Approximately 85% of adult dogs and cats have some form of oral disease. Dental problems are among the top three pet owners concerns in dogs and cats. As veterinary dental professionals it is our duty to dispel the myths and misconceptions of the myriad of home care products. Oral disease is one of the most prevalent diseases in dogs and cats. Calculus and gingivitis are the most common conditions diagnosed by veterinarians in all ages of animals. Ideally our clients would perform all of the home care we prescribe with due vigilance and enthusiasm. This would involve routine plaque removal, annual examinations and prophylaxis. Clients perceive healthy teeth by equating white teeth with healthy teeth or malodor. In veterinary medicine there are many myths, it is our responsibility to dispel these myths through education.
- Periodontal disease is an inevitable part of aging
- Calculus or tartar accumulations are the only indicator for a dental cleaning
- Referrals are too expensive, our clients will not be interested
- Our clients will think less of us if we suggest a referral
- Our clients will not perform home care
- Giving a dog a deer antler or bully stick will be enough to clean the teeth
- Dogs and cats don’t feel pain in the same way humans do
- If a broken tooth doesn’t appear to be hurting or bothering the animal, there is no need to treat
- Minor tartar can be scraped off without anesthesia
- Old animals should not be anesthetized for dental procedures
Periodontal Disease is an Inevitable Part of Aging:
Periodontal disease is not an inevitable part of aging but rather is defined as an infectious disease caused by plaque and the resulting inflammatory response. Periodontal disease is present when plaque bacterial induced inflammation has affected the gingival and other tissues of the periodontium: gingiva, periodontal ligament, cementum and the alveolar bone. Gingivitis is any inflammation of the gingival tissue. It is preventable and reversible!!!! Undisturbed plaque can lead to calculus and gingivitis. Gingivitis is present prior to periodontal disease and is characterized by erythema and bleeding. Plaque is the disease causing mechanism for periodontal disease.
Plaque is the soft gelatinous matrix consisting of bacteria and bacterial by-products. Plaque starts with a biofilm and is usually clear to light yellow. This biofilm begins to form within 20 minutes of a professional dental cleaning. You may need to use disclosing agents to visualize. Subgingival plaque can create destruction of the periodontium. As the plaque grows below the gumline, the bacteria morph into gram negative anaerobic bacteria. These black pigmented anaerobic bacteria species have been identified as: Porphyromonas gulae Porphyromonas salivosa Porphyromonas denticanis.
These bacteria produce and release inflammatory mediators and cytokines that activate neutrophils and release proteolytic enzymes. All the factors result in destruction of the epithelial tissues which increase sulcus depth thus destroying the periodontal ligament and eventually the alveolor bone is destroyed.
Dogs and cats can develop periodontal infections as early as 6-8 month of age but with good home care and regular professional cleanings the pet can maintain oral health well in their senior years!
Calculus is calcified plaque and forms within 48 hours if the plaque is not disturbed. Calculus itself is fairly inert and is not an indicator of dental disease. The rough surface of the calculus does give the tooth more surface area for more plaque to adhere. The amount of calculus present on the teeth is an indicator or a professional dental cleaning but more emphasis should be placed on the appearance of the gingival tissues.
Referral is not a bad word. Not every practitioner can be an expert at every single procedure performed in veterinary medicine. Clients appreciate that fact and would rather get the best treatment for their pet and often that is at the hands of a specialist. Never judge or predetermine what your owners will be willing to pay for, you will often be proved wrong. It is best practice to offer the opportunity for a referral to your clients because if they find out later that it was a possibility and you didn’t offer it, your doctor can be sue for veterinary malpractice. Offer the referral and let the owners decide if they want to accept.
Unfortunately, many clients believe that all that is needed to keep their pets teeth white and healthy is to feed a hard kibble diet. Many dental studies have shown that simply feeding a hard kibble is not as effective as feeding a specially designed dental diet. Most kibbles are simply too hard causing the kibble to immediately fracture when the animal bites into it resulting in no mechanical cleansing action to the tooth or the kibble is so small that the pet swallows it whole without chewing.
As veterinary health professionals, it is our job to promote dentistry and give accurate information. How can we do this? The use of dental report cards, giving out toothbrushes and sample packets are just a few ways to promote the services you offer. The technician is responsible for client education. Start this education process with your clients at the puppy or kitten visits. Talk with them about the importance of good oral care by expressing the fact that the mouth is a mirror to the body. Give handouts explaining the relationship between oral disease and systemic health. Pictures are worth a thousand words. Use them!!!
Before you prescribe home care for a patient, it is important to assess the client and the animal. Is the owner ready, willing and able to perform proper home care? Are they committed, interested and physically able provide care? Does the pet have the temperament to allow for home care? Don’t assume that just because you give the client information about home care and oral health that they will actually provide that care once they get home. Frequent rechecks is one way ensuring that your recommendations are followed. Some clients may be motivated by having just paid for a dental cleaning procedure. It is a good practice to offer more than one type of home care for the pet. Tooth brushing is the gold standard but not everyone can brush their pets teeth or do so everyday so offer a good options to provide dental cleaning on the days that are missed.
There are some clients that are happy to leave all the decisions to the professionals; however education can be improved by letting the client be involved in the treatment plan. Review dental charts and radiographs with them. This reinforces the importance of the problem to the client. Be sure to explain the problem in terms that appropriate in order to ensure your client understands.
When promoting prevention of dental disease, a great tool that can be used to help promote dentistry is to involve the kids. As we teach children to brush their own teeth, we can teach them to brush the pet’s teeth. This helps build the bond between the child and the dog and can teach the child responsibility providing the child is old enough to accept the responsibility.
It can be a mistake to assume that your clients will know how to brush their pet’s teeth. Technicians need to demonstrate oral cleansing techniques to the client. Be sure to use a soft bristled brush or gauze. Use a 45 degree angle to the tooth and circular motion. This can be done on the owner’s pet or a clinic pet. Demonstrate on one side and observe the client brushing the other side. By doing this, you are able to evaluate their techniques and offer suggestions and tips. If you use the owner’s pet, you are also able to access the pet’s temperament and acceptance of the tooth brushing. Give the client your card so they can call if they have problems or concerns.
An area of home care that holds the largest amount of myths is the multitude of consumer products that claim to whiten or clean teeth. It is the veterinary staff’s job to dispel these myths. Clients need to be warned to beware of products that claim to aid in dental health. Claims such as; “Veterinarian Recommended”, “Cleans Teeth and Freshens Breath”, “Whitens teeth”, need to be backed by solid research. Unfortunately there is no regulation of claims for over the counter products. Veterinary professionals need to ask for the research results to prove the product will be efficacious. The idea of evidence based research is becoming more and more popular. There are four grades of evidence based veterinary dentistry which are based upon the design of the research study that was conducted.
- Grade I – properly designed, randomized, controlled studies conducted in target species
- Grade II – properly designed, randomized, controlled studies conducted in target species in a laboratory study
- Grade III – appropriately controlled & designed studies, nonrandomized, using acceptable models of disease or simulations in targeted species
- Grade IV – studies in other species, reports from experts committees, case reports, opinions based on clinical experience
In 1997 a group of Veterinary Dental Health specialists formed a group called the Veterinary Oral Health Council (VOHC). This council rewards products that claim to provide some type of oral benefit a seal of approval. This seal of approval was based on the American Dental Seal of Approval currently used for human products. At this time, 29 products have been awarded this seal. The companies that have applied for this seal have tested their products using very strict protocols developed by the VOHC. Products that have this seal have good science behind them and have proven that they work. Look of it!!!! A complete product list can be found at www.vohc.org
Appropriate Chews and Toys:
Warn clients about the risks of offering items such as antlers, bully sticks, and other extremely hard toys to their pets. The dog mandible does not shift side to side like a human mandible. Therefore when a pet chews on an extremely hard toy or product it results in shearing fractures of the carnassial teeth. These fractures often go unnoticed and often result in abscess formation. A simple rule of thumb for appropriate chew toys for a pet is if you can’t easily bend it with your hands or if you could pound a nail in the wall with it, it is too hard for your dog.
Pain management is more than the latest popular terminology. It is an important part of veterinary dentistry. The fact that animals feel pain has been established and oral pain can cause an animal to be lethargic and listless. The anatomical structures and neurophysiologic mechanisms in humans and animals are very similar meaning that what is painful to us is painful to animals. Many of the procedures performed on animals are painful and it is our duty as technicians to ensure that our patients are as comfortable as possible. The delivery of local nerve blocks prior to performing many dental procedures or oral surgery is a great way to create preemptive analgesia. This can often be incorporated into a multimodal plan for pain control.
Broken teeth do cause pain and may lead to an abscess or infection. Dogs and cats are experts at masking pain and don’t want us to know when something is hurting them. Many times this signs of pain are very subtle and may progress over time causing it to be difficult for an owner to notice. Very few things including oral pain will cause an animal not to eat but signs or oral pain can be head shying, chewing on one side of the mouth, dropping food, heavy salivation and malodor. Veterinarians and staff should take a proactive stance of recognizing signs of pain in pets.
Anesthesia Free Dentistry:
Yes, tartar can be removed from the crown of the teeth with little to no anesthesia however the disease causing mechanism of periodontal disease is plaque and specifically the plaque that is below the gumline. This plaque and tartar cannot be removed without a surgical stage of anesthesia. Cleaning only the crowns of the teeth without going below the gumline does not help the animal at all. Yes, the teeth are white and clean but the destructive infection is lurking below the gumline.
Age is not a Disease:
My dog is too old for anesthesia. This is a myth! Age is not a disease; it is just a natural consequence of not dying! Older animal can and should have regular professional teeth cleanings. Even animals with changes in kidney values should have a good dental cleaning performed. Many times a good cleaning and removing the chronic oral infection can cause the kidney values to improve. Changes must be made to the anesthetic protocol and the patient (all dental patients) MUST have a dedicated trained anesthetist monitoring the pet during the procedure. If your veterinarian does not feel comfortable performing these procedures on older pets, refer the patient to a practice that has the advance equipment and training necessary to perform the procedure.
There are many myths about dental disease and treatment. Learn the facts and offer your patients the best possible care.