Upon displaying the dog’s loose teeth, sore and infected gums, and rotting tooth sockets to the dog’s owner, the response usually is one of surprise and shock. 

“Well, she does seem to have bad breath, Doctor” is the usual reply.  “But I’m sure at her age she can’t have anything done now”.  My response is that the continual presence of bacteria and their associated toxins have a daily impact on the dog’s health; anything we can do to change that for the better is appropriate.  Privately I’m thinking “How would you like that pathology going on in your mouth?”

Partly because the mouth is warm, moist and has significant nutrients present for organisms to grow on, the oral cavity of dogs is a perfect incubator for all kinds of bacteria.  Most are normal and natural but once plaque and calculus form on the teeth the normal microbial flora gets out of balance and if pathogenic organisms proliferate, trouble ensues.  Far too often veterinarians discover during the physical exam that their canine subject has a foul odor to the breath as a result of generalized periodontitis.  But foul breath is a mere shadow of a much more insidious disease process.  To help understand the topic of oral hygiene let’s take a look at a few basic definitions below:

DEFINITIONS
  Gingivitis… means an inflammation of the gums.

  Periodontitis… a general term for a disease of the oral cavity that attacks the gum and bone and delicate tissues around the teeth.

  Pyorrhea… inflammation of the gums and tooth sockets, often leading to loosening of the teeth and accompanied by pus.

  Caries… an area of decalcification of the tooth enamel leading to cavities in the tooth.  Caries are very rare in dogs.

  Plaque… is the first buildup of material adhering to the enamel of the tooth and is composed of a mixed colony of bacteria in an intercellular matrix of bacteria, salivary polymers, remnants of epithelial cells and white blood cells.  It can cause caries, calculi buildup and periodontal disease.

  Calculus (Tartar)… is calcium carbonate and calcium phosphate combined with organic material, deposited on the surface of the tooth.

VETERINARY DENTISTRY
Since most dogs presented with advanced periodontitis are older canines, owner concern regarding the safety of dental procedures always seems to be an impediment to performing dental procedures, especially since anesthesia is an important aspect of a thorough dental cleaning. Dr. Jones states,  “Age is not a disease, and senior citizen dogs that are otherwise healthy are generally able to tolerate anesthesia for an elective procedure.  Even though anesthesia safety will continue to improve, there will never be a time when there is no risk.  The question is really whether the level of risk is appropriately measured against the damage to the dog’s quality of life if it does not have a dental procedure.” 

Dr. Jones also points out that in modern veterinary practices the anesthetics utilized are markedly safer than those used 15 or 20 years ago and patient monitoring during anesthesia has become quite sophisticated.  The use of intravenous fluids during the procedure, warmed surgical surfaces to keep the patient’s body temperature stable, and preanesthetic blood chemistry evaluation all improve the opportunity for the patient to benefit from the dental procedure.

Teeth actually need to be exercised!  Pressure on and movement of the teeth help to strengthen the microscopic fibrils, called Sharpeys’ Fibers, that hold the teeth in place in the alveolus (socket).  In the dog that gets plenty of  “dental exercise” by chewing on hard food or such items as rawhide or chew toys, the teeth and surrounding tissues are mildly stressed; this in turn prompts regeneration of healthy new tissues.  Plus, the simultaneous physical abrasion against the teeth scrapes away early plaque that is forming nearly all the time.  Get rid of this early plaque and subsequent calculus simply has no chance to form.  Calculus buildup creates gum line recession and provides pockets for pus accumulation.  Pyorrhea results and foul breath odor is the signal that something is wrong.

If the teeth do little work and there is gum line recession, bacteria begin to invade the space between the tooth and gum.  Eventually, contamination reaches the delicate Sharpeys fibers and the connections between the teeth and bone are broken.  This allows the teeth to loosen, permitting even further organic material and bacteria into the tissues.  A vicious cycle of tissue breakdown and infection can plague the dog the rest of its life.

ADVERSE EFFECTS OF POOR ORAL HYGIENE
I asked a Diplomate of the American Veterinary Dental College, Jan Bellows DVM, of Hometown Animal Hospital and Dental Clinic in Weston, Florida, about the adverse health impact chronic periodontal disease can have on a dog.  He responded, "The toxins from periodontal disease are absorbed into the dog's blood stream. As the kidneys, liver, and brain filter the blood, small infections occur causing permanent and at times fatal organ damage. After periodontal disease is treated, and the owners give proper home care, most dogs respond wonderfully due to the decreased pain and infection.”

The adverse effects of periodontal disease are due in part, as Dr. Bellows states, to the toxins the bacteria secrete and the damage these toxins cause to delicate kidney, cardiac, and brain tissue.  As well, many veterinarians believe that actual bacterial colonies can spread via the circulation and set up housekeeping within the animal’s tissues, commonly in the heart valve areas, kidneys and liver.  Far better than extracting teeth, performing gingival flaps, filling erosions or doing root canal procedures, would be to prevent the health damaging periodontal disease in the first place.

ORIGIN OF PERIODONTITIS
Generalized periodontitis seems more common in small breeds of dogs, with Dachshunds, Yorkshire Terriers and Miniature Schnauzers leading the pack.  Certain conditions in the mouth such as acid/alkali balance, numbers and types of bacteria, amount of physical abrasion over the teeth surfaces and gingival strength all must be in balance for optimal oral health to be present. David Jones, DVM, Resident in Veterinary Dentistry and Oral Surgery at the School of Veterinary Medicine, University of Wisconsin, Madison, comments on how poor oral hygiene affects the dog. He says “People that have gingivitis and periodontitis report that it is painful.  Unfortunately with the majority of dogs neglect is the norm when it comes to the health of the mouth.  When dogs are presented for a dental cleaning, often they have substantial gingivitis and periodontitis, and almost certainly have been enduring significant discomfort or pain.  Even if the effects of gingivitis and periodontitis in dogs are limited to pain and discomfort it represents an unnecessary deterioration in the quality of life of man’s best friends.”  

PREVENTION
One of the best ways to insure optimum oral health is to provide the dog with a well-balanced, meat-based dog food.  Meat assists in keeping the mouth environment healthy.  Actively encouraging the dog to utilize chew treats that require some “exercising” of the teeth, such as is provided by compressed rawhide chewies, hard rubber or nylon chew toys, can assist in keeping the mouth structures vital.   Brushing the dog’s teeth can be a big help, too, but needs to be done almost daily.

One study reported in the Journal of Veterinary Dentistry, December, 1996, states  “Tooth-brushing every other day did not maintain clinically healthy gingiva in dogs. The daily addition of a dental hygiene chew to a regimen of tooth brushing every other day reduced the gingivitis scores and reduced the accumulation of dental deposits (plaque, calculus and stain). Daily tooth-brushing should be the recommendation to the dog owner irrespective of dietary regimen”.

Newer dental care products that include antiseptic impregnated chewies, canine appropriate tooth brushes, and even flavored tooth pastes to “reward” the dog for allowing the brushing, are available online, in any pet supply store or veterinary hospital.  Highly rewarding, too, would be routine oral hygiene visits where under light anesthesia the patient can undergo ultrasonic teeth cleaning, close inspection of teeth and gingiva, and assessment of overall oral health.  Addressing problems when they are minor and preventing the health damaging effects of bacterial contamination and systemic toxin release are immeasurably beneficial to the dog’s long-term health status.

The increase in number of Specialists in Veterinary Dentistry such as Dr. Bellows attests to the fact that we dog owners need to pay closer attention to our dog’s oral health status.  And that begins with the simple task of looking closely at the dog’s mouth.  Dr. Bellows sums up the need for optimum oral health throughout a dog’s life by stating, “When a client asks me how long their puppy will live, I usually respond 15-17 years if you brush their teeth daily, 11-13 years if you don't".