February is Dental Month

Gentle Care Animal Hospital Celebrates National Pet Dental Month
Dr. Trudi Bowden provides this month's feature on your pet's pearly whites!

To educate pet owners about the importance of regular dental care, February has been designated National Pet Dental Month by a partnership between the American Veterinary Medical Association, American Veterinary Dental Society, Academy of Veterinary Dentistry, American Veterinary Dental College, Academy of Veterinary Dental Technicians, Veterinary Oral Health Council® and Hill's Pet Nutrition Inc.

Unfortunately, dental care is often ignored by owners. A recent American Animal Hospital Association (AAHA) survey indicated that 66% of pet owners fail to provide essential dental care when recommended by their veterinarian. In fact, some studies suggest up to 90% of cats and dogs do not receive appropriate dental care. Experts agree that periodontal disease is the most prevalent disease of all cats and dogs. Periodontal disease is present in 70% of cats and 80% of dogs as young as three years of age. Although daily removal of plaque with tooth brushing is necessary for pets and people, the reality is that only two percent of pet owners actually follow through.

Regular preventive dental care includes oral home care by the pet owner and routine professional dental care by your veterinarian. The expenses associated with professional dental treatment are not insignificant. If, however, preventive care is ignored, the cost to the owner is often substantially higher for management of moderate to severe dental disease. More importantly, we must acknowledge that many of our pets are suffering in silence with undiagnosed periodontal pathology.


What is periodontal disease?

Periodontal disease is an inflammation of one or more of the support structures surrounding the teeth (gingiva, cementum, periodontal ligament, and alveolar bone) and is caused by a buildup of plaque over time. When compared to gingivitis, periodontitis indicates loss of surrounding bone due to infection. Initially, plaque is soft and brushing or chewing hard food, hard treats, or toys will dislodge it. If allowed to persist and spread, plaque can lead to gingivitis, inflammation of the gums. If left untreated, periodontitis may cause loose, painful teeth as well as internal disease.

Periodontal disease is caused by plaque. It begins as a sticky bio-film of plaque composed primarily of bacteria. Plaque builds up on the tooth surface and over time will harden or calcify into tartar due to the mineral content in normal saliva. With progression of tartar, or calculus, plaque begins to accumulate more rapidly. Initially, plaque is soft and brushing or chewing hard food, hard treats, or toys will dislodge it. If allowed to persist and spread, plaque can lead to gingivitis, inflammation of the gums. Inflamed gums are red, swollen, and bleed easily.

As plaque and calculus develop below the gum line, a professional cleaning is necessary for complete removal. If the plaque and tartar buildup continues without intervention, infection can spread to the root of the tooth. In the final stages of periodontal disease, the tissues and bone surrounding the tooth are destroyed and the tooth becomes loose. This is a very painful process for your pet, but these problems can be averted before they even start.

Bone loss from periodontal disease occurs below the gum line. This can not be detected on a routine, awake examination of the oral cavity. In order to evaluate the stage of periodontal disease as well as the best option for treatment, your pet must be examined under general anesthesia. In addition to a visual examination, a periodontal probe and dental radiographs are used to measure bone loss.Stage 1: Gingivitis only, no attachment/support loss. Gingivitis is treatable and curable with daily tooth brushing.

Stage 2: Early periodontitis-less than 25% support loss. Periodontal disease is not curable once bone loss occurs, but may be controllable once treated and followed up with strict home care.

Stage 3: Established periodontitis- between 25-50% support loss. These teeth may be salvageable with a firm commitment to daily home care and more frequent professional cleanings.

Stage 4: Advanced periodontitis- greater than 50% support loss. Extraction is typically the only option for these teeth.

What are the signs of periodontal disease?

The most common sign of periodontal disease is halitosis or bad breath, caused by plaque (bacteria) accumulation. Experts agree periodontal disease is painful; it is an insidious chronic inflammatory disease to which most patients gradually adapt or cope. Some dogs and cats will have problems chewing hard food; others will paw at their mouths. Tragically, most will not show any obvious signs to their owners. By the time a cat or dog shows obvious oral cavity pain and dysfunction, severe periodontal disease is well established and numerous teeth must be extracted. Dental disease doesn’t affect just the mouth. Studies have shown that dogs with severe periodontal disease have more severe microscopic damage in their kidneys, heart muscle and liver than do dogs with less severe periodontal disease.
Signs to watch for: Bad breath, missing or loose teeth or teeth that are discolored or covered in tartar, guarding the head/face/mouth, drooling, dropping food from the mouth, swallowing food whole, changes in eating or chewing habits, pawing at the face or mouth, bleeding from the mouth/gums, loss of appetite, unexpected weight loss

What is the cost of a routine dental prophylaxis?

The definition of a ‘dental prophylaxis’ is a professional dental scaling, polishing, and fluoride treatment to maintain healthy teeth. Sadly, by the time most owners allow their pets to have their teeth professionally cleaned, some degree of periodontal disease is already present and the procedure is no longer considered ‘routine’.

If however, your pet has no periodontal disease and no fractured/missing teeth, a routine cleaning will average less than $300. This includes a comprehensive pre-surgical exam, IV catheter for emergency venous access/delivery of IV fluids and other medications, anesthetic monitoring with Pulse-oximetry, temperature, blood pressure, and EKG in select cases, supplemental heat, premedication for pain relief/sedation, dental probing/charting of the entire oral cavity, scaling and subgingival curettage of all accumulated plaque/tartar, polishing of all teeth, application of an antiseptic rinse and fluoride treatment. This does not however include the cost of dental radiographs (x-rays), extractions, nerve blocks, suture material, antibiotics, pain medications, or home dental care supplies. Many pets presenting for a presumed routine cleaning will have one or more problem areas identified while under anesthesia. It is important to discuss this with your veterinarian in advance so that diagnostic and treatment options and cost can be discussed and agreed upon in advance.


How often should my pets teeth be professionally cleaned?

The AAHA Dental Care Guidelines recommend regular oral examinations and dental cleanings, under general anesthesia, for all adult dogs and cats. AAHA recommends these procedures at least annually starting at one year of age for cats and small-breed dogs, and at two years of age for large-breed dogs.


Are dental radiographs (x-rays) really necessary?

Radiographs of the teeth are needed periodically in order to completely evaluate your pet’s oral health. Approximately 70% of the tooth is below the gingiva and not visible on oral exam alone. In many cases, the surface of the tooth can appear quite healthy, while significant disease is present in the tooth root and/or surrounding bone. Early detection can prompt treatment to prevent the development of a painful tooth root abscess. In many cases, x-rays will confirm the need for extraction of teeth that are loose or badly infected.



Last Thoughts
Many clients often ask, "Are his/her teeth bad enough to need a cleaning this year?"

In taking a pro-active approach to veterinary care, the doctor's of Gentle Care Animal Hospital don't recommend waiting until the mouth is in bad shape before you are willing to seek dental care.

A commitment to home care and annual veterinary dental care is an investment in your pet's dental health and comfort.




See for yourself, the following images are provided from two works by Jan Bellows, D.V.M., Diplomate, American Veterinary Dental College - Smile Book III and Canine Periodontal Disease – Diagnosis and Therapy.

The first two images provide a normal benchmark of both dog and cat dental conditions for comparison:

Normal - Canine

Normal - Feline

The following images detail increasing attachment loss:

25% Attachment Loss

Radiograph - 25% Attachment Loss

50% Attachment Loss

Gingivitis is not a people-only problem!

Early Gingivitis

Advanced Gingivitis

Periodontitis

Severe Tartar / Early Periodontitis

Feline Alveolar Bone Expansion

Feline Alveolar Bone Expansion

Radiograph - Alveolar Bone Expansion

Progression of Feline Gingival Recession

Feline Gingival Recession

Marked Gingival Recession

Moderate Gingival Recession

Furcation Involvement

Furcation Involvement

Progression of Periodontal Disease

Grade 3 Periodontal Diseases - Canine

Grade 3 Periodontal Diseases - Feline

Stage 4 Periodontal Disease

As you can see, conditions can deteriorate quickly between stages. Preventative dental care at home and at your vet can help spot these issues become they become a problem.