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.

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.

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.

Why?

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.

Teethsy No 4 -What is a dental? really.

What is a dental?  Really?

I mean, pet owners ring us up every day for the price of a dental, just like they are asking the price for a bottle of milk.

The answer to this very important question will be different depending on who you ask.

So let's look at what pet owners, vet and, most importantly, our pets may think.

The pet owner - what is a dental? 

There are many subgroups of pet owners

There are some who realise that it takes skill and training to thoroughly assess the mouth, identify disease and treat it.  These pet owners will actually seek out those vets in their community who are genuinely interested in dental work, and who have a good reputation for doing this. 

There are some who just think it is clicking tartar of the teeth. Many of these pets often will get their teeth cleaned at the groomers, or at the cheapest grade 2 dental place the pet owner can find. To them, its all the same.

And there are those who think it is just a money making scam of vets.   I remember a journalist a few years back saying exactly this in a main stream newspaper.   These pet owners are surprised that their pet actually needs a dental procedure, and when they do see the tartar, have an expectation that the vet will just click it off in the consult itself. 

The vet - what is a dental?

Like pet owners, there are subgroups.

We are not all the same, and we don't all do the same thing.

There are vets who take dental work seriously, who, like me, have invested time and money into quality equipment, instruments and especially training. We try to practice to as high a standard as we can. We do the work ourselves, or delegate it to trained veterinary staff.

We recognise that dental disease is an Animal Welfare issue, and look at the Global Dental Guidelines as a tool that recognises this.

There are vets who train their vet nurses or even animal attendants to do the teeth cleaning for them. Few of these nurses receive formal training, but it is available.  I once received an application for a trainee nurse position who proudly said that they did extractions during their school work experience. That was an eye opener.

There are no doubt exceptional vet nurses who do an amazing job, as there are veterinarians who do not. My point here, is that the pet owner needs to be told the truth on who is actually doing the procedure on their pet.

The pet - what is a dental?

The pet is going to hope that if they are going to be subjected to an anaesthetic and an invasion of their privacy and to be taken away from their home whilst all of this is happening, that the person that is going to be doing all of that is one of those vets who has invested time and money into their skill.

They are hoping that the person is going to do the best job that they can. Every time.

To the pet, the whole idea of the procedure is to ensure that any disease is identified in the mouth and fixed. They want a mouth that doesn't hurt any more, even if they are not showing obvious external signs of pain.

To the pet, it is simple. They live for the moment.

They just want a job well done, by good people, who actually know what they are doing.

What is it that we do? 

My guess is that is what you were expecting this entire blog post to be on - the one that vets, including myself, have written in the past.

You expected us to write about the care we take, the anaesthetic, the way we assess each individual patient.

The personalised anaesthetic plan and attention we give to each pet under our care that day, and especially in the follow up - this is more crucial in my view than anything else.

The thorough oral cavity assessment, looking at not just the teeth, but the head shape, tonsils, tongue, under the tongue, back of throat,

You expected me to write about our thorough dental chart, and how we take and review the full mouth dental radiographs, that are done on each and every dental case.

My guess you also expected to read about how we were the first in the Illawarra to do dental radiographs, first with good old fashioned film, to then progress to digital in 2009.  The experience we have just by doing it for so long, and having assessed so many cases during that time, you can't learn in a textbook.

Experience is what you can't buy.

You expected to strut my chest out, like others, and say that we are the best.

Nah, I am not going to write stuff like that.

All I am going to say is that we do try to practice to a high standard, that we are not perfect, but we do try to do the best each and every time.

I am Dr Liz, the mad vet of Bellambi.

I love my pets, as many of them love me.  Keeping them happy and healthy is what all of us at Russell Vale Animal Clinic have devoted our lives to.

Please be kind to your pet's vet.

Teethsy no 3 - Anaesthesia free dental? Not for me!

Every day in all corners of the Earth, there are people who think that they are doing the right thing in clicking the brown hard tartar off the teeth of dogs and cats (and other animals). They dress it up and pretend it is the same as the dental procedure a pet would get under anaesthetic.

Most of these are people with a veterinary degree, whether from our own country or overseas. I would like to say that they have no qualifications, but sometimes they have some.  Some are registered to work as veterinarians within Australia, but most aren't.

 All of us would make an assumption that these people are always going to be animal lovers, and would never do anything that would hurt animals. It would be horrible to think that they knowingly hurting our animals.  The fact that they are, in many cases, unknowingly contributing to long term pain,  is painful  for me as an animal lover to realise.

Those who perform dental procedures without an anaesthetic, as far as I can see through their literature, comments and (short) conversation that I have had with one of them, genuinely believe they are doing the animal world, but especially,  their pet owners a favour.

Listen to both sides of the argument

They always argue that they are using the same equipment as dentists with ultrasonic scalers, and polishing tips. They say that the pets they treat do not suffer any anxiety during the procedure. They show before and after photos - first you see dirty teeth, and then there are pearly whites. (they are missing what is the crucial core of real dentistry - to treat underlying disease, remove source of pain in the mouth, get the mouth healthy again - i.e a pain free mouth).

They advertise that they are a service for pet owners, by not subjecting their pets to an anaesthetic to clean their pet's teeth. Their claim that they are  saving pet owners money in doing so. They say that they are providing an amazing, wanted service. It is in high demand, according to them.  They do not understand why more vets are not on board of this, and they claim that those who do not support what they do, are just good old fashioned money hungry.

Ok.... here is the rub!  What is the core focus of any veterinarian and associated team members who are involved in the care of animals - it is about the care of animals.  It is about doing right by them. It is trying to make sure that anything we do doesn't hurt them. It is about keeping them as healthy as we can,  doing the best we can with the skills and equipment we have, to make them pain free and happy, or as close to this as we can.

I totally understand the fear of anaesthetic.  I personally have had two very bad anaesthetics in my life (one in which I remembered being intubated and not being able to breath).  I get that it is scary, as I am dreading my next anaesthetic, but this does not mean I am scared to anesthetise my own pets for dental procedures or the pets that come under my care.

 It does mean that I take every available step to ensure that their anesthetic is as smooth and comfortable as I can make it for them.  Knowing how full the room is with every anaesthetic lecture I attend is, I am not alone in this aspirational desire for best practice.

Multiparameter monitor, part of our "Best Practice" for many anaesthetics. (this is demo mode, not a real patient)

It isn't about helping people save money ( you want to save money, don't have a pet, get a stuffed toy),  it isn't about doing something that a pet owner wants us to do because the pet owner wants it done (remember tail docking? declawing? ear cropping?).

As vets, we need to stand up to what we know to be the right thing to do... the welfare of our animals is at stake here.  As pet owners, we need to do the same thing.

We need to do the RIGHT thing.  The absolute, black and white, right thing! This is not a grey zone area.

Do the RIGHT thing!  An apple a day.....

But yes, performing a thorough dental assessment, radiographs of the mouth, developing a treatment plan, discussing this with pet owners, and then continuing on with that plan,  is  potentially going to cost more money than if you are just doing a cosmetic job of clicking brown stuff of the teeth.

What we can't compare is the treatment of disease, as I seem to find alot once I have performed a thorough oral examination, and they seem to find nothing but brown stuff on teeth.

Who is right in this situation?

I don't go in and colour in black areas around tooth roots on radiographs to make them look like bone loss. These are real problems, that need genuine caring vets to deal with.

Dealing with dental disease costs money.  Preventing disease costs alot less.  If you ignore the fact that dental disease is UNDER the gum, then you need to rethink what you believe.

Dental radiographs being reviewed, the hidden abscess is seen.

My dental equipment includes a periodontal probe to go under the gum margin to look for pockets,  my eyes to inspect each and every tooth, use of radiographs to assess underneath the gum to look for signs of abscessing, with my ongoing quest for knowledge on how to best manage dental disease in our pets.

The core of what we should be doing as any human being who cares for animals is to first do them no harm.

Piper getting her teeth cleaned.

Of course, if all that veterinarians are doing when they perform their "dental" is cracking tartar off the teeth, then yes, they are no different to the anaesthesia free mob,  with the only difference being the anaesthetic.  Many vets have gone beyond that basic dental service, and are now understanding the importance of a thorough dental examination, dental charting, dental radiographs, developing of a dental treatment plan, discussing this with the owner, and then proceeding with the agreed dental plan.

An example of one of our dental charts - every pet gets one! 

I only ask, as an animal lover, that if you ever subject your pet to Anesthesia Free Dentistry, that at least once you then allow your pet to have a thorough dental examination incorporating all of the above features for comparison.

The unerupted tooth causing a bone cyst. 

Let me tell you about a dog called Honey, who moved to Australia from Hawaii.  This was many many years ago, Honey is no longer with us except in our memories, but she was beautiful and loved.

Honey was so loved, she was groomed each 6 weeks, had her own personal dog walker,  and then each 6 months had Anaesthesia free dentistry at her groomers.  This was when she was in Hawaii.

Now that she was in Australia, it was time again to have her teeth looked at, but this time, it was with me. It was under anaesthetic, and the degree of hidden disease under the gum astounded me (and upset her owner).  She was upset to know that her dog must've been suffering with not just one dental abscess, but with 3, all seen on radiographs only. Probing or visual examination would not have picked them up.

I know that I am not going to convince those who genuinely believe that they are doing the right thing in subjecting their pet to scaling of the teeth without an anaesthetic.  I hope I can convince you that at some stage in your pet's life that you give them the genuine love to allow a vet who is familiar with dental radiographs, charting, and the thorough oral examination to also have a chance to examine your pet's mouth a bit more thoroughly and deeply.

The fractured tooth, but the tooth behind was abscessed.

Our pets do not complain about their dental pain... be the person your pet thinks you are and look after them.

If you want to know more about the Australian Veterinary Associations position on Anaesthesia Free Dentistry, click here. 

I am Dr Liz, the mad vet. I love making pets happy and healthy again, with dental disease and the hidden pain it causes one of my (many) soap boxes.  Sore teeth hurt - we complain, our pets rarely do.  Call us or your local vet for your pet's dental check now.

Where? I am the vet from Russell Vale Animal Clinic, on Bellambi Lane in Russell Vale, in the beautiful northern suburbs of the Illawarra.

Dental checks are available all year round with us, but August is the traditional month to flip the lip.