The Connection

In recent years, members of the Northern Virginia veterinary community have observed a positive toothy trend. Pet owners seem to be focusing more today on the oral health of their animals. 

“Generally, the number of pet owners seeking out oral care is increasing,” Dr. Natasha Ungerer, co-founder of Clarendon Animal Care and Urgent Animal Care of Arlington, said. “We are fortunate to work in an area where pets really are a part of the family, and as such we see quite good compliance with oral health care.”

Dr. Barron P. Hall, Board Certified Veterinary Dentist and oral 

Dr.Ungerer and her patient before dental care.

 

“Seventeen years ago, when I bought this practice, general practicing veterinarians did not understand what COHAT meant.” Dr. Hall said. “Now I would say that 75 percent of the clinics around here use this abbreviation.”

A COHAT is a complete oral exam and plan for treatment of a pet’s oral health issues. In the words of the Animal Dental Clinic’s website, COHAT “includes but is not limited to intraoral radiographs, cone-beam CT Scan of the oral cavity and head, oral exam and evaluation, tooth charting, complete dental cleaning, polishing, fluoride treatment, and any treatment deemed necessary and agreed upon by the owner.”

Although more pet owners and veterinarians are tuned into proper oral health today, Dr. Hall emphasized that “we’ve got a long way to go.” There are many misconceptions that stand in the way of pets getting the medical attention they need to have healthy, pain-free mouths. 

In this article, we will discuss some of these myths, and clear up some confusion around them.

Myth # 1: Your pet’s oral care won’t become a problem until he or she is elderly. 

A common misconception among pet owners is that pets won’t have periodontal or other tooth-related medical issues until they are elderly.

The reality is that periodontal disease is very common in dogs and cats of all ages. For example, according to Cornell University’s Richard P. Riney Canine Health Center, “studies show that 80-90% of dogs over the age of three have some component of periodontal disease.”

In her practice, Dr. Ungerer has seen plenty of instances of these kinds of oral problems among young animals – those even younger than three.

“Animals can be as young as a few months old in the case of malocclusions, and we often see tartar build-up on adult teeth as young as six to seven months,” Dr. Ungerer said. “In our experience, age is not a particularly strong correlator of dental disease. For example, we could see a two-year-old dog with significant periodontal disease [disease of the gums and tissues surrounding the teeth], and a ten-year-old dog whose mouth is in great shape. And vice versa. Pet owners should definitely be aware that age is not an indicator.”

Dr. Hall said that animals should be evaluated for oral health early on in their lives. Having an oral evaluation at a young age is especially important for certain breeds of dogs – including micro dog breeds and Brachycephalic breeds (dogs and cats with flat-faces).

“It’s not true that oral health is generally good until an animal reaches the end of its life,” Dr. Hall said. “It’s rare, but puppies can develop cancer in the mouth. Genetics play the biggest role in periodontal health. Certain breeds are going to be more prone to oral problems. I beg to see certain breeds of dogs – like brachycephalic and micro breeds – by six months of age to prepare the owner for what they have regarding their puppy’s oral cavity and to educate them that fewer teeth and less crowding will provide for better long term oral health. Humans have created many breeds for fashion, not function, and because of that, these animals are predisposed to many oral problems.”

Myth # 2: A pet will stop eating if he or she has an oral problem.

Many pet owners falsely assume that if their pet is eating regularly, then they must not have any mouth pain. Appetite, however, is simply not an accurate barometer of a pet’s oral pain.

“When an animal has a broken tooth with pulp exposure, it’s going to hurt,” Dr. Hall explained. “Still, a dog or a cat isn’t going to whine or complain. They will very rarely stop eating like a human would. Humans are wimpy.”

Dr. Ungerer also said that she has encountered plenty of scenarios where a pet’s mouth has gone unnoticed.

“What I find interesting is the number of cases where we incidentally note dental disease, but the client is not noting any oral concerns in the pet at home,” Dr Ungerer said. “But then following extraction of infected teeth, the pet owners report back that their pet is feeling so much better following the procedure. We know with certainty that animals feel pain; however, they manifest it differently and often will not give outwards signs of discomfort even with significant dental disease such as fractures, loose teeth, and tooth root abscesses. In many past cases, clients did not even realize their pets’ teeth were bothering them until the problem was addressed, and then they have seen how much better the pet is feeling afterwards.”

Although it’s often impossible to know if your pet is in pain, some signs that they have oral disease include halitosis, facial swelling, sneezing, nasal discharge, face rubbing, and dropping of food when eating. 

Myth #3: All veterinarians are comprehensively trained in dentistry.

When Dr. Hall recalled his days at veterinary school, he could not remember any curriculum specific to the oral needs of pets.

“I was never taught anything about pet dentistry in veterinary school [at The Ohio State University College of Veterinary Medicine],” Dr. Hall said. “We had a three-hour lab and I have no recollection of what was done, but I know there was no oral surgery. I never learned to extract teeth. What is scary is, the day I graduated, I was legally allowed to do anything.”

“It was a sheer accident that I ultimately became a veterinary dentist,” Dr. Hall said. “Back in April 1995 when I was at a practice in southwest Michigan, they sent me to a weekend meeting with the hope that I would do all the dental procedures. I was amazed at everything I learned, like how you were supposed to properly extract teeth and take intraoral images. I learned about all this new technology. Two years later, I participated in a Level Two course where we learned the basics of root canals. I spent two years in a private practice, doing a dentistry and oral surgery residency in Dallas from 2001 to 2003. Then I passed my boards in 2006 to become a Board Certified Veterinary Dentist.”

Traditional veterinarians without board certification will not have this level of experience or expertise with pet oral care. And while Hall said some veterinarians have had more training than others, it would be a mistake not to ask questions before allowing any professional to conduct any procedure on your pet’s teeth or mouth. 

“Some veterinarians are much better trained than others, and there are some very excellent veterinarians out there who have done a lot of continuing education,” Dr. Hall said. Still, “a licensed technician can do an extraction of a single rooted tooth in the state of Virginia. Clients need to ask, what the problem is and what the different options are. They also need to ask who is doing the procedure. Even if it’s a veterinarian, they should ask, ‘what training have you had?’”

He added that he is the only one who performs surgeries at the Animal Dental Clinic.  

Dr. Hall also said that many veterinarians will only offer extraction as a solution to a problem with a tooth even when there are other options.

“Pet owners need to be given the option of a root canal for teeth with complicated crown fractures,” Dr. Hall said. “Clients deserve to know the options when it comes to pets living with mouths free of pain.”

That is where a visit to a Board Certified Veterinary Dentist is the best option, he says. After completing the evaluation portion of the COHAT, veterinary dentists like Hall will work with each pet owner to formulate a treatment plan that makes the most sense for both them and their pets.

“I make recommendations to owners, who ultimately make the decisions,” Dr. Hall said. “I then get everything that was agreed on done under one anesthesia.”

Myth #4: Every pet needs all their teeth to eat and have a healthy life.

A typical mature cat will have 30 teeth while an adult dog’s mouth will contain 42 teeth.

According to Dr. Hall, these animals do not need all these teeth – or even any teeth – to live normal lives. On the flip side, it is better for the pet to have fewer teeth – or even no teeth at all – and a healthy, pain-free mouth than to have a mouth that contains problematic teeth. 

“Domestic animals really do not need teeth,” Dr. Hall, who himself has a toothless cat and a toothless dog, said. “Believe me, they can consume the food they need to, dry or canned, without any teeth. You are going to provide them with the food they need, and they will eat because they know they must consume food in order to survive. Based on my 30 years of experience, it’s better for pets to have fewer teeth to no teeth than to have a painful mouth.” 

Myth #5: Clean, white teeth mean good oral health.

You can’t judge a book by its cover, and you certainly can’t judge what’s going on in an animal’s mouth based on their pearly whites (or not-so-pearly whites).

“Just because teeth look healthy doesn’t mean they are healthy,” Dr. Hall said. “Most problems happen at or below the gum line. It’s more than a quick look to see if a tooth is dirty. It is how the gums are reacting to the microscopic bacteria within the biofilm of the plaque. An animal can have everything looking clean, but the gums are still inflamed due to a hypersensitivity to the bacteria containing biofilm on the plaque.”

He said he’s seen dogs with perfectly clean, white-looking teeth that are dead or have advanced periodontal disease.

Recommendations To Optimize Your Pet’s Oral Health

Just like with humans, dogs and cats who never have issues in their mouth without intervention are in the minority. However, there are actions you can take to keep your pets happy with (or without) their teeth.

First, brushing your pet’s teeth every day is undoubtedly a good preventative measure against oral problems.

“Brushing teeth with a bristled toothbrush will have the most impact on slowing down the buildup of plaque and calculus,” Dr. Hall explained, clarifying that calculus (tartar) cannot be brushed off.

He said he recommended products approved by the Veterinary Oral Health Council. These can be found on the organization’s website, www.VOHC.org. 

While brushing teeth is an excellent habit to get into, professionals do acknowledge that in some cases, brushing a pet’s teeth at all – let alone regularly – is impossible.

“Brushing is hard to get in the habit of,” Dr. Ungerer said. “We have wonderful clients in Arlington and many are doing a great job at home care; however, some dogs and especially cats are resistant to brushing. Even in my household, regular brushing is a challenge – and definitely is not happening with my cat.”

Enter professional examinations and cleanings, which all pet owners should pursue for their animals, even if regular brushing does happen, the professionals say.

“The COHAT should be done once a year,” Dr. Hall said. “Every time you get images of an animal’s mouth – full imagery of 30 teeth for cats and 42 for dogs – you have a stop time image. Then you have something to compare to down the line as issues either arise or progress.”

When professional cleanings are required, they should be performed with the pet under anesthesia.

“Anesthesia-free teeth cleaning is nonsense – completely ineffective,” Dr. Hall said. “Proper cleaning occurs at and below the gum line which cannot adequately be done on an awake animal.”

Dr. Hall said he also encourages you to ask every question you have of your veterinary professionals. As he stated, nothing is life or death regarding teeth, and you are your pet’s advocate. 

“People should be informed consumers, so ask questions of your veterinarians and veterinary dentists,” Dr. Hall said. “Don’t ever let a veterinarian tell you that you ‘need to’ do something – let them make recommendations. I never mind people asking questions. I can’t guarantee the outcome of anything I do, and I want people to feel as good as they can in their heads, hearts, and bellies with my recommendations.”

Another tip: know your dog’s genetic makeup because heredity plays the biggest role in periodontal health. Knowing what diseases to which your pet is predisposed can help you identify issues before they become too problematic. Anticipating certain issues will also help you plan and budget for them. 

Finally, do not let the cost of procedures stand in your way of pursuing sound oral health for your pet. 

Professionals often provide payment plans and other financing options, and oral care is critical. Teeth are windows into the health of the rest of the body. 

“Bacteria and inflammation that build-up in the mouth can cause not just significant issues locally, but also can affect other body systems,” Dr. Ungerer said. “Though rare, bacteria can spread elsewhere in the body and cause systemic illness – such as in the heart. Less uncommonly, we can see dental disease affecting respiratory symptoms. As an example, I have a patient whose chronic cough we have been managing for the past year with steroids to suppress inflammation in the lungs. After a dental extraction of several infected teeth, his cough has entirely resolved and he's off medication.”

For the same reasons you wouldn’t ignore your own dental health, you shouldn’t overlook your pet’s.