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National Pet Dental Health Month

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What’s below the gum line

By Matthew Kearns, DVM

Dr. Matthew Kearns

Dental x-rays have been around a long time. Dentists have x-rayed humans starting as far back as 1896 and became mainstream in the 1950’s. More recently, the use of digital dental x-ray units have become more mainstream in veterinary medicine and allow veterinarians to pick up as much as 60% more periodontal and dental pathology. 

Periodontal pathology is defined as disease surrounding the tooth. Peri, meaning around, and dontium, meaning tooth. The periodontium includes the gum, periodontal ligament (a meshwork of connective tissue that attaches the tooth to the jaw), and the alveolar bone (the bone of the jaw immediately surrounding the tooth). 

Periodontal pathology usually starts with plaque building up on the enamel of the tooth near the gumline which leads to gingivitis, or inflammation of the gums. If the plaque is not removed, it continues to grow into a calculus (a mineralized matrix of old food, saliva, bacteria and minerals). As the periodontal disease advances, the gums will either recede and expose the root or pockets will develop between the gumline and tooth.  

These pockets are the tricky part. They hide tartar (and bacteria) and, because the pockets are below the gumline, even brushing the teeth will not get rid of them. If the gums have not receded exposing the root, there is no way of telling whether the root is damaged and the tooth should be removed without dental x-rays. 

In my experience the biggest concern of a pet owner is not the cost of dentistry or having teeth removed, but rather anesthesia and length of anesthesia. Anything to reduce the time under anesthesia will help minimize any anesthetic complications and always puts my mind at ease.

Dental x-rays are also important for identifying other problems with the oral cavity. In younger pets, complications can occur from unerupted deciduous (baby) teeth. If a tooth that should have come through the gums does not, it is not only painful, but also can delay the eruption of adult teeth, lead to cysts around the tooth, infection, etc. 

Many veterinary dentists recommend a full examination of the mouth when a pet is spayed or neutered. This is a great time to do this because the patient needs to be anesthetized for the spay/neuter and it is much safer to keep a pet anesthetized a little longer than it is to anesthetize them multiple times. 

If anything suspicious is found during the exam dental x-rays are a great way to diagnose the problem and intervene immediately. Older pets are more at risk for tumors that arise from the bones of the jaw. Dental x-rays are important for evaluation the extent of any oral tumors and help veterinarians decide on an appropriate treatment plan.   

February is National Pet Dental Health Month so remember to take your pet to get those choppers checked out and if your vet recommends dental x-rays, you’ll know why.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. 

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By Matthew Kearns, DVM

February is National Pet Dental Health Month so I figured an article on dentistry is appropriate. A quick tooth anatomy reference: Everything below the gumline is considered the “root,” and everything above the gumline is considered the “crown.”

Feline odontoclastic resorptive lesions, or FORLs for short, is a strange pathology of the feline tooth, essentially a “hiccup” in the tooth loss cycle. Normal deciduous (baby) tooth loss involves the root and the structures around the root below the gumline. The destruction of the dentin is achieved by a type of cell called odontoclasts. 

Odontoclasts are specialized cells whose sole job is to absorb the bone of the tooth root and the weakening of the structures around it. This process is critical in the loss of deciduous, or baby teeth, to make room for adult teeth to erupt. 

I previously described FORLs as a hiccup in this normal tooth loss cycle because these same odontoclasts destroy the dentin, or layer of the tooth just below the enamel. The FORLs pathology progresses to invade the pulp below the dentin, and this is where the blood supply for the entire tooth lies. Once the blood supply is compromised, the enamel on the crown of the tooth starts to resorb, exposing the dentin underneath. This is above the gumline and can be painful as H-E-“double hockey stick.” 

FORLs differ from a cavity where bacteria adhere to the surface of the crown of the tooth (the portion of the tooth above the gumline). Bacteria in the mouth produce acid that eats away the enamel until the root of the tooth is exposed. 

Cavities are very unusual in dogs and cats for multiple reasons: the shape of the tooth, diet, type of bacteria in oral cavity compared to humans, and dogs and cats live shorter lives than humans. Dogs and cats suffer more from periodontal disease, or problems associated with structures around the tooth.

What triggers FORLs in cats? There are theories that include previous trauma, accumulation of plaque and tartar, impacted teeth around the affected tooth, etc. Bottom line, we as a veterinary community, do not yet know what triggers this pathology (to try to come up with a way to prevent it). 

Treatment of FORLs requires removing the damaged portion of the tooth. This is a far less complicated and painful process compared to extraction, but the only way to determine if there is damage to the tooth is to perform dental X-rays. If the root is not involved, then it is FORLs (no extraction, just remove the damaged portion of the tooth); and if the root is involved, it is periodontal disease (extraction). 

As more information becomes available about FORLs, I will give an update. Until then, make sure to get your cat (or dog) in for a dental checkup. SMILE!!!!!

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.