PET OWNERS

 

Below please find answers to frequently asked questions, as they relate to the oral health of pets. Please also visit our resources page for detailed information about oral hygiene at home, the subdisciplines of VDOS, and many other things.

"Explaining is understanding."

 

What is an emergency in dentistry and oral surgery?

Certain emergencies affecting the teeth, mouth and face require immediate veterinary medical attention and include (but are not limited to):

  • Very recent tooth fracture (if the tooth fracture happened within 24 hours and there is interest in saving the vitality of the tooth)

  • Tooth luxation and avulsion (if the acutely displaced tooth is otherwise intact, if the avulsed tooth is immediately placed in milk, and if referral to a specialist can occur within 12 hours)

  • Mandibular and maxillary swelling associated with oral and maxillofacial tumors

  • Swelling around the nose, mouth, jaws, face and neck associated with inflammation/infection

  • Jaw fracture, temporomandibular joint luxation, open-mouth jaw locking, mandibular symphysis separation, acute palate defects

  • Acute inability to open or close the mouth

  • Sharp or blunt head trauma injury, including lip and tongue laceration, oral bleeding, gunshot injury

  • Acute burns (thermal, electric, or caustic)

 

What is a certified veterinary technician (CVT)?

Veterinary technicians are highly skilled professional whose primary function is to provide technical support to veterinarians. Each state regulates their veterinary technicians differently. Some are registered (RVT), some licensed (LVT), and some certified (CVT). There are over 100 veterinary technology programs in the United States that educate veterinary technicians. In order to maintain a standard of excellence these programs are accredited by the American Veterinary Medical Association (AVMA). The course of study in these programs entails at least 2 academic years, leading to an Associate of Science or equivalent degree with four-year Bachelor of Science degrees available at some institutions. The National Association of Veterinary Technicians in America (NAVTA) represents and promotes the profession of veterinary technology.

 

What is a veterinary technician specialist (VTS)?

The National Association of Veterinary Technicians in America (NAVTA) has a Committee for Veterinary Technician Specialties that governs veterinary technicians who excel at their professional discipline of special interest. This committee has specific guidelines for Veterinary Technician Specialists (VTS). NAVTA has given full recognition to the Academy of Veterinary Dental Technicians (AVDT). The credentialing process takes approximately 2 years for new applicants. Once credentials are accepted, the applicant is known as a candidate and will be eligible to sit the entry examination, which is held yearly. Once the candidate has successfully passed all three parts of the examination, the VTS (Dentistry) designation will be granted. Please also visit specialty organizations for further information.

 

What is a registered dental hygienist (RDH)?

A registered dental hygienist (RDH) is a licensed oral health professional who provides educational and therapeutic services to human and animal patients. Hygienists’ oral/dental knowledge and clinical dental skills enable them to perform oral health assessments and periodontal therapies. They can play an important role in the organization and efficient operation of a veterinary dentistry and oral surgery service. Licensure of a dental hygienist requires completion of a minimum educational program of 2 years. State and national board exams must be satisfactorily completed. Many dental hygienists continue their education to receive a 4-year baccalaureate or Master of Science degree. The American Dental Hygienists' Association (ADHA) is the largest national organization. Please also visit specialty organizations for further information.

 

What is and where can I find a specialist in dentistry and oral surgery?

An AVDC or EVDC Diplomate has earned a DVM or VMD degree from an accredited veterinary college/school, which was followed by a structured internship or its equivalent of varied clinical practice, completion of a specific training program in dentistry and oral surgery, and passing the entry examination of the American Veterinary Dental College (AVDC) or European Veterinary Dental College (EVDC), the clinical specialist organization accredited by the American Board of Veterinary Specialties (ABVS) or European Board of Veterinary Specialties (EBVS), respectively. What does this mean to you and your pet? AVDC or EVDC Diplomates have demonstrated that they meet the highest standards for certification of knowledge and skills in veterinary dentistry and oral surgery. You can find an AVDC Diplomate here, and an EVDC Diplomate here. Please also visit specialty organizations for further information.

 

What is the role of students, interns and residents?

The missions of academic and some private practice institutions include excellence in teaching, research and clinical service. Clinicians working in such places are considered to be world leaders in their specialty disciplines. Many clients come to them because they can expect the attention of the best-trained and most experienced veterinarians in that clinical specialty. However, where there is teaching, there is also learning. Fourth-year students and interns assist clinicians in the diagnosis, treatment and care of dentistry and oral surgery patients. Residents are enrolled in specialty training programs and will obtain primary care responsibilities as their clinical experience increases. Good client communication and professionalism are imperative in providing the ideal environment for teaching and learning.

 

Why is daily tooth brushing recommended?

An effective home oral hygiene program consists of daily tooth brushing and use of various oral health care products (e.g., enzymatic dentifrices, dental diets, dental chews, treats and toys, oral rinses and gels, and water/food additives, etc.). Periodontal disease is the most common disease occurring in dogs and cats and is defined as plaque-induced pathology of any part of the tissues that hold the tooth in the mouth - the gingiva, periodontal ligament, alveolar bone, and cementum. Plaque is a soft biofilm which contains bacteria and toxins and accumulates on the surface of teeth within hours after a professional dental cleaning. When accumulation of plaque is prevented by effective oral hygiene, periodontal disease does not develop. However, when oral hygiene is less than optimal, plaque can mineralize within 2-3 days to form tartar (calculus) that resists being wiped or brushed off. Therefore, tooth brushing should be performed once daily to remove plaque from our pets’ teeth. All you need is a soft-bristled and appropriately-sized toothbrush, some patience, and 1-minute of your daily time. Do not use human toothpaste, as it contains foaming agents that can upset your pet’s stomach and fluorides which, when swallowed in sufficient concentrations, may pose a health hazard. Please also visit oral hygiene at home for further information.

 

Are dental diets of benefit to my pet’s oral health?

Certain veterinary diets may be beneficial to the maintenance of oral health. Many manufacturers have considered the relationship of diets to oral health of pets. So-called 'dental' diets were designed to either mechanically or chemically reduce plaque and/or tartar (calculus) accumulation. Some products provide a combination of both actions. The mechanical action is derived from a larger than usual, hard kibble that fractures into few large pieces as it is penetrated by the tooth, rather than crumbling into many tiny pieces. The large pieces are penetrated again, and thus the more crunching that is performed, the more abrasive action results and the bacteria-laden plaque is being disturbed. Some kibble also has layers of different textures that contribute to plaque disruption. Diets that help to clean teeth by chemical action are coated with various anti-plaque or anti-tartar agents that have been shown to reduce the accumulation of plaque or calculus. The Veterinary Oral Health Council (VOHC) provides a list of products that have successfully met pre-set criteria for effectiveness in controlling plaque and tartar deposition in dogs and cats. Please also visit oral hygiene at home for further information.

 

What are good dental chews, treats and toys?

Dental chews, treats and toys can be an important part of any pet dental health program. However, they represent only part of the overall maintenance of oral health. Toys and treats are used in combination with daily tooth brushing, oral health care products, appropriate diets, yearly dental check-ups, and professional dental cleaning and periodontal therapy as necessary. There are many different chew toys and dental treats commercially available for our pets. They should not be too hard, as very hard materials can fracture teeth. Inappropriate toys and treats include plastic bones made of hard nylon, meat bones (cooked and uncooked), and cow hooves. Rocks and large ice cubes can also fracture teeth and should be avoided. Tennis balls are a popular toy for many dogs; however, they are very abrasive to teeth because they collect tiny particles of dirt and sand and will wear down the teeth and occasionally cause pulp exposure. Acceptable toys include soft stuffed animals, flexible rubber bones, soft plastic balls, and ropes. Please note that the toy should be appropriate for the size of the animal, and caution should be exerted when pets are left unobserved when playing with toys. A good idea is to choose products that have the VOHC seal of acceptance, ensuring that the product has successfully met pre-set criteria for effectiveness in controlling plaque and tartar deposition in dogs and cats. Please also visit oral hygiene at home for further information.

 

Does my dog or cat have to be anesthetized in order to have its teeth cleaned?

Yes, in order to perform a thorough periodontal examination, dental radiography (x-rays), scaling and polishing, root planing and gingival curettage, the pet must be under general anesthesia. Anesthetic gas and oxygen are delivered through an endotracheal tube, thus ensuring pain-free procedures and also protecting the airways from aspirating fluids or debris. Owners of pets naturally are concerned when anesthesia is required for their pet. However, anesthesia-free dentistry performed by untrained individuals is inappropriate for several reasons, including:

  • Significant safety concerns for the patient and operator

  • Insufficient cleaning of inaccessible tooth surfaces

  • No debridement of periodontal pockets

  • Oral discomfort and serious pain

  • Accidental aspiration of debris that can result in pneumonia and death

Furthermore, it is illegal for anybody but licensed veterinarians or supervised and trained veterinary technicians to practice veterinary medicine. Although anesthesia will never be 100% risk-free, modern anesthetic and patient evaluation techniques used in veterinary hospitals minimize the risks, and millions of dentistry and oral surgery procedures are safely performed each year. Further information on anesthesia-free dentistry can be found here.

 

How often should I have my pet’s teeth professionally cleaned?

The frequency of the need for professional dental cleanings is dependent upon several factors. If thorough home oral hygiene is being provided on a daily basis, the bacterial accumulations that result in the formation of plaque and tartar (calculus) should be minimal, and scaling and polishing procedures can be performed less frequently. Specific dog and cat breeds are more prone to developing periodontal disease; therefore, a professional dental cleaning should be performed more frequently. Your pet should have an annual oral examination performed by a veterinarian to document the presence of abnormal conditions such as periodontal disease, gingival enlargement, fractured or worn teeth, ulcers, tumors, etc. Professional dental cleanings require your pet to be anesthetized in order for the skilled and trained operator to remove debris not just from the crowns of the teeth but also from below the margins of the gums (subgingivally). Since periodontal disease causes the destruction of the supporting structures of the teeth (gingiva, periodontal ligament, and bone), cleaning the crowns of an awake dog without addressing what lies beneath only provides a cosmetic benefit. This superficial procedure does not address the disease in deeper tissues or less accessible sites. In general, the condition (color, texture, shape) of the gingival tissues will dictate the need for placing your pet under general anesthesia to have periodontal probing, dental x-rays, and a professional dental cleaning.

 

My pet has red and receding gums, loose teeth, and a smelly mouth: what can I do?

Your pet may have periodontal disease which is an inflammatory response to infection of the periodontal tissues by plaque bacteria. Gingivitis is the reversible form of periodontal disease, affecting gingiva only. As inflammation continues, the gingiva detaches from the tooth, creating a periodontal pocket. Bacterial toxins and enzymes from inflammatory cells cause further destruction of periodontal tissues. Periodontitis is the more severe form of periodontal disease, resulting in attachment loss, gingival recession, and loss of alveolar bone. In multi-rooted teeth, the furcation between two roots becomes exposed. The loss of alveolar bone is usually irreversible, and with increasing bone loss the tooth becomes mobile and ultimately falls out. Halitosis (bad breath) often accompanies periodontal disease. The systemic effects of periodontal disease are well documented in humans and include heart disease and stroke, diabetes, respiratory disease, and increased risk of premature delivery and low birth weight infants. The impact of periodontal disease on systemic health in dogs and cats is now also increasingly investigated. A thorough oral examination includes probing of the gingival sulcus with a periodontal probe and obtaining a series of dental radiographs (x-rays). The goal of periodontal therapy is elimination of plaque and surgical reduction of periodontal pockets. Professional dental cleaning (often called a dental prophylaxis or 'prophy') refers to scaling and polishing of the teeth. Smaller periodontal pockets (4-5 mm deep) may be treated with smoothing the root surfaces (root planing) and removal of the inside lining of infected/inflamed gingiva (gingival curettage). For deeper periodontal pockets and moderate to severe gingival recession, periodontal surgery with open debridement (making a flap) with or without bone grafting is needed to eliminate diseased periodontal tissues and regenerate new healthy tissues. If a tooth has lost 50% or more of its attachment to the jaw bone, tooth extraction is to be considered. Some severely affected teeth can be successfully retained in the mouth by a combination of scaling, root planing, gingival curettage, periodontal surgery, and conscientiously applied home oral hygiene. Systemic antibiotic therapy is generally not required.

 

My dog has a fractured or severely worn tooth: what can I do?

If dental trauma has exposed the pulp cavity (the inside of a tooth), bacteria will infect the pulp through the fractured or worn crown. If left untreated, the pulp becomes inflamed and necrotic, and a periapical abscess may develop around its root(s). Endodontic therapy is then needed to prevent the possibility of tooth loss. Alternatively, the tooth can also be extracted. Dental x-rays, special instruments and materials, knowledge of various techniques, and sufficient operator skills are required for performing endodontic and restorative procedures. Fractures that extend under the gums deep into the root must be treated with periodontal surgery prior to endodontic therapy. The two basic endodontic treatment options are (1) vital pulp therapy and (2) standard root canal therapy. Teeth of young animals have a fairly wide pulp cavity, while in old animals the pulp cavity is usually very narrow. The narrower the pulp cavity, the thicker are the dentinal walls, and thus the stronger is the tooth. Vital pulp therapy is primarily utilized for very recent tooth fractures (less than 24-48 hours of duration) in young animals (less than 2 years of age). Sterile instruments must be used. The infected portion of the pulp in the crown is removed, a pulp dressing material is placed, and the tooth is restored. Dental x-rays are obtained in 4-6 months to confirm pulp vitality. If the animal is older or the pulp is exposed for longer periods of time, standard root canal therapy is performed. It consists of accessing the pulp cavity, removing any remaining pulp, and debriding, shaping, disinfecting and filling the root canal(s) with an inert material, followed by access restoration. Dental x-rays are of utmost importance during all steps. The goal of treatment is the removal of inflamed or necrotic pulp tissue and providing a hermetic seal around the root(s). Systemic antibiotic therapy is generally not required.

 

My pet's tooth is acutely displaced or pulled out: what should I do now?

Tooth displacement injuries frequently occur after automobile accidents, falls from great heights, fighting with other animals, or when a tooth gets caught in a fence. A tooth can be luxated to the side (mouth cannot be fully closed), into the alveolus (nasal cavity in the case of a maxillary canine tooth), or to the outside. When a tooth is completely out of its alveolar socket, then we call it an avulsed tooth. The teeth most commonly avulsed in dogs are the incisor and canine teeth. Luxated and avulsed teeth are dental emergencies and require immediate repositioning, stabilization, and endodontic therapy due to the likely loss of blood supply to the pulp. Success of replantation is influenced by the speed with which the tooth is replanted. The avulsed tooth should be placed in a transport medium (such as fresh milk which keeps periodontal ligament cells vital for up to 6 hours) until arrival of the patient and tooth at veterinarian. Systemic antibiotic therapy (amoxicillin/clavulanic acid, clindamycin or doxycycline) must be started as soon as possible. The luxated/avulsed tooth is repositioned/replanted, and a splint is applied. The first step of endodontic therapy is performed (pulp is removed and pulp cavity filled with a calcium hydroxide paste). In about 4-6 weeks, standard root canal therapy is completed and the splint removed. Resorption of the replanted tooth is a common complication, particularly if the avulsed tooth has been allowed to dry on air for longer than 20 minutes.

 

My pet sustained severe injury to the face and mouth: what can I do?

Jaw fractures, temporomandibular joint (TMJ) displacement injuries, and many orofacial soft tissue injuries are true emergencies that warrant immediate veterinary attention. Depending on the cause of trauma (hit-by-car, fall from a height, gunshot, burn, bite, etc.), clinical presentation of the patient and severity of the injuries, the patient's cardiovascular and respiratory status may first need to be stabilized prior to employing diagnostic modalities to determine the extent of oral and maxillofacial trauma. Dental x-rays are helpful to diagnose tooth and some jaw fractures, but computed tomography (CT) will often be needed so that any injury further back in the mouth, face, head and upper neck is not missed. Treatment is aimed at repairing hard and soft tissue injuries, establishing normal or functional occlusion, and providing acceptable cosmesis. The injured sites are debrided to remove blood clots, food particles, foreign material, small bone and tooth fragments, and necrotic tissue. Soft tissue lacerations are sutured closed and displaced TMJs reduced before or after orthopedic repair of fractured bones. There are various ways to repair jaw fractures, such as maxillomandibular fixation, circumferential wiring, interdental wiring with composite splinting, intraosseous wiring, and bone plating.

 

My pet has an oral tumor: what can I do?

Oral tumors may be benign (staying where they originate from) or malignant (having the potential to spread to lymph nodes and distant sites). Even those that are benign may be locally invasive and may result in oral pain, bleeding, drooling, or difficulty eating. Unfortunately, dogs and cats often show no obvious clinical signs until the oral tumor is already very large. It is important to have a thorough oral examination done regularly in an attempt to diagnose these tumors in the early stages. An incisional biopsy of the tumor may be done prior to treatment to determine tumor type and treatment options. Other diagnostic procedures often include fine-needle aspirates of head/neck lymph nodes and thoracic (chest) x-rays to determine regional and distant metastasis. Treatment may include one or more of the following:

  • Surgery: Removal of a portion of the lower (mandibulectomy), upper jaw (maxillectomy), lips, cheeks, tongue, etc. are generally very well tolerated, and in many cases result in pets with good function and cosmetic appearance.

  • Radiotherapy: Alone or in combination with surgery, depending on the tumor type, location, and the ability to remove the tumor surgically.

  • Chemotherapy: Few oral tumors respond to chemotherapy alone, but chemotherapy may be prescribed to minimize spread to distant sites.

  • Immunotherapy: Recent advances in vaccine technology offer a completely new treatment approach for certain tumor types.

Patients with rapidly growing oral tumors should receive immediate veterinary medical attention. Oral tumors are best treated before they have a chance to enlarge to the point where they are no longer surgically removable.

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