Ruby is a 7 year old, female neutered Cavalier King Charles Spaniel. She presented at Vet HQ for a general health check up shortly after arriving in her new home. On examination we discovered Ruby had very bad breath and severe dental disease.As vets, we often come across pets with bad breath (otherwise known as halitosis). Although there are many reasons your pet may have halitosis, more often than not it is due to periodontal disease.
What is periodontal disease?
Periodontal disease is a progressive disease that involves the inflammation and eventual destruction of the teeth’s supporting structures. These supporting structures include:
Cementum: a hard substance covering the tooth root which acts as an anchor by attaching to the periodontal ligament.
Periodontal ligament: the connective tissue fibres which attach the tooth to the alveolar bone. Alveolar bone: a thickened ridge of bone that forms the tooth sockets.
Gingivae: gum tissue covering the bone.
Why is my pet affected?
The primary cause of periodontal disease is a build-up of bacteria on the tooth’s surface. As humans, part of our daily regime is to brush and floss our teeth. The function of brushing and flossing is to mechanically remove plaque (a combination of bacteria, food particles and organic substances) from the tooth’s surface and beneath the gums, whilst toothpaste contains chemicals which reduce plaque formation and therefore prevent cavities.
Unfortunately our pets rely on us to either provide a suitable diet to “brush” their teeth, or to physically brush their teeth for them. There are however, several other factors which contribute to the progression and severity of periodontal disease. These include diet (soft or canned food), tooth crowding (as in Ruby’s case), retained deciduous teeth or systemic illness (such as kidney failure, diabetes mellitus, FIV).
How does periodontal disease develop?
The starting point of the disease process is a build-up of plaque on the tooth’s surface. Usually the plaque builds up along the gum-line: a portion on the visible surface of the tooth and a portion in the small gaps between the tooth and gum.
In the early stages of disease, these accumulations of bacteria produce chemicals and toxins that cause inflammation of the gums around the teeth which we refer to as gingivitis. This inflammation deepens the gap between the tooth and gum to form a pocket.
If the disease is able to progress over time unchecked, these pockets continue to deepen, allowing the bacteria and inflammation to spread along the tooth root to the level of the periodontal ligament. Once inflamed, the periodontal ligament begins to weaken resulting in a loose tooth which may either fall out or need to be extracted due to infection.
How do we grade Dental Disease?
- Grade I dental disease has very early signs of gingivitis. There will be a small degree of staining on the teeth and the gums next to the teeth will have a small amount of light red discoloration, but no regression. See Picture 1 below.
- Grade II dental disease, we begin to see significant inflammation (redness) of the gums. In addition, the gums will begin to sell and even recede slightly from the teeth. See Picture 2 below.
- Grade III status, they have significant inflammation and swelling of the gums, but they also have developed receding gum lines and early bone loss around the teeth. See Picture 3 below.
- Grade IV dental disease is the most severe; these teeth have all of the signs of Grade III, but in addition, there will be a pus-like discharge and the teeth will be unstable (loose). See Picture 4 below.
How do you diagnose periodontal disease?
We often detect various types and stages of dental disease when taking a history and performing thorough physical examinations on your pets. Signs of dental disease include smelly breath (as for Ruby), changes in salivation, inability to grasp or chew food, inability or difficulty to open and/or close mouth, weight loss, anorexia and/or facial swellings/deformities. However to definitively diagnose periodontal disease, your pet requires a general anaesthetic for a complete and detailed oral examination.Whilst Ruby was under general anaesthetic, we scored each tooth individually based on the amount of plaque, calculus (or tartar) and gingivitis it had. We then use a special probe to check the pocket depth of every tooth to determine the presence of and the severity of periodontal disease. Throughout the examination we recorded our findings on a special dental chart and formulate an individual treatment plan.
How do you treat it?
The treatment your pet needs solely depends on the severity of the periodontal disease. In the early stages of disease, we are able to scale the plaque and tartar off of every surface of every tooth with a special ultrasonic scaler (you may have seen one at your own dentist). Following this, we irrigate the teeth to remove the debrided bacteria and plaque and finally polish the teeth with a fluoride-rich toothpaste. In the later stages of disease, teeth often require extraction due to chronic infection, inflammation and damage to the periodontal ligament in addition to a course of antibiotics.
Unfortunately Ruby had several loose and infected teeth which required extraction. However the teeth that remained were cleaned and looked pearly white after a good polish. See before and after pictures below.
What can I do to prevent it?
As the old saying goes, “prevention is better than cure”. Raw bones are a natural way for dogs and cats to clean their teeth. The raw bones fed should be appropriate for the size of your pet. Examples of suitable bones include chicken wings, chicken necks, lamb necks, lamb shanks, spare ribs, and brisket bones.
Formulated dental diets are also available including Hills t/d and Royal Canin Dental DD. These diets are specially formulated to reduce the accumulation of plaque and tartar and mechanically abrade the teeth when chewed. Special dental chews are also available to clean teeth such as Greenies bones and Waltham rasks. Other alternatives include pigs ears and raw hide products. However nothing beats brushing your pets teeth daily to mechanically remove plaque, especially after a professional scale and polish.