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Taking the Bite out of Dental Disease  By Dr. Ira R. Luskin  Diplomate, American Veterinary Dental College    Director of Animal Dental Centers of Baltimore and Annapolis  Founder:   The Animal Dental Center The Animal Dental Training Center

Doesn’t it always seem that the most friendly, "up-close to your face and personal" pets are those with the worst breath! Why is it that despite giving our pets crunchy dry food, hard objects, and flossing rope chews, they still have breath that can stop a freight train? How often do we hear from our friends “My cat has stopped eating, her breath is very bad and she might have to lose all of her teeth" or “My dog was just at the vet's and had ten teeth pulled!” or  “My vet said that Fifi’s bad oral health has probably caused the failure of her kidneys but I told him that I brush my pets’ teeth once a week. Shouldn’t that have been adequate?”  Unfortunately, many pet owners  are realizing too late the importance of good oral health for their pets. Sometimes, despite their best intentions, they are sabotaging their pet’s oral health. Why should our pet’s teeth and oral health be any different from our own oral hygiene needs? 

At what age should I be looking at my pet’s mouth for signs of oral problems? 
What should I be looking for and what can be done?

At the beginning… “Baby Teeth”
Puppies and kittens, like people, have a primary or deciduous dentition. This refers to their baby teeth, which usually are all in place by 6-8 weeks of age and which, by 16-24 weeks, are subsequently replaced by the adult teeth.  In this age group we see two types of dental problems occurring... traumatic damage to the baby teeth and oral cavity, and improper eruption of the adult teeth. Unlike the adult, or permanent teeth, the primary teeth (sometimes we call them baby teeth) are very thin and fragile. They are not firmly anchored in place by strong mineralized bone and can easily be broken or pulled out of position. Therefore the most common problems we encounter in this young age group are traumatic injuries, sometimes self-inflicted, sometimes inflicted by well-meaning owners.

Puppies are very oral and enjoy having things in their mouths. Quite honestly, we should avoid the temptation of giving them hard objects, and playing “tug of war” with them. By pulling, we can either fracture or luxate (pull out of position) the primary “canine" or "fang” teeth of our small furry friends. Since the adult fang teeth are developing under the gums close by to where the baby fangs are, these developing adult teeth can also be damaged.  This can cause them to either never erupt or to come up in an improper position. This improper tooth location can cause injury to the mouth’s soft tissue.

Hard objects like “Indestructible Bones”, “Hooves”, sticks and rocks can break teeth. Catching a flying saucer-like play toy in mid-air can also lead to teeth breaking. These types of injuries are very painful and usually result in the tooth dying and may cause an infection or abscess of the bone. Signs of a possible oral problem include difficulty in eating or holding objects, bleeding, or drooling. The bone and overlying  gums will be sensitive to the touch, swollen, and the infection can start a draining abscess – a condition called a “gum boil”. Pet owners should frequently check the animal’s mouth for broken teeth. If any are detected, a veterinarian would immediately extract any of the broken baby teeth.  Kittens, unlike puppies, usually break their baby fangs by running into doors, steps, and walls. Especially on uncarpeted floors where they cannot put on the brakes in time, head trauma is fairly common. In addition to broken teeth, kittens and cats are notorious for chewing on electric cords and ornamental plants-- both of which can cause serious injury to the oral cavity and sometimes death. Poor or no appetite and persistent salivation are often signs of an oral problem. By looking into the kitten’s mouth and checking for any smell, redness, or swelling of the soft tissue, pet owners will often see obvious changes.

Malocclusions:   Teeth that don’t erupt correctly
In addition to trauma, the second most common dental problem seen in young dogs and cats are adult teeth that erupt improperly. This condition is due to either trauma, as previously mentioned, or the presence of persistent baby teeth. Normally, as the permanent tooth erupts, it does so directly under the root of the deciduous (baby) tooth causing it to break  down, which then allows the adult tooth to push it out. Sometimes the bud of the permanent tooth is not directly positioned under its deciduous counterpart. This improper positioning causes the permanent tooth, during its formation, to glide off the baby tooth root and erupt abnormally. The ensuing malpositioned adult tooth traumatizes the soft tissue in the mouth, causing the pet pain and possible subsequent infection. In addition, food often becomes trapped between the baby tooth and adult tooth causing the development of gum infections. The golden rule to follow is: There should never be two of the same tooth type occupying the mouth at the same time. By frequently checking your pet’s teeth between the ages of 14 to 24 weeks of age, any double presence of teeth will be detected and can be immediately corrected by a veterinarian. Never wait for the baby tooth to fall out by itself if you see even the slightest protrusion of the adult crown next to it. If the adult teeth are coming in incorrectly, then a Veterinary dentist should be consulted as soon as possible to prevent further complications. The teeth that are most often affected by the presence of retained baby teeth are the small front incisors and the canine or fang teeth. The lower fang teeth usually come in towards the inside of their deciduous (baby) counterparts. That means they will erupt into the hard palate if the baby fangs do not fall out promptly and are not extracted in time. This condition, if uncorrected by a Dental specialist, will cause a permanent hole in your pet’s hard palate creating a direct connection between the mouth and the nasal cavity. To correct this, the specialist will often construct an acrylic incline plane or “sliding ramp” to allow the inward directed lower fang to be forced out into a normal position. This is a very common occurrence in toy breeds but can occur in all animals. In order to avoid these common oral-dental problems in young animals, pet owners must be very alert. Avoid dangerous hard chew toys and games that can break teeth!  Check your pet’s mouth daily for signs of injury and teeth that are not coming in properly. Animals enjoy having their mouths stroked and played with, thus examining them is very easy.

An acrylic incline plane or “sliding ramp” assists in correcting tooth position.

 

Adult Dogs and Cats:   Dental Fractures
In this mature age group, we see a variety of oral problems that can occur. Fractured teeth, as in young  animals, if left untreated will cause abscesses and facial swellings. The fang teeth or canines, and the most important chewing teeth, the “carnassial” teeth, are often affected.  The carnassial or shearing teeth are the upper 4^th premolars and the lower 1^st molars. They do 90 percent of the animal’s chewing. Because of the tremendous chewing forces that an animal can exert, any indestructible chew toys  can cause these teeth to fracture and expose their nerve centers.  These important chewing teeth if injured should be saved by a Dental specialist rather than extracted. A veterinary dentist will perform a root canal treatment that prevents infection from going up the tooth and into the bone, and also allows the tooth to remain functional. If the tooth’s crown is substantially damaged, the dentist will take impressions and have a dental laboratory cast a metal “Jacket Crown”. The metal crowns are indestructible and will prevent further injury to the tooth. The metal crown’s strength is especially important in very oral dogs, such as the working breeds like  German Shepherds, Dobermans, and Rottweilers, and to the sporting breeds like the Retrievers and Setters. Quite often dogs that have been kenneled or have exhibited separation anxiety damage their teeth by chewing on their cages. The damage that is done occurs on the distal or back surfaces of the teeth. The enamel and dentin are worn down and the tooth appears hook-like. The normally white enamel at these worn areas becomes discolored to yellow or brown. These weakened teeth are more prone to further wear, fracture, and exposure of the root canal. A Veterinary dentist can strengthen the tooth with a ¾ crown, which covers the sides and back area of the tooth with metal and thereby prevents further damage to the tooth.    

Periodontal Disease
The number one disease that affects our pet’s mouth after the age of two is periodontal disease. This is a very slow, insidious disease that affects all of the supporting structures of the teeth. Just as in humans, the accumulation of plaque (food debris and bacteria) on the teeth leads to the gingiva (gums) becoming swollen and inflamed. Bad breath and bleeding red gums are the most consistent signs that the pet owner notices although occasionally, at this early stage of disease, the animal might drop food and rub its mouth as well. The veterinarian can reverse the damage with a proper dental cleaning or “prophy.” Unfortunately, most owners are accustomed to their pet’s bad breath and they think that foul smelling “doggy or kitty breath” is normal. They don’t realize that, during early stages of gum inflammation, the disease can be stopped and their pet’s oral health returned to normal. Pet breath or halitosis is not “normal.” There is a reason for it and that reason needs to be addressed and treated.

Unchecked periodontal disease will continue to wreak havoc. The gums start to recede and the supporting ligaments that hold the tooth to the jawbone and the bone itself becomes damaged. Deep pockets of infection cause pus, bleeding, and pain for our pets. They are more reluctant to chew on hard food and quite often an abscess develops in the gum and jawbone. The animal starts to loose weight, avoids having it’s face or head touched, and seems to become all of a sudden “ much older” overnight. 

This stage of the disease requires the intervention of a dental specialist who is skilled in periodontal therapy and surgery. The specialist will take dental radiographs to determine the degree of bone destruction and disease; radiographs (x-rays) will be beneficial in establishing an appropriate treatment plan to save the animal’s teeth. Often by doing deep root therapy and splinting teeth, the dentist can encourage new supporting bone to form. If nothing is done, the pet will succumb to the final stages of periodontal disease. Due to the advanced destruction of the jawbone, the teeth are lost. In the case of toy breeds, often the lower jaw will fracture because the bone around the teeth is severely damaged. Advanced periodontal disease that affects the upper fang teeth can lead to permanent oro-nasal fistula where the nasal and oral cavity are actually connected. Often the dog has sneezing episodes that lead to nose bleeds. When the tooth finally does fall out, there is a permanent non-healing hole between the mouth and nasal cavity that needs to be surgically repaired. A dental specialist skilled in oral surgery often is summoned to correct an oro-nasal fistula.

It should be obvious that bad breath, secondary to gum disease, is very serious and should be acted upon immediately. In order to prevent this problem, the pet owner should start brushing their pet’s teeth at an early age. It is best to use pet toothpaste that has been formulated to be swallowed, and an appropriate pet toothbrush.  Avoid human tooth paste and Baking Soda.

Brushing and tooth care
Start off by first massaging the pets muzzle with your fingers. When there is no resistance to having their face rubbed, lift up their lips and rub their teeth. One can put the paste initially on the fingers so that your pet can acclimate to the taste (there are numerous flavored pet tooth pastes). Once this is accomplished place the paste on a small beveled pet toothbrush and gently lift the lip and brush the teeth from side to side. Eighty percent of the plaque and tartar are formed on the outside surface of the teeth. With this in mind, keeping the mouth closed while brushing allows a more effective working of the teeth surface with the brush. Most of one’s effort should be concentrated on the back teeth first. Then work your way forward to the front teeth and, if your pet allows, brush the inside surface of all the teeth.

Cat Cavities
Feline Odontoclastic Resorptive Lesions or FORLS are a very common oral disease and occurs in 60 percent of cats. Normally the lesions start after the age of two. The most common signs of FORL are that the cats eagerly approach their food bowls but then walk away without eating. If this behavior continues it inevitably leads to weight loss. These FORLS or “cat cavities” or “Neck (as in neck of the tooth) lesions” are extremely painful. What is happening, usually at the gum line or “neck of the tooth,”  is that activated tooth-eating cells, called odontoclasts, start attacking the teeth. Eventually this leads to the tooth developing a cavity or hole into the root canal that is extremely painful. If left untreated, the crown of the tooth snaps off leaving the roots of the tooth to cause irritation and drainage. This can be likened to a splinter in your finger causing pain and infection.

In addition to noticing weight loss and lack of appetite, if you check your pet’s mouth you will see that the gums in the affected area seem to be growing up and into the teeth. Often if you touch this area, the painful animal will chatter its teeth and bleeding may occur. In the end stage of the disease, a swollen bulging gum where the tooth used to be replaces the missing crown. At the present time, we do not know what causes the tooth-eating odontoclasts to be activated to start destroying the teeth. We do see a higher incidence of the disease in cats with moderate periodontal disease. Siamese and oriental cats have a higher incidence of the disease. Cats that have immune suppressive viruses such as Feline Leukemia “FeLv” or Feline Immunsuppressive Virus “FIV” have a greater tendency to develop the FORLS. At the present time a Veterinary dentist can slow the progression of the tooth destruction by using special fluoride leaching fillings. If the teeth are severely damaged they need to be surgically removed in order to allow for proper healing. To prevent the disease, the current recommendation for pet owners is to brush their cat’s teeth daily and use an unflavored fluoride gel topically on the teeth.

Cancer
Animals eight years and older (less frequently young animals) can develop oral cancer. The third most common site for cancer is the oral cavity. In young animals, problems can involve tumors that affect the teeth directly. Odontomas are tumors that evolve from the tooth bud and, fortunately, are benign and if properly excised by a specialist will not return. If left in the mouth, they can grow and become locally damaging. Occasional checking of your pet’s mouth and comparing your pet’s teeth will help detect this tumor in it’s early stages and allow for timely removal by a Veterinary dentist. Unfortunately, most oral cancers are malignant which means they will not only grow locally but also can often spread or metastasize to other locations. Early detection offers the possibility of complete recovery. However, if the tumor has been present for a longer period of time and has aggressively invaded surrounding tissue, the oral surgeon often can only be palliative in his approach. We do not know at present what causes cancer in our pets. Pet owners that are proactive in their approach to their pet’s oral hygiene often can make early detection and cure of cancer possible.

What is there to be done?
As you can see from this brief cataloging of dental disease in our pets, there is no magic hard biscuit available that will clean our animal’s teeth and prevent oral disease. Our pet’s teeth, like our own, can be damaged and thus require regular appropriate care. Depending on the breed, age, and upbringing, we can have different oral problems to deal with. Very important is the daily care and inspection of our special friend’s mouth. The oral cavity is the gateway to either health or disease. Although our pets cannot talk, they have the same pain thresholds as we do. A broken tooth is painful. Don’t rely on the fact that the animal is eating as a sign that they are not experiencing pain. Quite often by the time they stop eating, the problem has become severe. A long, healthy, comfortable life for our friend can be assured by constant oral attention. It is up to us to guarantee this quality of life for our pets. Being proactive and taking care of problems immediately will help prevent further spreading of problems that can affect other organ systems in the body. “Sink your teeth” into this goal and brush and inspect your pets teeth daily!