★Helping you and your pets live healthier, longer lives★ by Dr. Margo Hunt
If so, those two questions likely have the same answer….unless you recently had your pet’s teeth cleaned (as in the past 6-12 months). Of course, I cannot make that judgment on your specific pet I have not examined, but as a rule, pets need regular dental care. Also, in light of a recent 20/20 episode implying that veterinarians are money-grubbing by recommending dental cleanings in pets, I felt compelled to write today’s blog to highlight a few of the reasons we recommend dental cleanings so often (and rightly so!)
First, I would like to ask you a few questions:
Pets are no different. If they have teeth; they require dental hygiene. Some people are diligent about brushing their pet’s teeth twice daily and having dental cleanings performed by their veterinarians every 6 months. But, do not feel alone if you are not one of those people! It is rare to have a pet parent value his pet’s dental health that highly, and may not be exactly what your pet requires…. but if your dog is 6 years old and has never had a dental cleaning, I bet he/she needs it!
It’s true, well, in most cases. Pet parents often wrongly assume that just because their pet is still eating, it does not have significant dental disease. The fact is, few dogs will stop eating because of their dental disease unless it is so severe that they physically cannot eat. I have seen dogs with broken teeth and dangling nerve roots still chomping on kibble twice a day. Cats as well. Most pets with painful dental disease do not show any signs of being in pain. If they do, they are subtle such as a shift in how they chew, and rarely is the correlation made by the pet parent. This does not mean that they are not feeling pain.
Broken teeth hurt.
Any tooth can break, but the “upper fourth premolars” seem to have more than their fair share of fractures. These two teeth (one left and one right) are the largest in the upper arcade and see more load during chewing than the other teeth. For this reason, aggressive chewers or dogs who chew hard bones, rocks, or other objects can often fracture this tooth. This type of “slab” fracture can be overlooked by a pet owner because the tooth is way, way back in the mouth, and if you don’t go looking, you rarely will notice it. Once the enamel has been breeched, extraction (or root canal and crown) is recommended. Since most general veterinarians are not trained in performing root canals, and the procedure can cost around $1500 per tooth, extraction is the more common outcome. Oh, and there are two teeth even farther back, so if you can’t visualize this premolar, good luck checking the molars!
Exposed nerve roots hurt.
Cats just don’t know how to follow the rules of people and dogs. The picture above is of a resorptive lesion (sometimes called a FORL, which stands for Feline Odontoclastic Resorptive Lesion). Resorptive lesions can occur in dogs too, but are much less common than in cats. If you look at this picture and think the tooth looks normal, don’t feel bad. It is rare that pet parents recognize the subtle changes in the enamel when these first develop. In fact, sometimes we can only notice these issues with radiographs. But, I guarantee your cat knows they are there. These are extremely painful! The enamel erodes leaving an exposed, painful nerve root. If this tooth is touched in an awake cat, she will chatter her teeth in pain. There is no known preventative measure or treatment to save these teeth. If your cat has a resorptive lesion, the tooth must be extracted and the sooner the better. Also, expect that she will develop more in the years to come. Not all cats have additional lesions develop, but many do. Finding one FORL, in my opinion, is reason enough to have annual dental cleaning and full-mouth radiographs for the rest of her life.
Oral lesions hurt.
Have you ever had a canker sore? Imagine that sore covering the entire back of your mouth and your gums. The above picture is of a recent patient of mine who by no means has the worst stomatitis/gingivitis/faucitis type lesions I’ve seen in a cat; they can be much worse (but those cats rarely let you get a picture given the severe pain.) Here’s a picture of a cat with severe stomatitis from the American Veterinary Dental College’s website. Looks like it hurts, doesn’t it?
When your pet doesn’t allow an awake examination of its mouth, do not be surprised if your veterinarian recommends sedating him for a good look. Pets often resist an exam of the body part that is diseased, injured, or affected. It is a survival mechanism, and that instinct runs deeply.
No dog or cat in the world will sit still, with its mouth open, for the 30 minutes or more necessary to do a dental cleaning, and certainly not for the radiographs (x-rays) and extractions if those are needed. That is an entirely unreasonable request of your pet and your veterinarian (not to mention our fingers are our livelihood and our equipment is expensive.) Please, do not, under any circumstances, ask your vet to ma
ke an exception to this requirement…. either trust us to give your pet the necessary care, which includes anesthesia, or decline the procedure entirely. There is no middle ground.
And, before someone asks about scaling a pet’s teeth without anesthesia… as some groomers and human dental hygienists do… I will share that that is a very bad idea! In fact, it can cause serious damage to your dog or cat’s mouth, is a liability if your pet bites the person, provides a false sense of accomplishment because the disease below the gumline (which is often significant) is ignored. A thorough oral exam is not possible on an awake animal. Oral masses, disease, and lesions are often missed on physical exams because of this, so do not be surprised if your veterinarian finds a new concern once they’re able to get a good look in your pet’s mouth.
To be honest, no. Veterinary dentistry is a relatively new field. When I was in vet school, 15 years ago, it wasn’t even a class. It was a side topic of the community practice rotation, and in my 2 weeks on that rotation there was exactly one dentistry per
formed on a dog. I scaled one tooth in vet school. I am happy to say that the Colleges of Veterinary Medicine across the country have very thorough dentistry programs today. Once we, as a profession, recognized the significance of dental disease in animals, the knowledge in this area has grown exponentially and pet oral health has improved significantly.
A few years after graduating, when this wave of knowledge hit veterinary medicine, I elected to attend an intensive veterinary dentistry continuing education seminar and lab to learn how to properly perform thorough dental examination, diagnosing oral disease including dental radiographs, cleaning of teeth, and surgical extractions of diseased teeth with sutured gum flap closures. This is oral surgery, and it is an essential part of being a veterinarian today. If I had not learned that information, I would not be comfortable performing dentistries today.
If you want to know if your veterinarian is a skilled dentist, there is one question I would ask, “Will my pet have dental x-rays performed?” The best answer is “Yes, all pets have full-mouth X-rays as a routine part of any dental procedure.” Not all vets believe in taking radiographs of every tooth. It doesn’t mean they’re bad dentists, but it is a less thorough approach to dentistry. If the clinic doesn’t even have the ability to do dental radiographs, I would ask for a referral to a board-certified dentist for all dental procedures, even a simple cleaning. Why? The majority of dental disease occurs below the gumline and without dental radiographs, the veterinarian cannot know whether or not the disease exists. To best avoid additional anesthesia or lingering, undiagnosed disease, this is a safer option. In my opinion, performing a comprehensive oral examination, and certainly an extraction, without dental radiography is malpractice.
I have seen a myriad of dental abilities and competencies among veterinary clinics I have visited in recent years. It is rare to find one with sub-standard abilities, but they do still exist. In one clinic I was visiting, I discovered a labrador had a slab fracture of his upper fourth premolar during a routine annual exam. I was describing a routine extraction of this fractured tooth which involves elevating a gum flap, using a drill to remove the bone that covers the tooth root, sectioning the tooth into three pieces, and delicately removing the roots before suturing the gum over the defect. As I explained this to the dog’s parent, I could see the technician assistant’s eyes grow wide, and she became more uncomfortable with every word I spoke. After we left the exam room, I inquired about her reaction, and she told me that their clinic did not even have a dental drill (let alone dental x-ray), and the regular veterinarian used a mallet and chisel to remove teeth. I was shocked. That was very outdated veterinary care (and I was glad to hear that the dog went elsewhere for his procedure). Again, this is the rare exception as most veterinarians pride themselves on staying up-to-date on all aspects of our profession, but it can happen.
Now, does having dental radiographs mean your veterinarian is an excellent dentist? No, but as with any evaluation of a healthcare provider, you will likely have a gut feel for their competence once you’ve asked a few questions or gotten referrals from friends. Many multi-doctor clinics have some vets who love dentistry (and are very good at it) and other vets who gladly allow those to do the dentistries. So, if your usual veterinarian doesn’t perform your pet’s dentistry, that should not be alarming. We each have our talents and preferences, and may delegate dental procedures to the veterinarians who enjoys that work the most.
Most dental conditions can be addressed by a general veterinarian; however, if your pet has a more complicated condition, you may be referred to a board-certified veterinary dental specialist.
It’s not likely. In veterinary medicine, the old adage that “you get what you pay for” is quite true. I can understand wanting to save money, but an anesthetized, surgical procedure is not the place to cut corners. The standard of care is to perform bloodwork the day of surgery. Sometimes that requirement is waived if the pet has very recent labs on file. An intravenous catheter is placed for anesthetic drugs and fluids to be administered. A thorough cleaning is performed by the veterinarian or dental technician, the oral cavity is examined by the veterinarian, radiographs are performed, and the veterinarian addresses any findings such as fractured teeth or oral masses.
It is not uncommon for discoveries to be made during the procedure. We cannot always see that a tooth is fractured or that bone loss has occurred around the tooth root until the teeth are cleaned and radiographs have been taken. This is why procedures for dental estimates often have a huge range or a disclaimer that the actual procedure could be significantly more expensive than the estimate. It is, after all, only an estimate. It is is not a quote or an exact list of everything that will be recommended during the procedure.
Veterinarians will often ask you, in advance, what your preferences are if new issues are discovered. Would you like us to make a qualified decision regarding what is best for your pet? Would you like to be called during the procedure to make the decision as to whether the disease should be addressed? Or do you decline all additional treatments that aren’t on the original estimate? If you picked the last option, know that you may be ignoring serious disease that is painful for your pet and that it ultimately will cost you more to come back and address those issues in the future. They don’t go away, and adding on an extraction (for example) is much less expensive than repeating the anesthetic event, bloodwork, catheter, radiographs, etc in a few months.
If the procedure needed is routine (not an emergency), ask if your veterinarian offers any dental discounts. Some clinics have “dental discount” months (often in February), or offer other discounts on certain days of the week. It doesn’t hurt to ask!
Photo credits: All images are Copyright AVDC, used with permission. (Exceptions: that cute tabby’s open-mouth photo, I took that… © Margo Hunt, the dog made out of money ©www.startingyourownbusinessovernight.com, and the before/after pix which are ©www.shakervet.com)
Product links: These are the products that I recommend to my clients, my friends and family, and use with my pets. I do not receive any compensation from the companies for making these recommendations. However, if you follow these links to Amazon and purchase the item, I will receive a small commission from Amazon. That doesn’t affect my decision to recommend these products. Rest assured, I will never recommend something to you based on any personal gain. My intention is always to help your pets by offering my best advice.