Sunnyvale Veterinary Clinic's Dr. Rowen on dental health
Dr. Rowen was kind enough to take some time out of her day and talk to us about how to care for our pets teeth. We went over preventative care for dogs and cats, why those "awake teeth cleanings" aren't a hot idea, got the low down on bone safety, and touched on small animal (rabbit, guinea pig, etc) oral health too.
Q: Why is proper dental care so important for our pets?
A: From the World Health Organization on oral health in people: "Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial well being."
The same applies to pets! Additionally, studies have shown connections between gum disease and heart, lung, and kidney disease in dogs and cats. Bacteria from infected gums is suspected to spread to other organs through the blood stream causing systemic inflammation and, in some cases, even infection.
Would you want to live in a part of the world where dental care for people wasn't widely accepted? Can you imagine what your mouth would feel like without brushing, flossing, or seeing your dentist?
Q: Does regular dry kibble actually clean teeth?
A: In general, yes, but some are better than others. Some diets have an abrasive material built-in to the kibble and those have been proven to improve dental health. (They are not of nutritional value and may represent some of the "filler" that gets a bad reputation.) Other hard diets may just crumble and small chunks can even get lodged between teeth. Canned food is more likely to do so, and table scraps can be even worse for teeth. VOHC.ORG has a list of over-the-counter and prescription diets proven to keep teeth cleaner compared to the average diet.
Q: What are a few ways I can help keep teeth clean at home?
A: Dental chews or a dental health diet are a good start. An oral rinse is better. Brushing is best! The goal is to do something for the teeth at least once daily. VOHC.ORG has a list of over-the-counter dental treats that have been independently tested by veterinary dentists and proven to work. I tell my clients that for every day they don't brush, they should put a dollar in a jar. After about a year, it will add up to the cost of a dental cleaning. It is also important to have a veterinarian examine your pet's mouth to see if they are a candidate for home care. If you start brushing a mouth that is infected or painful, your pet may learn to resist home care in the future. Some pets need professional care before a home program can be started.
Q: Why is a full dental cleaning at the vet so expensive? (FOLT note: I phrased this question this way because this is the #1 complaint we hear from people regarding professional dental cleanings)
A: That's a leading question! :D I actually think it is a tremendous value, given what is involved. In order to safely administer comprehensive oral care for an animal, general anesthesia is essential. With general anesthesia comes attentive monitoring of blood oxygenation, heart and respiratory rate, carbon dioxide levels, blood pressure, and body temperature. An endotracheal tube (a tube down the wind-pipe) is applied to administer costly anesthetic gases, on top of other injectable medications given beforehand, as well as to protect the airway from flying debris, fluid, and bacteria. Intravenous fluids support blood pressure and circulation, which requires an IV catheter. Specialized equipment is used to maintain body temperature. Blood chemistry and complete blood count evaluation help evaluate a patient's risk before anesthesia. A professional cleaning also includes hospitalization during recovery. Consider what it costs to be hospitalized for a day, or to have anesthesia for a person or even a pet having a tumor removed under surgery. Each dental procedure is treated with the same level of careful attention as more serious procedures. These costs add up, before you even add the dental services, which includes scaling above and below the gumline, polishing, full dental charting, and a professional oral exam to screen for cancer or other maladies.
Q: What about those groomers who do teeth cleanings when my pet is awake?
A: Tooth brushing by groomers is fine. However, short, more frequent brushing at home is better than longer brushing sessions less often at the groomer's. The idea is to get the invisible film of plaque off the teeth before it hardens into tartar, which can happen in 24-72 hours. You can brush tartar for hours and it will barely budge. An ounce of prevention is truly worth a pound of cure in this case!
Non-anesthetic procedures involving metal scalers, on the other hand, can be dangerous and are not recommended. If you have trouble brushing your own dog's teeth with flavored toothpaste, why would a stranger with a metal instrument have more success? A struggling dog is at risk for gum or cheek injury, or mouth contents going down the airway (which is protected under anesthesia.) Additionally, a metal scaler causes tiny scratches on the surface of the tooth, which makes it easier for plaque and tartar to accumulate. Polishing is a time-consuming necessary step that cannot be done properly in an awake patient. Lastly, cleaning under the gumline is the most important part of a professional dental cleaning, and it simply cannot be done comfortably in an awake animal. The anesthesia-free procedures give results that are more cosmetic in nature and give people a false sense of having accomplished something of value for tooth and gum health. I wouldn't do it for my dog even if it were free. Stick to chews, oral rinses, and brushing. And, of course, see your veterinarian.
Q: What about bones? There is risk, with a really hard chew, of cracked teeth, but many people like bones as they both keep the dog busy and clean the teeth. How does an owner balance the damage risk?
A: Great question! Yikes, my answer is long enough to be its own article!
Factors to consider when thinking about bones include: how much the dog enjoys it, how capable you are of providing safer home dental care, the likelihood of the dog ingesting sharp/large chunks that can cause injury before it is digested, and your preparedness to handle the consequences (are you ready to pay for a root canal, tooth extraction, or foreign body surgery?)
Anything that does not flex a little when you bend it, or that you cannot make an impression in with your thumbnail, is technically hard enough to break a tooth. Another good test is to bang it against your kneecap. If it hurts, it may also break a tooth.
All healthy dogs have the capability to digest bones with their stomach acid. However, some dogs will swallow large, sharp chunks that carry some risk of injury or obstruction. If your dog is swallowing large chunks, you are likely not getting any benefit to the teeth, as the chewing action is what is beneficial.
I look the other way when my husband (rarely) gives our dog a bone because he is missing the two largest teeth in his lower jaw, decreasing his risk of breaking his other teeth (he doesn't have much to chew against.) It really does clean his remaining teeth. He also does not break large chunks off- he is a dainty biter. I also have pet insurance so, if the need arose, I am prepared to handle the consequences. Oh, and he goes crazy for them. If I gave him the choice, I am sure he would eat a bone even if it meant certain death. As he gets older and his teeth become more brittle, I may reassess my risk-analysis at that time.
In short, it is an individual choice that you have to make based on your dog's chewing personality and your comfort with risk! I have definitely met dogs that chew bones regularly with no problem, but I have also treated a lot of broken teeth (and seen a few obstructions.) Do you make the gamble or not? A lot of veterinarians would tell you not to do it!
Q: Do rabbits/guinea pigs/other small animals get tartar? Is there anything I need to do to care for my small animal's teeth at home?
A: A rabbit on a healthy diet should not require brushing. Unlike dogs, cats, and people, who have one set of permanent teeth to last a lifetime (after the baby teeth have fallen out), rabbits have teeth that grow continuously. Their teeth are constantly worn down as they grow, so the older part of the tooth is replaced by newer tooth. This makes it tough for tartar to accumulate.
The most common dental problem we see with rabbits and small mammals is overgrown teeth due to improper diet. Roughage in the form of hay is crucial for proper wear of the teeth. With too many treats or pellets and not enough hay, teeth can overgrow. Over time this can cause misalignment of the jaw, painful points scraping the gums and cheeks, or even gum infection since tartar can then accumulate on a tooth not properly worn down.
In lieu of toothbrushing, a weekly home dental check up to check for good alignment and signs of pain or infection is recommended. Combined with the annual exam by a veterinarian, this can help catch problems early so intervention does not have to be as aggressive. Additionally, consult your veterinarian about your pet's diet to ensure it is appropriate.
Q: Why is proper dental care so important for our pets?
A: From the World Health Organization on oral health in people: "Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial well being."
The same applies to pets! Additionally, studies have shown connections between gum disease and heart, lung, and kidney disease in dogs and cats. Bacteria from infected gums is suspected to spread to other organs through the blood stream causing systemic inflammation and, in some cases, even infection.
Would you want to live in a part of the world where dental care for people wasn't widely accepted? Can you imagine what your mouth would feel like without brushing, flossing, or seeing your dentist?
Q: Does regular dry kibble actually clean teeth?
A: In general, yes, but some are better than others. Some diets have an abrasive material built-in to the kibble and those have been proven to improve dental health. (They are not of nutritional value and may represent some of the "filler" that gets a bad reputation.) Other hard diets may just crumble and small chunks can even get lodged between teeth. Canned food is more likely to do so, and table scraps can be even worse for teeth. VOHC.ORG has a list of over-the-counter and prescription diets proven to keep teeth cleaner compared to the average diet.
Q: What are a few ways I can help keep teeth clean at home?
A: Dental chews or a dental health diet are a good start. An oral rinse is better. Brushing is best! The goal is to do something for the teeth at least once daily. VOHC.ORG has a list of over-the-counter dental treats that have been independently tested by veterinary dentists and proven to work. I tell my clients that for every day they don't brush, they should put a dollar in a jar. After about a year, it will add up to the cost of a dental cleaning. It is also important to have a veterinarian examine your pet's mouth to see if they are a candidate for home care. If you start brushing a mouth that is infected or painful, your pet may learn to resist home care in the future. Some pets need professional care before a home program can be started.
Q: Why is a full dental cleaning at the vet so expensive? (FOLT note: I phrased this question this way because this is the #1 complaint we hear from people regarding professional dental cleanings)
A: That's a leading question! :D I actually think it is a tremendous value, given what is involved. In order to safely administer comprehensive oral care for an animal, general anesthesia is essential. With general anesthesia comes attentive monitoring of blood oxygenation, heart and respiratory rate, carbon dioxide levels, blood pressure, and body temperature. An endotracheal tube (a tube down the wind-pipe) is applied to administer costly anesthetic gases, on top of other injectable medications given beforehand, as well as to protect the airway from flying debris, fluid, and bacteria. Intravenous fluids support blood pressure and circulation, which requires an IV catheter. Specialized equipment is used to maintain body temperature. Blood chemistry and complete blood count evaluation help evaluate a patient's risk before anesthesia. A professional cleaning also includes hospitalization during recovery. Consider what it costs to be hospitalized for a day, or to have anesthesia for a person or even a pet having a tumor removed under surgery. Each dental procedure is treated with the same level of careful attention as more serious procedures. These costs add up, before you even add the dental services, which includes scaling above and below the gumline, polishing, full dental charting, and a professional oral exam to screen for cancer or other maladies.
Q: What about those groomers who do teeth cleanings when my pet is awake?
A: Tooth brushing by groomers is fine. However, short, more frequent brushing at home is better than longer brushing sessions less often at the groomer's. The idea is to get the invisible film of plaque off the teeth before it hardens into tartar, which can happen in 24-72 hours. You can brush tartar for hours and it will barely budge. An ounce of prevention is truly worth a pound of cure in this case!
Non-anesthetic procedures involving metal scalers, on the other hand, can be dangerous and are not recommended. If you have trouble brushing your own dog's teeth with flavored toothpaste, why would a stranger with a metal instrument have more success? A struggling dog is at risk for gum or cheek injury, or mouth contents going down the airway (which is protected under anesthesia.) Additionally, a metal scaler causes tiny scratches on the surface of the tooth, which makes it easier for plaque and tartar to accumulate. Polishing is a time-consuming necessary step that cannot be done properly in an awake patient. Lastly, cleaning under the gumline is the most important part of a professional dental cleaning, and it simply cannot be done comfortably in an awake animal. The anesthesia-free procedures give results that are more cosmetic in nature and give people a false sense of having accomplished something of value for tooth and gum health. I wouldn't do it for my dog even if it were free. Stick to chews, oral rinses, and brushing. And, of course, see your veterinarian.
Q: What about bones? There is risk, with a really hard chew, of cracked teeth, but many people like bones as they both keep the dog busy and clean the teeth. How does an owner balance the damage risk?
A: Great question! Yikes, my answer is long enough to be its own article!
Factors to consider when thinking about bones include: how much the dog enjoys it, how capable you are of providing safer home dental care, the likelihood of the dog ingesting sharp/large chunks that can cause injury before it is digested, and your preparedness to handle the consequences (are you ready to pay for a root canal, tooth extraction, or foreign body surgery?)
Anything that does not flex a little when you bend it, or that you cannot make an impression in with your thumbnail, is technically hard enough to break a tooth. Another good test is to bang it against your kneecap. If it hurts, it may also break a tooth.
All healthy dogs have the capability to digest bones with their stomach acid. However, some dogs will swallow large, sharp chunks that carry some risk of injury or obstruction. If your dog is swallowing large chunks, you are likely not getting any benefit to the teeth, as the chewing action is what is beneficial.
I look the other way when my husband (rarely) gives our dog a bone because he is missing the two largest teeth in his lower jaw, decreasing his risk of breaking his other teeth (he doesn't have much to chew against.) It really does clean his remaining teeth. He also does not break large chunks off- he is a dainty biter. I also have pet insurance so, if the need arose, I am prepared to handle the consequences. Oh, and he goes crazy for them. If I gave him the choice, I am sure he would eat a bone even if it meant certain death. As he gets older and his teeth become more brittle, I may reassess my risk-analysis at that time.
In short, it is an individual choice that you have to make based on your dog's chewing personality and your comfort with risk! I have definitely met dogs that chew bones regularly with no problem, but I have also treated a lot of broken teeth (and seen a few obstructions.) Do you make the gamble or not? A lot of veterinarians would tell you not to do it!
Q: Do rabbits/guinea pigs/other small animals get tartar? Is there anything I need to do to care for my small animal's teeth at home?
A: A rabbit on a healthy diet should not require brushing. Unlike dogs, cats, and people, who have one set of permanent teeth to last a lifetime (after the baby teeth have fallen out), rabbits have teeth that grow continuously. Their teeth are constantly worn down as they grow, so the older part of the tooth is replaced by newer tooth. This makes it tough for tartar to accumulate.
The most common dental problem we see with rabbits and small mammals is overgrown teeth due to improper diet. Roughage in the form of hay is crucial for proper wear of the teeth. With too many treats or pellets and not enough hay, teeth can overgrow. Over time this can cause misalignment of the jaw, painful points scraping the gums and cheeks, or even gum infection since tartar can then accumulate on a tooth not properly worn down.
In lieu of toothbrushing, a weekly home dental check up to check for good alignment and signs of pain or infection is recommended. Combined with the annual exam by a veterinarian, this can help catch problems early so intervention does not have to be as aggressive. Additionally, consult your veterinarian about your pet's diet to ensure it is appropriate.