The truth about dental disease in pets
Dentistry in small animals is so important; it goes far past being a cosmetic or elective procedure. Approximately 80% of dogs and cats over the age of 3 years have dental disease that requires treatment. Without treatment, these teeth will cause infection and pain.
Dental disease is most commonly recognised when a pet is presented to us for another issue, and a physical examination of the pet reveals dental disease. Most owners are not aware of dental disease (most people do not look in the mouths of teeth), and may only recognise the signs of oral pain, until they are very severe. Some severe signs of oral pain include severely bad breath, dropping food and difficulty picking it up and swallowing it, not eating, especially when the pet approaches the food bowl but then does not eat, pawing or rubbing at the mouth, crying or aggression when the mouth is handled and excessive drooling which may be bloodstained.
As vets, it is our job to help you understand dental disease, and to help your pet by identifying it for you. Below are some common questions and myths regarding dental disease in pets. I hope this allows you to better appreciate the mouth of your beloved furry friend, and also be an advocate for dental health in pets.
The truth about bad breath and tooth loss in older pets:
Bad breath and tooth loss in older pets is NOT inevitable. Bad breath means infection, which causes dogs and cats to lose their teeth when severe. Bad breath is a sign of disease – their breath should not smell foul!
Poor oral hygiene allows plaque and associated bacteria to build up on the teeth. This causes gingivitis. As gingivitis progresses, bacteria increases and different types of bacteria produce foul smelling gases and by-products. Bad breath is also influenced by pus in the mouth in severe cases of dental infection, as well as food, hair and other debris.
Older pets do not naturally lose their teeth as part of ageing. The teeth of dogs and cats are embedded deep within the bones of the face. For teeth to be lost, there has to be extensive damage to the ligaments and bones that support them. This is advanced periodontal disease.
The truth about dogs and cats feeling dental pain:
If something is uncomfortable or painful for us, it is also painful for dogs and cats. The teeth of dogs and cats have similar nerves to humans. For those of you that have experienced dental pain, you will agree that it is a very significant pain, causing significant discomfort. A bad tooth ache can be very debilitating. The feelings experienced for a dog or cat would be very similar.
The problem here is that dogs and cats are very good at hiding the signs of pain, and in particular, in hiding oral pain. The obvious signs of oral pain such as pawing at the mouth, drooling and not wanting to eat only occur when the pain becomes so severe that they are no longer able to compensate or mask their discomfort any longer. There are more subtle signs that are often missed by owners, including reluctance to have the face and mouth handled, chewing on one side of the mouth only, or swallowing food without chewing. Pets may also prefer softer food, but this is usually discounted as a minor rather than major sign of discomfort.
The reality is that we need to eat to live, and pets will continue to eat until there is no other option. If we wait until our pet stops eating to treat oral disease, it means the pain is so severe that they are now no longer able to sustain their life because they can no longer eat. This sounds very harsh, but it is true. Recognising dental pain before we get to this point means we can prevent months or years of discomfort.
We have had a large number of very aged pets come in for dental treatment when they have stopped eating. Treatment of this pain and infection through extraction of sometimes all teeth has had owners saying that their 14+ year old dog has turned into a puppy again, and that they had no idea how much the mouth was affecting the dog every minute of every day. It makes us so happy to make this change to the lives of these pets.
The truth about owners recognising dental disease:
Most owners do not look inside their pets mouths. Some of you do, but most do not. Dental disease is unfortunately hidden in the darkened depths of the mouth, and the signs of dental disease are usually very subtle, until the disease is very advanced. Also, most people think that bad breath is normal!!
If you do look in your pet’s mouth, it is important to recognise dental disease. The presence of plaque and calculus, gingivitis and fractured teeth is very significant. Everyone else’s pets may have teeth that look the same, but that is not to say the mouth is without disease.
The truth about pet dentistry:
Pet dentistry is performed to treat pathology (or disease), just as we perform surgical procedures and prescribe medications to treat pathology in the other areas of the body, such as the skin, joints, for hormonal imbalances, etc. The treatment is focussed on relieving pain and infection of a diseased mouth. Dentistry in pets is NOT an elective or cosmetic procedure, it is treatment of disease. The confusion here lies in the way that pets conceal their dental pain, so owners do not realise it is a problem. Scaling and polishing is performed in patients with gingivitis to resolve inflammation, extraction of fractured teeth is performed to remove pain from a broken tooth and exposure of the living part of the tooth, and even orthodontic treatment is only performed by specialists when malocclusions cause trauma to other parts of the mouth or difficulty in picking up and chewing food. All dental procedures are performed to treat disease.
The truth about a scale and polish procedure:
A scale and polish must be performed under general anaesthetic. The reason for this is because dental treatment cannot be performed safely (for your pet or for your vet!) without a general anaesthetic. It is also not possible to examine all surfaces of all teeth, and to clean all of these surfaces also. Assessment of teeth involves probing the gums and teeth, and it is not humane or safe for us to do this to a painful mouth while your pet is conscious. Additionally, we cannot take dental x-rays without general anaesthesia.
When we perform a scale and polish under general anaesthesia, we protect the airways with a breathing tube down the trachea (windpipe). If performed in a conscious patient, we would run the risk of inhalation of water, bacteria and debris into the airways and lungs. The scale and polish under general anaesthetic involves cleaning the tooth beneath the gumline, which is absolutely necessary to clean the bacteria and debris out of this area, as this area is the most important area when considering the progression of periodontal disease. This cannot be done with the patient conscious. Removing only what can be seen is not effective dental treatment.
The truth about older animals and dental treatment:
Older animals are NEVER unsuitable candidates for dental treatment. They feel oral pain from their dental infections just as much as our younger patients do. In fact, it is often worse because the disease is often much more progressed in these aged patients. Age is not a disease, so it should not be used as a reason to withhold important dental treatment from a pet. There is definitely concern about anaesthetic risk and safety in older patients, but the reality is that while their age does increase their anaesthetic risk, this risk is low. The benefits from treating the pain and infection caused by dental disease in almost all cases will outweigh the risk of a well planned and well managed anaesthetic.
General anaesthesia in pets has come a very long way. The drugs selected for older patients are very safe, they are placed on IV fluids to support their blood pressure and vital organs during anaesthesia, and they are monitored while under general anaesthesia by skilled nurses and vets, as well as with specialised monitoring equipment. We always recommend a blood test to identify other disease that may be present in older animals, and even if this is present, the benefit of a dental procedure is almost always worth it to improve the quality of the life that they have remaining.
We anaesthetise geriatric patients often for dental procedures, and very rarely have any problems relating to their anaesthetic, despite this higher anaesthetic risk. We always have a very happy pet and happy owner at the end.
The truth about dogs and cats eating after extractions:
It is a common concern that pets will not be able to eat if their teeth are removed. In fact, dogs and cats do not need their teeth to eat. Our pets do not need to hunt and kill their food like they would have to in the wild, we provide their food for them, often in many different forms just to give them variety! Owners are often very concerned about a pet losing a tooth, but in reality, extraction of a diseased tooth is often the fastest and most effective way to resolve oral disease and oral pain.
There is often a feeling of genuine surprise when pets after multiple extractions actually eat much better following their dental surgery, rather than having difficulty eating. This is because we have removed the source of pain. This change in eating behaviour can happen as quickly as within days of dental surgery. Most pets can continue to enjoy dry kibble following multiple extractions, however those that have had all teeth removed may enjoy softer foods.
I hope you have found this information useful, and now have a better understanding of dental disease in pets. If you have any questions regarding this information, or anything else regarding dental disease in pets, please contact the clinic on 02) 6884 9900.
References:
This information was largely sourced from Small Animal Dentistry Proceedings 413, published by the The University of Sydney Centre for Veterinary Education, Sydney, 2014.