July 6, 2023 — In this episode, Dr Kelly Diehl sits down for a question-and-answer session with Dr. Lauren Richman, a second-year veterinary dentistry resident, to discuss dental health in dogs and cats. The pair cover preventive care, common dental problems and what pet owners can do to keep their pets smiling!
Resources:
Veterinary Oral Health Council
American Veterinary Dental College
Taking a Bite Out of Dental Disease
Brush up on Your Pet's Dental Health - video
0:00:00.8 Dr. Kelly Diehl: Hi, this is Dr. Kelly Diehl and for this month's Fresh Scoop podcast, I'm doing something a little different. I'd like to share with everyone a recording that was made several months ago of a live question and answer session featuring myself and Dr. Lauren Richman, a resident in veterinary dentistry. It was a great session with lots of interesting information about dental health and taking care of your pet's teeth, I hope you enjoy it. On to the show.
0:00:47.2 DD: Well, welcome everyone. I think we'll go ahead and get started. I'm Dr. Kelly Deal and I'm going to be the questioner of our question-and-answer session tonight, which is sponsored by Morris Animal Foundation called Brush Up on Your Pet's Dental Health - what you need to know about treatment. And I'd like to go ahead and introduce Dr. Lauren Richman, Dr. Richman attended the University of Denver for her undergraduate degree and obtained her veterinary degree in 2008 from St. George's University School of Veterinary Medicine in Grenada, West Indies. She completed a one-year internship here in Colorado at Wheat Ridge Animal Hospital, followed by three and a half years as an emergency clinician... I bet you she was busy... in Santa Fe, New Mexico, and then eight years in general practice back in Colorado before joining Apex Dog and Cat Dentistry in 2021, to pursue a three-year dental residency program through the American Veterinary Dental College.
0:01:52.8 DD: And over the last decade, she has developed an intense passion for dentistry and learning about the impact that mouth quality can have on the quality of life for our pets. So welcome, Lauren, thanks for joining me tonight.
0:02:06.8 Dr. Lauren Richman: Thanks so much, Kelly, and I love being here.
0:02:09.9 DD: I know we just read an introduction about you, but can you tell us a little bit more about yourself?
0:02:17.1 DR: Yeah, so I'm kind of a typical Colorado native. I grew up in Denver, and I wanted to be a vet from when I was little, and I didn't realize I really, really loved dentistry until about three years into when I was full-time in general practice, and I started to realize just how much the mouth impacts the rest of the body and how keeping the mouth healthy can lead to good health all over, so...
0:02:51.7 DD: Well, that was going to be my next question, was about when you became passionate about this work, which you just kind of filled us in on, so I'm going to start by asking probably the million-dollar question that all of us think about as pet owners, which is what are the most common causes for stinky breath in dogs and cats?
0:03:13.6 DR: Yeah, so dogs and cats like to be up in our faces, so it's really important to know why their breath smells so bad, certainly there are a few diseases, systemic diseases that can lead to bad breath, like severe kidney disease or sometimes diabetes and some other things, but most of the time, if the pet is healthy, it's accumulation of plaque and tartar on the teeth, plus or minus periodontal disease or gum disease, as they call it in the toothpaste commercials, that can lead to accumulation of bacteria that produce those sulphur compounds that are quite smelly.
0:03:55.2 DD: And tell us what plaque and tartar look like. I think we all look at our dog and cat's teeth, but what should we be looking for?
0:04:03.9 DR: So, plaque is the active bacteria growing on your teeth, so when you eat something sugary and a couple 10-20-30 minutes later, your teeth feel kind of fuzzy, that's plaque accumulating on your teeth. So that's bacterial growth. Tartar, also called calculus, is what happens to that plaque after it sits there for a long time, it actually forms this hard layer where the bacteria there aren't living bacteria, but there's also kind of the by-products of bacteria and the dead bacteria that formed this hard... Concretions on the teeth. So, the plaque is kind of the creamy, whitish accumulation, and then tartar is more yellowish to brownish, and then under the gum line can be green sometimes as well....
0:05:04.9 DD: And I think we've all... All of us veterinarians have seen that. I was not a dentist when I was in practice, but I can remember seeing some patients where it gets kind of ...
0:05:18.2 DR: Pretty bad. Yeah. And so, some breeds accumulate those products a lot quicker than others, and that's not 100% well understood, but certainly small breed dogs are definitely more prone to developing that, and then other large breed dogs of certain specific breeds, sometimes such as greyhounds, are one particular breed that just jumps to my mind, but some... There's probably some genetic component to that in the breed-specific kind of pre-disposition.
0:05:57.3 DD: Okay. We're going to get into this some more, but I know there are people listening tonight who are going to want to know this question, which is, how often should animals have their teeth cleaned and at what age do you recommend that we think about dental cleanings for cats and dogs...
0:06:18.8 DR: Yes, for professional cleanings under anesthesia, it's probably a good idea for the average dog regardless of the breed, to start having that happen somewhere around maybe two to three years old, unless your vet sees that there's plaque and tartar already accumulating on the teeth by that time in which case maybe it should go earlier.
0:06:40.1 DR: And then certainly if they see any signs of gums receding or the breath is particularly stinky or you have a tiny little shih tzu or a little bitty poodle or a dachshund or something like that, where the breeds are predisposed, that would be one where you'd want to jump in there early or especially like the smushy face breeds, like pugs or boxers, you'd want to get those guys in on the earlier side rather than waiting until they're older.
0:07:16.3 DD: Okay. I'm going to get into a little bit more about care of teeth, but you reminded me to ask you a question, which is, what are the most common kinds of diseases you see in dogs and cats? And are they similar or different? You talked about breed differences, but what are the most common things you see...
0:07:36.2 DR: Yeah, so dogs and cats share one of the most common things that we see and that's periodontal disease, also known as gum disease, and that's where the gums have... It's really an immune system problem, the immune system over-reacts to the plaque bacteria on the teeth, and that leads to significant inflammation, which then results in the gums getting swollen and pulling away from the teeth, and that leads down a pathway towards significant issues along the teeth.
0:08:10.1 DR: In cats, the other most common thing that we see is tooth resorption, where the body starts to break down the teeth, and that's not really a super well-understood process, and unfortunately, there's not a good way to treat it other than to remove the teeth that have the tooth resorption happening, and there's not really a prevention for that either. For dogs, the other most common thing we see is tooth fractures because dogs love to chew on things and they don't tend to have good discretion as to the things that are safe for the teeth versus satisfying to chew on, [laughter] and their teeth can't resist some of the things that they chew on, like bones or antlers or rocks or sticks or whatever, so their teeth like to break, so kind of tooth resorption and periodontal disease and cats and to periodontal disease and fractured teeth, broken teeth in dogs.
0:09:14.1 DD: Okay, I know we should all do this, and probably all of us who are pet owners are, have been told this by our veterinarians, but we hear about brushing our pet's teeth and that seems tough, and I'm a veterinarian and it is tough. What are some suggestions you give to people... You must hear this right...
0:09:37.5 DR: Talk about it all day, every day.
0:09:39.7 DD: So, give us some help here on the best methods.
0:09:44.0 DR: If you're just getting started with a puppy or kitten, that's ideal because training them to accept tooth brushing is just like training them to sit or to fetch or to... You can definitely train a cat to sit, so don't you cat owners think you can get out of it. You start young, you keep the sessions positive, and you use food rewards, oftentimes the toothpastes out there taste delicious, and so you can use the toothpaste as a reward, so they associate, my mouth is being touched, I get this yummy thing afterwards, and most pets are pretty food motivated. Sure, there are the ones out there that aren't... And then there are ones, say you get a dog from the shelter and it's an adult dog or an adult cat, and it's never had that done to it before in its life until you get it, and it's just a slow training process. Just like anything else, you start by training the animal to just sit its head in your hands, and that's step one, and then you do that and you're touching the lips and it doesn't pull a head away, that's step two, and each of the steps may take weeks and that's fine.
0:11:04.3 DR: The idea is that you're not brushing the teeth for two minutes on day three, the idea is that maybe it takes two, three, four, six months to train your animal to accept the brushing, and then you're setting it up for a lifetime of good dental health. You don't have to worry about the short-term quite as much but make it a long-term goal so that your animal is really just excited about having this happen, because just like your dog gets excited when you go get the leash from wherever you hang the leash up, they should get excited when you pull out the toothbrush.
0:11:45.5 DD: My dog loves the toothpaste, it did take a little bit of work, but kind of... She grooves on it, but what are some other things that we can do as pet owners to help keep teeth clean at home, we all know we should brush. But are there are other things we can do to help?
0:12:04.3 DR: Yeah, so some animals, you just can't... You cannot get in their mouth, they will not accept that for whatever reason, training or whatever happened to them in the past, or some of the flat face breeds like shih tzus and pugs and Frenchies that when you lift up their lips, it pinches off their nose so they can't breathe very well when you lift their lips up, so they might not like that very much, and so for those animals and then also to supplement, if you are brushing, there's a whole host of other things you can add to your dental health regimen, such as water additives, dental chews and they have those for both dogs and for cats, and water additives that are good for both dogs and cats, there are dental toys that have different shapes that are good to kind of get the teeth embedded into them and to massage the gums and things like that, there are dental diets produced by several of the food manufacturers that have extra-large kibble and coatings on the outside to help keep the teeth clean, there are things that you can sprinkle on the food, there are other things that you can use like gels or oils that you can rub on the gums to help those...
0:13:29.0 DR: Stay clean or healthy. So, there's a whole host of different things. And a little bit later, we'll put up a website where there's a list of all the things, so just like the human supplement industry, there's no regulation for the pet supplement industry, and all of these products qualify as supplements. So, if you go to the pet store and you're standing in front of the dental section, you're going to see a million products and you have no idea which ones are good or which ones are bad or whatever... So, there's a group of veterinary dentists who have formed a group that evaluate products that have undergone scientific testing, and those scientific tests have shown that that product is helpful, and so there's a website you can go to... We'll put it up at the end, that lists all those products, and so if you choose products off of that list, you know that that product has undergone a scientific test to show that it's helpful, and so I would always recommend choosing products off of that list rather than just going by whatever, the pet store employee that's in high school is recommending for you.
0:14:52.5 DD: That is so, so helpful Lauren... But can you take a little bit deeper dive into how the dental diets work, like you alluded to it already, but tell us a little bit more because we see those out there, or maybe they've been recommended for our pet...
0:15:11.6 DR: Yeah, so the nutritional content is generally just a maintenance diet type thing, but they oftentimes will formulate the kibble to be very large, which forces the animal to then chew on it, because a lot of times for dogs and for cats, they're so enthusiastic about eating, they just swallow their food whole, which for anybody that seemed dog or cat vomit, they know that their pet doesn't choose very much of their food, so the large kibble encourages the animal to actually bite down on the kibble and thereby there's some mechanical cleaning of the teeth and then they also thought we'll put some coating on the outside of the kibble that helps to break down that bacterial plaque and enzymes and things like that, and they're good for... The plaque bacteria.
0:16:05.5 DD: That's great. I want to just mention very quickly, I see some folks starting to put in some questions, and what I'm going to try to do for everyone listening is stack them up a bit, and I'll ask Lauren at the end, we'll have a little bit more of an in-depth Q&A. But one thing that some people are asking about, and I wanted to ask you, which is, what are the best treats and toys to give pets for teeth, and talk about maybe the ones we should avoid.
0:16:39.1 DR: Yeah, so the one that everybody... First comes to mind. Everybody always asks about is bones, and bones come in two major forms, one would be like the baked white hard bones, and the other ones would be like raw, marrow bones that you might get in the frozen section at the pet store or grocery store. Bones make teeth generally pretty clean, so they look very clean, but bones break teeth, so you're sacrificing one thing, which is reduction of plaque and calculus on, or plaque and tartar on the outside of the teeth, for major fractures that can lead to severe infection, and a lot of expense on your part, either for doing root canals or extractions when those teeth get broken, so in general, no veterinary dentist would ever recommend that a dog have bones regardless of whether they're frozen and raw or baked and dry, same thing holds true with antlers. Same thing holds true with those, like yak milk treat things when those get soft eventually, but they start out extremely hard, if you could drive your car over the TREAT and it stays whole, it is too hard for the teeth [laughter]..
0:18:15.6 DD: That's a good... I guess, a good test as a former internist and gastroenterologist I'll put in a small warning here that I couldn't tell you how many bones I have taken out of dogs via endoscopy, and they can be bad and they could be rough on the GI tract, and I know there are people out there who swear by them, and they're lucky, I think in some ways, that they haven't run into a big, big problem. But be careful about those. So, let's take a deeper dive into something we talked about very early, which was dental cleaning under anesthesia, and I am going to put in a personal note and Lauren is going to convince me because my dog is 11 and she is getting ready for her next dental procedure, and I have to say even me as a vet, I get a little nervous. So first, why... We hear this all the time, right? From our vets, we need a dental procedure, and they go, bring them in for a physical, we've got to do some blood work. So, talk us through that a little bit, Lauren.
0:19:26.0 DR: Yeah, so before we even consider anesthesia, we want to make sure the pet is healthy enough to undergo anesthesia, anesthesia is scary, and we'll talk about it in a minute, why that tends to be... But in general, there's kind of an overriding fear because people hear bad stories of things happening mostly on the Internet and word travels fast, but.
0:19:50.5 DR: The things we do beforehand, like blood work, like our physical exam are assessing the organ systems to make sure that they are okay to undergo anesthesia, and so we're listening to the heart, we're listening to the lungs, were feeling the belly and making sure we don't feel any masses, that the organs feel normal shape and size, and then the blood work, we are looking at the body function, so what do the blood cells look like... Are they normal? And are the white blood cells, the immune system... Is that functioning normally? We're looking at the kidney values, we're looking at the liver enzymes, are those organs functioning well, because all of the medications that we use during the anesthesia itself and then also afterwards, if we need to use any kind of pain medication or anything like that, are going to be metabolized by those organs and dental procedures sometimes involve removing teeth and that can involve bleeding and things like that, and so we want to make sure that an animal can tolerate a certain level of those things and can metabolize the drugs appropriately, and if an animal has significant kidney disease or heart disease or liver disease we might choose one drug over another to tailor the protocol to make sure that we're making everything is safe, as we can.
0:21:29.1 DD: Walk us through Lauren like how a typical dental procedure goes like when you're doing one, maybe in general practice, and it's kind of pretty routine.
0:21:38.7 DR: Yeah, yeah. So typically, the pet would come first thing in the morning after being fasted overnight, so generally you wouldn't have them eat breakfast that morning so that they have an empty stomach because some of the medications we use, one of the side effects is vomiting, and so we want to make sure that there's not a bunch of food in the stomach for them to throw up during the procedure, because that could make it a higher risk for them to breathe in that food, if that were to happen. And then the veterinarian would do a quick pre-anesthetic exam to make sure that their findings didn't change from the last time that they looked at the pet, and if that all looked good, they would place an IV catheter into the dog or cat's leg so that they can deliver drugs straight into the blood stream, and they give induction drugs that make the pet fall asleep, and then they put a breathing tube down the throat, so that they can put oxygen in there and make sure that the put can breathe properly, but also the breathing tube, especially in a dental procedure, there's a lot of water, so the breathing tube helps to protect the airway and keep the water from the dental procedure out of the airway.
0:22:53.4 DR: And then they put the pet on their dental table, where a lot of times there's drainage underneath the head where the water is going to go, they put it in a warming system to keep the pet warm during the procedure, and then the procedure itself, usually they'll take some kind of dental x-rays, hopefully to look at the teeth under the gum line, and then usually a technician will scale and polish the teeth just like you or I get at the dentist when we go, and then the veterinarian will come in and chart the mouth, so looking at all of the pockets under the gum line same thing that they do on our teeth, measuring those pockets with the same instruments, and then they look at the X-rays and determine if there's any teeth with problems, then at least in our practice, we would call the owner and fill them in on exactly what we're finding and discuss with them what the treatment recommendations are, and then we go forward with that treatment, either cleaning out a deep pocket or extracting a tooth, or in our case, doing other procedures like a root canal, and then the patient wakes up after everything's all clean and the treatments are all done and we recover them for a couple hours under close supervision and then they go home.
0:24:19.6 DD: Yeah, that's really, really helpful to kind of think of those steps and... That brings me to the next question. I get a ton, I'm sure you get it a ton too which is, people talk to me about dentistry without anesthesia or scraping or things like that. Can you comment about that?
0:24:41.0 DR: Yeah. So, because of the fears of anesthesia, anesthesia-free dentistry has become... Or non-anesthetic, dentistry it’s also called... Has kind of become this common thing, but the problem with dogs and cats is A., they can't communicate to us that there's a problem with a tooth, they're never going to tell us that they have a toothache, and number two, the majority of the dental disease that dogs and cats get is under the gun line other than fractured teeth, and so if we're not looking at the teeth under the gum line, then we don't see those problems, we don't find them, and there was a set of papers written actually back in the mid-90s showing that in...
0:25:32.6 DR: Dogs up to 30%, and in cats up almost 50%, of normal, completely normal looking teeth had problems under the gum line when they did X-rays of them. So if you're not doing x-rays, which you cannot do on an awake animal, then you're missing a huge amount of the potential pathology that could be painful in or leading to other problems in the mouth, if you're not doing it under anesthesia, and generally anesthesia, if it's done properly, and that means tailoring the anesthetic drugs to the individual patient, having the proper monitoring equipment to monitor the heart rate, the EKG, and the blood pressure, the temperature, all of that kind of stuff, oxygenation, and then also having a human to look at those machines and make sure everything is going well, If those things are in place and anesthesia general in pets is extremely safe as well.
0:26:35.5 DD: Do you have any statistics on that, Lauren? because that's a really common fear of people?
0:26:40.0 DR: Yeah, I don't have specific statistics of the overall risk, those kind of studies are really hard because across different veterinarians in different settings, rural, university setting, I don't know that anybody can actually do an overall in aesthetic risk, but in general, if it's done properly, certainly bad things happen, and most of the time that's because corners are being cut either, there's not all of the equipment, there's not a human doing the monitoring, there's nobody watching the patient during recovery. And so, if you're asking your vet if you have concerns about anesthesia and you should ask your vet these questions, what are your protocols, and do you have all the equipment? Do you have the humans... Are the pets monitored before and after. And so, make sure to ask those questions. Those are really important questions because it's not always the case, because those are some places where sometimes corners are cut to save money or keep costs low or whatever, and that's where you sacrifice safety. So...
0:27:58.5 DD: Yeah, I think that's important. And I want to say to everyone who is listening, as a veterinarian, who has a dog that needs a dentistry, she developed a heart murmur in six months, and so I think it's really... I would get this in practice, you probably hear this too Lauren sometimes people go, "I was just in, they go I was just in a year ago," whatever, can't you just bring the dog in and I'm living the experience that something changed from the last time she was in to see her general practitioner to now. So, it does happen that things can... And dogs lives are compressed, right?
0:28:38.1 DR: Yeah.
0:28:40.1 DD: So, six months is a long time for us, but I'm seeing a couple of questions I'll ask you about this, because this is common too... Sometimes people hear their dog's going to need an extraction and people get very worried about that, and what do you tell people about losing teeth and etcetera.
0:29:00.3 DR: So, an extraction means surgical removal of a tooth in dogs and cats, we don't do implants to replace a tooth. Cosmetic dentistry is not a thing in animals, it's pretty unethical to do that because they don't care what they look like, we're concerned about function and comfort more than anything, and so an extraction for some teeth, you can do that without cutting into the gums and for other teeth that have more than one root or for a couple of teeth that have very big roots, you do need to make an incision into the gums, and so the thing about extractions in dogs and cats is their roots are about twice as big as the crowns of the teeth, this is a crown part that you can see, and the root is under the gum line, and so because their roots are so huge compared to their crowns, their teeth are very well anchored in the mouth and they don't tend to move around. Our teeth are the opposite, our roots are very small compared to very big crowns, and so if we remove a tooth in a human, the teeth shift around, you may notice that your teeth are shifting just as an adult, even if you have braces as a kid, your teeth still will shift, but that does not occur in an animal, so if we remove a tooth, the other teeth stay put and they all line up still, and we don't have to deal with issues where the teeth don't match up for chewing.
0:30:44.7 DR: And so we don't need to worry about removing a tooth and having things shift around. The other thing is, for the average pet animal, they're not hunting for their food, at least for all of it, some cats that go outside might hunt to supplement their diet or... because they like to do it, but that's not their primary nutritional source, like wild animals need to do that in order to eat, but our pets don't need that, and so really the teeth serve an important function, but they can do just fine without them and... Because we feed them things that are easily chewable without teeth, so we don't need to worry about a missing tooth or lots of missing teeth, in some dogs and cats’ cases, they actually function incredibly well without any teeth at all.
0:31:36.9 DD: Yeah, it's amazing. I think when you and I first talked about teeth, I never thought about our, people's little, tiny roots and dogs and cats’ big roots, and how our teeth move around.
0:31:50.3 DR: Yeah.
0:31:51.3 DD: When we introduced you, we talked about you being in training to be a specialist, and... Can you talk a little bit about when people might need to see a dental specialist, when it's something that's in the purview of their general practitioner as far as dentistry and this is really cool stuff. Can you talk a little bit about some of the new techniques you guys have for teeth?
0:32:16.9 DR: Yeah. So, reasons that you would visit us then, having your general practice that do the procedure would be... We have more tools in our tool bag as far as ways to be able to save a tooth that otherwise a general practitioner might not know, and their only tool is to extract the tooth. So sometimes if there's advanced periodontal disease where there's a big pocket around a tooth, we can go in and clean that out and do some bone grafting and things like that to save a tooth and rebuild that attachment, or we could go into a fractured tooth or dead tooth and perform a root canal rather than extracting a tooth, so those are some reasons that we would be useful to save teeth rather than extracting them.
0:33:11.6 DR: Other reasons would be, if there's a tumor in the mouth and it needs to be removed, we are the ones that generally do that kind of a thing. Sometimes dogs and cats like to get into trouble and they get their face broken, so if there are fractures of the jaw, we can fix those oftentimes with non-invasive techniques such as splints around the teeth, but sometimes we do go in and put plates on the bones to get them to heal, and then occasionally we do things like orthodontics to try and move a tooth that's in the wrong place, if it's a young animal or if there was a big wound like a lip defect, we can do some special flaps, maxillofacial flaps that move skin around to help close defects and stuff like that too. So.
0:34:16.5 DD: Yeah. It's pretty cool, and I'm going to give everyone a little preview that Lauren brought some great pictures we're going to share with everyone when we get done with this part of the interview, but thinking about that, what are some of the biggest misperceptions you encounter about dental disease in your practice?
0:34:40.2 DR: I think probably maybe one of the biggest one is that stinky dog and cat breath is normal. That they're just like that. But really, that's not the case. Their breath shouldn't be really smelly, if it's really smelly, it's because there's disease going on, and so that should be addressed. The other most common one is we get about that anesthesia is dangerous. And in a dog like yours that's developed a recent heart murmur there, we would send you to a cardiologist to have the heart evaluated first before we decide whether it's worth it to go under anesthesia, or another really common one is that my dog is... Or cat is too old to go under anesthesia, that's probably one of the most common ones that we hear, and that's often perpetuated by veterinarians that are nervous about the anesthesia, and that's one case where you might seek out a specialist because we have... Not just advanced training in dentistry, but we also have advanced training in anesthesia, and then sometimes for very fragile cases, we can bring in an anesthesia specialist to run the anesthesia, and we do that regularly in our practice for animals that have multiple non-dental diseases like your dog with heart disease and then maybe it has some kidney disease to...
0:36:09.5 DR: Or whatever, and sometimes we do that for owners where they're just... The owners are so freaked out about the anesthesia that they are, they just want that extra level of comfort to provide their pet with the best possible option, and that does come with an additional cost, but for some folks that's really worth it to have that piece of mind that they're doing all the things that they can to keep it as safe as possible, so.
0:36:38.6 DD: Right. I think our anesthetic options and protocols are way better than they used to be...
0:36:46.9 DR: Oh yeah. Absolutely.
0:36:47.0 DD: Certainly, when I was a kid, but even 30-40 years ago when I think was...
0:36:52.1 DR: Yeah. Anesthesia has developed so much, and we have so many different medications at our disposal that we can make an anesthetic safe for almost every patient, and it's extremely rare that we would have any kind of complications of anesthesia.
0:37:11.0 DD: Okay, yeah, before we get into the pictures Lauren, what's kind of your take home message for everyone who's listening?
0:37:19.5 DR: I would say we skipped over this part at the beginning, but when we were talking about tooth brushing, you should try and do that at least three times a week, but more often is better just like you generally... And I brush my teeth twice a day for the most part, if not more, sometimes some folks sneak in a brush after lunch, our pets would benefit from that too. Not everybody can do that in their schedule. But the more brushing happens, the better, but studies have shown at least three times a week is what's necessary in order to actually be effective as far as helping to keep the teeth clean, and then really just don't forget about the mouth, and I think the mouth is one of the things that, even though it's the part of the animal that we interact with the most, almost the face and the head, that is what we're seeing, the mouth is probably the most neglected part of our pets, and so... Just don't forget about it. Look in your pet's mouth, train them to have it be looked at, and if you see a problem, bring it up to your vet and then take care of that regularly with them if you're able.
(pictures are available in the YouTube video of this presentation at time stamp 38:25)
0:38:40.0 DD: That's awesome. I think I'm going to have Audrey come on or Audrey's going to share her screen, and Lauren is going to walk us through some just amazing pictures, and this is amazing picture too. [laughter]
0:38:58.4 DR: Oh, he's so cute.
0:39:00.9 DD: Oh, here we go. Walk us through this.
0:39:04.2 DR: This is a great one. So, on the left here is the picture of this dog, and then on the right is the x-ray of the teeth, and that x-ray is of the lower teeth with the big one in the middle. And on the picture you can see some brown spots on the gums and that's just pigment, that's normal, just like at the lip margin there by the fur, the lip edge is black, that's just normal pigmentation on the gums, so the teeth overall look pretty healthy. There's a little bit of redness on that top tooth up there, but when we look at the x-rays, you can actually see at the bottom of the roots, so at the bottom of the picture, the roots are pointing down and the crown is pointing up. So, inside the mouth is up and down in the bones is at the bottom, you can actually see little circles around the tips of the roots of those three roots that are showing there, and those are abscesses around the tips of those roots, all three of those roots have abscesses on them. Same thing with this one. Only this...
0:40:15.7 DR: Oh, too fast, go back. Yep, yep. Okay, there we go. So same thing, so this dog has a little bit of calculus or tarter on its teeth, so that's why it's, the tooth looks, that upper tooth there, it looks kind of yellow and brown, so it's a little bit dirty, the gums are a little bit red, but otherwise, that tooth looks pretty normal. Again, the black stuff on the gums is just normal pigment, and that's not disease, that's just healthy tissue. But when we look at this x-ray, not only does this tooth also have those little circles around the tips of the roots, but it has this big circle on the left there around the tooth, and that's this weird kind of cystic, cyst-looking thing going on around the roots. And none of that is obvious from the outside, and so a good example of why it's important to take x-rays on the teeth. And then this guy on the left is a broken canine tooth. So, at the tip of the root, at the bottom there where the pointy end is, you can see a little pink circle, and that is exposed pulp, so inside of each tooth, there's pulp, which is the blood vessels and nerves and lymphatics to the tooth, and that runs in a groove in the center of every tooth called the root canal.
0:41:53.2 DR: And this dog chewed on something that was too hard and broke the tooth and exposed that pulp, and so that tooth needs to have treatment, you can't just leave that pulp exposed, that's a highway for bacteria to go and infect that tooth and so the two treatment options for a tooth like that are to extract the tooth or to perform a root canal. And with a tooth like that, the canine teeth are some of the most strategically important teeth in the mouth, and so we'd prefer to put crowns on those teeth after we perform root canal therapy to reinforce the strength of those teeth, and so that's what you're seeing on the right photo there is a metal crown on the tooth after it got root canal therapy. Same thing here. This is a pre-molar in the back of the dog, little tiny dog's mouth, but it had a root canal performed at that tooth and then a shiny metal crown. And generally, in animals... In humans, a lot of times they'll do tooth-colored crowns to make everything blend in or you could get gold crowns or silver crowns like that, but an animal is that the tooth-colored crowns aren't strong enough, because animals are much stronger chewers than we are, and so generally we use metal crowns most of the time, those are titanium alloys.
0:43:22.7 DR: And so usually they're silver or kind of a gold tinge. Then this is my friend, Delilah. She had this wound, she was adopted by a rescue and they don't know what happened to her, she came to the rescue like this, but she had a big chunk of her lip and then the lower part of her nose missing, and she was really suffering from this she also has really bad disease called entropion in her eyes where her eyelids are rolled in because she's a Shar-Pei mix, so that's why her eye's all weepy, because her eyelids are rubbing on her eye. So, we took that and then if you want to go to the next slide, we closed that defect, so that's what it looks like afterwards. Now she has a relatively normal lip again, so...
0:44:21.4 DD: Awesome, I think that's all of our pictures and I have been taking a look at some of our questions, so you ready, Lauren?
0:44:28.3 DR: Yeah, let's do it.
0:44:29.9 DD: We're going to... And for... Oh cool. Sorry, I forgot about this one.
0:44:34.1 DD: So, this is that website that I was talking about earlier, where there's a list of products that have gone under scientific evaluation, and so VOHC is the Veterinary Oral Health Council, and its vohc.org is the website. And that'll go out in an email afterwards if people want that, but they have... You just click on the links there on the left, at the top accepted products, that'll bring you to this page, you pick dogs or cats, and then it'll have lists of the products broken down by category, so food, water additives, toothpaste, etcetera. So...
0:45:18.7 DD: Awesome, and I actually, again, to put in a little personal note here, I actually went there when I picked some dental chews for my dog, and it's really easy to navigate.
0:45:33.3 DR: They don't sell anything on that website, it's just giving you a list of products, so you can go then to the pet store or online or whatever to buy those things.
0:45:43.2 DD: Yeah, that's one of the best, I think, parts of that particular website. Alright, now we'll get to a question now, here's one I've heard before, and it's about discolored teeth, and someone asked about purple or gray teeth.
0:45:58.4 DR: Yes, so that's one of the things we deal with very commonly in our practice, so a purple or a grey tooth has undergone some kind of trauma, so the tooth has gotten a bonk and that has disturbed the blood supply to the tooth and created a bruise inside the tooth. But because the tooth is a rigid structure unlike your arm, where if you bang your arm, you would get a swelling, there's nowhere for swelling to go inside the tooth, and so the swelling is inside the root canal or the pulp chamber, and it just goes down on itself, so it literally cuts off its own blood supply, and the tooth initially is pink and then it turns purple, and then as the tooth dies, oftentimes it turns gray. Sometimes it's the whole tooth and sometimes it's just at the tip of the tooth. Studies looking at those discolored teeth show that those teeth are dead about 92% of the time, so there's a very good likelihood that that discolored tooth is a dead tooth, and if that's the case, then you can't just leave it because eventually that tooth may get infected and form a tooth root abscess. So, our treatment options for a discolored tooth are root canal therapy or extraction.
0:47:30.4 DD: Okay. Here's another really common one, but it's tougher than it looks. It is "What is the average interval between professional dental cleanings?"
0:47:41.4 DR: Yeah, that's a great question. So unfortunately, there's not a super consistent answer between one dog to the next, because it really depends on your individual dog or your individual cat and their propensity to develop certain dental diseases like periodontal disease, so some dogs could probably go 18 months between or two years between professional cleanings and other dogs and cats need to do it every six months, and there are some diseases where we're in there every three months. But for the average pet, if I'm making a blanket statement, I think yearly is probably a good place to start, and then once you've established a baseline after a few years, then you and your veterinarian can work on deciding what the appropriate interval is for your individual pet.
0:48:37.8 DD: Okay, I have someone asking about sealing products, can you comment on that?
0:48:42.8 DR: To seal the teeth, yeah. There are sealants that we use that are the same as what they would use to seal little kids’ teeth that are a bonded sealant product that your veterinarian would apply. Typically, we use those in two situations, one would be on a superficial fracture, and the other one would be if there's a lot of defects in the enamel on the teeth, which sometimes happens if dogs had infections when they were puppies, and they can get really bad abnormal enamel on the outside of the teeth. So those are the two situations where we would use a true bonded sealant product. There are other waxy type products, the two that come to mind that are most commonly used in a specialty practice or at the general practice level is one called OraVet® and a different one called Sanos®, and those are ones that have a professional application, then you would also potentially do that at home at a certain interval, for the OraVet® it's weekly at home. And that's a waxy product that actually adheres to the teeth at the gum line and helps to prevent bacteria from gaining access as easily. So those are some kind of less official sealant type things that you can do at home.
0:50:11.5 DD: That's actually...
0:50:11.7 DR: Usually...
0:50:12.9 DD: Oh, go ahead.
0:50:14.3 DR: I was going to say, usually you would start that after a professional cleaning, so you're starting with a clean slate.
0:50:18.5 DD: Oh, that's helpful, because a couple of people asked about what to do after a professional cleaning, and I actually have someone who asked about the OraVet® because they've switched to using them every few days rather than daily, because I guess it affects their dog stool and they wonder, is that okay? Or does it defeat the purpose?
0:50:40.5 DR: OraVet® also makes chews, dental chews, so I think that's probably what they're talking about.
0:50:44.9 DD: Yes. Yeah, sorry...
0:50:46.4 DR: And so... Yeah, so obviously, for any ingestible product, if they're going to eat it like Greenies® or OraVet® chews or any of the other chew products- there's a cool new one on the market called Yummy Combs® that are shaped like honeycomb type hexagonal things- so any of those obviously you need to take in mind how well they affect the digestive system and everything. And most pets can handle those, but occasionally, dogs chew things too quickly, and could choke on something like that, so you want to make sure that your dog is chewing it at an appropriate rate, but also not swallowing it whole. Usually, those are designed so that if they are swallowed whole, they are digested pretty quickly, so they don't cause an obstruction and then... But some animals just don't tolerate those on a daily basis, or they're too expensive to do on a daily basis, do what you can using common sense with the frequency and all of that.
0:51:47.2 DD: That sounds good. Someone asked something interesting, I don't... I sure don't know the answer to this, which is, are there any ingredients you should look for in pet toothpaste and any to avoid?
0:52:00.0 DR: So generally, effective pet toothpaste use enzymes to break down the bacterial biofilm, that film of bacteria that is built up on the teeth, and that's what... That's why pet toothpaste is flavored and formulated so that it can be swallowed because also human toothpaste has fluoride in it, and that's why you're not supposed to swallow it because you can actually ingest too much fluoride. Animals don't get cavities, hardly at all. Cats, there's never been cavities reported in cats. And dogs, we see cavities maybe two or three times a year in one patient, so it's extremely rare for us to see cavities in our patients because of several reasons, but the... Where were we? Now I just lost my train of thought.
0:53:00.6 DD: It was ingredients that you want to avoid in toothpaste...
0:53:02.1 DR: Oh, yeah, the toothpaste. So, the fluoride helps to strengthen the enamel, but dogs and cats don't have the problems with cavities that we have, and so they don't need that fluoride nearly as much as we do. Good dog and cat toothpaste use enzymes. If your toothpaste says that it only has coconut oil or olive oil or I don't know, whatever, then it's not doing anything other than feeding your pet. So again, that VOHC website is a perfect place to go and find a toothpaste that actually has shown to be effective in dogs, but yeah.
0:53:51.0 DD: I have... So, I have two... I'm going to try to tie these because we have a lot of questions together into one, which is... I've got somebody talking, asking about hypoallergenic treats and diet, and someone else who said, "What are the challenges you hear from pet owners as far as dental diets?"
0:54:13.6 DR: Yeah, so several of the big food companies will use coatings on the outside of many of their different diets that are good for the teeth, and often times they'll use that on their hypoallergenic diets. Obviously, if your pet has an allergy to any kind of food product, then you need to talk with your veterinarian about whether or not any kind of dental toothpaste or treat or whatever is appropriate for your pets. If your pet is allergic to life and can't have anything then even just brushing without toothpaste, just brushing with water, mechanical removal of the plaque is still helpful. If your pet tolerates it, you could probably use a little baking soda or something like that, but really you're just trying to mechanically remove the plaque from the teeth, and so in that case, if your pet really can't have anything else besides its food, then I would get after with a plain toothbrush as daily, if you can, because then you're really helping it to remove that plaque as much as possible.
0:55:33.8 DD: Okay, and on that, someone asked an interesting question, and you probably hear this too, is they talked about what diets do you do for pets that you've done, like a lot of extractions or actually toothless? Do you have any suggestions?
0:55:49.6 DR: Yeah, so if a pet has no teeth, both dogs and cats, they do just fine, as we talked about earlier, they don't chew their food very much, especially cats, they are... Their teeth are designed to kill and shred prey, animals like birds and mice and things like that. They are not teeth that are designed to eat kibble, and so cats generally, although you might hear them crunching one now and then, they do not chew their kibble. They are swallowing it mostly whole. And so same thing for dogs, most of them are very enthusiastic eaters, they don't also chew very much. And so, if an animal has zero teeth, and there are several reasons why an animal might have no teeth, say it just had very advanced periodontal disease, and all of the teeth ended up being extracted. There are some immune system problems where the body sort of becomes allergic to the plaque on the teeth, and we remove the teeth to try and get that to stop that. If they have no teeth at all, they can still eat a normal diet, it takes a few days to figure out how to do it with their new slippery mouth, but they figure it out just fine, animals are much more adaptable than people are.
0:57:12.9 DD: Alright, now we're coming up to the time, the end of our time, but I have... Let's see if we can squeeze a few more in. Oh, here's a, hopefully a short one. What's the best time of day to brush teeth?
0:57:27.2 DR: You can kind of decide if you want to associate the tooth brushing with the bathroom or the kitchen. Generally, animals like the kitchen better than the bathroom, but really the best time is whatever time you're going to do it most consistently. So, I tell people, if they have a routine where they're watching TV with their pet in the evenings, that's a great time to brush the teeth, because you're sitting there, you're already snuggling with your pet, break out the toothbrush and do it right there. So whatever time of day you can most easily incorporate it into your routine, that's the time of day to do it, there's... Before the meals or when they wake up or whatever, all of that is not nearly as relevant because again, they don't get cavities.
0:58:15.9 DD: That's good to know. So, someone asked, and I think you... This is an interesting question too. What should owners expect for follow-up care for their pet if they've had a root canal?
0:58:28.2 DR: Root canal therapy generally has excellent success rates in animals as long as the teeth are chosen appropriately, so if the tooth is really infected already when we perform the root canal, the chances of success with a root canal go down. But generally for the most part, the likelihood of success with the root canal is more than 90% for the life of the patient, but it's not 100%, and so we recommend follow up in a year with x-rays or other kinds of dental imaging to make sure that there's no signs of infection on a tooth that's had a root canal or if it was infected to begin with, that the infection is resolving at that point, or at least staying static.
0:59:14.3 DD: Okay, that sounds great. Well, we are about at the top... We are exactly at the top of the hour, and I'm so sorry we couldn't get to all the questions, they're really, really great. And I think for folks, this is going to be posted on Morris Animal Foundation's YouTube channel, and you could always take another look at it, if something went by kind of quickly. I want to give a big thanks to Dr. Lauren Richman. Lauren, this has been so great. I've learned so much as well, and I really appreciate you doing this webinar with us, and I want to thank everyone out there for joining us, you can find some more information, we'll have some follow-up. And of course, morrisanimalfoundation.org. I know it's a long word, but that's our website address and we'll have information there as well, and again, a big round of applause, I can applaud, for Dr. Richman for joining us so take care.
1:00:13.9 DR: Oh, thanks so much. I love talking about teeth and go talk to your vet about your pet's teeth.
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1:00:18.6 DD: Sounds great. Thanks everyone.
1:00:19.6 DR: Bye, everybody.
