Dental2

An Unusual Introduction About The 4 Different Types of Veterinarians That Also Happens To Be Very Informative About Pet Dentistry:

Human Beings: Thanks to decades of human dentists “educating the public” about the importance of gum health and dental hygiene, everyone knows that unless they brush, floss, routinely go in for a dental check up and cleaning, that they are going to start loosing their teeth in early adulthood, and they won’t be getting any French kisses.

And we know from human studies that inflamed gums are the number one port of entry for bacteria into our blood stream leading to septicemia, liver disease, kidney disease, and especially cardiovascular disease.

Dogs and Cats: Everything I just wrote about human beings (except for the French kissing part) applies to dogs and cats too. In fact, due to differences in salivary pH, our veterinary patients accumulate plaque and calculus 5 times faster than people!

Not only do pets accumulate plaque and calculus 5 times faster than people, don’t forget that pets age about 7 times faster than people.

And 7 x 5 = 35.

Therefore, since it’s recommended that people go to a dentist for professional cleaning every 6 months, that means you should bring your pet in for professional cleaning 35 times more often or about 70 times a year. … (I’m sorry, I couldn’t resist…just kidding)

Mathematical kidding aside, dental disease can seriously reduce your pet’s quality of life. More to the point, a little effort and attention taking care of your pet's mouth will likely improve your pet's life span, prevent numerous diseases, prevent the pain and irritation of inflammed gums, and help a lot with bad breath. To see just what you can do to improve and maintain your pet's oral and dental health, please read below.

If you’ll let me explain that there are 4 basic types of vets offering dental care, I think it will give you a much better understanding of what’s going on and what’s available. Not only that, but you can apply this to other areas of veterinary clinical care.

Level One Veterinarians: If the pet has obvious pain, discomfort, or strong oral odor on physical exam…especially if mouth pain is why the owner brought the pet in…, then the vet will offer to “pull” the offending tooth under anesthesia and clean up the rest of the teeth while doing the job.

If, during physical examination of a pet brought into the clinic, the vet demonstrates obvious heavy tarter or easily visible gum disease, the vet will recommend dental cleaning and inspection under anesthesia.

Level one veterinarians tend to be very practical and relatively inexpensive when it comes to dental care for your pet. It’s just that they’re not heavy into PREVENTIVE dental care, and because they do relatively little dentistry, they are not as likely to have extensive equipment or experience in doing more than the basics.

But even at this basic first level, in advanced countries, at least, you can expect cleanliness, careful anesthesia, pain management, fairly good basic dental skills, antibiotics and after care if needed…and a referral to a specialist or other vet if it turns out that the problem is bigger than first thought…cancer of the jaw for example.

Level one doesn’t mean bad…such basic, inexpensive, and practical care.

Level Two: Vets at this level will do everything level one veterinarians offer, but in addition they will check every pet for EARLY signs of plaque and disease and discuss with their clients the need for dental hygiene at home and preventive professional cleaning on a fairly frequent basis…usually every 6-36 months depending on the age, breed, oral condition, and genetics of the individual pet.

Level two vets typically have lots of client education material and dental hygiene product choices available at their clinics. And level two vets will typically have a fairly high standard of dental equipment and a tech well experienced and meticulous in his or her work.

But the level of actual dental services are still pretty basic involving mostly the common and important services of cleaning, polishing, inspecting, and extractions if needed. Fees at such clinics also tend to be fairly inexpensive. Level two vets are willing to put in the considerable effort of promoting dentistry to their clients on their pet's behalf before the gums start to recede and oral disease is obvious.

Level Three: Veterinary clinics offering level three dental services for your pet will have spent a lot of time, money, and effort to be able to offer you this very high level of medical care. And you can expect such care to cost several hundred dollars each time you bring your pet in for dentistry.

They aren’t “ripping you off”, though, they are simply doing the job at a very high standard and that costs money. So what’s different? Well, a level three clinic will include or offer some or all of the following that less expensive clinics might not:

Very aggressive check ups designed to catch periodontal disease early. This may include special fluorescent lights and/or dyes that highlight plaque. And it may include recommendations to have dental x-rays done to make sure decay hasn’t begun hidden under the gums. Level three vets know that offering dental care after it’s easily visible without x-rays may be too late to stop permanent damage to the underlying dental structures.

Blood chemistry and other testing prior to anesthesia.

More extensive anesthetic protocols. Some vets have elaborate equipment and highly trained personnel to monitor your pet while under anesthesia in addition to having a well trained dental hygienist. They will run IV Fluids, perform Oxygen therapy, and have continuous EKG, pulse oximetry, and machines that measure and monitor CO2 concentrations during the dental procedure.

Before and after digital pictures of your pet’s teeth. They will keep detailed records about each tooth and procedure your pet has.

Complete oral radiographs…either done routinely or done when deep decay, root disease, cancer, mineral deficiencies, or jaw bone disease is suspected.

Level three vets will offer fluoride treatments.

Level three vets will offer to coat your pet’s teeth with sealants to further protect from plaque accumulation.

Level three clinics are likely to have the latest high tech equipment and highly trained, certified techs and assistants. The vet performing the dental procedures is likely to have additional training, certification, or post doctorate degrees.

And, as with level two veterinarians, you will be highly encouraged to come in for preventive dental work on a regular basis. Not only that, but they will want you to take your pet’s oral health seriously at home and offer your pet dental hygiene products, toothpastes, diets, and they will expect you to reinforce the sealants that they applied with a little take home kit.

Level Four:

Yes, some clinics offer even more. Level four clinics will have a veterinarian skilled as a dental surgeon supervising the techs during routine cleanings and, of course, performing the extractions, gum surgery, capping, bridging, cavity repair, and root canals should they need doing. Some vets are even skilled at orthodontics.

I’ve written about the different levels of veterinary dental care mostly to introduce you to all the possible options for your pet and to explain why the range in fees among clinics can be so large. If you were to phone a few vets telling the receptionist that your pet had a toothache and you wanted to know how much it might cost to have that taken care of, you’d probably get a range of quotes from $125 to $1000. Now you have an idea why.

Let me make something clear: Just because your vet offers level one…basic and inexpensive… dental care doesn’t mean he or she is a poor vet. It simply means …at least where dentistry is concerned… the offerings are basic.

And thank goodness such vets exist.

Think of all the people with pets in America who spend a whole lot more each month than they make…all the pet owners in America on social security or other types of very modest means…

Where do they go if their pet is in agony with a bad tooth?

Offering Level three or Level Four care is cool, it’s ideal, and it protects the clinic from getting sued for inadequate care, but such clinics have to turn away those who can’t afford their fees. Not because they’re uncaring, but rather because they have to pay for all that equipment, all those tests, and all those certified salaries.

This same logic often holds true for procedures other than dentistry, whether it be general surgery, wound care, trauma treatment, or whatever.

There are different levels of care or standards offered by different clinics and in general the price difference is big and indicative.

And again, it doesn’t mean the lower level clinic is bad, it’s just more practical and that may be all your pet needs or all you want.

The only important question, in my mind, is that if you’re going to a lower level vet, will he or she tell you, when needed, that “ hey, I can treat this with minimal expense, but this case is a little more serious than you might realize and it would be better if you went to see Dr. FancyPants who's set up and experienced in tough cases like yours.

Okay, that was a bit of a sidetrack. Here's a more traditional introduction:

Oral health in pets is real important.

It’s often overlooked.

It’s often not addressed until it’s obvious your pet has a rotten mouth.

Gum inflammation is a major source of disease and death!

Death!

In the sense that bacteria in the blood stream is a major cause of kidney, liver, and heart disease. And that kidney, liver, and heart disease are often fatal. And that the number one way for bacteria to enter the blood stream is through inflamed gums!

Unless you’re broke.

And unless you don’t take pet care responsibility seriously.

You need to heed your veterinarian’s advice to clean, inspect, and polish your pet’s teeth. How early and how often will depend on the individual pet, it’s age, breed, and the condition of the teeth and gums.

Okay, that’s the introduction. We hope that you’re one of those wonderful people who believe in preventive health care for their pets and are willing and able to spend the effort and money to do the job. You’ll find a discussion below about all the options and products designed to make your job easier and effective. And as usual, a scattering of comments, miscellaneous information, jokes, pictures, links, and so forth. As always, God Bless, Roger Ross, DVM

Want to get on board and help your pet? Here’s a summary and some comments about all the things you can do. We realize that some pets are more difficult to treat than others, so hopefully you’ll find at least a couple of things that you can manage that will help your pet live a happier, healthier life.

OraVet Dental Sealant

I’ve listed this new service at the top of the list because it’s likely to be the most effective at protecting your pet’s teeth from plaque and the resulting gingivitis that causes periodontal disease.

Plague begins accumulating on the teeth in as little as 6 hours. You know this intuitively when you think about your own teeth… what’s your mouth feel like if you don’t brush your teeth for a day?

One of the most effective means of preventing plaque and calculus formation once your pet’s teeth have been professionally cleaned is by sealing the teeth with the newly available tooth sealant call OraVet.

This new product is applied in concentrated form with a bonding agent by your veterinary dentist after the teeth are cleaned under anesthesia. This creates an invisible barrier preventing bacteria from attaching to the tooth surface.

Unfortunately, this protective seal doesn’t last forever, and for ideal results an additional coating of the polymer should be reapplied at home by the owner weekly. Nonetheless, we’re still pretty excited about this product because it works so well and it turns out that the reapplication process is quite simple…you just apply a thin line of the sealant with a swab along the upper gum line.

Professional reapplication of the bonding agent should be reapplied every 6-12 months for best results…which just happens to correspond to how often your pet’s teeth should be professionally cleaned in ideal circumstances.

Not only does this sealant work better than brushing, but let’s face it, we’re having a hard time getting people to brush their pet’s teeth day in and day out. Whereas weekly swabbing is manageable.

The sealing gel is odorless, tasteless, super safe, and invisible once applied. There’s all kinds of published studies raving about how effective these sealants are in the prevention of oral disease. Most other products are designed to remove plaque from teeth; OraVet is designed to prevent plaque from bonding to the teeth in the first place!

Ask your vet if he or she offers dental sealing yet. Most vets are charging about 10 times less than human dentists for the same service.

Note: this new sealant is not damaged by brushing or oral washes and gels. And while I just said sealing is better than brushing, it would be even better to also brush or supply your pet with dental chews, Greenies, and so forth. Just like with us, we ideally take a multi-prone approach (Brush, floss, and swish), except with pets it’s a little impractical to floss and swish.

Tooth Pastes: Daily brushing…or even brushing 3 times weekly (it takes plaque about 2-3 days to really bond tightly to the enamel) is very helpful and effective. The only big negative is getting people to do the job and getting the pet to accept the procedure on a regular basis. On the other hand, a good many pets will readily accept brushing, and even seem to enjoy the attention and the various flavors (including poultry flavor) of tooth pastes available for pets.

Note: Human toothpastes are not recommended. For one thing, they weren’t designed to be swallowed. And dogs and cats have different pH levels in their saliva making human toothpastes less effective.

Chlorhexidine Products:

Chlorhexidine is widely used in medicine as a germ killer safe to mammalian tissues and kills bacteria, fungi, and some viruses. It also happens to be the most effective plaque-inhibiting agent used in human dentistry. Once in contact with the teeth, it works well for about 24 hours, the only catch being that the contact duration needs to be at least several minutes for the agent to attach to the enamel. There are several products designed to do this:

There are chewies and rawhide type products containing 10% chlorhexidine that work well. C.E.T. Hextra Premium Chews is a common brand sold by vets that works well. In this case, the rawhide chewing also provides the benefit of mechanical plaque removal.

More Options

Milk Bones and other similar biscuit type bones heavily advertised for “clean teeth”:

I don’t know how effective these are. One dental seminar speaker claimed they did more harm than good! The mechanical removal of plaque from chewing something crunchy is good, but the ingredients of baked starch and fat is, while delicious to most pets, are ideal “food for oral bacteria” and that’s bad.

Greenies: In contrast to Milk Bone type treats, dental seminar speakers are giving high praises to Greenies. They’ve earned the Veterinary Oral Health Council seal of approval (VOHC) in 2004. They’re certainly well liked by most dogs. Lots of dogs go nuts when offered Greenies.

They’re quite expensive compared to Milk Bone type treats, but you might decide that the ease of use, the pleasure your dog gets in chewing these things, and, of course, the oral health of your pet is worth it.

Greenies crystals for cats are now available too.

Maxiguard Oral Gel: Another great and effective product that’s fairly easy to use for both dogs and cats. And it’s the most effective breath freshener we’ve used. Maxiguard is a complexed zinc and vitamin C gel that stimulates gum healing, oxidizes bacteria, chelates sulfur compounds that cause bad breath, and reduces the amount of harmful proteolytic enzymes produced by bacteria that cause gum inflammation.

You simply smear a little gel on the teeth with your finger or directly from the bottle. You don’t have to carefully apply it to each individual tooth as it will mix well with the saliva and distribute itself over the teeth and up into the pockets hidden by the gums.

This is a great product if you’re willing and able to get in the habit of using it at least several times a week. Most cats and dogs accept this product well. It’s alcohol free, tasteless, and has a bonding agent that helps it bond to the gums and mucus membranes. I especially recommend this in pets after dentistry who had extractions, oral ulcers, or other types of advanced oral disease. It’s also nice for pre-dentistry as it strengthens connective tissue and reduces bleeding time.

I really like Maxiguard Oral Gel ... It's what I use on my pets.

Hexametaphosphate and acetic acid products: These agents are effective at binding mineral deposits and therefore preventing plaque from turning into tarter or calculus. DenTee Stars and Chews…which also contain grapefruit seed extract and clove are examples. DentAcetic Wipes are dental swabs are similar except instead of feeding your pet chewies, you swab the product on the teeth with these little wipes that fit over your finger tip. Gels are also available.

Ham Bones, etc: The frequent chewing of bones is very helpful and good for the teeth. And this should appeal to those of us who like that it's a natural thing to do. However, bone chewing can cause digestive upsets, bone splinters wedged in the roof of the mouth or worse, cause serious damage further down the digestive tract. And bone chewing in dogs with really bad teeth could cause a jaw fracture. So, exercise a little judgement and avoid bones that are prone to splintering such as cooked poultry bones, rib bones, etc.

Chew Toys, Chew Ropes, NylaBones, etc: All these things help exercise the gums and to different degrees remove plaque. The main trouble with this type of thing is getting your pet to use them regularly, especially once they stop being puppies and become mature like me. Some mechanical methods of removing plaque such as playing tug of war with nylon rope probably help quite a bit if done regularly…especially if the rope is designed for cleaning teeth and coated with chlorhexidine or hetametaphosphate.

Diets designed to promote oral health:

The easiest method of all, of course, is to simply feed your pet one of the new diets designed to reduce plaque and tarter. It’s a little difficult to tell from the studies and research which brands are the most effective, but I’ve been impressed with Hill’s TD (Tartar Diet). Even when fed a few chunks a day as treats instead of food, my clients have seen improvement in both breath and teeth cleanliness.

TD is a prescription diet sold by vets, but the same company makes Science Diet Oral Care for cats and dogs which is sold by quality pet stores. TD and Oral Care contain a specially developed fiber matrix that simulates flossing when pets chew the kibble enabling it to clean up under the gum line…not just the visible tips like most other foods claiming to control tarter. It works “like a squeegee cleaning glass”. These diets have earned the Veterinary Oral Health Council certification which is pretty impressive.

Iams and Eukanuba diets containing teeth cleaning micro-crystals have a reputation for effective tarter control. I’m not sure how effective these crystals are though and none of the seminar speakers have come out yet and told us “hey, you vets need to be recommending Eukanuba diets for tarter control because it’s really working well.” Keep an open mind until I find out more, please.

Anything crunchy that your pet chews theoretically helps with tarter control, so lots of products claim something along the lines of “Aids in the control of plaque and tarter”, but such foods weren’t specically developed to be effective dental diets…they just happened to be crunchy or tough to chew like rawhides and rubber chew toys.

The big question with such products is How Effective are they under the gum line where the real battle for oral health rages?

Doxycline gel: This is an antibiotic gel that is quite effective in fighting and preventing oral infections and is prescribed by your veterinarian for the treatment of advanced gingivitis and for after extractions and so forth. It is often packed in gum wounds during surgery and stays effectively in place for over a month.