Dental disease is a HUGE deal.
Periodontal (gum) disease is the number one diagnosed problem in dogs
and cats. By the age of just two, 80% of dogs and 70% of cats have some
form of periodontal disease. In addition, 10% of dogs have a broken
tooth with pulp (nerve or root canal) exposure. This is extremely
painful until the nerve dies, at which point the tooth becomes infected!
Infectious oral diseases affecting the gums and root canals create
systemic bacteremia (bacteria in the blood stream, which can infect
other parts of the body). Periodontal inflammation and infection have
been linked to numerous problems including heart attacks, strokes,
kidney disease, emphysema, liver disease, osteoporosis, pregnancy
problems and diabetes. Therefore, oral infectious diseases are known as
"the silent killer."
In addition to systemic effects, oral disease can also cause
inflammation to the eye, resulting in blindness. Furthermore, jaw bone
loss from chronic infection can lead to a jaw fracture known as a
pathologic fracture, and these have a very hard time healing. Finally,
infectious oral disease can result in osteomyelitis (an area of dead,
infected bone), nasal infections and an increased risk of oral cancer.
Speaking of oral cancer, the oral cavity is the fourth most common place
for cancer. Unfortunately, by the time that most are discovered, they
are too advanced for therapy. Early treatment is necessary for cure.
That's why you, the pet owner, need to check your pet for oral growths
on a regular basis. Anything suspicious should be shown to your
veterinarian promptly.In cats, a very common problem is feline tooth resorption lesions, which are caused by normal cells called odontoclasts eating away at the cat's own teeth. Approximately half of cats over 6 years of age have at least one. They are similar to cavities in that once they are advanced, they are VERY painful and can become infected. They are first seen as small red areas along the gumline.
Other oral problems include bacterial cavities, painful orthodontic problems, dead teeth (which are commonly discolored), and worn teeth. Almost every pet has some form of painful or infectious oral disease that needs treatment. Unfortunately, there are few to no obvious clinical signs. (See below, What are the warning signs of periodontal disease?) Therefore, be proactive and ask your veterinarian for a complete oral exam, and perform regular monitoring at home.
The first step is to place the patient under general anesthesia. Anesthesia-free dentistry is NOT recommended (see below, Why does a dental cleaning have to be done under anesthesia?),
and is even illegal in some states. Don't be fooled by "sedation"
dentistry. In my opinion, sedation dentistry is more dangerous than
general anesthesia for two main reasons. First, in sedation dentistry
(or any other anesthesia-free dentistry), the trachea (windpipe), and
therefore the lungs, are not protected from the particles generated
during a dental cleaning. These particles are full of bacteria and, if
inhaled, can result in pneumonia.
The other difference between anesthesia and sedation is the
length of effect. Most practices today employ relatively short-acting
agents to put the patient under anesthesia, and then a gas to keep the
patient under anesthesia. If a problem occurs under anesthesia, the
veterinarian can turn off the gas and the patient will recover quickly.
But under sedation, the effects generally do not go away until the drug
is cleared by the system, which can take too long. General anesthesia is
very safe today, thanks to advances in anesthetic drugs, training and
monitoring equipment.A true dental prophylaxis consists of several steps, some more critical than others. The required steps that must be performed include:
- Supragingival scaling: This is the removal of the plaque and calculus above the gumline (what you can see).
- Subgingival scaling: This is the thorough cleaning of the area under the gumline to remove disease-causing bacteria. It is typically performed by hand and is time consuming, but it is the most important step of a dental prophylaxis.
- Polishing: Scaling slightly roughens the teeth. This promotes plaque and calculus attachment and reduces the lasting effect of the cleaning, so the teeth are polished afterward. There has been some controversy about this in human dentistry, due to the loss of enamel with many cleanings over time. However, in veterinary dentistry, with relatively fewer cleanings in an animal's life, this is not a concern.
- Sulcal Lavage: Cleaning and polishing results in debris being caught under the gumline, which must be thoroughly rinsed out.
- Oral exam, periodontal probing and dental charting: This is a critical and often misunderstood part of the dental prophylaxis. There are teeth that cannot be thoroughly examined in a pet who is awake, when periodontal probing is not possible. With the patient under anesthesia, the mouth is thoroughly and systematically examined, and all findings are noted on a dental chart. Any diseased teeth or tissues are then properly treated.
