What exactly happens during a dental procedure?

It can be nerve-wracking dropping your pet off for a procedure at the vets.  Most pets will require dental treatment at some point in their lives to keep them healthy: we thought perhaps you might like to know a little bit more about the procedure, and what actually happens to your pet during the day.

 

What?  No breakfast?

Before the procedure, you will be advised to fast your animal overnight.  This means that after their supper the night before the procedure, they shouldn’t have any more food.  They shouldn’t have breakfast on the morning of the procedure.  However, it’s important that they have free access to clean fresh water.  The reason we fast animals before anaesthesia is because they may regurgitate their stomach contents under anaesthetic.  As they are unable to swallow, they would be at risk of inhaling or aspirating this material.  An empty stomach reduces this risk. 

Pets shouldn’t have breakfast on the day of an anaesthetic.

 

The first friendly faces you will see

Upon your arrival at the practice, once you have checked in with our reception staff, you will usually see one of the nurses for your pet to be admitted to the clinic for the day.  Sometimes, if there is something more complicated to discuss, your admit appointment may be with a vet.  At the appointment, your pet will be weighed, and the nurse will take a brief history to find out how their general health has been recently and if they are on any medications.  This is to ensure we select the right anaesthetic drugs for your pet to be as safe as possible, or to determine if we advise any other investigations be carried out before hand.  Often, our dental patients are more senior pets.  Anaesthesia isn’t inherently more dangerous for older pets, but they may be more likely to have other underlying conditions we need to be aware of and manage.  For that reason, we often advise a blood test be carried out before their procedure, or that they receive IV fluids.   

A blood test may be advised if your pet might have other health problems

 

Preparing for the procedure

After being admitted, your pet receives a physical examination by a vet.  This is to determine that they are fit and healthy enough to go ahead.  If they are having a blood test, the sample is usually taken now, and checked in our in house laboratory.  The vet then calculates the dose of pre-medication the pet will receive.  A pre-med is a combination of pain relief and a sedative, which prepares them for anaesthesia.   

 Once their pre-med has taken effect, an IV cannula is placed into your pet’s vein.  We use this to deliver the anaesthethic induction drug into the vein, as well as any other drugs that might be required.  We start the anaesthetic, and place an endotracheal tube into their airway.  This allows us to administer oxygen and anesthetic gas, and keeps the airway clear while we work in the pet’s mouth.  A throat pack is placed at the back of the throat to catch any water, saliva or other debris that might enter the airway.  We are then ready to start cleaning your pet’s teeth. 

 

Cleaning and charting

First, a complete examination of the mouth and throat is carried out.  We make a note of any damage or inflammation of the soft tissues such as the tongue, back of the throat, lips or gums.  It’s very difficult to examine these fully in animals when they are awake.  We examine the teeth using a dental probe.  We use this to look for any loss of attachment between tooth and gum.  If this has occurred, the probe slides under the gum next to the tooth.  The depth of this attachment loss helps to determine how healthy the tooth is.  We use a sharp probe to check the enamel for any defects.  All our findings are recorded on a chart.   

Next, the teeth are cleaned using an ultrasonic scaler.  This vibrates at very high speed to break up the hard mineralised tartar on the tooth.  The most important part of this process is to clean under the gum line.  This cannot be done effectively and safely when the animal is awake, as it is uncomfortable; it also involves the use of sharp instruments that can damage soft tissues if the pet were to move.  This is the reason that conscious dental cleanings are ineffective and widely considered unethical by veterinary organisations such as the Royal College of Veterinary Surgeons, British Veterinary Dental Association, and the European Veterinary Dental Society, as well as the American Veterinary Dental College, American Veterinary Medical Association and Australian Veterinary Association.  You can read the RCVS statement here.

Open wide!  It isn’t possible to fully examine a dog’s mouth when they are awake.

Looking below the tip of the iceberg: dental radiography

Once the tartar is removed from the teeth, they may be checked again with the probe; damage might have been hidden under thick tartar.  This is also the stage when x-rays are taken.  About 50% of the tooth structure is actually the root sitting within the jaw.  The only way to assess this is with radiographs.  Dog and cat teeth have much longer roots than human teeth.  In cats, full mouth radiographs are advised (just like you have when you go to the dentist).  This is because problems with the enamel and roots are very common.  In dogs, generally only teeth that are damaged or have marked periodontal disease will be radiographed, to help us decide if the teeth need to be extracted.   

 

Tooth extraction

If any teeth are badly damaged, they are then extracted by the vet.  Did you know that nurses can carry out scaling of the teeth, as well as take the x-rays, but removing a tooth is legally an ‘Act of Veterinary Surgery’?  To remove a tooth, we use a sharp tool called an elevator which is inserted into the tiny gap between the tooth root and the gum.  This is then used to gradually tear and break down the periodontal ligament holding the tooth in place, and the tooth is removed.  Many teeth in dogs and cats have two or even three roots.  In these cases, we use special instruments to lift up the gum overlying the tooth.  We then use a high speed drill to cut the tooth into sections, and remove some of the bone on the outside of the tooth socket.  This allows us to remove the individual roots one by one without damaging them.  The gum is then stitched back into place with special suture material that dissolves once the gum heals. 

 

Recovery and returning home

Once their procedure is complete, your pet is monitored by one of our nurses until they have recovered fully from their anaesthetic.  They then return home later that afternoon.  We like to keep our dental procedures until a little bit later in the day than other surgeries, as they will often have been under anaesthetic much longer than other routine procedures, so can take a bit longer to recover.   

Three days after the procedure, they will have a check up with the vet.  We check that their extraction sites are healing as expected.  They will then have a check up with the nurse a week later to discuss ongoing homecare with you.  After a cleaning under anaesthetic, plaque and bacteria will start to build up again almost immediately; in order to make the most of the care they have received, ongoing regular cleaning of some sort should be started as soon as the mouth has healed enough.   

Ongoing homecare after a dental procedure is important

 

 

Dr James Breen wins Judges Special Award at 2018 Cream Awards!

Many congratulations goes out to our very own Dr James Breen for winning Judges Special Award for Dairy Vet of the Year at the 2018 Cream Awards. The aim of the dairy industry trade awards is to showcase some of Britain’s brightest and best working in the dairy industry. Congratulations James!

Feline fangs – dental problems in cats

Did you know, we probably see more cats for dental problems than dogs?  Just like dogs, cats can suffer with tartar build up, periodontal disease and damage to their teeth such as fractures.  However, there are two additional conditions that are seen almost exclusively in cats, and almost never in dogs.

 

Cat’s don’t have as  many teeth as dogs, but they can be more prone to problems

 

 

Tooth resorption

Tooth resorption is very common.  It has been recorded in 30-40% of healthy cats; in cats presenting for dental treatment, tooth resorption is found in about 70% of cases.  The condition has had many names over the years; you might also hear it referred to as enamel defects, neck lesions, or feline oral resorbtive lesions (FORLs).  In this condition, the enamel of the teeth is broken down by the body.  This process initially starts under the gum line, and moves towards the tip of the tooth.  Once the defect in the enamel reaches the surface, the soft inner pulp of the tooth is exposed to the air.  The pulp contains all the blood vessels and nerves supplying the tooth.  From this point onwards, the lesion is very painful.     

As with all dental issues, cats with tooth resorption more often than not don’t display any overt signs of pain.  Occasionally you will see them drop food as they are chewing it. They may seem to be hungry but then suddenly turn away.  Any cat showing these signs should be examined by a vet.  At your cat’s annual health check appointment, your vet will examine your pet’s teeth and will inform you if they see any lesions.  Often they are very small and subtle and can only be detected under anaesthetic by a combination of x-rays and probing the teeth.   

This cat is missing a lower canine – this might be due to tooth resorption

Once a resorptive lesion develops, we cannot save that tooth.  If left untreated, eventually all the enamel of the tooth would dissolve away and the gum would heal.  Generally if a cat has missing teeth but has never had previous dental work, this is due to resorption.  However, this process takes a prolonged period of time and there is no real way to control pain in the meantime.  For this reason, affected teeth must be extracted as soon as is reasonably possible. 

Unfortunately, we don’t currently know the cause of tooth resorption.  Cats that suffer tooth resorption on one tooth will almost inevitably develop it on other teeth.  For this reason, regular checks of their teeth are vital, and most will have to undergo more than one dental procedure as the condition progresses.  There seems to be a link to gingival inflammation in some cases.  Keeping your cat’s teeth clean by brushing or using a dental specific diet may prevent these.  It will also reduce tartar build up, which can hide resorptive lesions, meaning that any that do develop are diagnosed and addressed promptly.   

 

Gingivostomatitis complex

 

Gingivostomatitis complex is severe generalised inflammation of the soft tissues of the gum (gingiva) and mouth (stoma).  While we see gingivitis associated with plaque and bacteria, in feline gingivostomatitis the inflammation is out of all proportion to any build up of plaque.   

Gingivostomatitis is incredibly painful, especially if very severe.  Affected cats will often be unwilling or unable to eat, they may salivate and they often have very unpleasant breath.  Their saliva will often stain their coat a brownish colour where they have been grooming.  They are often very reluctant to have their mouth opened and examined due to the pain. 

We don’t yet know the exact cause of gingivostomatitis complex.  Affected cats have always been previously infected with a virus known as feline calicivirus – but not all cats with calicivirus will go on to develop gingivostomatitis.  Essentially, it is thought to be an over-reaction of the immune system to plaque and bacteria in the mouth, or possibly even something in the tooth structure itself.   

There are two main options for treatment of cats with gingivostomatitis complex.  Normal oral hygiene measures are insufficient to control plaque and inflammation – and in any case tooth brushing would be far too painful for affected cats.  The current most recommended treatment is what is termed ‘full mouth extractions’.  As you might imagine, that is extraction of all their teeth, or more correctly usually their cheek teeth.  In some cases their canines are affected as well.  This seems very extreme, but in many cases, especially young cats, it is the best option for maintaining ongoing quality of life for these cats.  Studies have shown that around 60% of these cases will resolve fully after extractions, and 20% will be significantly improved. 

Extracting all teeth might seem extreme, but for cats with gingivostomatitis, it can be the best chance of a pain free life

The other mainstay of treatment of this distressing condition, is regular use of medication to control the excessive immune reaction.  This is often a good option for cases where full mouth extractions are not possible or considered to be the best choice for the cat.  The most reliable drugs at producing these effects are corticosteroids.  However, use of these drugs is not without the risk of side effects or adverse effects, which in cats may include the development of diabetes.  In addition, they often seem to become less effective over time.  A few cats will not be cured by total dental extractions and will still need a variety of medical treatments lifelong.

#Februdairy

You may have seen recent press about #Februdairy on social and mainstream media. #Februdairy is a social media initiative to turn the tables on the negative press that the dairy industry has been experiencing recently.

You may have heard some of the emotive language being used, including rape to describe artificial insemination. This language is not reasoned or well-informed, but it is powerful. A quick Google-search for Februdairy, which has only been in existence for 2 weeks, gives links to anti-dairy sites in the top 4 results.

For every one piece of negative press the dairy industry receives, five pieces of positive press are needed to override the myths and mistruths. We have plenty of scientific arguments to counteract with, but the few negative voices don’t reason with science!

Those of you who use social media can help with the campaign by posting a photograph, a comment, or a video that encapsulates why you are so proud to be working with dairy, with people who really care for their animals. Add the handle @Februdairy, or hashtag #Februdairy.

Lungworm in cattle – Huskvac

After the heavy rain in recent months, lungworm may be a significant risk on many pastures in the next grazing season as infective larvae are washed out of faecal pats onto vegetation. Don’t forget that unlike many gut worms, lungworm can remain infective on pastures for much longer periods of time and as such it is very difficult to make use of “clean grazing”.

Vaccination is a great start in preventing clinical disease, but don’t forget that vaccinated animals will have to have  exposure to lungworm larvae to boost their immunity so don’t over-treat for worms at pasture.

Keeping your pet healthy: dental care

At Orchard Vets, we not only want to help your pets if they are poorly, but also prevent them from getting unwell in the first place. And probably the most common illness we see in pets is dental disease.

As many as 80% of pets over three years old suffer from some degree of gum disease. This starts as very mild changes: just a small amount of reddening of the gums, known as gingivitis. If not addressed this progresses to periodontal disease, loss of tooth attachment and even the tooth itself, and painful infections in the mouth. These infections can even pass into the bloodstream, potentially causing problems with other organs such as the kidneys or heart.

The cause of all these problems? Bacteria, which form into a sticky ‘biofilm’ known as plaque. This sticks to your pet’s teeth and gums, and the bacteria produce toxins that lead to gum inflammation. We can’t see plaque, but we don’t remove it, it hardens into tartar or calculus – the brown material you may be able to see on your pet’s teeth. Calculus is rougher than the tooth surface, so bacteria stick to this even more easily.

Eventually, the inflamed gums start to retreat away from the bacteria – a process known as gingival recession. The bone in which the tooth sits is also attacked and lost. If enough attachment is lost, the tooth may fall out. This process is very painful and uncomfortable for the pet, though they will almost never show this obviously. One of the most common comments we hear when checking patients after a dental procedure is that the animal seems so much ‘brighter’, ‘happier’ or ‘younger’ – now they are no longer suffering from chronic dental pain.

So what are the signs of periodontal disease?

  • Reddened gums – in the early stages, you may only see a little gingivitis or redness of the gums. If a good preventative care regime is established now, these changes may be reversible.
  • Gum recession – the edge of the gum where the teeth sit should be a straight line. If this starts to form a curve, you are seeing gingival recession. This is not reversible, but starting homecare at this stage could still stop it from progressing further.
  • Bad breath – we don’t expect dogs or cats to have minty fresh breath. However, it isn’t normal for them to have foul smelling breath. This is due to the production of gas by bacteria in the mouth.
  • Tooth loss – in some cases, if periodontal disease is severe enough, teeth may fall out. This is never normal – just like us, pets shouldn’t lose their adult teeth. If your pet has lost one tooth, chances are high that other teeth in the mouth have painful problems that need addressing.
  • Facial swelling – the roots of dogs’ and cats’ teeth are as long, or even longer than the crown (the part that is visible above the gum line). Infections around the roots of the teeth can sometimes lead to painful swellings of the face, or discharging wounds as the infection bursts through to the surface. Inflammation or infection at the roots of the teeth can sometimes also cause signs such as sneezing, nasal discharge, or discharge from the eyes.

With severe periodontal disease in toy breed dogs, bone loss in the lower jaw can weaken it so much that it can fracture – even just with the action of chewing!

So how can you prevent dental problems in your pet? The most important thing is to find some way of cleaning their teeth at home!

  • Brushing – brushing your pet’s teeth is the best way to prevent build up of tartar and bacteria. However, it needs to be done regularly. It takes about three days for plaque to harden and form into tartar, so brushing less often than this will be ineffective. I often speak to people who say they have their pet’s teeth cleaned at the groomers. As most pets go several weeks between grooming appointments, this is unlikely to have any real effect if this is the only tooth cleaning they get. Daily brushing is best of all, as it gives bacteria very little chance to cause damage. Using a pet toothpaste is important. They contain enzymes which continue to work against bacteria after you finish brushing. They also don’t froth – pets don’t like it!
  • Dental diets – did you know that a standard dry kibble diet doesn’t actually have any proven benefits to the teeth over a wet diet? However, there are special dental diets available that will clean your pet’s teeth as they chew. These are particularly useful for cats, who are less likely to tolerate tooth brushing than dogs. As a matter of fact, I’m still waiting to meet a cat that will allow their teeth to be brushed, including my own, so if you own that cat, let us know! Cats are also very prone to getting severe, painful cavity-like enamel defects with even a small amount of gingivitis. I recommend providing a proportion of your cat’s diet as dental kibble from a young age to reduce this risk. A dental diet has a large kibble size, so pets are more likely to chew them, rather than swallowing them whole. They have a softer, slightly fibrous texture that wipes the tooth clean as the pet chews. They are very useful for toy breed dogs and cats, but larger dogs will often still swallow the biscuits whole.
  • Dental treats/ chews – A dental chew – such as Virbac’s VeggieDent chews – can be a good way to help clean your pet’s teeth. Just like brushing, they need to be given daily or every other day to have much effect. Ensure that you are feeding the right size chew, and don’t forget that while these are low fat treats, they still contain calories. You may need to reduce their food allowance to avoid weight gain. Dental chews don’t do anything to clean the teeth at the front of the mouth that the dog doesn’t use for chewing.
  • Water additives – these contain ingredients which act against the bacteria in the mouth. This helps reduce their numbers and the damage they cause. The downside of water additives is that they do not have an abrasive effect to remove plaque. They are still useful at slowing periodontal disease when used alone, or in conjunction with other methods of teeth cleaning.

Veterinary dental treatments – Whenever you bring your pet to see us, we examine their mouth. The vet (or nurse) will advise you of their findings. They may recommend that you book the pet in for a full dental procedure. This is done under general anaesthetic, and we:

  • Examine the mouth and throat in full
  • Ultrasonically scale the teeth
  • Check the teeth above and below the gumline using dental probes and radiographs
  • Extract any teeth that need to be removed.
  • Polish the teeth to give a smooth surface.

If we carry this out at an early stage, it is less likely that teeth will be severely affected and need extraction. We brush our teeth twice daily, and still visit the dentist for an examination and scaling regularly, so we should really plan for most pets to have a full treatment under anaesthetic every few years. The better your home care, the less frequent these will need to be!

Dr Lucy Fleming MRCVS