Dental tartar and gingivitis is the number one problem we see in our pets at CCPH (at least 90% of our cats and dogs!).  Dogs, cats, ferrets, rabbits and rodents all suffer from various kinds of dental disease, and most owners do not even realize their pets are affected because they do not show signs until very late in the disease.  We want to talk about what constitutes dental disease, tell you about the grading scale we use, and how we treat and help prevent dental disease in our pets.

Lift up your pet's upper lip - normal, healthy teeth are white with a nice pink gum line.  There may be a slightly darker pink line right at the gum line, and this is normal.  If there is yellow or brown tartar, or if the gums are swollen, red, or you can see teeth roots, your pet is suffering from dental disease.  There are different levels of dental disease which we use as a rough estimate of how involved your pet's treatment will be.  They include:   

• Grade 1: mild tartar, little to no gingivitis or bad breath
• Grade 2: mild to moderate tartar, gingivitis is present but there is no or only minimal tooth root exposed, gums are swollen
• Grade 3: moderate to severe tartar, gingivitis and swollen gums are present, bad breath is present, and teeth roots may be exposed (antibiotics will be given prior to dental cleaning)
• Grade 4: severe tartar or tooth root exposure, loose teeth may be present, bad breath is present (antibiotics will be given prior to dental cleaning)
  

Some symptoms that can be attributed to dental disease include:

• Bad breath
• Decreased appetite, or a reluctance to chew hard food
• Excessive drooling, licking the lips or pawing at the mouth
• Swelling just under the eye or on top of the nose (dental abscess)
• Chronic coughing, gagging or sneezing
  
• Nasal discharge that is green or yellow
  

Besides causing bad breath, dental tartar traps bacteria and causes erosion of the gums.  This can lead to loose or infected teeth.  If not treated, this infection can move to the jawbones and surrounding tissues, causing eye infections, sinus infections and other localized problems.  In the worst cases, the bacteria from the mouth can get into the bloodstream and affect the kidneys, heart and other organs.

Any pet with dental tartar (Grade 1) can get a dental cleaning to prevent progression of dental disease to later stages.  Pets with Grades 2-4 need a dental cleaning to treat their condition and may need teeth extractions, antibiotic gel, mouth x-rays or antibiotics.  It is very important to treat dental disease in the first 2 stages before it becomes a health risk to your pet.  This not only is medically better for your pet, but it reduces the cost of the dental cleanings because your pet will be under anesthesia for less time and hopefully antibiotic treatments and teeth extractions will not be necessary.

It is necessary to place our pets under general anesthesia to clean their teeth.  Most of the time we are cleaning the teeth we do cause some bleeding, and this would be painful in the awake pet.  With all of our patients, we run full bloodwork prior to the dental to make sure they are healthy enough to undergo elective anesthesia.  We use inhalant isoflurane or sevoflurane anesthesia during our procedures, which allows your pet to wake up within minutes of the end of the cleaning.  The heart rate, blood oxygen saturation, and respiratory rate are monitored throughout the procedure and patients receive fluids during anesthesia.  The teeth are cleaned with an ultrasonic scaler device to remove the tartar and clean under the gum line.  Any problems are then assessed by the doctor, including loose or broken teeth, possible infections, and pockets of inflammation in the gums.  Depending on the pet, we may recommend full mouth x-rays or teeth extractions at this time.  After all necessary medical procedures are done, the teeth are polished and a fluoride treatment is done.  The pet is then woken up from anesthesia with appropriate pain medication if necessary.

Teeth extractions are common for healthy, broken teeth (to prevent future infections) or diseased, loose teeth.  When a patient will need an extraction, we always make sure to give them pain medication before and after the procedure.  Most pets do very well with dental extractions, and feel considerably better once the diseased teeth are out.  If routine dental care is provided, this greatly reduces the need for extractions in the future.

This only depends on the preventative care you do at home and how much your pet is predisposed to getting dental tartar buildup.  The small and toy breed dogs and Greyhounds are genetically predisposed to develop dental disease.

This is a great question.  For most owners, putting older pets under anesthesia is worrisome.  However, for older dogs without any severe underlying conditions anesthesia is relatively safe when we take the proper precautions.  We always run pre-anesthetic bloodwork to make sure anesthesia is safe, and a thorough physical exam to check for heart murmurs is always performed.  A catheter is placed during anesthesia and fluids are given to maintain blood pressure.  Thorough anesthesia monitoring is done throughout the procedure.   In my opinion, older dogs receive a huge benefit from treating their dental disease, especially if it is advanced.  They feel much better once their dental problems have been addressed and a large number of times signs that owners attribute to aging (decreased activity, decreased appetite, increase in aggressive behavior such as snapping) will improve once the teeth have been cleaned.  Another important thing to consider is early intervention of dental problems in older dogs.  If we can do preventative cleanings with a POD level of I or II and not have to take time to do x-rays or extract teeth, then there is less time under anesthesia and less risk to your pet. 

We like to customize dental care to the patient, but here is a list of the available options we have:

• Daily teeth brushing with toothpaste designed for pets is the best way to decrease the need for dental cleanings.  This will help reduce bacterial buildup and decrease tartar formation.  Make sure you use a dog or cat toothpaste as human toothpastes are not made to be swallowed and can be harmful if used.
• Feeding dry food instead of canned will slow down progression of tartar in dogs.  I do not believe it makes a difference in cats (just this one DVM's opinion!)
  
• Dental diets: these work very well and are designed to break of tartar as the pet eats.  These are prescription diets and can only be purchased at your veterinarian's office.
• Dental chews/treats: these work by enzymatic cleaning while the pet chews on them.  These are a great addition to a dental care program.
  

Cats can have significant dental disease without much evidence of tartar or gingivitis on the physical exam.  For this reason, we recommend any cat with tartar or symptoms attributable to possible dental disease receive a dental cleaning because most of the problems happen underneath the gum line.  We also include full mouth x-rays for all cats that get a dental cleaning because this is usually how we identify problems.

If you think your pet may have dental disease, please give us a call!  Our technicians are trained to do a free dental evaluation (Grade1-4) and let you know if your pet could use a dental cleaning.  It is a common and often overlooked problem that needs to be addressed in our pets.