$4.25
Volume 4, Winter
KEEPING YOUR PET’S MOUTH HEALTHY Advanced Dental Care Periodontal Disease: Answers to all your questions oral tumors – does your pet have one? a new dentistry vaccine
Contents Beyond Oral Hygiene: Advanced Dental Care / 2 Pet Quarterly® is an educational resource provided by your veterinary hospital. It is published by Educational The Dangers of Xylitol / 5 Concepts, LLC, Tulsa, Oklahoma. Comments are welcome at Q&A Periodontal Disease / 6 [email protected]
©Copyright 2006. All rights reserved. Oral Tumors: What You Need to Know / 8 Pet Quarterly® magazine does not make any representations as to opinions or facts as presented. Reproduction of contents in any form is prohibited without prior written Dental Vaccines: A New Preventive Tool / 10 permission of the publisher.
winter, volume 4 ◆ pet quarterly Beyond Oral Hygiene Advanced Dental Care for Your Pet
By Brett Beckman, DVM, FAVD, DAVDC President-Elect of the American Veterinary Dental College
Advances in veterinary dentistry have dramatically changed the way we look at our pets’ mouths. Advanced dental training programs for veterinarians and the availability of dental x-rays provide viable options for diagnosing and treating dental conditions.
Unfortunately, pets can’t tell us that their teeth or gums hurt. As a result, many cases of oral disease escape detection and pets suffer in silence. Therefore, it is vital for pet owners to seek help from their veterinarian. A complete oral examination including dental x-rays is necessary to discover potentially painful conditions that would otherwise go unnoticed. More Than Once a Year?
What’s that? You have your pet’s teeth cleaned every year? Fantastic! However, this is often not enough. As humans, we should brush daily to prevent infection of the gum and bone surrounding the teeth. When we visit our dentists every 6 months they clean and polish our teeth—in other words, our dentists clean teeth that we have already kept reasonably clean. Unfortunately, we can’t say that for most of our pets. Limited time and lack of pet cooperation often limit our ability to keep infection (periodontal disease) at bay. Take a moment to smell your pet’s breath. If it is offensive, then infection is already present. Fighting Oral Disease
Top. This pet’s teeth are brushed daily to help prevent periodontal disease. Advanced training is required to correctly Bottom. This pet has periodontal infection—cleaning alone will not help. diagnose and treat periodontal infection and
pet quarterly ◆ volume 4, winter 1 2a
2b
Figure 1. A variety of special instruments is used to clean the tooth root and remove diseased tissue. Figure 2. An advanced case of periodontal disease. These x-rays show before (a) and 6 months after bone treatment (b).
other conditions such as fractured infection, an antibiotic gel is causes bleeding into the dentin teeth, discolored teeth, malpo- often needed as well. If bone is (material just below the enamel) sitioned teeth, and oral masses destroyed, gum tissue must often and tooth discoloration (Figure (swellings). Many veterinarians be surgically opened to expose and 4). Recent studies show that a have had such training and possess properly treat the infection. A bone discolored tooth is either already these skills. graft is placed at this stage to help dead or dying. Discolored teeth are grow new bone in the area where it treated in the same manner as a It is essential that you has been lost (Figure 2). If disease fractured tooth with pulp exposure. see your veterinarian if has progressed beyond this stage, Root canal therapy or extraction your pet has a fractured extraction is often the only viable are the only options. Again, doing or discolored tooth—your treatment. nothing is not an option! Teeth Traumatized Teeth receiving root canal therapy may pet may be in severe Fractured teeth with exposed require placement of a crown to pain, but showing no pulp require immediate care and protect the tooth after treatment sign of it. are very painful (Figure 3). Tooth (Figure 5). It is essential that fracture results in pulp exposure you see your veterinarian if your to oral bacteria. The bacteria then pet has a fractured or discolored Periodontal Disease migrate through the root tip to tooth—your pet may be in severe Removing root tartar and surrounding bone, causing more pain, but showing no sign of it. diseased gum requires special infection and pain. Ideal treatment Teeth that cause trauma to other instruments and is often all that involves root canal therapy. Extrac- teeth or oral tissue represent a is required for very mild peri- tion is also an option; however, potentially severe problem for pets odontal infections (Figure 1). If ignoring the problem is not. (Figure 6). Puppies and kittens oral examination shows deeper Blunt trauma to a tooth often should be evaluated for malpo-
winter, volume 4 ◆ pet quarterly 3
sitioned teeth, which involve both tooth-on- tooth or tooth-on-tissue problems. Once the adult teeth are in (usually around 6 months of age), have a veterinarian examine your pet’s teeth to ensure that no occlusion (the way upper and lower teeth meet when biting down) problems are causing discomfort. Treatment differs according to the specific problem— extraction and orthodontic movement (akin to braces) are among the most common options. 4 Troublesome Tumors Oral masses (swellings) often indicate tumors. Both malignant and some benign oral tumors expand to destroy bone and gum tissue (Figure 7). Biopsies of oral masses are therefore essential in all cases to allow early detection and prompt treatment. Advances in veterinary dental x-rays allow us to determine the extent of many masses. Other more advanced imaging methods like CT (computed tomography or “CAT” scan) and MRI (magnetic resonance imaging) may need to be used in some cases. Currently, most tumors are curable by surgical removal and new treatment options are being evaluated. (See page 8 for additional informa- 5 tion on oral tumors.) Keep Oral Disease at Bay
Care of pets with oral disease often requires more than teeth cleaning. Please see your veterinarian to determine if your pet has evidence of oral disease. Veterinary dental specialists are available throughout the country to assist your veterinarian in diagnosing oral disease and determining the best treatment n plan for your pet.
Figure 3. A fractured tooth with exposed pulp that will soon become infected. Figure 4. Blunt trauma has caused discoloration of 6 7 this tooth. Figure 5. A metal crown on this dog’s tooth after root canal therapy prevents further wear. Figure 6. This puppy has an abnormal bite—the lower jaw (mandible) is too short. Figure 7. Surgical removal of the oral mass shown allowed the patient to recover fully with no tumor regrowth.
pet quarterly ◆ volume 4, winter Good for You, Not for Fido XYLITOL POISONING By Jennifer L. Schori, VMD
Xylitol is a sugar substitute used It was initially believed that only in sugar-free products such as large amounts of xylitol would cause Products that may chewing gum, candy, and baked toxicity. However, recent reports contain xylitol: goods. Xylitol has no known toxic suggest smaller amounts—as few effects in people and has even been as 2 sticks of gum in a 20-pound Gum Toothpaste promoted as having health benefits. dog—can be harmful. Clinical signs Peppermints & Skin care However, the same is not true for of xylitol poisoning result from a breath mints products your dog. In dogs, xylitol can have sudden drop in blood sugar and can Candy Lipstick serious, sometimes life-threatening, include depression, loss of coordina- effects. As its use has increased in tion, and seizures. There also seems Baked goods Soap human products, so have cases of to be a strong link between xylitol Diet bars Vitamins xylitol toxicity in dogs: The Animal consumption and liver failure in Poison Control Center (APCC) of dogs. Signs of xylitol toxicity can the ASPCA managed more than develop as quickly as 30 minutes In the meantime, keep xylitol- 170 cases of xylitol poisoning in after ingestion, or, in the case of containing products out of reach of 2005, up from about 70 cases in smaller ingested amounts, up to 12 your pets, and call your veterinarian 2004. Approximately 114 cases had hours after ingestion. Research is immediately if you suspect that your already been seen by the APCC as still pending on the effects of xylitol pet has consumed something that n of August 2006. consumption in other animals. contains xylitol.
winter, volume 4 ◆ pet quarterly Periodontal Disease
By Sharon Hoffman, DVM, DAVDC Structure of the canine tooth Courtesy Pfizer
What is periodontal In the diabetic pet, periodontitis may swallow hard food without disease? may lead to insulin resistance and chewing. The best way to detect Periodontal disease is an infection poor control of blood sugar. There periodontal infection in your pet of the periodontium, the area is also a relationship between the is to have an oral examination surrounding the tooth. The peri- severity of periodontal disease and performed by your veterinarian. odontium consists of four struc- inflammation of the liver, kidneys, How will my tures: gingiva (gum), alveolar bone lungs, and heart. veterinarian detect (socket where the tooth root is held), Are there any breeds periodontal disease? cementum (outer lining of root), and predisposed to the periodontal ligament (ligament periodontal disease? Since three of the four areas that holds the tooth in place). infected by periodontal disease are The disease is caused by bacteria, Small-breed dogs are frequently under the gum, your veterinarian leading to gingivitis (inflamma- affected by periodontal disease—it will need to use a special instru- tion of the gums) and often to is not uncommon to find periodon- ment, a periodontal probe, to detect periodontitis (inflammation of the titis in dogs 2 years of age, and “pockets” around each tooth. When periodontium). While gingivitis advanced periodontitis and tooth a pocket is detected, it is recorded is reversible, periodontitis is not, loss by the age of 4. Greyhounds on a dental chart, and your veteri- and it results in pockets of chronic are a larger breed commonly narian will take a radiograph to infection around the tooth roots. affected with periodontal disease. diagnose the extent of the destruc- How do I know if my tion around the tooth. This is exactly Why should I be the same process your dentist uses concerned? pet is suffering from periodontal disease? to detect periodontal disease in your Periodontitis is painful and may mouth; however, veterinary patients lead to premature tooth loss. Periodontal disease hides under the require general anesthesia. Severe infections involving the lips and gums, and unfortunately, Why shouldn’t I have upper teeth in dogs can create a your pet can’t tell you when he or “anesthesia-free fistula, or opening, between the she is in pain. You may notice a dentistry” performed? mouth and sinus cavity, which foul odor from your pet’s mouth, may cause frequent sneezing. but because the disease comes on More and more pet care providers Advanced periodontal disease can gradually, you may miss it. Your are advertising “anesthesia-free also predispose small-breed dogs pet may avoid chewing hard food dentistry.” Calculus, or tartar, accu- to fractures of the lower jaw. or its favorite chew toys. Cats mulates on the crowns of the teeth
pet quarterly ◆ volume 4, winter and is often brown and unsightly. laxis. It also costs more than a basic It is the calculus that is partially cleaning. removed during “anesthesia-free Can cleaning be done dentistry.” This technique neither with sedation instead prevents nor treats periodontal of anesthesia? disease. Rather, it is a cosmetic procedure. Remember, periodontal Sedation for a dental cleaning is disease occurs below the gum around risky. It doesn’t allow for respiratory the roots of the teeth. It is impossible support and doesn’t prevent water, to treat these areas in pets without saliva, or calculus from entering the general anesthesia. With “anes- lungs. In many cases, it doesn’t allow thesia-free dentistry,” the infection intraoral radiographs to be taken. and disease remain hidden below the Sedation is also time-limiting—the gum and pain and destruction will procedure has to be stopped when continue. In addition, the instru- the sedation wears off, even if there ments used to remove calculus are is more cleaning to be done. sharp. Any unexpected movement, What can be done which can be expected from pets in to decrease the risks pain from periodontal disease, could of anesthesia for my cause injury to the pet’s gum, lips, senior pet? tongue, or eyes. Top. X-ray of normal teeth What is the difference Treatment of dental disease in the senior patient invariably leads to Bottom. X-ray of teeth with periodontal between a dental disease “prophy” and improved quality of life. However, periodontal treatment? pet owners’ fear of anesthesia is one of the biggest deterrents to profes- Can periodontal Dental prophylaxis, often referred sional pet dental care. disease be treated to as a “prophy,” is cleaning and Certain procedures can decrease with antibiotics? polishing of the teeth (above and the risks of anesthesia in patients, below the gum) for prevention of especially senior pets who may have Plaque bacteria are much more periodontal disease. Once peri- preexisting medical illnesses. A resistant to antibiotics than the bacteria odontal disease has begun to destroy general physical examination and that cause most infections. Antibiotics the areas around the tooth roots, the blood and urine tests should be done without periodontal treatment are patient needs periodontal treatment. in all patients. Your veterinarian may ineffective in managing and controlling The goal of treatment is to relieve also recommend an ECG, chest periodontitis. pain and control periodontitis and radiographs, or an echocardiogram What can I do for my it involves not only cleaning and based on your pet’s individual needs. pet with periodontal polishing the crowns (enamel) of These tests give your veterinarian disease? the teeth, but also cleaning the information about your pet’s preex- pockets and tooth roots. It may also isting risk factors, medications to use Following professional periodontal include applying an antibiotic under or avoid, and how to prepare your pet treatment, your veterinarian will the gum or periodontal (gum and for the procedure. recommend daily dental home care bone) surgery. A temporary plaque During anesthesia, the pet’s vital for your pet. The care you provide at barrier (Oravet®) may be applied to signs will be monitored continuously home between professional treatments the crowns of the teeth to prevent to prevent and detect any compli- is essential in controlling periodontal plaque (which harbors bacteria) cations. Pain medication will be disease and providing continued from adhering. provided before, during, and after the comfort for your pet. In addition, a Because periodontitis can only procedure to help improve recovery new vaccine is available that can help be controlled, not cured, treatment from anesthesia. These procedures prevent periodontitis in healthy pets n must be done more often (two to add expense but are essential in (see article on page 10). four times per year) than prophy- decreasing risk factors. winter, volume 4 ◆ pet quarterly Oral Tumors
By Jan Bellows, DVM, DAVDC and DABVP (Canine and Feline)
Just like other parts of a dog or cat’s body, the mouth can develop growths. They may be caused by infection of the gum or problems with a tooth or teeth or they can be tumors. The mouth is a common site for a variety of tumors and certain breeds are more likely to have these tumors than others. For example, black cocker spaniels are prone to oral melanomas, while boxers are prone to mast cell tumors. Tumors of the mouth can be benign or malignant. Benign tumors may spread to nearby tissues, but malignant tumors have the ability to spread to distant organs (a process known as Swelling due to a malignant oral tumor metastasis).
Benign Tumors have these tumors. They arise from the gums and are red The most common type of benign oral tumor is the and ulcerated, sometimes with cauliflower-like projec- epulis. These tumors usually arise from the periodontal tions. SCC may invade local tissue and spread to other ligament of the tooth (see illustration of the tooth’s areas. Treatment can include surgery, radiation, and/or anatomy, page 6) and can affect dogs and cats of all chemotherapy. ages. Epulides usually have a smooth, pink surface and require surgical removal of both the tumor and Did You Know? surrounding tissues, including the tooth. One type of epulis, known as an acanthomatous February is National Pet epulis, is classified as benign but tends to invade adjacent bone. To treat these tumors, the tumor as Dental Health Month. well as surrounding tissue and diseased bone, if any, According to the American Veterinary Dental must be removed. Surgery may be combined with Society, 80% of dogs and 70% of cats show signs radiation therapy. of oral disease by the time they are 3 years old. Malignant Tumors Because of the potential health effects to pets, many veterinary hospitals recognize Pet Dental Malignant melanoma is the most common malignant Health Month and are happy to provide informa- oral tumor in dogs. These tumors are most common in tion to clients who want to do the best for their male dogs, especially cocker spaniels, German shepherds, pets. Take advantage of this time to focus on your chow chows, and dogs with heavily pigmented mucous pet’s dental health: call ahead to make an appoint- membranes (gums). They are aggressive and often spread to ment for your veterinarian to check your pet’s the lymph nodes and lungs by the time they are diagnosed. teeth, schedule the dental cleaning you might have Treatment can include surgery, radiation therapy, and/or been putting off, or find out how you can help injection of chemotherapeutic drugs into the tumor itself. keep your pet’s teeth healthy at home year-round. Squamous cell carcinoma (SCC) is the second most Your pet will thank you with a healthy smile and common malignant tumor in dogs and the most common fresher breath! type in cats. In dogs, older, larger breeds are more likely to
pet quarterly ◆ volume 4, winter Left. Benign epulis oral tumor Right. Abnormal cells from an oral tumor.
Fibrosarcomas are another type pet’s mouth, both at home and at As in humans, early diagnosis is of malignant tumor that can occur your veterinary clinic, is important. critical to long-term survival. See in the mouth. In dogs, these tumors Once you or your veterinarian your veterinarian for an examination tend to arise most commonly from notices an oral mass, tests must at least twice yearly and get used to the maxilla (the upper half of the be performed to determine the looking into your dog or cat’s mouth mouth) of large, male, middle- cause of the swelling and to plan frequently for abnormalities. Your n aged animals, especially retrievers. appropriate care. Your veterinarian best friend will thank you. In cats, they are locally invasive may take a sample of cells from and unlikely to spread. Treatment the mass and examine it under includes surgically removing the a microscope, or a larger tissue tumor and some surrounding tissue specimen may be removed for Left. Malignant squamous cell carcinoma and/or radiation therapy. testing to determine whether the oral tumor cause is infection or a tumor. Blood Right. Healed lower jaw after successful How Are Oral Tumors tumor removal. Diagnosed? tests and chest x-rays may also be performed to evaluate your pet for Your veterinarian is your pet’s metastasis if a tumor is diagnosed greatest ally in diagnosing oral or suspected. tumors. Often, a tumor will not What Is the Prognosis be noticed until an oral examina- for Oral Masses? tion is performed at your veterinary clinic. Most pets will not show The prognosis is directly related Symptoms of signs of oral tumors until the mass to the type of mass, where it is Oral Tumors becomes large enough to inhibit located, and how it is treated. With chewing or swallowing. Some pets therapy, dogs and cats affected with oral tumors have bad breath, with benign tumors usually have • Bad breath excessive drooling, and/or a bloody a normal life span. Animals with • Excessive drooling oral discharge. Other animals will aggressive malignant tumors, • Bloody oral discharge develop a swelling on the outside however, often live for only weeks of the oral cavity. Because of this, to months after diagnosis, with or • Swelling on outside of oral cavity regular visual examination of your without treatment. winter, volume 4 ◆ pet quarterly Dental Vaccines A New Method for Managing the Most Common Disease in Pets
By R. Michael Peak, DVM, DAVDC
Do you know what the most common disease in dogs and cats is? According to a study conducted at the University of Minnesota, as well as mounting supporting evidence, peri- odontal disease is the most common disease our pets have.1
Periodontal disease is inflammation expected considering the level of or infection of the tissues that plaque, calculus (tartar), and overall surround and support the teeth. oral hygiene. You may have noticed It occurs for a number of reasons, the same thing in your pets—some but the primary causes are seem to have more severe signs of bacterial growth in the mouth dental disease than others. Many and lack of regular oral hygiene. human and veterinary studies are Other influencing factors include now focusing on particular bacteria genetic predispositions, pH of the and its effect on the development oral cavity, nutritional status, the of advanced periodontal disease. consistency of food eaten, and stress (yes, even though they may not The ultimate result of show it, our pets often have stress). periodontal disease is More recently, researchers have loss of bone around the found that the type of bacteria may play a more important role than tooth roots and eventual 2 loss of the tooth. This mouth is in need of dental care—note the once thought. plaque and tartar accumulation, gum recession and inflammation, and missing teeth. What Research Has Shown Near & Far Consequences Symptoms of It has been known for many years in human dentistry that peri- Locally, periodontal infections eat Periodontal Disease odontal disease goes hand in hand away at the gingival attachment with other diseases and conditions (tooth/gum attachment), the bone • Plaque & tartar accumulation such as diabetes, preterm low birth around the tooth roots, and the ligament that holds the tooth root • Gum recession weight babies, and the incidence of cardiovascular disease (stroke).3-8 to the bone. The ultimate result is • Gingivitis (inflammation of Early in periodontal research, it loss of bone around the tooth roots the gum) was assumed that as plaque (which and eventual loss of the tooth. • Missing teeth harbors bacteria) developed, more While this may seem bad, it is only the beginning of the story. • Root exposure advanced disease followed. However, we know now that this is not always Loss of bone around the root • Pus at the gum line the case. may have a dramatic impact on the overall stability and integrity • Halitosis (bad breath) Some people have much worse periodontal disease than would be of the jaws, and in some cases
10 pet quarterly ◆ volume 4, winter Left. Dental x-rays are important to evaluate the full extent of periodontal disease. In this case, the tooth on the right has extensive bone loss around both roots (arrows). Right. Porphyromonas bacteria Courtesy Pfizer
Studies in the United States and in Europe have now The vaccine has only been studied shown associations between periodontal disease and in dogs, but a feline periodontal changes in the heart, liver, and kidneys in dogs. disease vaccine may be available in the future. Vaccine Candidates results in such weakening of the bacteria Porphyromonas is slightly lower jaw that jaw fracture follows. different in its make-up. In fact, Studies have shown that smaller These “pathologic” fractures of researchers have found that there dogs and older dogs are more likely the lower jaw are difficult to treat are three Porphyromonas-type to be affected with advanced peri- because of bone infection and the bacteria associated with greater odontal disease. Also any dog with a small amount of healthy bone left than 75% of cases of advanced familial tendency toward periodontal for healing. The other effect of periodontal disease in dogs.2 It disease as well as larger breeds that periodontal disease is the constant is proposed that control of these are predisposed, such as greyhounds, immune response and release of bacteria may result in less peri- would be good candidates for this toxic by-products from the bacteria odontal tissue loss, less tooth loss, type of protection. As with any within the periodontal tissues. less loss of important jaw structure, immunization, any information you Periodontal infection can also and less damage to the overall body. can provide about your pet’s history have far-reaching effects throughout One way to control these bacteria will help your veterinarian assess the body. Studies in the United would be to stimulate the body to your pet’s risk for disease, need for States and in Europe have now create an immune response that protection, and the appropriateness shown associations between peri- would target these bacteria specifi- of the vaccine. odontal disease and changes in the cally. A vaccination that is aimed at Any dog with a familial heart, liver, and kidneys in dogs.9 the Porphyromonas bacteria respon- tendency toward peri- The Culprit: sible for most periodontal tissue 10 odontal disease as well Porphyromonas infections has been developed. Safety studies and several studies as larger breeds that In humans, a bacteria called to see how well the vaccines work are predisposed, such Porphyromonas gingivalis has been have been completed. The results as greyhounds, would identified as being associated with are promising and this vaccine is periodontal infection and advanced now available in veterinary clinics be good candidates for periodontal tissue loss. In dogs, the for administration to patients. this type of protection. <
12 pet quarterly ◆ volume 4, winter volume 4, winter ◆ pet quarterly 13 PRSRT STD U.S. POSTAGE PAID Lebanon Junction, KY Permit No. 266