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VETERINARY DENTISTRY AND ORAL HEALTH CARE

Veterinary dentistry has made amazing progress in the past 20 years.  Every day, all across America, veterinarians and veterinary technicians are helping dogs and cats to live healthier lives through oral health care education and by performing dental procedures.  To help us understand more about oral health care of pets we asked David Jones, DVM, a few questions.  Join us... 

A conversation with David Jones, DVM, a Resident in Veterinary Dentistry and Oral Surgery at the 
School of Veterinary Medicine, University of Wisconsin, Madison...

Question:  In your experience, Dr. Jones, what are the most health impacting effects of poor oral hygiene on the dog?

Poor oral hygiene in dogs results in periodontal disease.  Periodontal disease is damage to or inflammation involving the tissues around the teeth (gingiva, periodontal ligament, alveolar bone) and results in loss of attachment of the teeth to those tissues.  Regarding health impacting effects there is not a lot of research in dogs that shows a direct correlation between periodontal disease and health problems in dogs – probably because there has been very little in the way of research done in dogs about this.  There has been a good deal of research in humans regarding correlation between periodontal disease and health problems.  One study (DeStefano F, Andra RF, Kahn HS, et al. “Dental disease and risk of coronary heart disease and mortality” British Medical Journal 1993; 306: 688) illustrated an association between poor oral health and general mortality – people with significant periodontal disease were 2.6 times more likely to die before their tenth year in the study as compared to those individuals with good oral health.  Another research group (Mattila KJ, Nieminen MS, Valtonen VV, et al. “Association between dental health and acute myocardial infarction”. British Medical Journal 1989298:779) found a link between dental infections and acute myocardial infarction and cerebral infarction. 

Periodontal disease in dogs often results in the loss of so much of the attachment that the tooth becomes loosened and non-functional, or is lost (extracted or falls out).  On other occasions, the tooth stays in place and stable, but the periodontal disease reaches the apex of the root, and bacterial infection destroys the pulp tissue inside the tooth (periodontic-endodontic disease).  Once a bacterial infection becomes established inside of the tooth it can cause an abscess involving the bone and soft tissues around the tooth.  This may result in clinical signs of swelling, heat, mucopurulent discharge (pus) and pain; there may also be the development of an oral-nasal fistula (a communication between the oral cavity and the nasal cavity) if this lesion involves the upper corner incisors or canine teeth.  If the infection involves the first molar tooth on the mandible, it may cause enough destruction to the bone of the lower jaw to cause a pathologic fracture.    

Research in dogs and in humans has shown that when the teeth are cleaned a number of bacteria find their way into the circulatory system.  It will be considered speculation until there is research data in dogs to substantiate the supposition that chronic infection of the periodontal tissues allows bacteria access to the circulatory system resulting in seeding of the internal organs (heart, kidneys, liver) and the development of endocarditis, pyelonephritis, hepatitis, or other diseases associated with bacteremia. 

People that have gingivitis and periodontitis report that it is painful.  Unfortunately with the majority of dogs neglect is the norm when it comes to the health of the mouth.  When dogs are presented for a dental cleaning, often they have substantial gingivitis and periodontitis, and almost certainly have been enduring significant discomfort or pain.  Even if the effects of gingivitis and periodontitis in dogs are limited to pain and discomfort it represents an unnecessary deterioration in the quality of life of man’s best friends. 

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Question:  Do you notice any relationship between the dog's diet (meat-based versus grain-based, for example) and oral health?

In terms of diet it has not been reported (and it has not been my observation) that there are significant differences between most commercially prepared dry kibble diets that make a difference in oral health.  There are a couple of notable exceptions – first the Hill’s T/D diet is prepared in such a way that in order to break up the food a dog has to sink it’s teeth deeply into the biscuit which scrapes on the tooth and helps to remove plaque and debris.  This of course involves cooperation on the part of the dog in that it has to chew the biscuit – some food motivated dogs however just swallow these large kibbles without chewing, which makes it just a more expensive form of good nutrition (but not better for the teeth). 

The other exception is what Eukanuba has done with their diets in order to promote oral health – the “Eukanuba Dental Defense System” is essentially that they have incorporated Sodium Hexametaphosphate (HMP) into all of their diets.  HMP has been shown to slow the rate at which plaque turns into calculus.  Plaque is soft and in this state it is easily removed from the surface of the tooth by brushing or chewing.  When plaque has minerals deposited into the matrix it becomes very hard and adherent to the tooth (calculus).  Laboratory tests that have been done by Eukanuba show a difference in the rate of accumulation of calculus between dogs eating the diet supplemented with HMP and those eating a diet without HMP.  The commercial product has only been available in the last 4 months, so it is still early to know how much of a difference this diet will make with regard to oral health in the general dog population.  

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Question:  Does chronic oral infection stress the immune systems of the dog adversely?

That is a good question – there is no definitive research showing specifically that chronic infection in the oral cavity of dogs causes suppression or development of an inappropriate immune response.  (Please see the response above about bacteremia).  

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Question:  Many dog owners have the notion that the dog is "too old" to be anesthetized for dental procedures and elect to do nothing even in the presence of severe oral pathology.  How do you respond to that client and what would be best for the patient?

Anesthesia is the biggest barrier to providing appropriate dental care for pets of all ages, not just our canine senior citizens.  We have all heard stories about pets that have had problems or died under anesthesia.  Fifteen or twenty years ago many of these concerns would be valid reasons for not proceeding with an elective procedure in an older pet.  Things have changed fortunately, for dogs having anesthesia today.  Contemporary anesthesia that is being done for dogs today is much safer in several ways.  

First, pre-anesthetic testing helps us to recognize those pets that are having functional problems that aren’t yet recognizable at a clinical level, and allows for stabilization or further work-up as indicated.  

Second, inhalant gas (Halothane, Isoflurane, Sevoflurane) is a much safer arrangement than using injectible agents to achieve an appropriate plane of anesthesia and having a cuffed endotracheal tube in the trachea prevents aspiration of fluids or vomit.  

Third, monitoring has changed from watching to see if the dog is breathing to tracking pulse rate and quality, oxygen saturation, blood pressure, respiratory rate, carbon dioxide levels, and electrical rhythm of the heart.  When pets are being monitored appropriately it allows veterinarians and technicians to detect trends and initiate therapy to avoid anesthetic problems.  

Fourth, many veterinarians are using fluid therapy delivered by intravenous catheter during anesthesia to maintain vascular volume and blood pressure, ensuring that dogs will go home with the same number of viable brain and kidney cells that they had before anesthesia.  Many hospitals also use thermal support such as warmed water blankets or Bair Huggers (warm air blankets) for dogs during anesthesia because many dogs (especially small ones) can become hypothermic changing the rate at which drugs are metabolized or excreted.  Dogs kept warm during anesthesia have a more predictable response to anesthetic agents and recover more quickly than do hypothermic dogs. 

Age is not a disease, and mature dogs that are otherwise healthy are generally able to tolerate anesthesia for an elective procedure.  It is important to not misrepresent anesthesia to clients – there is a very small but real risk to the dog.  Even though anesthesia safety will continue to improve, there will never be a time when there is no risk.  The question is really whether the level of risk is appropriately measured against the damage to the dog’s quality of life if it does not have a dental procedure.  

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QUESTION:  Any tips for dog owners to prevent poor oral hygiene such as Nylabones, routine brushing, rawhide chewies, etc?

This is a question that is frequently comes up with owners.  There is no question that chewing helps to scrape off plaque and debris from the teeth.  Some people give bones to their dogs in order to help keep the teeth clean.  Although many dogs will do well with this approach, a number of them will break their teeth on bones, so I can’t recommend to clients giving bones to their dogs (and I don’t give bones to my own dog).  {See a presentation about the dangers of feeding bones here. TJD}  There are many chew items marketed for dogs to help reduce development of calculus, and many of them are hard enough that some chewing-motivated dogs will be able to break their teeth on them.  The only items that are apparently safe for dogs (with otherwise undamaged teeth) are flat rawhide chews (such as CET chews or Chew-Eez) and rubber chew items such as Kong toys – keep in mind that dogs should only be given these items when they are being directly supervised, as some will try to eat and swallow the object whole.  {To see some dental products that are safe for pets, look here. TJD}

Click on an image below to see a full sized photo BRUSHING YOUR DOG'S TEETH CAN BE FUN!

Many people would really like to solve their dog’s oral health issues by giving a chew item or treat, however daily brushing of dog’s teeth remains the best way to remove plaque and slow the accumulation and development of calculus.  Also, owners who are looking in their dog’s mouths on a daily basis will be more likely to find problems before they get serious enough to cause lasting problems.  Regularly brushing the teeth requires exceptional commitment on the part of the owners, but yields the best benefits for the dog. 

ThePetCenter.com wishes to say... "Thank you Dr. Jones".

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