Dentistry

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Periodontal Disease

INTRODUCTION

One of the most overlooked aspects of preventative health maintenance is dental care for your pet.  Just like humans, dogs and cats have problems with their teeth too.  Many of these problems are very slow in their onset. A gradually increasing reluctance to eat, bad breath, loss of energy, and reluctance to play are a few of the signs that point to dental disease.

CAUSE

Periodontal disease is the most common cause of dental problems in cats and dogs. Just as in the human mouth, periodontal disease starts as bacterial growth on the surface of the tooth and tissues in the pocket around the teeth.  The bacteria produce toxins that injure the lining around the tooth.  The bacteria then enter deeper into the soft gum tissue and destruction of the connective tissue begins.  As the tissue loss continues, the pocket deepens.  Calculus (tartar), a hard calcium deposit, forms around the base of the tooth.  At this stage serious problems occur.  The bone holding the tooth in place recedes and the tooth becomes painful as it loosens.  The infection in the gums results in a discharge of debris (bacteria and toxins) into the blood stream, which can and often does seed out into the liver, heart, and kidneys.  The resultant infections in these major body organs can severely damage those organs affected and even cause death.

TREATMENT

When you observe calculus, pain, odor, or redness around the gums, those teeth should be examined.  If they are found to be worse than Grade 2/5, a professional cleaning, polishing, and possible fluoride treatment will be recommended to restore the teeth and gums to health.

DENTAL PROPHY

When you bring your pet in for a dental prophy at WAH, you should be aware that dental prophys in different veterinary hospitals are often quite different.  At Windsor Animal Hospital we want to be sure your pet gets their teeth cleaned and polished in as high quality a method as possible, but teeth cleaning is only one part of a quality dental prophy in animals.   In addition to teeth cleaning:

1.  We also want the anesthesia to be as safe as possible.  Hence we often recommend pre-anesthetic blood work in order to be sure the patient’s liver and kidneys can handle the anesthetics.

2.  Our doctors will give your pet a pre-med of either a sedative or narcotic as soon as they check into the hospital.  This is a critical step in the process as without these pre-meds pets become stressed where their cortisol levels, heart rate and respiratory rate increase.  These factors followed by anesthesia can and often lead to anesthetic complications and even anesthetic death.  Administrations of pre-meds significantly decrease the complications of stress under anesthesia.

3.  We also place an intravenous catheter in ALL patients in order to support their blood pressure under anesthesia.  Those IV fluids support liver function, kidney function and cardiac function.  Patients receiving IV fluids recover MUCH faster, recuperate MUCH faster and live.  Additional proof of the importance of these IV fluids is knowledge that if your physician put you under anesthesia without an IV catheter and IV fluids, it would be considered malpractice.

4.  We also place cardiac monitors, blood-pressure monitors, temperature monitors, and blood-oxygen monitors in order to detect problems and prevent anesthetic complications.

5.  We also surround your pet with heat support as the body under anesthesia cannot maintain it’s own temperature.  Our external thermal support maintains the normal body temperature – just as is done in human anesthesia.

6.  We also polish your pets teeth after the teeth cleaning.  Polishing removes the etching from the enamel surface which retards attachment of bacteria and future plaque and calculus formation.  this VERY important step is critical in decreasing your pet’s dental disease rather than increasing it – which is what happens when your pet’s teeth are only scaled and not polished.

7.  We also recommend full mouth dental X-Rays.  This is important because we can only see 40% of the tooth.  The remaining 60% of the tooth is below the gum-line and we can only “see” it with X-Rays.  Dental abscesses, reabsorbing roots, etc are all hidden from us without dental X-rays.

Dentistry, extractions and recovery

When the dental prophy procedure is completed if the doctor believes from the dental exam and review of the dental X-rays that your pet is suffering with a tooth or teeth that need extraction, they will telephone you, discuss their findings and recommendations.  If extractions are done the doctor – just like your dentist will administer a local anesthetic block, administer a pain-blocking injection and send your pet home with pain-blocking medications.  The dental technician or veterinarian will contact you and update you on your pet’s progress after recovery, and confirm your discharge appointment.

Discharge

Dental patients will be discharged the day of their dentistry to rest at home under your care and where they are most comfortable.  A discharge appointment is set up at the time of admission and is typically between 5:00 – 5:30 pm.  When you arrive for your discharge appointment, a dental technician will explain the printed discharge forms, review medication instructions, and plan follow-up care if needed.  You will also be provided with 24 hour emergency hospital contact information should your pet require emergency care.

Please see the attached (below) sample post-dental aftercare sheet for more information regarding aftercare

HOME CARE

Prevention of dental problems and care of the teeth begin at home by training your pet to accept the cleaning of his teeth.  This is not always an easy job, but be patient, persistent, and soon it will be a game for them.   Make it fun.   Give them a treat before and afterwards.  Windsor Animal Hospital recommends you establish a routine of cleaning your pet’s teeth every 1-2 days with a child’s soft toothbrush or rubbing the teeth with a gauze pad.  At first do not use any cleaning agents. Get your pet (cat or dog) used to the idea.  You may need to work up to cleaning the entire mouth over several weeks using a beef or chicken broth solution.  The most important factor is the mechanical removal of the bacterial film that coats the teeth.  In the pet without periodontal disease, water used with the gauze pad will remove the accumulated bacteria if used daily.  In the pet with extensive dental work (i.e. root canals, crowns, etc.), all will be wasted without good home care. If this is a problem, discuss it with the doctor prior to extensive work.  After cleaning the teeth at home, twice per week apply 1 pea-sized drop of Stannous Fluoride to your finger and rub over the outer tooth surfaces.  This will help prevent plaque formation.

Dental X-Rays

Dental X-rays of the full mouth are recommended following a complete dental cleaning because we can only see 40% of the tooth.  The remaining 60% of the tooth is below the gum-line and we can only “see” it with X-Rays.  Dental X-Rays show us infected dental roots, reabsorbing dental roots, dental cysts, hooked tooth roots, cancer, open canals, infected jaw bone, etc.  When your pet comes in for a dental prophy, it will be recommended to you that we also do full-mouth dental X-rays in order to determine if your pet has any rotten tooth roots, etc.  Because your pet can’t talk and tell us if or where they have a tooth-ache, these dental X-rays are even more important than dental X-rays we have taken on our own teeth by our own dentists.

Dental X-Ray 3

A canine patient having a dental procedure.  The doctor is extracting a tooth, the anesthetist is monitoring anesthesia and a second nurse is organizing the patient’s dental X-Rays on the monitor in the background.  The blankets are to contain the warm air produced from a heat generating unit surrounding the patient while anesthetized.  Maintaining body temperature is one of the many critical parameters for safe anesthesia.

Dental X-Ray 1

PERIODONTAL DISEASE:GRADE 1-5

  • Grade 1 = Slightly red gums. Continue home care with cleaning and fluoride twice per week, hard dry food and Nylabones or rawhide bones.
    • Grade 2 = Moderately inflamed gums.  Plaque.  Continue home care with cleaning once per day and fluoride twice per week, hard dry food, and nylabones or rawhide.
    • Grade 3 = Severely inflamed gums. Plaque.  Calculus.  Beginning of pocket formation. Clean, polish, & fluoride at Windsor Animal Hospital.
    • Grade 4 = Severely inflamed and receding gums.  Plaque. Calculus.  Deep pocket, pus, bone loss, and slightly loose teeth. Clean, polish, & fluoride at Windsor Animal Hospital.  Root planing and possible gum flap surgery, extractions, restorations.
    • Grade 5 = Rotten, bleeding gums.  Calculus.  Loose teeth and infected bone.  Extractions and flap surgery.  Clean, polish, & fluoride for the remaining teeth.

The photo above shows a cat with severe gum disease – Grade 5

 

The photo of the dog below shows a carnassial tooth covered with tartar – before a dental prophy.

Canine Carnassial Tooth covered with tartar

The photo below shows a carnassial tooth after a dental prophy.  The tooth has had a root-canal and a crown placed to help prevent future fracture of the tooth.

Canine Carnassial tooth with root canal and crown