• What is a "dental"?

There is no such thing as a typical "dental". Veterinary dentistry should involve comprehensive examination of the patient consciously and under an anaesthetic. This involves examining every tooth individually,  both visually and with a periodontal probe, and charting findings. In some cases dental radiography may be indicated  to see what is happening beneath the gum-line in the root/socket area. Extractions, or other treatments may be required, and usually all patients require scaling (above and below the gum-line) and polishing of teeth to remove both plaque and tartar.

 

  • Why does my pet need a general anaesthetic to have dentistry performed?

Vets can gain a lot of valuable information by examining your pet's mouth while they are awake. However, most of what we can see is literally 'the tip of the iceberg'. Disease is often not found until the animal is examined under an anaesthetic. Dogs and cats do not tend to allow us to hold their mouths open for long enough to see all surfaces of all of the teeth. More importantly, we need to know what is happening beneath the gum-line, which can only be assessed by using a blunt-ended probe underneath the gum, and taking dental radiographs.  Obviously this would not be tolerated in the awake patient. Secondly, our priority is to ensure that your pet does not experience any discomfort or pain during the procedure. Even scaling and polishing can cause minor discomfort (I don't like it!) so to ensure your pet doesn't experience any pain, we must have them anaesthetised to perform dental treatment.

 

  • Is a general anaesthetic safe?

Unfortunately, no general anaesthetic is 100% safe (including those for humans). However, modern anaesthetic drugs, combined with intensive monitoring using experienced qualified veterinary nurses and special equipment can provide an anaesthetic with relatively low risk. Dental procedures are often carried out on older patients, so it is often sensible to obtain pre-anaesthetic blood tests which will give an overview of your pet's internal health (for instance kidney function, liver health and signs of diabetes). As dental procedures can also be quite lengthy, it is also often recommended to use intravenous fluids during the anaesthetic. This will help your pet recover more quickly.

 

  • What is periodontal disease?

Periodontal disease (also known as gum disease) is a very common disease in humans, cats and dogs. It is probably the most common disease affecting dogs and cats today. Periodontal disease is caused by plaque. Plaque is a sticky collection of bacteria which have the ability to stick to each other, and surfaces such as the enamel of teeth, forming an adherent film (termed a  bio-film). Plaque causes inflammation of the gums (termed  gingivitis). Gingivitis can initially be very subtle, with a mild reddening of the edge of the gum. Inflamed gums will  bleed more easily.  If plaque is not removed from the tooth, over time it will harden and mineralise  into calculus (also known as tartar). This is the browny yellow hard substance that you can see on your pets' teeth. This is a perfect surface for more plaque to stick to, and so the process accelerates. Gingivitis  may progress if left untreated, and cause the disease known as  periodontitis. Gingivitis is the  reversible stage of the disease. 

Plaque and tartar removed
Advanced, irreversible periodontitis

Periodontitis is irreversible, and is characterised by loss of attachment for the tooth in the socket, which may lead to loss of the tooth, tooth mobility, and severe infections. Bacteria may potentially enter the animal's bloodstream every time it chews, which can lead to infection and disease inside the body, potentially affecting the heart, lungs, and kidneys.Move your mouse over the image on the right to see the heavy plaque and calculus disappear. Notice how much the gum and bone has receeded, exposing the roots of the tooth.

  • What is tooth resorption in cats? (TR)


Premolar affected by FORL

Tooth Resorption (TR) in cats has been known by many terms, including until recently FORL (Feline Odontoclastic Resorptive Lesions) and originally 'neck lesions'. These are relatively common in cats. They are potentially a source of extreme  pain, and can be difficult to diagnose without meticulous examination of the mouth and dental radiography. We do not yet know what causes these problems in cats, but we do know they occur very commonly. The process starts beneath the gum-line in the root of the tooth. A resorption process is triggered which can lead to destruction of the root of the tooth and replacement by bone. This can go unnoticed.

FORL affecting left lower premolar

 As the disease progresses, the inside of the crown of the tooth becomes affected, and the thin covering layer of enamel can easily be chipped off (for instance during normal eating), exposing the sensitive structures within the tooth. This can be seen as a small red dot on the crown of the tooth near the gum (the neck of the tooth, which is why the disease used to be known by this name) or an overgrowth of gum over the crown. These are painful problems, as the internal nerves of the tooth are erxposed and the only recommended treatment to date, is extraction of the affected tooth. There are two recognised types of tooth resorption in cats, one of which is more commonly associated with periodontal disease. It is important to understand that if your cat has had one tooth affected, they are likely to get more in the future. As we don't yet know the cause, we cannot unfortunately recommend any treatment to prevent them. If your cat has the type associated with periodontal disease, then plaque control will certainly help.

  • How do I know if my pet is in pain with dental disease? He doesn't appear to be.

The sad fact is that animals are VERY good at covering up signs of pain. Their instinct is to survive, and to do this they need to both eat, and appear healthy. Dental disease will often NOT stop an animal from eating, but that does not mean it isn't experiencing any pain. There can often be subtle behavioural changes, or animals may chew preferentially on one side of the mouth, because the other hurts (we will often detect this on dental examination, by heavy tartar accumulation on one side of the mouth (the painful side) and very little on the good side). Owners will often remark how well their pet seems after dental work, commenting that they are like a puppy/kitten again. The obvious signs of dental pain are pawing at the mouth/face, dribbling, and reluctance to eat but these are rarely seen. If in doubt, ask your vet for a dental check up.

  • Why does my dog/cat have smelly breath?


Bad breath might indicate a problem!

Doggy breath is not normal! A common cause of bad breath (halitosis) in dogs and cats (and people) is periodontal disease (see above). Imagine your own breath if you stopped brushing your teeth for a few days!  This is an early warning sign of the disease and should not be ignored. There are many other causes of bad breath too, and it is important to get it checked by your vet, rather than assume it is normal.

  • My dog/cat has broken a tooth- does it need treatment?
Fractured canine tooth exposing the pulp- this hurts!

Yes! Think how you would feel if you broke a tooth. It makes your eyes water just thinking about it! The pulp of the tooth contains bloods vessels, and nerve fibres that sense pain. This runs inside the tooth (like the yolk of a hard-boiled egg). If a tooth breaks, exposing this pulp, the tooth will often bleed. More importantly it will be painful and allows bacteria to invade, causing inflammation of the pulp. This can last a long time, causing bouts of throbbing toothache. Eventually the tooth will die when the pulp dies. However bacteria love dead tissue, and multiply even more causing a root abscess. This is very painful! Dogs and cats however do not react in the same way as us. They often will not stop eating- their instinct is to survive, and to survive they must eat. Just because your pet isn't showing any outward signs of pain, it doesn't mean they aren't experiencing toothache. A vet once told me he had toothache for the longest time. He didn't stop eating, but he became the grumpiest Dad around! Treatment options include extraction of the affected tooth, or a procedure known as a root canal, which removes the inflammed or dead pulp and restores the tooth with an inert substance.

  • Why is my pet's tooth discoloured?
A discoloured upper canine tooth

Discoloured teeth may range in colour from pink, to purple, to beige, grey or even a blackish colour. This happens when the tooth suffers some kind of blunt trauma. The pulp will bleed, and this seeps into the porous white dentin of the tooth (in the hard-boiled egg analogy, the dentin is the white of the egg). At this stage the tooth may look pink. With time, the blood in the dentin breaks down, and the protein is reabsorbed by the body. The iron component though remains in the dentine, giving it the brownish colour. In many instances these teeth will be dead teeth, and will require treatment just like a fractured tooth (see above). Again, pets will often not show any signs of pain with these teeth. Small areas of discolouration may be suitable to leave alone, but if the whole tooth is discloured, it is likely to require treatment.

What is a malocclusion?

Malocclusion with lower canine teeth causing trauma to hard palate

A malocclusion is when a cat's or dog's teeth don't meet in the correct way when the mouth is closed. In some cases, this is a problem as it causes pain and potential infection. Here the lower jaws are shorter than they should be, and the lower canine (fang) teeth are hitting the roof of the mouth when the mouth is closed. This is painful: it leads to ulceration and potentially a communication into the nose which is disastrous! It is likely that many cases of malocclusion are genetic in origin, meaning it is not wise to breed from affected animals.

Orthodontic treatment can be used to alleviate pain in dogs and cats

It is possible to treat most malocclusions, with the aim of providing pets with a comfortable and functional bite. In this case, the upper canine tooth (fang) was moved backwards and then the lower canine tooth tilted outwards. In now sits in a normal position, and most importantly, is not causing any pain. The appliance used to tilt the tooth can be seen attached to the upper canine tooth. This is removed once the necessary position is achieved.

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