Spencer’s Cautionary Tale
This month our resident dental expert Dr Nicole Hoskin ponders the challenges in identifying and treating dental problems in our pets. She also delivers a cautionary tale which illustrates the danger of substituting your vet’s care, when it comes to pet dental health
Once again August rolls around and with it our annual focus on pet dental health. This year it prompted me to think about what dental disease really is and how it affects our pets: Why do we consistently see animals seemingly able to tolerate severe oral disease, apparently eating well? How does it get so bad that some come in needing multiple teeth removed, yet no one knew until the check up at the vet?
The reality is that our pets will only go off their food as a last resort. They will chew on one side of their mouth, they will wait for softer food to be provided, they might be perceived as being a bit pickier. Some patients will avoid using the water bowl instead preferring to drink from a running tap. As the pain gets worse it gets harder for them to hide the smell, but yet they still eat, picking up larger bits of food and swallowing them whole rather than chewing with loose teeth.
I can only assume that our pets’ tenacity in the face of dental pain is a survival mechanism. Put simply, if they do not eat they die. It is little wonder therefore, that many cats and dogs with bad dental problems continue to eat.
We cannot use the presence of appetite to guide our treatment decisions. So, what can we do?
Whilst we do our best to examine a pet’s mouth as part of their health checks, there are limitations to this approach too. When an animal is awake it is often very difficult for us to see all of the disease present. Sometimes the extent of dental disease is not evident until we perform a complete oral health check under sedation. Pain, temperament, or a mouth shy patient can all make awake examinations difficult, but the most common problem is that most of the disease we treat is actually beneath the gum line (60% of the tooth is hidden away under the surface). Cats are particularly tricky, because they often resorb the roots of their teeth and get nasty holes in the enamel that can’t be detected without X-rays.
X-rays have now become the standard of care in veterinary dentistry
Xrays play a vital role in our practice by helping us uncover a lot of severe but hidden disease. They are a tool, which when combined with careful observation and probing of the teeth, helps us to identify and carefully plan resolution of all of the problems in your pet’s mouth.
Have you ever had xrays at the dentist? They put the xray film in those little plastic bite wing trays and put it in your mouth, then you have to sit really still while the technician exits the room and operates the machine via a remote button. Can you imagine your pet sitting patiently unrestrained for a few minutes with an awkward dental film in their mouth? That’s just the physical side, imagine the potential stress they’d experience having someone probing and manipulating their mouths to clean and examine every single surface of every single tooth!? To look after our patients mouths completely we’re in no doubt that X-rays and anaesthetised examination are absolutely necessary.
To illustrate how some of these issues play out, let me tell you the story of Spencer.
Spencer is a lovely miniature Schnauzer with conscientious paw-rents keen to do their best to keep his teeth healthy. Unfortunately some unsound advice lead to Spencer regularly having his teeth attended to by an exponent of so-called “anaesthesia-free dentistry”, he was treated in this way (at considerable expense I might add) three times a year for four years! Spencer’s teeth looked white and he was eating well, but his family noticed he still had a terrible smell coming from his mouth.
Spencer was really reluctant to let us near his mouth in the examination room, so the decision was made to perform an anaesthetised assessment because we were worried about how red his gums still were, even despite not having any visible tartar. What did we find? EVERY single tooth in poor Spencer’s mouth had severe infection around it, X-rays showed lots of infection in his jaw causing severe bone destruction! These issues had clearly been rumbling along for ages; there was so much damage that he needed 36 teeth removed (adult dogs usually have 42 teeth). Spencer’s remaining six teeth have been treated to see if we can reverse some of the damage, but sadly it may be too late to save them from future extraction as well.
What is deeply troubling about Spencer’s case is that it is not isolated. The cosmetic tooth scraping that had been done to remove his dental calculus was just that, cosmetic. It is even possible these regular treatments could have contributed to his periodontal disease, the jury is still out on that one (there are currently several studies being undertaken by dental specialists in the USA). What I am certain about is that the disease went untreated for far longer than it should have, primarily because the person doing the scraping did not understand the true nature of the problem, and did not recommend that Spencer be seen by a veterinarian for treatment much earlier in the process (when we would have had a reasonable chance of reversing some of the changes and saving more than just six teeth). Spencer was doubtlessly in pain for a long time and he was unable to tell us.
the person doing the scraping did not understand the true nature of the problem, and did not recommend that Spencer be seen by a veterinarian
As veterinarians we do not submit animals to an anaesthetic for intellectual pursuit nor do we do it to pad out the bill! We take anaesthesia very seriously, every animal in our care is considered individually when weighing up the potential risks of anaesthesia versus the benefits to their dental health. As a progressive group of practitioners we realise that the only way to deliver safe, effective dental care with minimal stress to our patients, is to perform it under expertly supervised anaesthesia and with the ready capacity to perform dental X-rays. That way we hope there’ll be fewer stories like Spencer’s.