Bad-Mouthed Pets, Part 1

Let me start by saying that I understand ignoring oral care. I spent four years in veterinary school without a trip to the dentist. When I finally went, it took two trips and local anesthesia to get them clean. It hurt. It bled. I don't recommend it. It was a good thing I got in when I did, though. Bear in mind, I brush my teeth a couple times a day, and they didn't look nearly as bad as the pets I see every day.

February is National Pet Dental Health Month, and this is the first of several articles on oral care. I'm going to cover home care, what veterinary cleaning entails and why it is necessary, and the questions and concerns you should have as a pet owner when deciding where to get dental care. But first I need to convince you that oral health is important - important enough to spend your time and money, because dental disease does effect overall health and it does result in pain.

Like many things in medicine, most periodontal disease revolves around bacteria and inflammation. Bacteria in the mouth form a biofilm - basically a colony of germs that creates a slimy film to make them stick to a surface (teeth) and also serves to protect them from the environment. That biofilm is better known as plaque. Over time that slimy plaque layer will mineralize and harden into tartar; this creates a rough surface that is great for more plaque to attach to. It's a handy cycle if you're a bacteria.

Note the dark, heavy buildup (tartar),
and the red, puffy gumline (gingivitis).

Problem is, the body doesn't like bacteria, so the immune system gets fired up and causes inflammation of the surrounding gums. That's gingivitis, and it is readily visible as reddening and swelling at the gumline (go check your pet's teeth, I'll wait). Making matters worse, that biofilm does a good job of protecting bacteria from the immune system, so the inflammation just worsens without solving the problem. Over time all the inflammation damages the attachment between the tooth and bone (the periodontal ligament) and the gingiva recedes; eventually even the surrounding bone itself gets eaten away, leaving a loose, painful tooth.

That's the obvious part of dental disease - except it usually isn't obvious. You don't need a medical degree to see thick, dark calculus on the surface of teeth, but plaque buildup below the gumline causes the worst problems. Likewise, the front teeth often don't look nearly as bad as the molars in the back (see above) - I often call those the "vet" teeth, as the vet is usually the only one to see them. Worst of all is that the real problems for your pet - pain and loose, non-functional teeth - can be almost impossible to recognize. Most of the time the only signs of dental pain are subtle changes in behavior and attitude that often go unnoticed. The pet will avoid using the affected teeth, but if the other side of the mouth isn't too bad there's no change in appetite. Anyone who has ever had a toothache will tell you it's a dull, constant pain they wouldn't wish on an enemy - but they probably muddled grumpily through with it, pain meds in hand, until they could tell the dentist what hurts and wait for them to fix it. Pets can't do the latter; they rely on us to figure out the problem  so they don't have to muddle grumpily and painfully through.

The jagged, dark area is a large fracture
on the inner surface of the tooth.

Fractured teeth are a huge problem, too, given dogs' love for chewing. When a broken tooth exposes the pulp cavity - the vital, living part of the tooth - it is extremely painful. Eventually the root dies and the pain will subside, but now there's a tube leading right up to the bone, setting up for nasty infections. I find alot of fractured teeth wellness exams - and probably miss at least that many, since very few animals will permit a thorough oral exam without being heavily sedated. Indeed, I recently found a fractured tooth on my own dog during a dental cleaning - he'd broken part of it off on the inside surface, which is pretty much impossible to visualize on an awake animal. The pulp was long since dead, so it likely wasn't hurting anymore, but that hole was begging to set up a nasty infection in the jaw.

Speaking of infections - that's probably the most accurate way to think about periodontal disease. You have gobs of bacteria (plaque) causing inflammation (gingivitis) leading to damage of the surrounding tissues. But what's more, those inflamed gums are red and puffy due to increased bloodflow, which means all that bacteria gets quick access to the bloodstream. So, the bacteria could potentially spread anywhere, and studies have shown periodontal disease results in an inflammatory state throughout the body. Another study showed a correlation between dental disease in dogs and changes in the kidneys, liver, and heart. Indeed, in human dentistry correlations between dental health and all sorts of other problems are well established.

This is a long article, so I'll keep the summary short. Dental health is a vital part of overall health and well-being, and we owe it to our pets not to ignore it.

Continue to Part II - Home Oral Care.