Tuesday, August 27, 2019

Teethsy No 7 - The Art of Saving Teeth

As the polar blast whips up the coast, and our teeth are shuddering from the cold, it is timely to talk about how to keep the mouth healthy.

After all, it is no fun having teeth shudder when there is pain in your mouth.  

No one likes the thought of extracting teeth, in ourselves or in our pets.  

How will they eat? 

Is it really necessary? 

Why did it happen? 

These are the questions that are commonly asked by loving pet owners.  The answers are easy, though. Easy on paper. Harder when they apply to a loving living creature.

They will eat just fine - trying to eat with a painful tooth means that they were eating around the pain.  They will now eat with the pain lifted from their shoulders.  Removing pain is never a bad thing to do. 

Yes, it is really necessary.  If there was another way of salvaging the teeth, we would do it. In some cases, there are ways of salvaging the teeth, but this would mean travel to a vet dental specialist (there are not many of those around in  Australia). 

And your pet has dental disease because despite your best attempts (or because you didn't attempt anything), due to a complex series of pathological events, disease was able to destroy the bone around the tissue that holds the tooth in. The tooth is a living structure, and if the tissue around it dies, it has nothing in which to support it. 

The art of saving teeth does not mean that we are able to save all of the teeth in a pet's head. The art comes in saving the teeth that absolutely need to be saved, if the teeth around them are diseased. 

An example would be of extracting incisors (the little teeth at the front of the mouth) to protect the canines (the fang teeth).  

One often thinks that saving every single tooth in a pet is the ultimate goal. It's not. It is not even like that with us.  How many of us have had our wisdom teeth removed, or, some other teeth to prevent crowding.  

Sometimes, we need to remove teeth to save teeth. 

Sometimes, we need to remove teeth that are a cause of pain, and that there are no other ways of removing that. 

Do not be afraid of your pet needing teeth to be extracted, rather, look at what the intended goal of the extraction.  

In virtually all cases, it will be to remove a source of oral pain in your pet.

 Why, as a pet owner, would you not want that for your pet?  

The only thing that I would demand, as a pet owner, are dental radiographs before and after the extraction. "I want a copy please" would be what I would be saying.  (we give a copy of these at discharge EVERY time). 

  I would demand a dental chart, and a logical scientific reason why these teeth needed to be extracted.

  Every vet should be able to explain and prove why teeth should be removed, and prove that they were, in fact, removed. 

I am Dr Liz, the mad vet of Bellambi.  

My dental credentials: I am an active long term member of the Australian Veterinary Dental Society (for over 10 years), have published many articles on dental care (from a general practitioners perspective), an active member of the American Foundation in Veterinary Dentistry, and read the Journal of Veterinary Dentistry like many people read Womens Day.  I am also a member of the Veterinary Dental Education Centre, and have attended many wetlabs as well as lectures on basic and advanced dentistry.

Tuesday, August 20, 2019

Teethsy No 6 - Want forever teeth? Then do forever care.

Welcome to another Teethsy talk for Pet Dental Month 2019.  We are now half way through this month, and I am seeing so many cases that actually have nothing to do with teeth.

I am seeing pets with severe ear infections, diarrhea, pancreatitis, itching, sore bottoms. Even a few cat and dog fight wounds, dogs with lumps, and those dogs who are losing weight.

Many of these pets  also have dental disease.

Talking about dental disease during these times of illness, to me, seems wrong, even though it is the right thing to do.

You see, the pet owner didn't bring them in for a dental check. They didn't and often don't, recognise that their pet has sore teeth.

 They brought them in for "whatever thing they were doing", not because they have dental issues.

As soon as the discussion goes towards other issues with the  pet (such as stiff joints, sore mouths, lumps or anything else we may find during our thorough general examination), many owners seem to have the look on their face as if to say "you are about to upsell me on something".

Pet owners seem to forget that my job, as a vet, is to examine your pet thoroughly, identify any issues that are outside the normal spectrum, discuss that with you, and turn you into an informed pet owner. This is what I have been trained to do - this is what my desire is as an animal lover to help the pets that are under my care.

I certainly would not expect my mechanic to keep his mouth shut that my car needed new brake pads, just because I took my car in to check the oil leak.  I would never accuse him of upselling just because he was doing his job.

80% of pets will have some form of dental disease at 2 years of age and older.

80% of pets will not have diarrhea by this age.

Dental disease is THE most common disease in our pets.

It is not THE most common presenting complaint to vet hospitals.

Diarrhea is common, and if your pet has had diarrhoea for several days, I can guarantee that you will be taking them to your local vet for a thorough examination and treatment. I know you do, because you love your pet.

If you want your pet to have their teeth for a long time, then you need to step up and take your pet to the vet for a dental check.

These dental checks are free all year round with us, with many vet hospitals all over Australia offering free dental checks in August of every year.  The only initial cost is your time.

What can you do for home care? 

There are so many products out there that have the word "dental" in them. Anybody can produce a chew, a toy or a food, and say it will help keep your pet's breath smelling good, and your pet's mouth healthy.

How do you know that they actually do what they say they do?

Ask us about what would work for your pet, or if you are not in our area, your trusty local vet.  Try to look for one who is a member of the Australian Veterinary Dental Society as they are likely to be a bit more dental savvy.

The reason why I won't go into specific  home care here, is that we individualise the dental program for each pet, which we can't do here.  Anything I say would have to have similar fine print that goes into many financial counselor documents (general in nature blah blah blah)

We know that many products are great, but we know that there are many human and pet factors which will affect how well they work. We also know that many products are crap. To say that they are crap in a blog would set me up for defamation.  Truth is not a defence.

When to start? 

If you never want to hear the line "your pet needs to have 10, 12, 15, 20 teeth removed", and you want your pet to have forever teeth, then the care starts as soon as they enter your family.

For most of you, that is when they are kittens or puppies - only months old.  Dental disease can be prevented in many pets, or the progression slowed in many others, just by starting early.

Once dental disease exists, it is always going to be a tough battle. It is going to be hard work, but doable. Seriously, your efforts, can make a big difference.

So, no matter how old your pet is, get their teeth checked now, and make sure it is done each six months of their lives FOREVER.

 If you want your pet to have forever teeth, then forever care starts now. And it starts with the help of your vet. You know the one that your pet should visit at least two times a year for life, not just for baby shots, desexing, and then to euthenase them.

I am Dr Liz, the mad vet of Bellambi.

 My dental credentials: I am an active long term member of the Australian Veterinary Dental Society (for over 10 years), have published many articles on dental care (from a general practitioners perspective), an active member of the American Foundation in Veterinary Dentistry, and read the Journal of Veterinary Dentistry like many people read Womens Day.  I am also a member of the Veterinary Dental Education Centre, and have attended many wetlabs as well as lectures on basic and advanced dentistry.

Tuesday, August 13, 2019

Teethsy No 5 - Rare as hen's teeth -the weirdo teetho

Teethsy no 5 is here - we are now almost half way through Pet Dental Month for 2019.

I was originally going to write about the types of pathology I see in a pets mouth, simply because we perform a thorough oral examination and full mouth dental radiographs for many years. You know, the weirdo teetho thing, which is what this post is all about.

There is a wonderful list that includes teeth with 3 roots that would ordinarily have 2, the extra teeth, the buried teeth, the cysts because of impacted teeth, the teeth with roots that decide to curve at 90 degrees.
From a cat.

I have so many xrays and photos from so many pets over the years.  So many pets with such weird stuff in their mouth, not just the brown stuff on the teeth which pet owners all over the world associate with bad teeth (and by default, white teeth must be healthy.. not necessarily).

Those conditions can be written in as rare, but only because the majority of vets are not looking for them.

We miss more for not looking, than not knowing, an old vet professor used to say when I was at uni.

Observe. ( he said) 

So I have observed. I check the mouth of all of the pets I see. We start from their very first visit to us. We don't wait until disease starts to then start the dental care discussion.

We start when their teeth is healthy.


Because a normal, healthy mouth is actually rare. As rare as hens teeth. 

The stats show 80% of pets 2 years of older will have some form of dental disease.  Four pets out of five will have dental disease.

That means that a pet with a healthy mouth is rare.

The other way of wording this statistic is that 1 pet out of 5 will have a normal mouth.

  When I was a much younger vet, it all went downhill from 3 years of age, but thanks to human meddling (aka breeding), it starts much younger.

The earliest stage of dental disease is gingivitis, which is the red line along the gum margin (I call it the lip liner look).

Flip your pet's lip, check them out - if there is anything other than normal pink in their mouth, any lip liner look along the gum, you  need to see a vet, AND, your pet deserves an improved dental home care program.
NOT a healthy mouth, but the owner thought the dog WAS healthy. 

The pet who gets regular home and veterinary dental care - As rare as hens teeth.

I have many pets who do get regular home dental care, they come in for their dental checks when they need to  (at least twice a year), and then get any veterinary health care that is needed, when its needed.

Regular home care involves daily brushing of the teeth, supported with the use of oral chews, diets, and gels.

Veterinary care involves regular dental checks, and if disease identified, then a thorough assessment and treatment under anaesthetic is done. (the COHAT)

Many pet owners knows that their pet  needs dental care, but I don't understand why that then translates to "my pet needs more bones". No, they don't need more bones - they need a decent dental check, and, more likely that not, a proper COHAT with an experienced dental vet.

But all that I have written above is rare.  For those who do the right thing, I know it is a concept that may be hard for you  to understand. It isn't that these pet owners do not care, but they do not care enough to make it a priority for their pet.

My pet needs a dental specialist? No problem. 

A pet owner said to me the other day that she loved that we always looked after the pet's welfare first and foremost. That we always referred to others when needed.

I love dentistry. I love being able to remove pain from a pet's mouth in just an hour or three of work. The difference I can make just by reducing the bacterial loading through their blood stream just by removing abscessed teeth and performing a thorough oral examinaton.

There are times, though, that despite the skill I know I have, the pet would be better served by attending a dental specialist. They do exist, believe it or not.  As a member of the Australian Veterinary Dental Society, I know a few of these dental specialists very well.

Dr Christine from Sydney Pet Dentistry with Indi.

Referral to a specialist is not a failure in me as a vet, but a genuine understanding of what I am capable off compared to the needs of the pet in front of me, with the knowledge of what is possible if all of the stars align.

Sometimes the stars do not align - the owners resources do not allow the "if money was no object, what should be done" test. Actually, it  is most times.

Hence, why this falls into the hens teeth category.

I am Dr Liz, the mad vet from Bellambi.  I am sorry if you expected gruesome photos of dental diseases.

Those sorts of things tend ot excite fellow veterinary dentists rather than pet owners, unless your pet has been identified with some of the weird teeth things that we see.

Come in, say G'day, and ask us to flip your pet's lip this dental month.