Treating And Preventing Dental Disease In Geriatric Pets

Pets with dental problems often suffer in silence.


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We all know that our patients suffer from the same dental problems that we all do. Dogs and cats feel dental pain and discomfort just as we do, and yet it is far more common for them to have significant dental problems because they don’t get regular dental care. 

The biggest reason that pets often do not receive the dental care they need is because they rarely show obvious signs of pain or problems, which means that they suffer in silence.

Oral/dental disease is by far the No. 1 medical problem in dogs and cats. It is estimated that more than 70 percent of dogs and cats have some form of periodontal disease by just two years of age.

Research suggests these shocking numbers actually underestimate the incidence of dental disease. To find out if your patient has periodontal disease, lift his/her lip and look  for tartar or redness and swelling of the gums (Figures 1). If the breath smells, it is a sure sign of an oral infection. 

A new method for determining the level of gum disease in animals is provided by a simple technology called Orastrip QuickCheck Canine. This quick and painless diagnostic test can tell the level of dental disease in 10 seconds, giving your client peace of mind, and alerting you to your patient’s need for treatment. 

We now know how important oral health is, as periodontal disease in both humans and animals has been linked to many systemic diseases including kidney and liver disease, heart failure and heart attacks, lung disease, adverse pregnancy effects, cancers and complications of diabetes.1

This is due to the consistent bacterial load in the mouth entering the bloodstream through bleeding or inflamed gums. Many of these conditions actually improve with proper dental treatment.
 
In addition to systemic diseases, periodontal infection leads to problems in and near the mouth such as tooth root abscesses, nasal infection, eye loss, jaw fractures and oral cancers. The bottom line is that dental disease can actually shorten the lifespan of both humans and animals.

There are numerous other painful and infectious conditions that occur in the mouth such as broken teeth, cavities, orthodontic disease and oral cancers. 

In cats, there is a very common condition called tooth resorption. It is estimated that up to half of cats over the age of 6 have at least one. They are caused by the cat’s immune system attacking its own teeth. This results in a defect (like a cavity) which is very painful (Figure 2). 
 

All of these conditions are painful and the incidence of almost all of them (especially periodontal disease, tooth resorption and cancer) is greatly increased in older pets. Therefore, dental care becomes more important in geriatric patients.Virtually every pet has some type of oral disease. 

Treatment and prevention of dental disease in our patients requires homecare and regular professional cleanings. Professional cleanings are generally recommended annually, but the frequency varies among breeds and individuals.
 
In general, the smaller the breed of dog, the more prone it is to periodontal disease and thus more frequent dental cleanings are necessary. Professional dental therapy can greatly benefit pets with other diseases, such as heart disease, kidney disease and diabetes.

Proper veterinary dental care requires general anesthesia. “Anesthesia-free” dentistry is not only ineffective, it is stressful to the pet and it is dangerous to have sharp instruments in their mouths while they are awake. This practice is illegal in some states. Anesthesia in animal patients is safe when performed correctly and at current standards.

It is a common misconception that older patients are a high anesthetic risk. We commonly hear our clients say, “My pet is too old for anesthesia.” They may have heard this from friends or family, but far too often it is from their veterinarian. 

First, it is known that age is not a disease. In fact, if the pet is otherwise healthy, age has been proved not to increase anesthetic complications. Age does make it more likely that the pet has some systemic illness.  However, it is not a forgone conclusion that a 12- or 15-year-old dog or cat has any systemic problems. We cannot tell if a patient is (or is not) an anesthetic candidate until we run a few basic tests.
 
What I recommend in my older pets is:

  • A complete blood panel (chemistries, thyroid and CBC).
  • Urinalysis (critical for evaluation of kidney function in cats).
  • Chest radiographs to make sure the heart and lungs are normal.

If these tests are normal, there is no increased risk for anesthesia. Even if a pet has mild to moderate systemic problems, the vast majority would benefit from good oral health. Even patients with severe systemic disease can be treated, especially if their level of disease is significant. Once the baseline health of the patient is established, we can determine the appropriate risk to benefit ratio for each patient.  

Once it has been determined that the patient can undergo anesthesia, it is important to perform the anesthesia correctly. Well performed anesthesia is exceedingly safe. 

Many anesthetic drugs are available, but for older patients there are a few recommendations. First, an IV catheter and fluids are mandatory to support blood pressure. Propofol or etomidate in conjunction with Valium is considered a good combination in older patients. This should be followed by intubation, which also protects the lungs from water. Finally, make sure to use good patient warming and pain management practices.

Our staff, and those of most veterinary dental specialists, have received extensive extra training and are well versed in older and sick animals. We treat a patient over 15 almost every day, and many of them have moderate to significant systemic disease problems. So far, they have all done very well.

If the patient would benefit from a dental procedure and you are uncomfortable with the anesthesia, seek out your local veterinary dental specialist for advice or referral.

If clients want to keep their pets’ teeth healthy and avoid anesthesia as much as possible, they need to perform homecare. Plaque forms in 24 hours and daily care is recommended. Ideally, this includes daily brushing, but there are a number of diets, rinses and treats that can also be effective preventive measures. For a list of veterinary approved products, visit www.VOHC.org

If you would like to know more about veterinary dentistry, visit our website, which features educational articles and videos about periodontal disease as well as other common oral conditions in dogs and cats. 

Dr. Niemiec, a diplomate of the American Veterinary Dental College and a fellow  of the  Academy of Veterinary Dentistry, works at Southern California Veterinary Dental Specialties in San Diego, Irvine, Murrieta and Ontario, Calif.

This Education Series article was underwritten by PDx BioTech of Lexington, Ky.

REFERENCES
For references go to www.dogbeachdentistry.com

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