In episode 3 Dogtor S will examine a commonly encountered question surrounding dental health in dogs and cats. Focusing again mostly on dogs, we will take a look into the average dental procedure and what dental health can mean for your beloved pet.
Hello and welcome to episode three of paws press play. In this episode we will try to touch on a topic that is broad enough to have its own books written about it, and in fact, it does. My name is Dogtor S, and I hope you will enjoy this episode, so whether you’re on the way to work, coming home, or staying in today sit down, paws and press play.
Stretch is an 8 year old Dachshund mix that is doing great at home. He eats well, he plays with his toys and never misses a walk. The only issue that his ‘parents’ have seen is that he will sneeze occasionally and have some discharge from his nose. Oh by the way his breath is bad too, but that’s just how dogs are…
He presents to the clinic for his annual checkup and his owners mention this problem to their veterinarian. Stretch’s teeth are just covered in tartar, I’m sure we have all seen this to some degree in our dogs at some point in their/our lives. The veterinarian recommends a dental cleaning and states there will likely be extractions.
This comes as a great shock to Mr. and Mrs. Doxon. “Extractions?! They exclaim in unison.” Veterinarians are very used to this surprise for our clients, and we often do try to soften the blow believe it or not. Nonetheless it frequently comes as a surprise when tooth extractions are discussed. This is likely because our own dentists are very infrequently making this recommendation. Now, it must be kept in mind that our dogs are not brushing their teeth twice a day, and they most certainly are not flossing. So, this allows periodontal disease to progress much more dramatically in our pets than in us. Periodontal disease is a complex of factors that make up disease to the tooth itself, the tooth’s attachment, and the gums, and when this has progressed far enough the tooth usually needs to be extracted.
Once the initial shock around extractions has worn off, people usually ask about price. Now this question is very difficult to answer within the exam room. We are not lying to you when we say the best we can do is make an educated guess on your awake animal. Some teeth that need to be extracted will be very obvious. For instance a severe tooth fracture or something of that nature; however, often times periodontal disease progression is predominantly below the gum line and findings of both periodontal probing and x-rays are key before extractions can be decided. Most clinics will have some form of estimate giving that is as accurate as they can make it. I personally will include obvious extractions as well as a few of the most commonly extracted teeth depending on how bad the teeth are to hopefully be estimating a little too high rather than too low. The price of dental procedures has extreme variability between clinics, some will be in the hundreds whereas others can easily get into the thousands. Ultimately, wherever you go, the procedures that are done will largely be the same.
What about Stretch?!
Well, after some discussion it was decided to go forward with a dental cleaning, x-rays and extractions if needed. Stretch was anesthetized… A quick side note, I know that anesthesia is very frequently a major concern of these procedures, I will touch on this in future episodes hopefully to an extent that will ease your mind… and his teeth were examined using a probe to search for periodontal pockets and x-rays of the mouth. The x-rays showed there was an abscess, or a pocket of white blood cells (or pus), around the root of one of Stretch’s canine teeth. This tooth needs to be extracted. The canine teeth in dogs have the largest roots in terms of length out of all the teeth in the mouth. In most dogs the root of the canine tooth will be about 1:1 with the visible portion of the tooth. This puts the upper canine tooth root just below the nasal cavity. This was causing Stretch’s sneezing and discharge because the abscess had broken into the nasal cavity! Dachshunds in my experience, seem to be overrepresented in this, but it can conceivably happen in all dogs and cats too. This is called an oronasal fistula. All it took to fix this sneezing was to remove the affected canine tooth. Now in Stretch’s case, he had several other extractions totaling to 12 teeth. These additional teeth all showed x-ray evidence of attachment loss, they had fractures with pulp exposure (pulp is the life source of the tooth), or they had some other significant form of disease. This is a shockingly high number to many people, but dogs begin with 42 teeth. People only have 32 and cats have 30. On the upper jaw, dogs have 6 incisors, 2 canines, 8 premolars, and 4 molars. On the lower jaw they have all the same aside from they will have 6 molars. On the upper jaw, cats have 6 incisors, 2 canines, 6 premolars, and two molars. The lower jaw is the same with only 4 premolars. Stretch woke up from anesthesia great and went home to recover.
In all practices that I’m familiar with, your dog or cat will be anesthetized by veterinary technicians under the supervision of a veterinarian and then the veterinary technician will clean and polish the teeth similar to you or me going to our dental hygienist. In many clinics, dental x-rays are available, the technician is often the one positioning and taking the x-rays; whereas the veterinarian will uniformly read and interpret them to decide what extractions if any are necessary as well as if there are teeth that require any additional treatments. Dental x-rays are similar to standard x-rays however they use less radiation and are a more focused shot allowing one to truly check the tooth roots closely. Once the cleaning and/or x-rays are done your veterinarian will probe the teeth for any pockets or other defects, like fractures, that would indicate a need to remove the tooth. If they find one then the tooth will be removed, any tooth that can stay is going to be left in the mouth. Extractions are not easy, nor are they cheap, and so any tooth that is healthy enough to remain in the mouth is going to be left there. I should also say that there are dental specialists that can perform procedures more advanced than general practitioners. SO, certain conditions that often require extraction of the tooth affected may be correctable by a dental specialist. Things like root canals, vital pulp therapy, and other advanced procedures are more widely offered nowadays. If people are interested in these options, I can describe them in future podcasts.
Stretch’s example is a great one for when things have progressed a little too far before being addressed, but this represents a majority of the types of cases that we see. Dental hygiene for our dogs and cats is one of the most rapidly developing fields in veterinary medicine, and the importance of not only major procedures, like Stretch’s, but also practicing good hygiene at home cannot be stressed enough. There are many things that you can do for your animals’ teeth while you’re at home. The ultimate best thing to do, like with people is to brush your pets’ teeth. A minimum of three times per week is ideal in order to ensure you are making a significant difference in the amount of plaque and eventually tartar that are building up. We recognize that this is not feasible for all animals, so there are many chews and treats that can be useful. The veterinary oral health council or VOHC is a great reference. They are a group of veterinary dentists and technicians that evaluate products on the market and put their seal onto products that they deem are scientifically worth using. The link to their website is under helpful links on the home page. Contrary to popular opinion hard food i.e. kibble, does not actually help reduce tartar and plaque buildup. Furthermore, things like Antlers or bones do have some potential to chip off tartar and make the teeth appear a little cleaner; however, they also have great potential to fracture the teeth which makes for another visit to the veterinarian and possibly an anesthetic procedure. Ultimately, the best option is brushing the teeth as this is the route that most consistently will target disease underneath the gumline and help slow and prevent periodontal disease. Just like in us!
Stretch’s example shows us that things can be pretty severe, but realistically it is important to note that our pets, our family members are likely suffering long before they get to stretch’s point. The reality of dental disease (periodontal disease) is that it is slow and progressive. That said it is a known source of chronic pain and inflammation. There are numerous sources that equate, in both people and animals, poor dental hygiene with disease of the liver, kidneys, and heart. This alone should be enough to prompt the discussion around dental hygiene between you and your veterinarian. We as a whole recognize that not everybody has budgeted, or is simply unable to budget, for expensive anesthetized cleaning, and nor may it ever be an option for some. That shouldn’t discourage you from asking for the best options to help your pet and try to keep their mouth comfortable and clean for years to come. Often time’s annual cleanings will be recommended, but it will all depend on what your veterinarian sees at your pet’s checkup. Thanks again for listening, and we’ll catch you on the next one.