In honor of Pet Dental Health Month, here’s an article I wrote for Your Dog, the newsletter of the Cummings School of Veterinary Medicine at Tufts University (published September 2009)
Maybe you’ve seen a sign for “Teeth cleaning without anesthesia” in your groomer’s shop or on a pet store bulletin board, and you’ve wondered: Would my dog benefit from some quick tartar removal, free from the perceived dangers — and costs — of a professional cleaning under anesthesia at a veterinarian’s office?
“Definitely not,” says Jean Joo, DVM, a veterinary dentist at Tufts Veterinary Emergency Treatment & Specialties in Walpole, Mass. She stresses that the hazards of such services far outweigh any superficial cosmetic benefits. “Not only do these types of cleanings fail to prevent periodontal disease, which takes place below the gum line,” Dr. Joo says, “but they create a false sense of security in the owner because the teeth look clean.”
The results can be devastating. “I had a toy poodle come in with clean, white teeth,” Dr. Joo says. “The groomer scaled her teeth every month, and they had almost no calculus at all. However, when I examined the dog under anesthesia, I saw that her teeth were in terrible shape, many of them loose and diseased. I ended up extracting 16 of them.”
Calculus, commonly called tartar, is the hardened form of plaque, the bacteria-laden material that naturally forms on and between teeth. It’s easy to chip tartar off the upper part, or crown, of the tooth — which is why it can be done without anesthesia — but that’s not where problems occur.
Painful below-gum scaling is not the only essential cleaning that must be done under anesthesia to be safe and effective. Without the smoothing action of polishing and a final antiseptic rinse — only achievable with suction since dogs can’t be trained to spit — the teeth and gums are even more susceptible to bacterial infection than they are before being scaled. And it’s difficult to perform an in-depth examination or get accurate dental X-rays when the patient is squirming or making sudden moves.
Steven Holmstrom, DVM, who is board certified in veterinary dentistry and practices at the Animal Dental Clinic in San Carlos Calif., has seen many patients after an anesthesia-free cleaning. “They were better off before the procedure,” he says. “We tried teeth cleaning without anesthesia 35 years ago. If it had been appropriate, we in the AVDC [American Veterinary Dental College] would all be doing it. It would dramatically increase our business.”
Dr. Holmstrom, former president of the AVDC, suggests that anyone contemplating a nonprofessional cleaning read “Companion Animal Dental Scaling Without Anesthesia,” a position statement posted on the AVDC’s web site. It details the medical issues involved and points out the legal ones, noting that, “In the United States and Canada, only licensed veterinarians can practice veterinary medicine …. Anyone providing dental services other than a licensed veterinarian, or a supervised and trained veterinary technician, is practicing veterinary medicine without a license and shall be subject to criminal charges.”
The statement also addresses the fears that many people have about anesthesia — fears that Dr. Joo encounters regularly in her practice. “I never tell clients that there are no risks,” she says. “But they’re greatly reduced by tailoring the anesthetic protocol to each patient. As long as we have current blood work and urinalysis, know the dog’s medical history and are proactive in monitoring and treating the patients while under anesthesia, we can minimize the risks.” Besides, she says, “Anesthesia has become a lot safer now with the use of balanced techniques and inhalant anesthesia.”
Dr. Holstrom concurs, noting that most problems associated with anesthesia date back decades, when barbiturates, which are a lot less predictable, were used. “The effects of today’s anesthetic agents like sevofluorane and propofol are reversed more quickly and the drugs metabolized far more easily than the ones used in the past.”
Concerns over anesthesia and the proliferation of nonprofessional teeth cleaning services — which sometimes exaggerate anesthesia’s dangers to drum up business, according to Dr. Holmstrom — reflect widespread public confusion about veterinary dentistry and especially preventive care. The confusion is understandable. The American College of Veterinary Dentistry was established little more than 20 years ago, in 1988, and full recognition of dentistry as an approved specialty in veterinary schools was granted only in 1995. Dr. Joo says, “Today, less than half of the veterinary schools in this country have veterinary dentists on staff.”
The awareness of the impact of dental disease on other body systems, in humans as well as in dogs, is also relatively new. “We are just beginning to find the links between overall health and dental health,” says Dr. Holmstrom, one of fewer than 100 diplomates in veterinary dentistry in the United States. “Studies on humans show that advanced periodontal diseases lowers mortality.”
There’s no question that, if left unhindered, bacteria from the teeth and gums can spread through the bloodstream and infiltrate other parts of the body, including the heart, liver and kidneys. At minimum, periodontal disease causes mouth pain in dogs, and, as a result, difficulty eating.
Professional cleaning is the only way to prevent and treat it.
“Subgingival [below the gums] calculus harbors the bacteria that cause periodontal disease,” Dr. Joo says. “We brush our teeth daily and still need to go to the dentist for professional cleanings because we can’t reach below the gum line. Most owners don’t brush their dogs’ teeth at all, so you can imagine how much more plaque and calculus build up.”
Indeed, according to the [gross picture alert if you click on this link] Veterinary Oral Health Council, periodontal disease is the most common clinical condition in companion animals. Most studies indicate that at least 75 percent of dogs show signs of it by the time they’re 2 or 3 years old. And because these statistics rely on a sample of pets who receive regular veterinary care, the percentage is likely higher.
Toy breeds affected
The disease is particularly rife among small and toy breeds. “They have disproportionately large teeth for their small mouths and jaws, which results in crowding,” Dr. Joo says. “This means that food and debris, which turn into plaque and tartar, get caught on and between teeth. It doesn’t take much before the teeth become loose and for infection to set in. In extreme cases, small dogs have such severe dental disease that they can break their jaws.”
This happens when the alveolar bone, which surrounds the tooth sockets, erodes. This weakens the lower jaw so much that a slight trauma — everything from bumping into furniture to chewing on a toy — can cause it to fracture.
In contrast, larger dogs have a more balanced tooth-to-jaw ratio. “When they lose a few milliliters of attachment, it’s not as significant,” Dr. Joo says. Larger dogs also tend to chew on toys and other things that help keep their teeth healthier — as well as some that don’t. These breeds need regular dental checkups because, Dr. Joo cautions, “They have a tendency to break their teeth chewing on hard objects like bones or rocks.”
Also affecting the onset and progression of periodontal disease is a dog’s tendency to pant. The more a dog pants, the drier the mouth and the less saliva available to perform natural dental cleansing, Dr. Joo says.
Although size definitely counts when it comes to the recommended frequency of professional cleanings, each case has to be judged individually. Larger dogs can sometimes go for more than a year without professional care if the owner keeps up with brushing while some smaller dogs may benefit from cleanings twice a year, no matter how assiduous the home care.
But it’s not only the lack of knowledge about the prevalence and repercussions of dental disease and the fear of anesthesia that keep people from having their dogs’ teeth cleaned professionally. For many, it’s the cost. No question: Professional cleaning can be expensive. Prices vary across the country, from little more a hundred dollars to more than a thousand.
Fees will vary
In part, teeth cleaning rates are based on the cost of living. For example, you can expect to pay more in cities where office space is at a premium. Other factors that impact fees include the experience of those performing the procedure and the quality of the equipment used. “Many practitioners go to continuing education courses to fill the gaps in their knowledge,” Dr. Joo says. “And while some practices have only simple hand scalers, others offer state-of-the-art dental units.”
How do you rationalize spending the money to clean your dog’s teeth? Dr. Joo quotes the proverb “an ounce of prevention is worth a pound of cure,” adding that by providing routine dental care, owners can avoid multiple extractions. Moreover, dental care may pay for itself by mitigating other costly conditions. As an example, Dr. Joo has seen dogs with hard-to-manage diabetes become significantly better once their dental disease had been treated.
The most immediate, direct benefit of a professional cleaning is usually the elimination of canine bad breath. Getting kissed by your dog without wanting to recoil? Priceless.