Dental Myth #1: Dogs and cats do not feel pain the way people do. They have a higher pain threshold.
Basis for Myth: Serious dental problems are often detected only as incidental findings during routine examination. Owners may say that they have observed no indication that the pet is uncomfortable. The pet still eats and may even still chew on hard toys.
The Truth: Studies indicate that dogs and cats have the same pain thresholds and tolerances as humans across all categories of pain, including dental pain. They react and withdraw/defend at the same level of stimulation and have the same physiologic reactions to pain as humans.
If a dog has a sore tooth, that is one problem. If the dog allows that sore tooth to keep her from eating, she now has two problems: a sore tooth and hunger. From her perspective, it is better to eat with a sore tooth than to go hungry. Also, dogs live in packs (our families). A pack member seen as weak or distressed will lose social status and may even be cast out as a liability to the pack. Cats, being small animals, are subject to predation. Therefore, nature has taught dogs and cats to mask their pain and pretend everything is fine. Finally, pets have no way of knowing that by complaining, they can increase their chances of getting relief. Therefore, they have no reason to complain and a few reasons not to.
Often, owners will agree that the animal has been showing signs that might well be related to dental disease. There may be a history of a change in preference toward softer food and toys, chewing on one side, bad breath, a general decrease in vigor, drooling, pawing or rubbing at mouth, decreased enthusiasm for food and games, ocular discharge, sneezing.…
Time and again, pet owners state that their pet was showing no obvious signs of pain, but once the problem has been treated, they realize that the pet was indeed suffering. The improvement in attitude and well being after successful dental treatment is often very dramatic.
Recommendation: If you see a condition that would cause pain in your mouth and would cause you to seek dental care for yourself, assume that it is causing pain for your pet and seek treatment.
Myth #2: If a broken tooth does not seem to be bothering the patient, there is no need to treat it.
Basis for Myth: Often patients will present with a fractured or worn tooth in which the pulp has been exposed but the owner will state categorically that it is not bothering the animal. They point out that the dog or cat is still eating and chewing normally and shows no signs of discomfort (see Myth #1). On physical examination, there is often no evidence of oral swelling or gingival inflammation.
The Truth: If a tooth has been broken or worn to allow pulp exposure, it is a problem that must be treated. A tooth with an open pulp chamber becomes a direct pathway for bacteria to enter the periodontal space around the root tip and the body is powerless to stop this. Even superficial enamel chips lead to tooth sensitivity and possible abscessation.
The result will be a chronic inflammatory response (abscess) at the root tip. This causes a chronic, dull ache as well as acting as a source of septicemia. Occasionally, these root abscesses will eat through the bone, spreading the infection into the surrounding tissues. This is the situation with facial swelling associated with fourth upper premolar fractures. However, only about 20% of these diseased teeth will provide such an obvious indication for treatment. The other 80% of tooth abscesses will remain encased in bone or fester to a less obvious site (nasal passages or oral cavity).
Recommendation: A fractured or worn tooth with pulp exposure must either be extracted or have root canal treatment. Superficial enamel fractures can have protective sealants bonded to the tooth that reduce sensitivity and the risk of abscessation. To recommend nothing could be considered negligence. In the case of a facial swelling or draining fistula associated with an abscessed tooth, antibiotics will often bring temporary relief, but the problem will recur after the medication is discontinued. Giving antibiotics for a few days pre-operatively is a good idea, but antibiotics should never be offered as a substitute for surgical treatment.
Myth #3: For minor tartar accumulations and mild gingivitis, a simple scaling without anesthesia will often be sufficient.
Basis for Myth: This myth likely grew from client concerns about the risks involved in general anesthesia. In order to offer some level of dental care at reduced risk, some veterinarians have offered “Standing Dentals”. Groomers and breeders have also been known to offer this service. When finished, the visible portions of the teeth look clean to the naked eye and the animal’s breath is often less offensive. This, coupled with a much lower fee and no anesthetic risk, tends to satisfy some clients.
The Truth: Proper dental care requires general anesthesia with a properly fitted, cuffed endotracheal tube. For an oral hygiene procedure (prophy) to be therapeutically beneficial, it must involve complete removal of not only all visible calculus and plaque, but more importantly, that which is below the gums. All periodontal pockets must be probed and charted prior to root planing (either with or without flap surgery). All exposed tooth surfaces must be polished after scaling to remove residual plaque and create a smooth tooth surface that will be easier to keep clean. Other concerns such as oral and gingival masses, fractured and worn teeth, orthodontic problems, etc., should be investigated and either treated or referred.
In the “Standing Dental”, only the outer surfaces of the crowns are scaled. It is not possible to probe and clean below the gum-line, in between teeth or on the tongue and palate side of the teeth. It is not possible to polish the teeth in the conscious patient, nor is it possible to conduct a thorough oral and dental examination.
“Standing Dentals” leave plaque and calculus in places where owners cannot see it, so the owner is given a false sense of security that the mouth is healthy. “Standing Dentals” scratch the enamel surface but do not allow polishing so the tooth is left even more plaque retentive than before. “Standing Dentals” are unpleasant for the animals and so can make them head-shy which makes instituting an effective home-care program much more difficult. “Standing Dentals” often damage the gingiva as the animal wiggles about while there is a sharp instrument in the mouth. “Standing Dentals” do not allow for a thorough oral examination and so subtle problems are left undetected and untreated until they become serious and obvious problems which are usually much more difficult to treat.
Recommendation: Since “Standing Dentals” do more harm than good, refuse this service. A “Standing Dental” is bad for the pet (there are risks with no benefit) and bad for the owner (who pays for worthless and potentially harmful treatment).
Myth #4: Old animals are not suitable candidates for dental treatments.
Basis for Myth: Generally, older patients have higher anesthetic risks and so some veterinarians feel the benefits of treatment do not justify these risks. In the past, anesthetic risks were higher and the level of dental treatment available lower and so the risks might not have been justified.
The Truth: Things have changed! It is true that some patients are too systemically ill to be candidates for a general anesthetic. However, no animal should be denied the benefits of proper dental care merely because they were born a long time ago. According to Veterinarian’s Oath, we are sworn to prevent and relieve animal suffering. Many dental conditions are not only sources of chronic pain, but also serious sources of chronic septicemia (infection in the bloodstream). These situations have significant negative impact on both the quality and quantity of life for the patient. With our present resources for pre-operative diagnostic screening, intra-operative risk management and post-operative care, the risk of losing a patient to a general anesthetic has been greatly reduced (there is always a risk with any procedure in any patient). Also, the level of dental care available, particularly through referrals to veterinary dentists, has increased incredibly over the past 10 years. It is now safe to say that the risk versus the quality and quantity of life associated with dental treatment is less than the risk associated with dental neglect.
Myth #5: Periodontal disease is an inevitable consequence of aging.
Basis for Myth: Many old dogs and cats have severe periodontal disease.
The Truth: Periodontal disease is entirely preventable. Through the judicious use of abrasive foods and toys (nothing too hard), appropriate home-care programs and timely professional oral hygiene procedures, it is very possible for a dog or cat to live a long life and lose no teeth to periodontal disease. Any time a dog or cat does lose a tooth to periodontal disease, it can been seen as a failure on our part to effect an appropriate preventative program. (The exceptions to this are Feline External Odontoclastic Resorptive Lesions and animals with immune mediated and systemic conditions such as Lymphocytic/Plasmocytic Gingivostomatitis). Adopt a preventative approach to oral health by starting dental care before disease is established.
Myth #6: Dentistry is too expensive.
Basis for Myth: Human dentists can perform ‘prophies’ for under $100. Yes, many invoices are large due to the presence of advanced periodontal decay, but most clients would tell you they felt the service was worth every penny when they see how much younger their pets act following treatment. It is not uncommon for advanced procedures to run two to three hours under general anesthesia.
The Truth: With regular home dental care, a true prophylaxis procedure can be performed in about 45 minutes for about $200 – $400, even with general anesthesia. This does not including pre-anesthetic screening or IV fluids, dental radiographs (x-rays) or extractions (we have had clients from California report that this runs anywhere from $750 – $1500 before surgery or other therapeutics). However, 75% of pets over the age of 2 years have at least one undetected painful condition in their mouths that need additional attention. If during that ‘routine prophy’, an unexpected problem (such as a deep periodontal pocket or chipped tooth) is detected, it can be diagnosed and treated at the same time, thus maximizing the therapeutic benefit to the pet and eliminating the need for a later referral with a second anesthetic. This is value for your money, which your pets will appreciate.
Which is more costly: timely therapy or untreated painful infections that lead to irreversible oral decay and damaged internal organs?