What is board-certification?

A board-certified veterinary dentist is a graduate veterinarian who has completed several years of residency training and has passed comprehensive written and practical examinations to become certified as a specialist by the American Veterinary Dental College (AVDC). The AVDC is one of several specialty organizations recognized nationally by the American Veterinary Medical Association. There are currently a little over 100 Diplomates of the AVDC in the U.S.

Why see a specialist?

The anatomy and physiology of teeth and their surrounding structures differ significantly from any other organ system; as a result, the disciplines of medicine and dentistry are taught separately in the human field. In the same four-year period that dental students devote exclusively to the study of oral anatomy, physiology and disease, veterinary students must learn about multiple organ systems in several species. Therefore, the amount of time spent on oral disease in the veterinary curriculum is limited, and general practitioners may choose to refer to a dental specialist for diagnosis and treatment of oral disease.

Furthermore, many pets with dental disease are geriatric and have multiple medical problems, requiring more intensive management for anesthesia. A dental specialist will have undergone additional training in anesthesia and may therefore be more comfortable treating a geriatric or medically-compromised patient.

Why does my pet need a consultation first? Why can’t we just come in for the procedure?

Although your family veterinarian may have examined your pet recently, it is important for Dr. Lommer to evaluate your pet prior to the procedure for a number of reasons.

Most importantly, because general anesthesia is required for all dental procedures, Dr. Lommer needs to perform a thorough physical examination on your pet prior to the procedure. Rather than taking a “one-size-fits-all” approach to anesthesia, we tailor the anesthetic protocol (including the types and dosages of anesthetic drugs) to each individual patient. It is important for us to get to know your pet’s medical history, current physical condition, and personality in order to select the best anesthetic regimen.

In addition, Dr. Lommer may identify additional oral problems beyond those identified on a routine physical examination by a family practitioner. By performing the initial examination at a separate visit, we are better able to schedule the appropriate amount of surgical time for each patient.

How much will it cost?

While it is impossible to give an accurate estimate without first evaluating each pet for the extent of plaque, calculus and gingivitis present, most of our patients who have routine cleanings (without extractions or advanced periodontal therapy) have invoices in the $850-950 range.

Why is it so expensive to have my pet’s teeth cleaned?

Effective dental cleaning requires anesthesia, which adds considerably to the expense of the procedure. Pre-anesthetic blood tests to evaluate kidney and liver function, placement of an intravenous catheter, administration of intravenous fluids, and monitoring by a veterinary nurse throughout anesthesia, while adding to the cost, all decrease the likelihood of complications. We use of state-of-the-art ultrasonic scaling and air-polishing techniques and equipment. In addition, the cost of cleaning includes full-mouth radiographs (x-rays) and diagnostic dental charting, both important tools in diagnosing oral disease.

Why do you need to take x-rays? My pet just needs a cleaning.

Plaque and tartar on the teeth are not merely unpleasant, they are often accompanied by inflammation in the gums and tooth-supporting structures (bone and connective tissue). Just as with other organ systems, early diagnosis of problems in the oral cavity can allow us to slow or stop progression of the disease process. The crown of the tooth is really just “the tip of the iceberg”. Intra-oral radiographs (x-rays) allow us to evaluate the bone and tooth-supporting structures, where the majority of oral disease occurs, in addition to the teeth themselves. (Photograph by Joe Pettit, National Science Foundation)

Why does my pet have to be anesthetized for oral care? Why can’t I just use this spray I found online which dissolves tartar?

Many “natural” or “holistic” products claim to restore normal oral health, get rid of “sewer breath”, and eliminate plaque and tartar from pets’ teeth. There are a number of problems with these claims:

  • Most of these products have not been tested for either safety or efficacy. All medications with FDA approval have undergone extensive testing to show that a) they do what the manufacturer says they do, and b) they are not toxic when used as directed. For most “natural” products on the market, there is no published research to either confirm or refute the manufacturer’s claims that the product improves oral health.
  • Even if the product works to reduce surface tartar and plaque, there’s no way it can go below the gumline or into periodontal pockets. So for pets with pre-existing periodontal disease (which must be diagnosed with dental x-rays and charting under anesthesia), successful use of such a product may give clients a false sense of security that everything’s ok when there could be significant disease below the gumline.
  • Most of these products are advertised as an ALTERNATIVE to professional dental care rather than an adjunct to it. Without anesthesia, periodontal probing, and intra-oral x-rays, it is impossible to accurately evaluate a pet’s oral health. Some of these products may indeed be useful to help reduce plaque and tartar between professional cleanings, and may help extend the time between necessary cleanings by a veterinarian. However, it is irresponsible of the manufacturers to suggest that anesthesia is incredibly risky and that, if you use their product, your pet will never need anesthesia for oral care.

  • What about “anesthesia-free” teeth cleaning services?

    In the San Francisco area, a number of pet supply stores and grooming shops are offering “anesthesia-free” teeth cleaning through an independent contractor.

    It is important to note that tartar and plaque are not just a cosmetic problem, but often a symptom of disease. In an awake patient, it is impossible to remove bacterial plaque from below the gumline, where the bacteria cause an inflammatory response which ultimately leads to destruction of the bone and tooth-supporting connective tissue. Removal of tartar and plaque without anesthesia provides cosmetic improvement, but no medical benefits. Any underlying bone loss remains undetected and untreated, allowing continued progression of the disease.

    Aside from these important medical issues, animals have also been injured during the “anesthesia-free” teeth cleaning process; broken jaws and asphyxiation have been reported, and in at least one case, an animal has died while being treated. These procedures are being performed by personnel with no veterinary training, and is therefore illegal, in violation of the Veterinary Practice Act of the State of California.

    My dog chews tennis balls, and now his teeth have brown spots in the center. Does this need treatment?

    Probably not, but it’s a good idea to have dental x-rays taken to be sure. When the teeth suffer low-grade, chronic trauma such as frequent chewing on tennis balls or other abrasive toys, the pulp (blood vessels and nerves in side the tooth) responds by creating a protective bridge of “reparative dentin” (also called tertiary dentin) over itself. Dentin is the layer under enamel. If the abrasion occurs slowly, reparative dentin will prevent the pulp from being exposed to the environment. Because the enamel normally present over the dentin has been worn away, the exposed reparative dentin becomes stained, usually a dark brown color. This can be mistaken for exposed, dead pulp on initial physical examination, and can be differentiated from exposed pulp by using a dental explorer. An explorer will glide across the surface of reparative dentin, but will penetrate into an area of exposed pulp.

    Sometimes the trauma from abrasion is severe enough to cause pulp necrosis (death of all of the blood vessels, nerves and dentin-producing cells inside the tooth) even if the pulp is not exposed. This could be detected with dental radiographs (x-rays), and root canal treatment or extraction would be recommended.

    My pet has a broken tooth, but still eats fine and acts normally. Why does she need root canal treatment?

    When the nerves and blood vessels (pulp tissue) inside the tooth are exposed, bacteria in the mouth invade the pulp tissue, and the pulp eventually dies. This is called pulp necrosis. In addition to the discomfort of an exposed nerve, your pet will ultimately endure a process of inflammation and bone destruction around the root tip, which results from the body’s response to the invading bacteria and pulp necrosis. In severe cases, the infection can lead to disease in vital organ systems, such as the heart, liver and kidneys.

    While extracting a broken tooth will solve the problem, root canal treatment allows us to preserve the tooth. By removing the necrotic debris and bacteria from the inside of the tooth, root canal treatment stops the destruction of bone around the root tip and allows healing to occur. Your pet has the benefit of maintaining a functional tooth without the high risk of infection and prolonged discomfort which may occur without treatment.

    What can I do to help keep my pet’s teeth and gums healthy?

    Just like we do, dogs and cats get plaque on their teeth, which can be removed by tooth-brushing. Plaque is made of proteins (from saliva) and bacteria. If the plaque is not removed every day, the bacteria will multiply rapidly, resulting in gingivitis, or inflammation of the gums. In many cases, build-up of plaque eventually leads to destruction of the bone around the teeth and loss of attachment of the teeth (periodontal disease). Ultimately, the teeth may become loose or even fall out.

    Fortunately, gingivitis is reversible and periodontal disease may be preventable! When plaque is removed by tooth-brushing, the gums and bone around the teeth will stay healthier. If plaque is not removed, calculus or “tartar” will form when minerals from saliva cause the plaque to harden. Once tartar is present, professional cleaning is needed to remove it. You can prevent tartar from forming by removing plaque every day with tooth-brushing.

    How do I brush my pet’s teeth?

    Here are some helpful videos:

    Brushing your pet’s teeth
    Brushing your cat’s teeth
    Brushing your dog’s teeth

    Tooth-brushing should be introduced gradually. Don’t force the mouth open. Start by just sliding your finger under the cheek and running your finger along the teeth and gums. Do this every day for about a week, and always praise your pet during and afterwards, or give her a favorite toy when you are finished. When she is used to this, begin using a soft-bristled toothbrush and pet toothpaste. (Human toothpaste contains foaming agents which can upset your pet’s stomach. Fluoride is also not needed, as dogs and cats don’t usually get the same kind of cavities people do.) The paste should be pressed down into the bristles, so the pet doesn’t lick it off the brush. Start by brushing just a few teeth at a time, focusing on the outside surface of the teeth. Hold the toothbrush at a 45 degree angle so the bristles go under the gumline. Try to use a circular motion with the toothbrush if at all possible.

    Brushing should be done at the same time every day so it becomes part of your pet’s daily routine. Afterwards, give rewards such as a favorite toy or game, a walk, or lots of petting and praise. Most dogs and some cats will actually learn to enjoy this daily ritual, and will see it as extra attention from their favorite person.

    What if I can’t brush?

    Chew toys and treats can be helpful in controlling plaque and tartar build-up above the gumline. It is important to select toys or treats which are not too soft or too hard. Toys or treats that are too soft can be chewed into small pieces, which may present a choking hazard or cause intestinal blockage if swallowed. Toys or treats that are too hard, such as cow hooves, hard nylon bones, or sterilized real bones, will cause tooth fractures. Fresh real bones with meat and cartilage still on them are generally ok, but they should be removed after a few hours, because they become hard as they dry out. Appropriate toys include firm rubber toys, flexible plastic or gummy bones (especially those with rubber nubbies on them), and compressed rawhide (made of many tiny pieces of rawhide held together with a digestible glue and pressed into a bone shape). Not every chew treat is safe for every pet. If your pet has a tendency to take one bite and then gulp down treats, chew treats are not going to have much dental benefit, and may cause life-threatening obstructions.

    Several diets and treats have been formulated to help prevent plaque and tartar build-up. Products which have received the Seal of Acceptance from the Veterinary Oral Health Council in both the “Helps Control Plaque” and “Helps Control Tartar” categories have been clinically proven to reduce plaque and tartar when compared to pets being fed a standard dry diet. For a full list of products which have earned the VOHC seal, click here.

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