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.

Teethsy No 2 - Don't let Old Dogs Down - doggie dentals

My dental blogs over the next month is going to be like a scavenger hunt, where you have to work through the clues to go to the next one! In other words, it is going to be in the order which doesn't seem to make sense (except to me).

Mr Hill, my history teacher from High School (back in the 1980's) got upset with me in one of my history examinations. He was angry that my discussion about World War II was back to front.  So, in keeping with my teenage self, I shall start at the end stages of a pet's life as I talk about teeth.

It is at this stage of their life where age is a disease, as like any other disease, it affects the pet's ability to get the treatment they need for the problems they may have. As a vet though, we are trained to think, and many of us believe, that age is NOT a disease.

Its a constant challenge for me when I  have owners saying "at their age, I don't want to put them through that" when I have the knowledge that their pet is in pain now. Ignoring this pain is  not going to make it go away.

And at their age, they are not getting any younger. No owner wants to think that their pet is pain, but it is a sad reality for many of our pets out there.

An old Teddy!

The comorbidities may be enough to make the owner think twice about dental work - you know, the pet that is arthritic,  has heart disease, kidney disease. Is it the dollars that is stopping them too? If there is alot of disease, it is likely to cost alot of money, into the thousands, to address this.

The pet where the owner sometimes wakes up some mornings, only to go over to their pet to wonder if they are still alive.

Very much alive, but sleeping.

These pet owners are often (understandably) loathe to subject their elderly pet to an anaesthetic just to clean some teeth.

This is where the problem lies - whenever I recommend a dental procedure for a pet, it isn't just to get them back to being pearly white, but to examine, identify, and then treat any disease that is hiding in that mouth of theirs. My goal is to make their mouth pain free.

Abscessed teeth  - identified on radiographs, but the mouth didn't look "too bad" visually.

If all I am  doing is flicking tartar (brown stuff) off teeth, well, you might as well do that yourself, or get your dog's hairdresser to do that.

An older photo of our dental set up

To say that is what a "dental" is, is to not understand what a "dental" is. (that is a soap box talk all of its own).

What can we see in older pet's mouths?

Advanced dental disease in a fat maltese terrier -  still eating well but so much pain.

- Abnormal wear from too much playing with tennis balls, chewing on rocks, chewing on themselves
- Draining sinuses from fractured teeth
- Ankylosis of bone and tooth
- Periodontal disease (significant bone and/or gum loss ) - although not necessarily an old dog disease
- lumps on the gum or bone
- broken teeth
- fractured jaw from advanced dental disease.

Fractured jaw from advanced dental disease

And the signs they show we often subscribe to just being old. They may chew slowly, not move around much, not be so keen to play. But they are still eating well.

Please do not let your pet's first anaesthetic for a dental procedure be when they are older. Start your pet's dental program from when they are younger, address any issues as they come along.

This is the best gift you can give your fur-companion.

Book your pet in now, whatever age they are, for a dental check. They are free at Russell Vale Animal Clinic all year round. For the month of August, selected Vet hospitals all over Australia are also offering FREE dental checks.

Even if your pet has had a recent vet check for their vaccinations, take them in for a dental check alone, to make sure that sufficient time is given to discuss your pet's oral health, and to give you information on how to keep your pet's mouth healthy.

I am Dr Liz, the mad vet of Bellambi at Russell Vale Animal Clinic, all for happy healthy pets, which comes with great oral health.

Looking forward to seeing you all soon.