Q: My pet's tooth is fractured. Can I just watch it to see if it swells or causes pain?
A: If the pulp was exposed, then it needs treatment. A fractured tooth that has exposed the pulp chamber (red or black spot in the middle) requires treatment even when there is no swelling or observable signs of discomfort. The pulp is contaminated or infected. Inflammation travels to the root tip where it causes inflammation, damages the bone and can cause discomfort. Pets usually show no outward signs at all, but inflammation and infection are inevitable.
Q: What are my options for treating a fractured tooth?
A: Root canal treatment or extraction will both provide healing of the damage. Important or very large teeth are best treated with a root canal (endodontically) to keep the tooth in function and to avoid the discomfort of surgical extraction. Small teeth that are less important and require less aggressive surgery to extract them may be best treated by extraction. Here at Harbor Veterinary Hospital we do not perform root canals so if you prefer not to take your pet to a veterinary dentist, we can extract any affected tooth, large or small.
Q: What is a "root canal"?
A: The term "root canal" often refers to the procedure of endodontic treatment of a tooth that has an unhealthy pulp. The pulp is the blood vessels and nerves that are in the center of the tooth and root. The inside of the tooth is called the "pulp cavity" and is made of the "pulp chamber" in the crown of the tooth and the "root canal" that is in the tooth root. A root canal treatment involves removal of the pulp or necrotic debris from the tooth, filing and shaping the root canal space, flushing and disinfecting the inside of the tooth, filling the tooth with a material that extends all the way to the root tip, then placing a final restoration. If you want a root canal for your pet we are happy to refer you to a veterinary dentist.
Q: Is a fractured tooth an emergency?
A: Usually not. It may take months for an exposed pulp to become abscessed. The discomfort associated with the fracture usually decreases after the first few days. However, it should be treated at your earliest convenience to avoid damage to the root from chronic inflammation that could make the tooth a poor candidate for root canal treatment and require extraction.
Q: My pet has bad breath. What does this mean? Bad breath in pets is most commonly caused by dental plaque. This is the tan "goo" that forms on tooth surfaces that is made of bacteria and bacterial by-products (yup - pure bacteria and their poop). Other things that can cause halitosis include oral infection, oral foreign body (e.g. a stick lodged between the upper fourth premolar teeth across the palate, or a splinter wedged between the teeth), abscessed teeth, and certain metabolic diseases (e.g. kidney failure).
Q: How can I treat my pet's bad breath?
A: If there is only mild plaque accumulation and the periodontal tissues are healthy, then a home oral hygiene program may be all that is needed. To treat inflammation and remove large accumulations of calculus, a professional dental scaling and polishing is needed.
Q: I just had my pet's teeth cleaned a month ago and they are already dirty again. Were they not cleaned correctly?
A: Plaque will begin accumulating immediately, even when the teeth have been cleaned and polished correctly. Home oral hygiene is required to keep them clean.
Q: How can I prevent bad breath and periodontal disease?
A: The same way that we do for ourselves: brushing the teeth every day. The good news is that you only need to devote 5 seconds a day (per pet) to this. Brush the outside surfaces (towards the lips and cheeks) using circular motions with a soft bristled tooth brush. Finger brushes with short rubber bristles are not the most effective - brushes that are best for humans are also best for our four-footed friends.
Q: My pet fights me when I try to brush the teeth. Am I doing something wrong?
A: It is important NOT to struggle during toothbrushing; your pet will win and this is not the relationship that we want with our canine and feline friends. Dogs can be conditioned to allow it by starting very slowly. Once a day, offer a little treat or flavored pet toothpaste on a tooth brush. This can be peanut butter, a little baby food, some cheese or whatever is safe. Offer the snack only for 2 seconds - enough time to quickly lick it off. Do not allow any chewing of the brush. Then give a food reward, praise and walk away. Do this every day for one week.
For the next week, offer the brush with the treat on it, then lift the front lips up and wipe the brush on the incisors once. Then give the food reward, praise, and walk away. Every day for a week. The third week, rub it around a little on the incisors. The fourth week work back to the canine on one side, etc. Always perform the new procedure daily for a week, and always give the food reward and praise. It will take 2 months to work up to the final procedure, of circular motions for the cheek sides of all the upper teeth. You do not need to open the mouth to brush the inside surfaces since they do not accumulate plaque nearly so quickly in most dogs.
Q: I have tried everything and still can not brush the teeth. Do I have any other options?
A: Mechanical plaque removal is the best option, and brushing is the best way to do that. Other options include special diets designed to remove plaque and prevent calculus, wiping the teeth daily with a gauze pad, treats and toys designed to wipe the teeth. Cats rarely allow regular toothbrushing, but they often allow a quick wipe with a dry gauze pad.
There are many products that can help keep the pet's mouth healthier. You can visit www.vohc.org which is the website of the Veterinary Oral Health Council. Products recommended there are known to be safe and effective..
At Harbor Veterinary Hospital we sell dog and cat toothpaste, dental tartar control diets for dogs and cats and CET enzyme chews for dogs.
Q: If I have the teeth cleaned by a veterinarian once a year, is that enough?
A: Regular veterinary dental cleanings are the first step to oral health for your pet, but plaque forms on the tooth surfaces within hours of a good cleaning. If the plaque is not removed, within three days it can begin to mineralize into hard calculus that cannot be brushed off. If you know you cannot brush daily, please ask about SANOS which is a sealant applied every six months after dental cleaning under anesthesia, or Oravet which is a waxy coating applied at home once a week.
Q: How often should I have my pet's teeth professionally cleaned?
A: Just like their humans, different individuals have different recall needs. A large breed dog that eats large kibble diet, gets its teeth brushed and chews trees for kicks may only need them cleaned every few years. A toy breed that eats soft food and never has the teeth brushed may need cleaning with SANOS every six months, and still have periodontal problems.
Q: I do not like general anesthesia for my pet. Can the teeth be cleaned without anesthesia?
A: The surfaces can be scaled and cleaned on an awake pet, but this only helps the teeth to look better. We call this "tooth grooming". It provides almost no health benefit over a simple tooth brushing to remove plaque. Anesthesia free dentistry is not recommended because it can injure your pet's gingiva if s/he jumps or moves while a sharp metal instrument is being used, it can make your pet afraid to allow oral manipulations and home toothbrushing that IS of huge value, large pieces of calculus can be aspirated into the lungs, and it makes the teeth look pretty while rampant periodontal disease and infection can continue under the surface. Anesthesia allows a complete oral examination and cleaning of all surfaces of all teeth. It allows subgingnival periodontal cleaning, which is the area that actually improves periodontal health instead of just addressing how the teeth look. Oral examination under anesthesia allows probing for periodontal pockets, exploring for dental lesions, and dental radiographs if needed.
Q: My pet is too old to be anesthetized. Am I forced to allow him to live with a painful and infected mouth?
A: "Too old" is not a reason to withhold anesthesia and treatment. While risks of anesthesia are higher in an older patient, the risks of not treating infection are much greater. Dogs and cats in their twenties can be safely anesthetized as long as their body systems are working well. If they are not healthy, then adjustments and special techniques are made in the anesthetic regimen to address and minimize the additional risks. We use many monitors and extra equipment to decrease the risks associated with general anesthesia.
Q: Do pets get cavities?
A: Dogs can get caries lesions similar to those in humans. They appear as a brown area on the occlusal (chewing) surfaces of the back teeth, and sometimes on the surfaces between teeth (particularly the lower molars in the back). The tooth is tested for caries the same way your dentist checks your teeth; a sharp dental explorer is used to test the hardness of the tooth. if the explorer sinks into a softened area or "sticks" then it is most likely caries. Caries is relatively rare in dogs, and it seems that some terrier breeds are predisposed to them. Cats have never been shown to suffer from caries.
Q: But my cat has holes in the teeth that look like cavities. What are they?
A: They are probably tooth resorption (TR) lesions. Web searches under some of the other names (feline odontoclastic resorption lesions, FORLS, resorptive lesions, RL, cervical line lesions, neck lesions and many more) that have been used for them will supply you with much information (as always, some is more accurate than others). The lesions are not caries lesions, they progress despite treatment, and an affected tooth should nearly always be removed. An early lesion can appear as only a mild inflammation of the gums adjacent to a tooth (see picture).
Q: My dog has a malocclusion. Does he need braces?
A: If the malocclusion is causing discomfort, inflammation, or loss of function then it needs to be treated. Correcting a malocclusion does not always mean converting the "bite" to normal one...just to one that is comfortable, health and functional. Orthodontic treatment is not provided to make a functional bite into a perfect, of "show" bite. Sometimes the best treatment is extraction of specific teeth to resolve the traumatic contact.