Dental Disease in Pets - Causes, Treatment, and Prevention
Dental Health Awareness Week 2022
Proper dental care is essential for the health of our pets. Yet most pet owners do not care for their pet’s teeth and gums on a regular basis. The statistics tell the story:
- Based on information from a scientific study published in The Journal of Veterinary Medical Science, 80% of pets have periodontal disease, with most of them showing signs of disease by the time they are two to three years old.
- Only four percent (4%) of pet parents brush their dog’s teeth daily.
- White teeth with little tartar may seem normal to the untrained eye; however, 75% of dental disease is found below the gum line.
What is periodontal disease?
Periodontal disease is an inflammatory condition of the tissues that surround the teeth. Specifically, periodontal diseases are infections of the periodontal ligaments that hold the teeth in place, alveolar bone surrounding the teeth, and/or gum disease. There are four stages of periodontal disease. If treated in the earlier stages, the disease can be treated and even reversed. More advanced stages often result in removal of the teeth.
- Stage 1: Gingivitis is caused by a buildup of plaque on the teeth. The plaque is formed as bacteria colonize on the surface of the tooth to form a biofilm. If left untreated, the biofilm will mineralize and produce a hardened calculus. The trapped bacteria under the gum line results in red and bleeding gums.
- Stage 2: Early periodontal disease is defined as 25% or less attachment loss between the teeth and gums. X-Rays will show early signs of the disease.
- Stage 3: With moderate periodontal disease, there is significant bone loss under the gum line. Tooth removal may be necessary at this stage; however, progression to Stage 4 can still be prevented with proper care.
- Stage 4: Cases of advanced periodontal disease have more than 50% gum retraction from the bone. Often, teeth will need to be extracted and a deep cleaning including scaling and root planing will be necessary.
What are the signs of periodontal disease?
Some signs of periodontal disease can be subtle, but they are important to identify.
- Bad breath – foul smelling dog or cat breath is not normal.
- Tartar build-up
- Red, swollen or bleeding gums
- Difficulty eating or chewing
- Loss of appetite
- Weight loss
- Pain – If your pet is reluctant to let you touch their mouth, outside or inside, they may be experiencing pain. Pain occurs when tartar and food are trapped below the gum line. Remember that your pet can be very good at hiding their pain.
How do I know if my pet requires a dental cleaning?
An examination by a veterinarian is the only way to know if regular cleaning is recommended, and whether the cleaning is enough or a more invasive dental procedure, such as root canal or dental extraction is recommended. I do not recommend non-anesthetic dental cleaning, as this is mostly a cosmetic procedure to remove plaque and tartar above the gum line. If not removed, plaque and tartar below the gum line will continue to accumulate and lead to advanced periodontal disease.
An anesthetic dental cleaning is the gold standard for thorough examination. Many dogs and cats need once-per-year tooth cleaning. Some pets need their teeth cleaned more often. This type of dental care involves scaling and polishing. The teeth are scaled to remove plaque and tartar. Scaling eliminates build-up on the crowns of teeth, which are the visible parts of the teeth, but will also include probing along the gum line and pockets around the teeth where the gums may be receded. Dental radiographs will be required to determine the health of the roots of the teeth and surrounding bone.
Upon examination under anesthesia, your veterinarian may need to perform oral surgery. Usually, extractions are necessary due to fractures or chips that expose the pulp cavities which can lead to pain and infection. Abscesses, periodontal disease, and dental cavities may also require oral surgery. Once teeth are extracted, sockets are stitched closed with dissolvable sutures. Advanced procedures such as root canals and tooth restoration can also be performed at specialty veterinary dental centers.
A preanesthetic physical exam, along with pre-operative lab work, should be performed to make sure your pet is healthy enough to be anesthetized.
How is safe anesthetic dental cleaning performed?
Complications and deaths from anesthetic dental cleanings are uncommon in dogs and cats. From diagnosis to discharge, you are part of the care team for your pet. It is crucial for your veterinarian and his or her team to be in communication with you before and after the procedure.
Prior to the procedure, schedule a complete physical examination with your veterinarian. The exam should include listening to the heart, abdominal palpation, and an oral exam. Pre-op lab work is critical! If not already a standard part of the complete exam, request full pre-op lab work (CBC, Chemistry panel, urinalysis). A thyroid blood test and a chest x-ray is also recommended if your pet is middle aged or older. Based on the results of these tests, the anesthetic protocol can be adjusted based on the organ function of the animal. If a specialist (ex. cardiologist) is regularly part of your pet’s care team, schedule a pre-op exam with them as well. If your animal is considered at high risk for anesthesia, taking him/her to a veterinary dental specialist may be a safer option.
When dropping off your pet on the day of the procedure you will be asked to complete the hospital’s admission forms. As part of the forms packet, you will be asked whether you give a “red,” “yellow,” or “green” light for administering CPR in the rare event that your pet’s heart stops during the procedure. It’s important for your veterinarian to know your wishes before the procedure begins. To prevent additional stress on your pet’s immune system, do not give permission to administer vaccines on the day of the procedure. Acupuncture, cold laser and removing small lumps and bumps are safe to perform while your pet is under anesthesia for a dental cleaning.
At the start of the procedure, an IV catheter will be placed to administer IV fluids and medications. IV fluids support the kidneys in processing the anesthesia and filtering it out of the body. IV fluids also help keep blood pressure stable. After administering IV fluids, an induction agent to sedate the animal is administered. Once the sedation has taken effect, an endotracheal tube is inserted into their throat to keep their airway open, and to prevent saliva and debris from the dental procedure from entering their airway.
During the procedure, your animal’s vital signs will be monitored including blood pressure, body temperature, oxygen saturation, carbon dioxide levels, respiratory rate, heart rate, and electrical heart activity (EKG). A full mouth exam will be conducted with a dental probe. Scaling (scraping away) tartar and plaque will be performed. X-rays will be taken of every single tooth. If extractions are needed, the animal may receive a nerve block. By adding a nerve block, animals will come out of anesthesia with less pain. Deep root extractions will require sutures. The teeth are then polished to remove the scratches on the teeth created by scaling and planing. Scratches left on the surface of the enamel can invite tartar and plaque to adhere quickly.
When the procedure is finished, the gas anesthesia will be removed from your pet. When the care team has observed your pet sitting up and able to swallow, the endotracheal tube is removed. Vital signs will continue to be monitored until he or she is fully awake and walking around. Your veterinary office will contact you when your pet is ready to be discharged.
When you arrive to pick up your pet, you will be given discharge instructions as well as a report containing copies of the x-rays and/or a diagram showing what teeth were missing prior to procedure as well as any teeth that were removed during the procedure. Be sure to review the report with a member of the care team before you head home and get answers to any questions you may have. You may also receive prescribed medications for pain management and infection control.
What post-dental procedure care is recommended?
For the first 24 hours, no solid food is recommended. It is best to have your pet consume a liquid diet (bone broth, goat milk, congee). Pets may be nauseous from anesthesia and painful from the procedure. Do not give hard chews, bones, or hard treats for 7-10 days if sutures are present. DO NOT give any over-the-counter medications for pain. Veterinarians often prescribe NSAIDS (nonsteroidal anti-inflammatory drugs) for pain management. If giving an NSAID, watch for bloody or dark tarry stools; if they are present, stop these medications immediately and call your vet for an alternative medication. Natural alternatives to NSAIDS include:
- Herbal formulas such as Dog Gone Pain (DGP)
- Homepathic remedies include:
- Arnica, 1 M and Hepar Sulphvris 200C twice daily for 7 days
- Arnica IM and Hypericum IM Twice daily for 2-5 days if extensive work was done.
- If extensive bleeding occurs during the procedure, administer one dose of phosphorous 200C immediately following procedure
Watch for signs of pain: dropping food, flinching, tossing the head, aggression, increased drooling, blood in saliva, halitosis, pawing face, swelling of the mouth and gums, drainage or swelling around eyes. These signs and behaviors can be a sign that a secondary infection is present.
Probiotics are important for recovery, especially if antibiotics are prescribed. A high-quality probiotic containing billions of CFUs and multiple strains is recommended. These can be started days in advance of the procedure if your animal does not regularly take a probiotic.
Once your pet has healed from any extractions, offer softer chews, softer dehydrated meat chews and softer treats.
To detox the liver from the anesthesia, the following can be given to your pet one week before and two weeks after the procedure:
- Milk thistle: 100mg per 20 pounds of weight twice daily
- NAC (N-acetyl cysteine): 250mg per 30 pounds of weight twice daily
- Sam-e (S-adenosyl-L-methionine): 90-425 mg once daily 1 week before and 2 weeks following procedure on an empty stomach.
- B vitamins
- Foods with sulforaphane – broccoli, brussels sprouts, kale especially helpful is broccoli sprouts – 1/8-1/2 daily for 10 days. Green Juju’s “Just greens” is a good substitute in place of these foods.
To detox the kidneys from the anesthesia, give your pet fresh or dried parsley. The dried parsley can be infused to make a tea. Another great herb is dandelion root or leaves. The leaves can be chopped or ground and added to food. Dried dandelion root and leaves are also available in powder and tea.
Other excellent supplements to use as your pet recovers from a dental procedure include:
- Golden Paste – good for moving stagnation and is anti-inflammatory
- Vitamin C – buffered is best
How do I maintain good oral hygiene for my pet?
Pets need daily dental care, just like people do. Ignoring your pet's dental care for the first year of life would compare to waiting until your child is nine years old to begin dental care. Start training your puppies and kittens to allow you to examine their teeth and gums at a very early age so that dental care will be easier to perform. Even if your pet is older, it is never too late to start daily dental care. Maintaining good oral hygiene for your pet is a life-long commitment.
High quality diet: For over 100 years, studies have shown that dietary sugars (such as those found in kibble) can negatively affect the dental health of pets. These sugars can alter the microbiome in the mouth, causing a bacterial biofilm that results in thicker plaque, more calculus and periodontal disease. A diet high in carbohydrates influences the kinds of metabolic waste products produced by the oral microbiome that result in a highly acidic environment, greater inflammation, and a breakdown of the tooth enamel. To maintain good oral hygiene and a healthy mouth microbiome, your pet’s diet should:
- Restrict diets containing simple and complex carbohydrates such as chickpeas, potatoes, including sweet potato, rice, wheat, and corn.
- Limit treats and chews that contain modified starches used as binding agents such as tapioca and potato.
- Choose food in which the major ingredient is protein.
Daily dental care: There are several products that can be used alone or in combination to maintain good oral hygiene.
- Raw meaty bones: Raw meaty bones are available in different sizes. Dogs of all sizes can use these to help cleaning the teeth using the abrasive action of chewing and work to maintain a healthy microbiome.
- DO NOT USE THE FOLLOWING Dental products:
- Commercial products containing poor quality ingredients and a myriad of chemicals. Many contain different forms of sugar, sugar substitutes, and artificial dyes. Be sure to read the labels before you buy and avoid as many chemicals as possible. Pet parents have a responsibility to keep track of the safety profile of these additives.
- Human dental products should never be used in pets. Human products contain cleaning agents and other ingredients that are not intended to be swallowed. Your pet will naturally swallow anything that is put into his/her mouth. Human products also commonly contain sweeteners and higher levels of salt which will upset the digestive tract.
- Do not use baking soda to clean your dog’s teeth. Baking soda has a high alkaline content and, if swallowed, can upset the acid balance in the stomach and digestive tract. It is also high in sodium.
- DIY Toothpaste for your pets: the following recipes and suggestions are healthy alternatives for brushing your pet’s teeth. To avoid chemical additives and flavorings, these suggestions contain natural flavor so that your pet can better enjoy the experience of brushing.
- My favorite toothpaste is made using 1/4 teaspoon of coconut oil mixed with 2-4 drops of New Zealand Deer Antler Velvet Oral Drops. Use coconut oil high in lauric acid, as it helps to reset the microbiome.
- Add 1 teaspoon of coconut oil to 1/16 teaspoon of Adored Beast Love Bugs probiotic powder.
- Dog Breath Lite from AnimalEO contains a combination of essential oils with anti-inflammatory properties.This product can be added to coconut oil to make a toothpaste. It can also be added to your pet’s water or applied directly to your dog’s mouth or paw (to lick off).
- Kittyboost from AnimalEO is a topical oil applied to the paw for kitty to lick off.
You may need to experiment to find a product that your pet enjoys. For example, you can add a drop or two of bone broth to your DIY toothpaste. If you use a product that tastes good to your pet, he/she will be more likely to enjoy the experience.
- Regular dental checkups: Dogs and cats should be taken for oral examinations annually. Veterinary teams perform these exams. Six months is the right age for the first dental checkup. Small and medium-sized dogs usually have the most urgent dental needs and may need checkups more often.
- DNA testing: Basepaws (cats) shows the chances that the animal will have periodontal disease, tooth resorptive lesions, bad breath, etc. Embark testing checks for an inheritable condition called enamel hyperplasia in dogs. The results of these tests may motivate pet parents to begin good oral hygiene in their early years.
Good dental care helps pets to survive and thrive. Whether you use water or food additives, sprays, rinses, or perform daily brushing, it is imperative to continually monitor your pet's dental health while providing good dental hygiene.