Periodontal disease is by far the most common disease found in the mouth of adult dogs and cats. Studies have shown than by 3 years of age most pets have some level of periodontal disease. So what is it? Periodontal disease develops as a result of bacteria and plaque under the gum line. Plaque mixes with minerals in the saliva and hardens into dental calculus (tartar) which is firmly adhered to the tooth. Once the bacteria make it under the gum line they set in motion a cycle of tissue destruction by releasing toxins and causing inflammation. This results in damage to the periodontal ligament and other soft tissues that support the tooth root. As periodontal disease progresses, it becomes increasingly painful and if left unchecked will result in the loss of the tooth. Signs of periodontal disease include: bad breath, redness along the gum line, tartar accumulation and oral pain. Signs of oral pain include can be subtle in pets and often go unnoticed by the pet owner. The good news is that with consistent home dental care and regular professional COHATs, periodontal disease can be slowed or even prevented!
Malocclusion is the term used when one or more teeth are not properly positioned. Selective breeding has resulted in malocclusions being “normal” for some breeds (e.g. Boxers, Bulldogs, Pugs, Shih Tzus, etc.) due to shortening of the upper jaw (maxilla). Problems associated with malocclusion include: trauma to adjacent tooth or soft tissue structures which causes pain, inability to close the mouth properly, difficulty chewing and crowding / rotation of teeth which can lead to periodontal disease. Assessing your pet’s occlusion is an important part of his/her veterinary care. Depending upon the severity of the malocclusion and the effect on surrounding tissues intervention may be necessary. Treatment for malocclusion may include extraction, crown shortening or rarely orthodontic appliances. The goal of these procedures is to result in a healthy and reasonably functional mouth free of pain.
Retained Deciduous Teeth
Just like in people, our pets have deciduous (“baby”) teeth which serve as precursors to their permanent (“adult”) teeth. Deciduous teeth start erupting between 4-6 weeks of age with complete eruption in most pets by 8 weeks of age. These teeth stay in the mouth until 4-6 months of age when the adult teeth should erupt pushing the deciduous teeth out. This process does not proceed correctly in some pets which results in the deciduous tooth being retained in the mouth. Retained deciduous teeth cause problems by impeding the eruption of the adult tooth into the correct position and if not corrected can result in permanent malocclusion of the adult teeth. Retained deciduous teeth also result in crowding which causes increased plaque accumulation and hastens periodontal disease. All pets should be checked by a veterinarian for retained deciduous teeth between 5-6 months of age. If retained deciduous teeth are identified they should be extracted promptly.
Feline Resorptive Lesions
Resorptive lesions are one of the most common diseases of adult cats. This is a painful condition which results in destruction of the enamel and underlying dentin of the tooth. The common appearance of resorption is a tooth with a red inflamed area near the gum line, sometimes with extra gum tissue growing up over the tooth. These teeth are painful and often result in the cat “chattering” its jaw when that area is touched. Resorption can happen both on the crown of the tooth and the root below the gum line. Affected teeth need thorough examination and intra-oral radiographs (x-rays) to assess the location and severity of the resorption. Extraction is the only recommended treatment for these painful teeth. In cats with resorptive disease, frequent (twice yearly) monitoring and annual full mouth radiographs are warranted. Dogs can also have tooth resorption, however, it is much less common and usually occurs below the gum line.
Stomatitis or gingivostomatitis is another common disease affecting primarily cats. This is a painful condition which involves severe inflammation of the oral soft tissues. Frequently the inflammation starts near the gum line but any area of the mouth including the hard palate, throat, tongue and cheeks can be affected. This process is not fully understood, however, it appears that stomatitis results from the cat’s immune system reacting to the plaque film on the teeth. Some cats can be managed with regular COHATs and diligent daily home plaque control if the disease is caught early. Most cats, however, continue to progress with worsening of the disease. The best treatment at this time is extraction of all tooth structures to eliminate the surfaces to which plaque can adhere. The sooner in the disease extractions are performed the better the prognosis long term.
Teeth may break for a variety of reasons including: trauma, aggressive chewing, decay and resorption. Fractures can include just the outer layer of the tooth (enamel) or may extend into the deeper tissues (pulp canal, root, etc.). Any tooth with signs of wear or fracture should be evaluated promptly. Broken teeth can result in pain and predispose teeth to developing infection in the pulp canal which can result in the tooth becoming non-vital. The earlier treatment is initiated after a fracture, the better for the pet. Options for treatment include: restoration/bonding, root canal therapy and extraction. Which option is selected depends upon the overall health of the tooth, the owner’s goals and the importance of the tooth for normal oral function.
Masses / Oral Tumors
Any time a growth or abnormal tissue is noted in a pet’s mouth investigation is warranted. Sometimes masses or growths are not identified by the pet owner and are only found during the detailed examination under anesthesia during a COHAT. Pets can have a variety of intra-oral growths which can be either benign (non-cancerous) or malignant (cancerous). A detailed examination under anesthesia, intra-oral radiographs (x-rays) and biopsy of the mass is the starting point for evaluation. Treatment then depends upon the type of mass, location and other oral health considerations.
This article highlights a few of the most common disease conditions identified and treated as part of a Comprehensive Oral Health Assessment and Treatment (COHAT). It is important to remember that dental disease and oral health is like an iceberg; what is seen above the gum line is only a small glimpse of what is happening in your pet’s mouth. The best protection for your pet is to combine daily home dental care with regular professional COHATs. As with any disease, prevention is the best medicine!
- Dr. Kristina Whitmer