Is it safe?

Photo courtesy: Prashant_sh@Flickr

Photo courtesy: Prashant_sh@Flickr (October 4, 2012)

In the movie Cast Away, Tom Hanks is a Fedex employee who survives a plane crash and finds himself stranded alone on a deserted island.  After years he has learned how to survive and “make fire”.  At one point during this nail biter, he develops an abscessed tooth.  The pain becomes so unbearable that he resorts to using the blade from a found ice skate to knock the infected tooth out of his mouth.  It still makes me queasy just imagining that scene. 

To get to the root of the cause of my dentaphobia -- that rests squarely on a movie from my formative years in the 1970’s in which the phrase “is it safe?” was the theme of torture and clove oil was the remedy (good trivia question).

It is with this inner feeling that I approach our patients with dental disease.  If you have ever known anyone with a “bad tooth” they will tell you how overwhelming it is.  Forget sleeping, eating, working or living.  All you want is for the pain to stop.  You will, I guarantee, bite the bullet and see your dentist ASAP.  It is with this same urgency I would suggest to you to treat your pets with dental disease, who often times will not complain as I expressed in my last blog.  It still amazes us how our pets go about their daily routine with not one, but many abscessed teeth. 

Signs may be very subtle; slight decrease in appetite, chewing with one side of their mouth, excessive drooling, or bleeding from the gums, often none of these.  Our most common complaint is bad breath, but by the time this occurs it usually indicates raging infection.  However, like humans, some individuals just have bad breath with no decay due to the type of bacterial flora in their mouth. A true full-blown abscess of one of the larger molars in the back of the mouth will often result in a sudden swelling under the eye the size of a walnut which may even ooze or bleed. This obviously requires immediate medical attention.

Imagine what our teeth would look like if we didn’t brush and didn’t see a dentist for 7 years.  I asked my dentist, Dr. Campbell (who uses clove oil instead of torture most of the time) if he has ever seen a patient like this, and not to put words into his mouth, I guess it’s not pretty.  Remember, this is what’s happening to our pets.  Decay starts out with bacteria and soft layers of plaque attaching to the tooth which later hardens into the cement-like brown covering we see, called calculus.  You can brush off the plaque, but once it has advanced to calculus, it must be scaled off with hand or ultrasonic instruments. 

We obviously prefer to just clean our pets’ teeth before the decay gets to the point that it requires extracting and pulling teeth.  A real dental cleaning absolutely requires anesthesia, complete exam of the oral cavity, hand and ultrasonic scaling of the teeth (above and under the gumline), full mouth radiographs (x-rays), extractions or endodontics of infected or non-viable teeth, fluoride treatment and antibiotics with pain medication if needed. Bonding can even be applied to teeth with exposed dentin layers to save the tooth from being extracted in the future. This comes straight from the horse’s mouth, Dr. Tony Woodward, a Board Certified Veterinary Dentist in Colorado, who lectures around the country and who we visited with this past spring.

Since we have been including full mouth radiographs in our dentals, hardly a cleaning goes by that we don’t find something that we would have never known.  Fractured roots, periodontal disease under the gum line, loss of bone, abscesses that we can’t detect visually, all of which affect our pets’ general health and especially the pain they experience.  Gone are the days of “if it’s loose, pull it”. 

One of the most common concerns from our clients when we advise a dental is the fact that we may have to extract some teeth; in fact they beg us not to pull any.  I would suggest quite the opposite.  Why would you want to keep a tooth, which is abscessed, rotting and painful in the mouth at all?  The body is actually trying to get rid of it.  Much like an oozing sliver in your finger, it is a huge relief to get it out.  The result of being pain free has our client saying “he’s like a new dog” or “I didn’t realize he was in that much pain”.  I will say that years ago it was like pulling teeth to get a client to have a dental on their pet, which doesn’t seem to be the case any more.

It is interesting how varied our patients can be in developing dental disease.  We have dogs and cats that are ten years old with “pearly whites” never having had a dental prophy, and with all their teeth, and yet the next patient we see is a 4 year old with a rotting, abscessed, mouth of decay.  Smaller and toy breeds dogs are hugely more prone to decay due to their shorter tooth roots.  A 2-3 mm loss of gum tissue or bone in a toy breed may be half the length of their tooth root versus a large breed in which that loss is comparably insignificant.  Therefore, smaller breed will require much more frequent dental care.  Cats have a unique disease that requires extractions (sometimes full mouth extractions of all the teeth) due to Feline Odontoclastic Resoptive Lesions (FORL).  The cause is unknown, but the outer layers of the tooth are progressively destroyed and eroded.

Dogs have 42 teeth, cats have 30 teeth.  Remember, the canine (fang) teeth are for holding prey, the incisors are for ripping flesh off of bones and the molars and premolars are for chewing.  These are the ones we want to save.  We would like to keep them all, but in reality that is unlikely.  If a few need to be extracted due to decay, they will live healthier and happier.  Infected gums and teeth shower the entire body with bacteria that can affect the heart valves, lungs, liver, and kidneys, among other internal organs. 

To keep a healthy mouth in your pet is a life-long commitment.  Brushing your pets’ teeth (start as a puppy) is huge in preventing dental disease.  Using a finger brush and a good dentifrice (not human toothpaste) just a few times a month can make a big difference. Chewing on hard toys also helps keep teeth clean.  You have to balance the benefits and risk of fracturing a tooth with this also.  I am a fan of rawhides for keeping teeth clean, as dogs seem to really work them.  We definitely see the benefits in our office in those who regularly chew them.  Just throw them away when they get small enough to swallow pieces.  Of course hard foods and treats are better than canned or soft foods.  Stay away from the additives for water and mouth washes, etc. that are all marketing hype. I wish it was that easy. 

So far, my two 10-year-old yorkies and 8-year-old Shih Tsu have lost several teeth each.  Remi, our 4-year-old Bulldog, has been lucky so far and lost none, though I never look a gift horse in the mouth. Ok, I don’t know how many idioms or expressions are in this blog, but it is getting long in the tooth.

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