any teeth and many times they are better off without them.  Full- mouth extractions is the most common procedure I perform in my referral practices in both Texas and California..  For perspective, many animals that end up needing my help have a lifetime of disease, and might only have a few healthy teeth.   For the most part, it makes sense to remove all the teeth at once rather than having to have the few remaining teeth cleaned every 6-12 months as a significant expense.  We can leave some teeth behind, but in the interest of full disclosure, you will end up spending much more to keep those teeth in the mouth and they will likely be lost eventually.  

There are strategic teeth which serve a more significant function but there are not any essential teeth.  Sometimes it is just better to have no teeth than to battle infection or experience pain.

 How will my dog or cat eat without teeth?

 The short answer is “better”! Teeth are not necessary in pet dogs and cats.  Once we determine that a tooth is painful, or infected beyond repair, it is better to be without that tooth or teeth than to have continued pain or infection.  Teeth are similar to our gall bladder in the fact we can survive without it.  If it becomes diseased we do not get a transplant but we have it removed.

Animals rely on instinct to survive and will continue eating in spite of dental pain.  We commonly see animals act younger and eat better once the pain and infection is removed.

With that being said, there are plenty of times when saving a tooth makes sense.  When I evaluate the mouth, I will give the pet owner all the available options and we can make the decision together that best suites them and their pet.

What will I feed my dog or cat after multiple extractions?

We will have you add hot water to their regular food to make it soft.  You will do this for 2 weeks to allow the mouth to heal.  After 2 weeks has past, he or she can return to dry food.  Most animals without any teeth actually prefer hard food.  Pet food, unless it is specifically formulated for oral health, is not designed to be chewed.  Most animals throw their food back and swallow it whole. Think back to a time when your pet threw up.  The food was likely whole and soaked in saliva.

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