What's going on in your pet's mouth?

Clean teeth are a necessary precursor to overall health. We all know this, and new research is showing that even the marginal amount of periodontal disease in humans can contribute to heart disease and early mortality.

Sparkly white teeth after a dental prophy

We have some evidence-based knowledge about what oral disease does in pets. We have seen for many years a link between dental disease and heart disease. In addition, the bacteria overload from dental and periodontal disease in the mouth has been implicated in kidney disease, urinary tract infections, and even chronic GI issues.

How often do you look in your pet's mouth? I'll be honest, I have great dogs and a full knowledge of how dangerous dental and periodontal disease can be and even I can go months without peering into the dark dank recesses of my dogs' mouths.

February is National Veterinary Dental month. It is a month when we dedicate ourselves to remembering how overlooked the mouth often is in our day-to-day interactions with our pets. Even people who are way more diligent than I am about brushing their pet's teeth may not actually be looking at what they're doing.

I would like to walk you through a Comprehensive Oral Health Assessment and Treatment (COHAT) (typically called a dental) which is a systemic assessment, cleaning, polishing, and treatment of your pet's oral cavity done under anesthesia. I will explain what makes a COHAT far more than a routine "cleaning" or "scraping". In addition, I will explain why it is necessary and what we are looking for and why it is important not to wait until your dog has bad breath, red gums, and disease.

The picture above is of my own dog, Cassidy. She got a COHAT here about two weeks ago in conjunction with a mass removal. If you look at the picture above you will see that she has minimal tartar on her teeth and a little bit of redness. By doing the dental now I chose to avoid waiting until she had ongoing disease.

In this picture, the technician is using an ultrasonic polisher with a sand-paper like paste to polish the teeth after the cleaning. Both the cleaning and the polishing must occur above and below the gum line to remove all of the bacteria. Leaving bacteria below the gum line is actually worse than doing nothing because the teeth are now clean, but the gums and underlying structures are spreading infection. We use an ultrasonic cleaner specially designed for subgingival (below the gumline) use. The gingiva is delicate and sharp objects (such as tooth scaling equipment) can damage it.

After we clean the teeth we, polish every part of the exposed tooth surface. This is an important step, as the dental tools cause microscopic grooves which will serve a great surfaces for bacteria to reproduce.

In this (admittedly too bright) photo, the veterinarian is probing the gingiva for pockets. Pockets often hide diseased roots and can indicate bad teeth that may need to be removed. Each root and each edge of the tooth along the gumline is probed and the resulting depth is recorded. Three millimeters or less is considered healthy. Even perfectly healthy looking teeth can be harboring bad roots (think of your own teeth). Probing is a vital part of the dental process. Cassidy, here, had no pocketing of any significance.

This is the goal of preventive care - absence of disease - not waiting until disease occurs and then going in and fixing what is now broken.

In this picture (of a different dog) you can see the yellowish material - that is tartar. Under the tartar bacteria are destroying the teeth along the gumline and under the gums at the roots. There are times when knocking the tartar off causes the tooth to fall out.  Against the gums especially along the gum line, you can see a darker line. that darker line is actually active infection (pus). Around the canine tooth (the long one in the front) you can see the redness and inflammation caused by the infection.

In this dog's case there was significant pocketing around several of the teeth, and the last tooth on the back (with three roots) had to extracted due to the fact that it could not be saved. This dog's owner "waited" until the teeth "looked" bad enough to treat.

The teeth have been shedding bacteria into the bloodstream for months, the gums are red and painful, deep pockets are forming exposing sensitive roots and dentin to attack and teeth had to be extracted as a result. This is too late - this is not preventive medicine, and this is why we do not want to wait until the teeth look 'dirty' before we do a COHAT.

Cool new products

One of the coolest aspects of my job is seeing all the great new products that arrive every year from our drug companies to help us help our pets. Right now Ventana Animal Hospital is assessing two new drugs to establish how helpful they will be to our clients.

A fair amount goes into any decision to carry a new medication. We must ask and answer several questions before we even consider bringing a new medication into our hospital.

First and foremost, does it solve a problem that cannot otherwise be solved. If we carried every cool drug out there we would have no room to treat pets, and we would be broke because all our money would be tied up on our shelves. Many drugs are redundant, or they cover the same ground as older drugs, or they have one small change over an existing drug - in these cases, there would have to be a very compelling reason to add them to our pharmacy. We are only interested in truly breakout drugs or innovations that really make a difference to your  life or the lives of your pets.

Second we ask ourselves what the research really says. Many medications, especially ones that people hear about on the internet or from the media are poorly or not at all supported by the science. We only bring in new medications that have been FDA approved, which mean that they have undergone extensive research into efficacy and safety. Even after undergoing FDA scrutiny we will oftentimes wait on a medication until others have used it for a while.

Lastly, we look at cost and need. Just because a medication is effective, it's use might be so limited that we would never use it, or use it so rarely that we could never use all of the product before it expired on our shelf. We also look at cost. If a medication is prohibitively expensive and it is not a huge improvement on existing medications we will not carry it.

So, what cool medications are we looking at right now?

First we are looking at a new flea and tick product called NexGard. Unlike every other flea and tick product on the market, this one is not topical. Instead of having insecticides on your dog - and your hands and furniture - the dog eats a chewable tablet once monthly. The tablet contains a naturally occurring insecticidal molecule - found, interestingly enough in living sponges to kill sea snails which will eat them otherwise.

In addition to NexGard we are also studying a new medication released by Zooetis for skin allergies. This medication has already been used successfully by local dermatology specialists. The product is called Apoquel. We are still looking into some of the details of this medication, how, exactly, it works, safety, dosing etc...

Every month we receive notice of some new medication, protocol, or gadget. We try to think about how these products can improve the quality of care that we offer. We rarely end up pursuing these new things because they often do not meet our criteria, so it exciting that we are looking at two new products at the same time.

How to tell if your pet needs to go to an Emergency Center

One of the biggest issues owners face is a veterinary situation that happens after hours or during the weekend when their primary veterinarian isn't open. Ventana Animal Hospital is open from 8-5:30 on weekdays and from 8-12 on Saturdays - but we all know that accidents and illnesses don't always conform to business hours.

It's hard to know when something is an emergency and something isn't. Two am is also not the time to be trying to guess how dangerous your dog's symptoms are, or where the nearest veterinary emergency center.

We list two Tucson area veterinary emergency centers on our website. Both are affiliated with Specialty Veterinary Centers, and both provide excellent after hours emergency care.

Now that you know where to go, it's helpful to know when to go. Of course, before I list these symptoms that should send you scurrying to your nearest veterinary center, I must make the usual disclaimers: This list is in no way exhaustive - when in doubt, go to the Emergency Center, or give them a call - they will usually tell you how to proceed. (Their numbers are listed on the Ventana Animal Hospital website linked-to above).

So, what is an emergency?

Excessive bleeding, bleeding from the ears or nose, or bleeding in conjunction with swelling.

Any facial swelling or swelling anywhere especially after going outside and especially if there is a small drop of blood (we worry about rattle snake envenomation)

Any seizure that doesn't stop within seconds - a first seizure is scary and always needs to have a follow up at your regular veterinarian. Groups of seizures or a seizure doesn't stop can be life threatening.

Any signs of difficulty breathing - this is especially true of cats - blueish gums, heaving chest, unwillingness to lie down are all signs of repiratory distress in dogs. If your cat is breathing through an open mouth, that is generally a sign of breathing issues.

Any time a small dog is attacked by a larger dog even if there is no visible injury.

Any attack by wild animals - especially javalinas which create huge amounts of damage below the skin - always have your pet up to date on rabies.

Any possibility of a rattlesnake bite at all.

A broken bone, or possibility that a bone was broken.

Collapse of any kind.

Possible ingestion of a toxic substance (dark or bakers chocolate, sugar free gum, rat bait, household cleaners, diet pills, human medications, or anything that would freak you out if your kid ate it) - even if you know how, NEVER induce vomiting at home, some toxins an be inhaled into the lungs when vomited up and cause serious complications or even death.

Ingestion of anything sharp or anything that can cause blockage - especially dangerous are cutlery, rocks, tennis balls, toys, toy stuffing, anything that can act like string,

If your pet falls off anything from a significant height, chews on an electrical cord (the damage to the pet can be massive and life threatening even if you see nothing), your pet is hit by a car, golf cart or ATV, Your pet is kicked by a horse.

A cat (especially male) that cannot urinate, is yowling or straining in the litter box.

Any puppy under six months old with vomiting or diarrhea.

Any eye injury at ALL!

Of course there are a zillion other crazy things your pet can get into that weren't included here. The strange and terrifying things that your pet can get into are limitless. Many of them are scary but not life-threatening. But for those things that are dangerous, it is important to know what should cause you to drive to your nearest Emergency Center (or regular veterinarian if they are still open).

We sincerely hope that you never need to become acquainted with Tucson's Emergency Hospitals, but if you ever do, we hope this information helped you make a life-saving decision for your pet.

Welcome to 2014!

Happy 2014! We all hope you had a fantastic and safe holiday season and are now recovering by calling all of your friends who live back east and telling them how tan you are.

A new year is a great time to make a new start. We promise ourselves to make broccoli a bigger part of our diet and limit ice cream for dinner to special occasions. We also promise to be better at being us.

Our pets can benefit from the new us too. Research has shown for some time that people who walk their dogs are fitter. Our pets benefit from the exercise and the ability to explore the sights and sounds of the bigger world. Dogs that go for walks benefit from the socialization as much as we do.

I run with my dogs - well, one dog. This dog:

Kate on a mountain bike ride

These two dogs

Miss Kitty

Ketchum

Stay home. They stay home for two rather inexcusable reasons. First, these two, as the pictures above illustrate, embrace dirt, and all sorts of unknown, and unknowable, sketchy whatnot. Frankly they are kind of yucky.

Second, Kitty is well behaved, but, Ketchum - not so much. Her recall is dubious, her sit is non-existent and she thinks a leash is a lethal device and will flop around like a trout if I put one on.

This is sad - after all, I know how to bathe a dog and I certainly know how to leash train a dog.

So for 2014, I promise this blog will contain more stories of these two neglected pooches having adventures with their mom - which, of course, they really really want to do.

To get that achieved, I intend to use some of the coupons we have here at Ventana Animal Hospital to help everyone fulfill their pet's new year's resolutions. We have bags of Purina OM dog food for pets who need a jump start to a slimmer waistline, and for slackers like me, we have coupons to Central Pet for grooming and training.

Not only will Ketchum and Kitty benefit from smelling slightly less offensive, but learning to walk on a leash and come when called will allow them to go running and cycling with me.

Becoming better us's sometimes means helping our pets become better them's.

We look forward to seeing your better you in 2014, and we are very happy to help you help your pets become better them's.