Dr. Kim’s Blog

Root canals, dental x-rays, extractions, orthodontics, implants, crowns, and periodontal surgery for you pet? You must be kidding! Not at all. These dental procedures are performed routinely in veterinary practices today.

Oral disease is one of the most prevalent diseases in dogs and cats. 85% of dogs and 70% of cats have some form of dental disease by 3 years of age. Why is the incidence of dental disease so high? Since pets don’t brush or floss their teeth, the calculus continues to accumulate on the teeth on a daily basis causing gum, tooth and bone damage through the years. Pets are also living longer allowing the disease to progress even more.

There is little difference between our pet’s teeth and our own.

We all have a set of baby teeth that come in and fall out to make way for adult teeth. We all have nerves, blood vessels in our teeth surrounded by dentin and enamel. The problem begins when bacteria accumulate at the gum line around the teeth. Unless removed daily, these bacteria can destroy the gums and cause bleeding and pain. The enamel becomes covered by plaque which then mineralizes into calculus (a yellow or brown accumulation on the tooth surface). The gums become very painful, the periodontal ligament becomes damaged and the bone around the tooth is eaten away. Eventually the tooth is lost and if the bone damage is severe enough, the jaw can actually break.

The bacteria in the mouth can seed other areas in the body through the blood stream leading to infection in the heart, liver and kidneys. This is no different than in humans. Poor oral hygiene can shorten our and their life expectancy.

How does a loving pet owner know if dental care is needed?

Since cats and dogs cannot point to dental abnormalities with their paws, an examination is the key.

1. Usually the first sign is bad breath. If you smell a disagreeable odor, gum disease is probably already present.

2. Other signs include red swollen gums, tartar accumulation on the teeth or even loose teeth.

3. When examining your pet's mouth, look for chips or fractures on the tooth's surface which can cause sensitivity. A deep fracture can expose the pulp or root canal which can lead to an abscess.

4. Watch your pet for signs of mouth pain. Have you noticed any changes in chewing or eating habits? Pain in animals is manifested very differently than humans. Dogs may whine but may simply become more timid or possibly aggressive, have a decreased appetite or simply restless behavior. Cats may purr or growl and try to hide and may stop grooming themselves. Animals are also capable of hiding their pain for protective reasons and it is possible that as an owner, you may not even be aware that the pain exists.

Professional Veterinary Care

When your home exam reveals dental problems or if you are simply uncertain, a trip to the veterinarian is in order. The veterinary oral examination will begin with a complete visual examination including the face, head and mouth. The teeth are carefully examined and the oral cavity for gum disease or cancer. If any abnormalities are noted, anesthesia would be necessary for the dental procedure to be performed. The professional cleaning performed at your veterinarian’s office is similar to what a person receives at their dentist’s office. I recognize that some clients are reluctant to have dental cleanings done due to their fear of anesthesia. Modern veterinary medicine offers a wide array of safe and effective anesthetics plus organ monitoring equipment that should allay concerns of anesthesia. Unfortunately by the time some pets come to a veterinarian for dental care, it is often too late to save all of the teeth. More than 50% of the dental procedures that I perform result in extractions simply due to an owners procrastination. Remember the better your home care routine, the less veterinary bills will ensure therefore saving you money in the long run. It is important to note that a “cosmetic or non-anesthetic” teeth cleaning is NOT recommended as a complete examination, X-rays and cleaning under the gum line cannot be performed in an awake animal.

Home Care Products

1. Toothpaste and Brushing-Just as with your own teeth, nothing beats brushing. A toothbrush acts as a tiny scrub brush for the closest possible cleaning. Never use human toothpaste as xylitol may cause kidney disease in pets when swallowed. Animal toothpastes come in pet-preferred flavors such as chicken and seafood. Finger brushes are also available for smaller dogs and cats.

2. Dental Wipes, Rinses and Pads-Some animals, especially those with tender gums, will not tolerate brushing but are more amenable to disinfecting wipes or pads. These products will help wipe off plaque deposits from the surface on the tooth.

3. OraVet-OraVet is a wax-like substance applied once a week to the outer surfaces of the teeth. It minimizes the re-attachment of plaque to the tooth.

4. Dental Treats-For many people, doing anything inside their pet’s mouth on a regular basis is simply not going to happen. Fortunately, simply chewing on a proper dental chew can reduce plaque by up to 69%. This is not be as good as brushing but is better than doing nothing.

5. Dental Diets-on the market today use several techniques to help reduce plaque. The kibbles are large forcing the pet to chew them before swallowing. These diets are also high in fiber holding the kibble together forcing the tooth to sink into the kibble thus scrubbing away the plaque.

6. Hard Chew Toys- Although hard chews maybe beneficial in removing some calculus, chewing on rocks, bones or other hard materials may break teeth as well.

Dental care is very important in your pet for their overall health and should be as routine as vaccinations and physical examinations. Any home care routine you perform is beneficial but should not be considered as an alternative to full dental cleanings. Our pets should not suffer the pain and discomfort of broken or loose teeth or infected gums. With the combination of home care and veterinary care, your pet should be able to keep their teeth and live a longer and healthier life.

Sheree Everett DVM

Joint replacement surgery is a commonly performed surgery today. Seven percent of all joint replacement surgeries are revision procedures, meaning the surgeries have to be repeated. More and more, joint infections are becoming recognized as being one of the complicating factors in joint surgery failures, and new information is pointing to the systemic spread of periodontal bacteria through the bloodstream. Physicians and surgeons should work closely with dentists and dental hygienists to certify that periodontal disease is dealt with prior to joint replacement surgery, and vice versa.

Anyone considering a joint replacement should plan on a visit to a qualified dentist, beforehand. If at all possible, they should make sure their mouth is free of gum disease before they schedule for that new hip or knee. Otherwise, there is a risk the new joint will become infected.

It is commonly accepted in medicine that bacteria and infection in the mouth does not remain in the mouth, but spreads throughout the entire body. With periodontal disease, the bacteria that cause the disease travel from the infected gums, through the bloodstream, to every tissue in the body. Not only is this bacteria linked to heart attack, stroke, high blood pressure, diabetes, Alzheimer’s, lung and kidney disease, cancers and other disease states, it is very dangerous for those undergoing surgical procedures. There is no place in the body that is protected from the invasion of aggressive and injurious periodontal bacteria.  Additionally, infection anywhere in the body compromises the entire immune system.

Joint disease currently affects more than 20 million people in the United States. More than 1 million total joint replacements are performed every year, according to the American Academy of Orthopedic Surgeons. With thousands of revision procedures performed, determining risk factors is prudent before surgeries are performed.  Deep infections of the joint replacements usually result in the failure of the new joint and create the need for extensive revisions, the AAOS says.

This concern is nothing new to medicine. In a 1994 article published in the British Medical Journal, Wirral University Teaching Hospital in Great Britain reported that the mouth was a principal source of bacterial infection in patients’ prosthetic joints.

When a joint surgery becomes infected, both patient and physician question, “Why?” Commonly, the surgical procedure went smoothly.  However, the patient feels warmth around the joint. There is continued pain and swelling with the joint remaining in a chronic state of infection. Oftentimes, retreatment is necessary.

Infection caused by dental disease, (typically periodontal infection), can be prevented if surgery is postponed until dental clearance is confirmed by a dentist skilled in a proper pre-surgical evaluation.

Without a comprehensive dental screening, there’s no way to confirm whether periodontal disease is present. In some people with very advanced levels of periodontal disease, the condition may be obvious—inflamed, bleeding gums tell the story. But even life-threatening levels of gum disease can remain an invisible health risk. Alarmingly, people with dental disease often have no symptoms until the disease is in its moderate to advanced stages. The effects of the bacterial infection are not necessarily visible on the outside of the gums, but hidden on the inside surface, adjacent to the root of the tooth. People typically have no idea they have the disease, yet it is rampant in our society.

Of all American adults, 75% have periodontal disease, according to the American Academy of Periodontology. A significant number of this population also seeks joint replacements. If current trends continue, 1.4 million knee replacements and nearly 600,000 hip replacements will be performed in 2015. By the year 2030, the total number of hip and knee replacements combined is expected to exceed 4 million, according to The Kaiser Permanente National Joint Replacement Registry.

The American Academy of Orthopedic Surgeons and the American Dental Association recommend that people requiring joint replacement surgery receive a dental clearance prior to joint replacement surgery. Dentists can and should provide in-depth diagnosis and treatment for patients who are preparing for or who have already received joint replacement surgery, and to provide a dental clearance prior to surgery.

In my experience, when the orthopedic surgeon is informed that our mutual patient has a serious level of periodontal disease, the surgeon is appreciative and always postpones the surgery, unless it is an emergency procedure.

Orthopedic surgeons typically follow the recommendations of the AAOP and have their patients take antibiotics prior to future dental appointments. It is important for anyone who has had joint replacement surgery to inform their dentist so he or she can collaborate with their physician on the appropriateness of antibiotic pre-medication prior to dental care.

By postponing joint replacement and seeking a dental examination and treatment first, individuals will have both a healthier mouth and improved recovery from joint surgery.  Since the body’s immune system is not compromised by dental infection, patients’ healing will be swifter, more uneventful and more predictable.  Most critically, their risk for serious joint infection is minimized, post-surgically.