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.