In the last week of July, a few early blackberries ripened in a sunny part of the wilder area of my garden. So, I picked one and tasted that tart sweetness most of us are familiar with.  However, a seed lodged itself between one of my molars, resulting in a second interdental flossing of the day.  Success brought disproportionate relief.  It prompted me to think about dental issues in pets and how they can’t perform routine tooth care for themselves. I thought this could be the perfect opportunity for us to ‘brush up’ on pet dental health!

Dentistry takes up a good proportion of a vet’s time in small animal practice, for good reasons. Only a few of us brush our dogs’ teeth daily, even though this is an excellent idea. As expected, pet dental health isn’t often top of the agenda. Let’s leave flossing out of this along with brushing cats’ teeth. Both are impossible for all but exceptional animals (none of which I have ever come across). 

But what about brushing our dogs’ teeth? Yes, it’s a good idea but it needs starting early in puppyhood even though all the milk teeth will be lost by 6 months or so, to be replaced by the permanents.  The point of the early start is to train your puppy to accept a toothbrush. Later on, it then becomes part of the daily routine.  The incentive to brush your dog’s teeth is significant. Brushing at least 4 times weekly prevents plaque build-up, avoiding remedial dental work later in life.

If you are going to start brushing your puppy’s teeth, a few weeks of gently opening the mouth, moving lips and touching gums followed by a tasty reward is the best introduction. When you have good compliance, use a child’s soft nylon toothbrush with a liver or chicken-flavoured dog toothpaste (yummy!) to start gentle brushing of incisors and canine teeth. Only brush for a minute or two before giving a reward and moving to other teeth, if puppy is happy. 

The outside (buccal) surface of a tooth is obviously easier to brush. But, as confidence grows, the inside (lingual) surface also needs attention.  The problem is, newly erupted teeth are sparkly white and so there seems little incentive to brush them.  Before long though, depending on diet and your dog’s breed, food residue trapped between the teeth becomes calcified and invaded by bacteria. This leads to the formation of “tartar”, the brown crusty deposit that resembles the rock in our kettles.  The difference between the two is the organic component of tartar which feeds the bacteria, which in turn causes gum inflammation (gingivitis) and odour.  

The interface between the tooth crown, the root and the gum is amazing if you think about it, as it must seal the bacteria in the mouth away from the boney socket of the root while at the same time allowing some movement during tooth eruption and must withstand the forces of biting and chewing.  These are considerable. The seal is called the periodontal (around the tooth) ligament, likened to the button at the top of a zip fastener.  If the button is missing, the zip opens very easily.  So the chain of events is this; tartar build up at the base of the tooth, inflammation damages the periodontal ligament, gum recession (it unzips) and root exposure.  Hence the expression “long in the tooth”, which means the root becomes visible rather than the crown becomes longer.  Many of us are familiar with this!  

Crowns have a covering of non-stick enamel, roots do not. So the root becomes even more heavily tartared than the crown, more bugs invade the surrounding tissues and further inflammation and infection results.  Brushing teeth prevents this vicious circle! Sadly, by the time this process becomes advanced, tooth removal is usually necessary. Without removal, it will become a focus for future infections and ongoing problems.  

Tooth removal is an emotive issue for many dog and cat owners!  For this reason, all our vets and nurses explain the need to remove teeth that will cause future issues. But there’s a problem.  A tooth covered in tartar cannot be properly assessed for removal until the tartar is removed by ultra-sonic scaling and the integrity of the periodontal ligament has been tested.  As this can only be done after the patient has been anaesthetised, accurately predicting the outcome of dental surgery is very difficult in many cases. 

There are some exceptions. Clearly, for example, if a tooth is visibly loose or badly damaged. Or, in the case of a cat, has a form of endodontal (within the tooth) disease, called FORL.  Long name, Feline Osteoclastic Resorptive Lesion! It means tooth destruction from the inside, leaving the crown as a fragile shell.  This strange condition is almost unique to felines, for reasons we do not fully understand.  It is recognised by a hole in the enamel with usually pink tissue showing through and indicates advanced destruction of the inside of the tooth.  Gentle removal of the remnants of the crown (and root) is necessary, then the gum heals over the site. 

If tooth extraction is emotional for owners, it can be technically difficult for the surgeon. Very deep roots and fragile facial bones do not make a good combination. So, great care is necessary, made worse by old age and any concurrent problems.  Pity, as most of our dental patients are older (naturally, pet dental health declines with age) and have declining health! However, with thorough pre-operation tests and multi-modal monitoring during the anaesthetic, risks are minimal. Within a very short time afterwards, the patient is much happier even though the smile might be a bit gappy!