Dental Primer

by

Ellen & Kismet (GA)

click here to download this primer as a .pdf (adobe acrobat)

Importance of Good Dental Hygiene

All systems of the body work together as a whole to sustain life.  If one system is taxed due to infection or disease, the entire body is affected.  The mouth is the “gateway” to the gastrointestinal tract and plays a vital role in obtaining the nutrition that ultimately provides fuel for the body.  When your pet’s ability to masticate or chew his food properly becomes compromised due to tartar build-up and gingivitis, not only is the digestion process disrupted, but your pet’s overall health is at risk from the multitudes of bacteria proliferating along the gum line.  Thus, it is very important not to dismiss the importance of good oral hygiene.  Periodic dental cleanings are just one step in the process of maintaining clean, healthy teeth and gums.  Following up with a regular regimen of continued oral care is the other.

Signs of Oral Health:  “The Good, the Bad and the Ugly”

Healthy teeth are free of tartar and white to off-white in appearance.  Gums should be firm to the touch, tight along the gum line and pink in coloration.  Some of the signs to look for when determining if a dental cleaning is needed are:

• Tartar Build-up: Tartar is creamy to yellowish-brown in appearance, firmly attached to the teeth and often found caked along the gum line.  Sometimes the build-up is so extensive that the teeth are obscured from view.  It is most often found in the molar region of the mouth. 
• Red and/or swollen gums, sometimes bleeding freely when touched.
• Drooling
• Halitosis, or bad breath
• Pain or favoring one side of the mouth when eating. 

Dental Cleaning or “Prophylaxis”

A veterinary dental cleaning or “prophylaxis” is a more complex process than what one may expect because unlike humans, most cats & dogs must be anesthetized for the procedure.  Depending on the type of anesthesia used, monitoring that is done before, during and after the procedure, whether tooth extractions are necessary and the extra precautions that may be required due to the health status of the patient, the cost of a dental cleaning can vary widely.  A typical dental cleaning procedure consists of the following:

• Pre-Procedural Physical Exam:  may also include blood work or other types of testing to determine the physical fitness of the patient for anesthesia
• Anesthetic Induction and Maintenance
• Tartar Removal and, if needed, Tooth Extraction(s) are usually done at this time
• Polishing
• Fluoride Treatment
• Recovery
• Home care

The “High Risk” Patient

A “high risk” patient is one whose physical fitness is compromised by illness, disease or advanced age and as such, is at a higher risk for anesthesia-induced complications during a procedure.  Some of the more common diseases which put a patient at a higher risk are: Cardiomyopathy, CRF, Diabetes and Hyperthyroidism.  In the same respect, it is these patients that can significantly benefit from a thorough dental cleaning whenever the condition of the mouth is such that the subsequent infections are taxing an already stressed body system.  A veterinarian will carefully weigh the risks vs. benefits when determining the timing of a dental cleaning for these patients.  He or she will often recommend more extensive testing prior to the procedure and will develop a procedural/anesthetic plan best suited for that patient based on those test results and the medical history of the patient.  Some of the more common additions to a high risk patient’s procedural plan are:

·        Extensive Testing: May include more thorough blood work, urinalysis, radiology, etc. prior to the procedure.

·        Fluid Therapy before, during and/or after the procedure:  This may include subcutaneous fluids or placement of an IV catheter and use of a fluid pump for intravenous hydration depending on the needs of the patient.  Extra fluids will help the patient clear the anesthesia more efficiently and thus reduce the length of the recovery time and stress on the body.

·        Closer Monitoring: a patient may require monitoring with devices such as a Doppler for checking blood pressure, Pulse/Oximeter, EKG, Glucometer for spot checks of blood glucose (diabetics), etc before, during and/or after the procedure.  A high risk patient also requires closer physical monitoring by the staff throughout the day.

·        Antibiotics:  A high risk patient is more likely to be sent home with antibiotics as a preventative measure.

Thus, dental cleanings often cost much more for “high risk” or geriatric patients because of the fact that more needs to be done in order to increase the chances of a successful procedure and recovery.  It is always a good idea to talk in depth with the veterinarian about the procedure, to ask questions concerning the risk involved and what will be done to reduce that risk, and to get an estimate as to what the procedure will most likely cost so that there are no surprises at check-out time.

Antibiotics: Reasons Why They May Be Prescribed

A veterinarian will prescribe antibiotics for two reasons:

·        To address a primary infection

·        To prevent a secondary infection

Particularly in the case of the high risk patient, a veterinarian is more likely to prescribe antibiotics to prevent a secondary infection.  The reason why is because oftentimes a high risk patient has a disease which compromises the immune system.  Diabetics, for example, usually have a hard time fighting off infections once they have started and are prone to urinary tract infections due to the amount of glucose in their urine which provides food for bacteria to thrive on.  When the teeth are cleaned, bacteria along the gum line are flushed from the mouth.  In the process, some bacteria may try to grab a foothold in other areas of the body, such as the bladder, kidneys or lungs.  In order to reduce the chance of this happening, a veterinarian will determine a method of antibiotic therapy best suited for a patient’s needs.  For example, sometimes antibiotics are prescribed prior to the procedure and continued for a time afterwards, in other cases, once the procedure is complete.  As with any medication, there is always a risk of side effects with antibiotics.  Some of the more commonly seen symptoms are nausea, vomiting and diarrhea though there are others, depending on the type of antibiotic used, and are usually less common.  Be sure to talk to the veterinarian about the possible side effects for the particular antibiotic prescribed and what to do if your pet exhibits any of those symptoms. 

Home Care

The care your pet receives at home is an essential part of his total recovery from the procedure.  Some tips and ideas to consider are as follows:

• Keeping Your Pet in a Quiet Environment: Even though most of the anesthesia has worn off by the time you have brought your pet home, some of the effects may linger for several hours afterwards.  By keeping stress levels to a minimum, your pet will recover more quickly from both the anesthesia and the experience of being at the vet clinic all day.
• Food:  It is not uncommon for your pet to have a sore mouth after a dental cleaning.  Try offering soft foods such as chicken baby food (no onions), watered down canned food, finely minced meats, etc as a first meal.  As far as dry food is concerned, let your pet tell you when he can tolerate crunching down on kibble once again by leaving a small serving out at all times.  It may be a day or two until your pet consumes dry food once again, but until then, keep offering meals of soft foods at regular intervals. 
• Have Plenty of Fresh, Cool Water Available:  Don’t be surprised if your pet consumes quite a bit of water when first arriving home.  This is not necessarily an indicator that he didn’t receive water or fluids at the clinic, but rather, some pets find cool water soothing to their sore mouths.  Some pets are also reluctant to eat or drink much while at the clinic and will often make up for lost time once they are home. 
• Medications:  If your pet regularly receives medications for other ailments, be sure to discuss with the vet when the next dose should be given.  Sometimes a vet may ask you to skip or reduce a dose that first night home, just in case your pet doesn’t eat well.  If your pet is to receive antibiotics due to the dental, the same holds true.  It is not uncommon for a pet to receive some sort of antibiotic injection at the time of the procedure that will often last for 24 hours – so oral antibiotics may not be needed until the following day.

Practicing Good Oral Hygiene: More than just a “Dental” 

As mentioned before, regular dental cleanings are just one step in the process of practicing good oral hygiene.  In order to keep those teeth and gums healthy for as long as possible in between cleanings, there are several things one can try:

• Brushing Your Pet’s Teeth: Brushing your pet’s teeth on a regular basis is one of the best ways to keep a healthy mouth “healthy”.  There are many “veterinarian approved” toothpastes, gels and styles of brushes available in order to make it easier for the pet owner to complete this onerous task.  Of course, many pets object at first to having their teeth brushed, but with practice and a little patience, some can learn to accept the process with little or no grief. 
• Treats: There are many treats on the market that are labeled as “dental treats” but some are more or less effective than others.  Those that contain enzymes are the most effective and are usually only available through a veterinarian.  Enzymatic treats are one of the easiest methods for keeping tartar build-up to a minimum and a good alternative for those who cannot brush their pet’s teeth.  They can also be used in conjunction with other products to provide even more protection.
• Diets: Several pet food companies have developed diets that are designed to help keep plaque and tartar build-up to a minimum.  The effectiveness of these diets is dependant on many factors, such as a pet’s eating style or preference, and may or may not be beneficial in some cases.  If you are interested, be sure to discuss with your veterinarian beforehand as to whether one of these diets may be beneficial for your pet as sometimes such diets may not be suitable if your pet has compromised liver or kidney function or, in the case of diabetics, a change in diet may require a subsequent change in insulin dosage.
• Water Additives:  There are some enzymatic water additives on the market that can also help with reducing the amount of plaque in your pet’s mouth and thus reducing the amount of tartar build-up over time.  When first trying one of these products, be sure to have an extra source of plain water available just in case your pet objects to the taste of the additive. 

As far as how often a dental needs to be done, it all depends on the pet.  Some need dental cleanings more frequently than others due to a genetic predisposition to dental disease or due to a disease or illness which contributes to poor dental health.  Regular trips to the vet for check-ups are one of the best ways to ensure that the state of your pet’s oral health is being monitored and will help keep small issues from developing into major problems.

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