The sequel...

Treating Periodontal Disease.

I like writing two part blogs. It means I don't have to think of a topic for the following week. This week, I am writing again about periodontal disease. Last week we touched on what it was and how it affected your pet. This week we will read about what we can do about it. If you haven't read last week's post you can find it here: Here he goes again...

Again this week I am going to ask that you pass this on to all of your friends with dogs or cats or both! Maintaining a healthy mouth is one of the biggest things we can do to ensure that our pets live longer healthier lives. If you have a twitter account you can share this with your followers by clicking the link provided here: 

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I am going to break the treatment of periodontal disease down into three separate categories. Prevention, Basic Treatment and Surgical Management.

Prevention is the best form of treatment for any condition. When we are talking about periodontal disease we are talking about preventing bacteria from adhering to the tooth surface and hardening the minerals in the saliva into cement like tartar. This can be done in several ways but the absolute best way to do it is to brush your dog's (or your cat's) teeth! I know it sounds silly but our pet's teeth are a lot like our own. If we didn't brush your teeth for several months or years I would imagine they wouldn't be much better than our dog's or cat's teeth. Brushing a pet's teeth takes practice and time. I usually ask people to start by putting a small amount of peanut butter or canned dog/cat food or flavored tooth paste on the brush and letting their dog or cat lick and chew at the bristles. Then we work our way up to brushing over a few weeks. There are also chew toys, water additives and even dry dog and cat foods that reduce tartar but the gold standard of plaque control is still brushing. For clients of ours we are always available to show you how to brush your pet's teeth and give you advice on how to make it easier on you and your pet. This is a picture of me brushing a stray cat's teeth. We have been caring for him while he's been waiting to find a home.

 

Even with the best prevention program we can still expect to have to see the dentist ourselves about once a year. Our pets too then can expect to see their veterinarian once yearly for an annual check up. At this visit your vet may recommend a scaling and polishing to "reset" the mouth and clear away any subgingival plaque or tartar. Please do not take that as a failure on your part to keep periodontal disease at bay. We brush our teeth at least twice daily, floss and use disinfecting mouth rinses and even with all of that we still need to see our dentist at least yearly. When we see our dentist they still manage to find plaque and tartar we have missed. Imagine then how our pet's mouths are after a year of our best attempts at prevention. Basic treatment still involves general anesthesia, a dentist visit is not comfortable for you or I but we know what is happening and expect a little discomfort as they are making our mouths happier places for our teeth to live. our pets don't see it that way and general anesthesia makes this process a lot easier on them. It's also the safest way to do it medically speaking as well. The average scale and polish with full mouth radiographs (everyone gets full mouth dental x rays at Riverside Veterinary Care) takes about 45 minutes. We start with the radiographs and a comprehensive oral exam combined with hand scaling to get a better view of the teeth and subgingival space. From there we will give you a call and let you know what we found. A simple scale and polish then involves ultrasonic scaling of the tooth surfaces above and below the gumline as well as polishing using a pumice flour. Flouride is applied to the teeth and the pet is recovered from anesthesia.  Most pet insurance companies will cover one annual scale and polish. Most pets with good at home prevention do not need annual cleanings at least for the first few years and will probably need annual cleanings as they get older. This is, unfortunately, especially true if they develop other diseases such as diabetes or heart disease. After a basic periodontal treatment I would expect the pet to return to normal eating and activity after 24 hours.

Some dogs and cats, like some people, just seem to have the worst of luck. Even with the best at home preventative care some dogs and cats are going to develop advanced periodontal disease. What's worse about these cases is that these animals often will have beautiful teeth above the gum line and roots and alveolar bone that need serious surgical attention if we are going to keep the mouth healthy. In these cases during that phone call after the x rays and oral exam involves explaining the amount of disease we are finding and letting you know what your options are. Most teeth in a dog's or cat's mouth are not necessary, in fact we can pull all of the teeth out of your pet's mouth and they will do just fine. There are eight teeth that I recommend trying to save if we can. These are the canines and carnassial teeth, those big scissor teeth in the back. Most of the time with most of the teeth I will counsel towards extraction. I will try to save any tooth you want me to try and save but if it isn't one of the big eight I will lean more towards deleting than I will towards treating the tooth. Teeth with periodontal disease including bone loss around the roots will require a surgical approach to the tooth roots by elevating the gums off the tooth and making a flap. We then go in and scale the exposed root surfaces with an ultrasonic scaler. If there is considerable bone and soft tissue damage around the root we may perform a procedure called Guided Tissue Regeneration. This involves placing a matrix around the tooth root and promoting the regrowth of alveolar bone and periodontal ligament. This is surgery and is going to be more time consuming and involved than extracting the tooth. As a result it becomes increasingly more expensive. This is the reason I really only push for periodontal surgery on the big eight teeth. After Periodontal surgery the pet will be on soft food for two weeks. I ask people to stop brushing during this time as well. I like to recheck these pets at two weeks (there is no charge for a dental recheck at Riverside Veterinary Care) and during that visit if you haven't been brushing you can expect me to go over brushing with you. The photos below are representative of the standard approach to periodontal surgery and the closed incision site after. In this particular case you can see that I actually removed the carnassial tooth and treated the tooth next to it.

 

Again I am requesting this week that you please share this week's and last week's blogs with nay friends you have with cats or dogs or both! Your sharing may encourage someone to make their pet's life a bit healthier, happier and longer!

Comments

[Brendon Spaziani]

Better teeth do lead to better health. That applies to both humans and pets; after all, a toothache hurts no matter what species you are. We rely on our teeth to eat, and dental complications can bring forth a series of health issues.

[Fort Collins Colorado Dentist]

Thanks for sharing! I am a dog lover as well and sometimes I do encounter this problem when it comes to their dental health.

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