Chew on This

Today hasn’t gone as Bill Rosenblad, V95, had planned. An emergency has cropped up: a 16-year-old cat with heart, lung, kidney and adrenal gland disease is being prepped for a tooth extraction, and Rosenblad, an oral surgeon, needs to see her safely through the procedure and recovery.

And while it may seem ill-advised to anesthetize an animal with multiple chronic health conditions for a procedure that may, on the surface, appear frivolous, veterinary dentists would disagree. Most vets wouldn’t hesitate to put critically ill or infirm pets under anesthesia to treat dental disease. That’s because in animals—just like in people—good oral health is conducive to overall health and quality of life.

“If you made a list of the things that are right with this cat, it would be much shorter than the list of what’s wrong,” says Rosenblad, the head of dentistry and oral medicine and surgery at Angell Animal Medical Center in Boston. “But she has an upper canine tooth that is in such bad shape that it’s soon going to stop her from eating. And this cat cannot afford to lose any more weight, given her extensive medical issues.”

Even so, a recent American Animal Hospital Association study found that two-thirds of dog and cat owners do not take care of their animals’ teeth.

Veterinarians take their cues from human dentistry when it comes to determining how pets’ oral health affects everything else in their bodies. In humans, researchers have documented the link between dental disease and conditions that affect the brain, heart, liver, kidney, lung, skin and joints.

Dental health also can play a part in controlling diabetes in pets, notes Jean Joo, who performs advanced periodontal treatment, oral surgery and restorative work at the Cummings School of Veterinary Medicine and at Tufts VETS in Walpole, Mass.

“Chronic inflammation and stress, both of which are consequences of dental disease, are two of the biggest factors in causing the insulin resistance” that leads to diabetes, says Joo. “In quite a few cases we’ve seen pets with fetid mouths and hard-to-control diabetes. Often, once we clean up these pets’ mouths, their insulin needs go down within just a few weeks.”

Dental disease likely plays a part in animal health issues that are still not well understood, says Andrea Moolenbeek, V98, chief of staff at the Natick Animal Clinic in Natick, Mass. Oral health problems “may be why cats have so much unexplained kidney disease,” she says. “Kidneys are the filters of the bloodstream, and if a cat’s mouth is constantly shedding bacteria, that has to hurt that system.”

Equal Opportunity Bacteria

Some 80 percent of dogs and 70 percent of cats show signs of oral disease by age three, according to the American Veterinary Dental Society. However, problems can start at a much younger age. “I have taken puppy or kitten teeth out of animals that are six or seven months of age, and there is already tartar buildup,” notes Rosenblad, who teaches veterinary dentistry at Tufts and is president of the Veterinary Alumni Association.

Just as in humans, tartar begins life in the mouth as plaque, a film of bacteria that can be scrubbed away by brushing (and, to some extent, chewing). But in less than 36 hours, plaque can harden into tartar, which in turn leads to gum disease. As tartar accumulates unchecked, infection attacks areas around a tooth root, destroying the surrounding tissues and the bony socket that holds the tooth in place.

Although cats and dogs have evolved to be experts at masking discomfort (in the wild, any sign of weakness can lead to lower standing in the pack hierarchy or to being seen as prey, not predator), the progression of oral disease is pretty painful.

Small dogs tend to do less of the recreational chewing that fights plaque buildup. And because their teeth are proportionately larger given the smaller size of their heads, they have more tooth crowding above the gum, which creates more pockets for tartar and bacteria to marinate. This causes periodontal disease, which, unlike its precursor gingivitis, is irreversible and eventually erodes the jaw bones that support the teeth. Small dogs also have less bone to lose.

“They can go from tooth loss to jaw fractures at a remarkably young age,” notes Rosenblad. “I’ve seen it happen in small dogs that are a year-and-a-half old.”

Round-headed breeds of dogs—pugs, Boston terriers, boxers and bulldogs—have even more tooth crowding than other small breeds. Their teeth “tend to be stacked on top of each other, rotated at least 90 degrees,” explains Joo. These abnormal tooth positions cause an abnormal gum line and, consequently, a greater risk for periodontal disease.

Large dogs tend to fracture teeth while chewing on things that are too hard. Because of the pain, these dogs often switch to chewing on the opposite side of their mouths—and break the same tooth on the other side.

Most cats experience the same dental problems that small dogs do. However, cats that eat only canned food are at an even higher risk for oral disease because they’re not chomping on the dry food that reduces plaque buildup.

And despite the best preventive dental care, some cats experience what is known as tooth resorption, an extremely painful condition in which lesions erode the tooth enamel and eventually attack the dentin and the pulp canal containing the tooth’s blood vessels and nerves. The only treatment is to extract the tooth. Why resorptive lesions appear in some cats and not others remains a mystery.

Basic Tooth Care

Fortunately, you can take some simple steps to prevent dental disease in your pet—and it’s actually pretty easy, compared with wrangling with your toddler over tooth brushing or even keeping up with your own flossing.

“You don’t have to brush for two or three minutes at a time because you don’t need to worry about cavities,” explains Rosenblad. Dogs, he notes, get cavities much less frequently than humans. Cats are even luckier: they don’t get them at all.

“You’re just looking for plaque removal,” Rosenblad says of the daily brushing regimen. “It’s mouth closed, with circular motions along the outside of the upper teeth. My cats get only eight seconds of brushing a day,” which is plenty, he says.

To get started, choose a soft-bristled, appropriately sized toothbrush (the finger caps also sold at pet stores won’t get under the gum line). A veterinary toothpaste flavored with poultry, salmon, malt or peanut butter can help make cleaning more palatable to your pet.

While most pet toothpastes have some anti-plaque ingredients, they do not contain the fluoride or foaming agents found in human toothpastes. Veterinarians caution that you should never use human toothpaste on your pet because it can cause heavy-metal toxicity (from the fluoride) and gastrointestinal upset. You also shouldn’t use baking soda, which is high in salt and can harm pets with heart or kidney disease.

Begin by offering your dog or cat a taste of the veterinary toothpaste. The next time, after your pet tastes the toothpaste, run your finger along the gum line of the upper teeth. The following day, repeat the process with the toothbrush.

To make brushing even easier, associate those eight seconds with a treat. For dogs, keep a toothbrush next to their leash or the treat jar, and then brush before a walk or snack. With cats, brush their teeth during lap time or before play time or a treat. Pets can actually enjoy their daily cleaning. Rosenblad cites one older Abyssinian cat that sits on her owner’s chest if she doesn’t get her nightly brushing.

Food and some chew treats can also aid in plaque removal, but be sure you learn which ones actually help, which do nothing and which do harm. The Veterinary Oral Health Council website lists foods and products that have been independently evaluated and shown to stem the growth of plaque. A word of caution: Joo says you can’t rely on dental claims found on the labels of treats and other products, because these aren’t regulated.

Generally, though, dry food is better than canned because the act of chewing produces saliva—nature’s own system for cleansing the mouth of harmful bacteria—and hard food particles help clean the teeth.

There is a short list of items you should never give your pet to chew on: animal bones of any kind; some nylabones (if you can’t flex the nylabone or stick a fingernail into it, it’s too hard); and hooves. “Those three types of chew treats give me more business in fractured teeth than I care to say,” says Rosenblad. “There’s a misconception that they are going to remove tartar, when they are actually going to remove teeth.”

Appropriate chew treats include bully sticks, biscuit-type treats and dental sticks. When choosing a treat for your dog, Rosenblad recommends picking one that appears almost cartoonishly too large—to make sure your dog gets the plaque-removing benefit of actually chewing the treat instead of wolfing it down whole.

Regular Checkups

Just as human dentists recommend regular cleanings no matter how much we brush and floss between visits, brushing your pet’s teeth at home may not completely eliminate the need for a professional cleaning.

“Dental disease is progressive, so treating it right away keeps it to just a cleaning, which is a less expensive, shorter procedure that’s needed less frequently,” says Rosenblad.

A dental exam should be part of your pet’s regular physical checkup. Your vet may be able to spot fractured teeth, evidence of resorptive lesions in cats, gum recession and some level of gum disease or tartar buildup. Based on that, your vet may recommend your pet be scheduled for a professional cleaning or dental procedure, usually a one-day outpatient affair.

Although owners are justifiably cautious about the use of anesthesia, dental procedures cannot be properly performed when an animal is awake.

“Anesthesia is a necessity because not all dental disease is on the tooth’s surface,” says Rosenblad. “The disease that’s going to cause tooth loss and systemic disease is what’s going on below the gum line or within the teeth themselves—particularly with cats. You also cannot take radiographs on an awake animal. Pets are not going to hold a bitewing [for X-rays].”

Effectiveness aside, you also want your pet asleep during a dental procedure for safety’s sake. The instruments used to clean the teeth are sharp and can cause major tissue damage or even break a tooth should an animal move suddenly. Pet dentistry is also a fairly wet operation, and pets aren’t very good at rinsing and spitting.

In addition to the cleaning, polishing and X-rays, it is not uncommon to have pets’ teeth extracted as part of routine dental care. Many owners worry about just how their pets will manage to eat with missing teeth. The good news is your pet likely can afford to lose all its teeth if necessary (although that’s no excuse for avoiding dental care).

“If you watch them eat, most dogs and cats don’t really chew their food,” says Joo. “Their teeth aren’t designed to grind dried kibble; they’re meant to shear and tear off flesh. So cats and dogs don’t need to go on soft food just because they lose a few, or even many teeth.”

And although your veterinarian can handle most of your pet’s routine dental care, including extractions, more complicated cases may require a specialist.

Take the canine P4 tooth, a large, upper chewing tooth located toward the back of the mouth.

“It’s a tooth that everyone seems to hate to extract, and not everybody has the equipment to do it,” says Joo, who compares the canine procedure to removing impacted wisdom teeth in humans. Because the P4 has three roots that angle outward, “it’s really well-designed to stay in the mouth,” Joo says. “But unfortunately, it’s one of the most common teeth that dogs break.”

Joo also receives a good number of referrals to remove upper and lower canine teeth, which have deep, curved roots that can fracture the bones in the nasal cavity or jaw if extracted incorrectly.

Moolenbeek, who has referred about 20 cases to Joo, says she sends patients to Tufts if they have health issues that would be complicated by anesthesia or if there’s a tumor or cyst in the oral cavity that’s going to require fairly extensive surgery. “I also refer patients for endodontics, as we don’t do any root canals, crowns or restorative work,” she says.

A happy, healthy pet is the best reason for regular dental care. “Ninety-nine percent of the time, when I do a dental procedure on a dog or cat, the owners tells me that their pet feels better, eats better and is more playful,” says Moolenbeek.

“Everybody wins,” adds Rosenblad. “A pet’s immune system is no longer having to work as hard. Their pain system isn’t working hard. And given that a dog or cat’s sense of smell is many, many more times potent than ours, if their breath smelled to us, what must it have smelled like to them?” he adds. “Getting rid of that bad breath must feel like quitting smoking after a thousand years to a cat or dog.”