Straight Talk: a DVM Goes Dental

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Monday Medical Dental Health Series: Part 2

Previous:    2/4/13: Overview

Next week: 2/11/13: Interview with Dr. Huber, part 2

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Dr. Huber with one of her patients

Meet Dr. Sara Huber of Leawood Plaza Animal Hospital, the practice that keeps our herd so robustly healthy. This woman is passionate about her charges.

And when we mentioned recently that we had some questions about pets and dental health, it was clear that this is a subject she's also pretty keen on!

A Tonk's Tail: Do you have any pet peeves about the way most pet owners view dental health?

Dr. Huber: Actually, I have two! The first one is the idea that our pets don't really feel or respond to dental pain to the same degree that humans do.

This could not be more false.

Studies performed in the 90's showed that pets react to the same level of stimulation and have the same physiological responses to pain as humans. Cats will instinctively mask pain to avoid predation (a survival tool from their days in the wild), so it may appear as if they are not in pain when they in fact feel quite a bit of discomfort.

If you see a lesion in a pet’s mouth that may cause pain, address it. It is remarkable how many people will say that they notice a tremendous improvement in their pet's attitude and behavior after addressing dental problems.

ATT: You mentioned a second peeve?

DH: Yes. It's when I hear, "he only has mild tartar buildup, its not a big deal."

Tartar build-up (tanakawho, Creative Commons 2.0)

I often hear pet owners state that a pet has terrible breath but only mild tartar buildup so they don't feel a dental procedure is necessary quite yet. The problem is that by the time you begin to see build-up on the tooth, you’re often seeing just the tip of the iceberg.

Teeth that do not appear diseased can have disease under the gum line that goes all the way to the root. This can only be found by a combination of gentle probing deep below the gum line during the oral exam and cleaning process. 

This physical exam, combined with radiographs (x-rays) can reveal disease to the root and even the surrounding bone.

It’s important to remember that tartar builds up because of the presence of bacteria in the mouth. When the gums and/or roots are diseased, this can then allow a direct route for bacteria to access the rest of the body.

ATT: Which leads to the next question: Can dental disease negatively impact overall health?

DH: In a word, YES.

There has been a lot of research done on this particular topic in both human and veterinary medicine. While it has been difficult to demonstrate a direct cause and effect relationship between periodontal health and systemic health, the evidence suggests that this is the case.

Photo: Wikimedia Commons, via Creative Commons 2.0

There have been numerous studies that show an association between oral health and systemic health. If you think about dental disease and what causes it, this makes perfect sense.

Periodontal disease (or disease of the underlying support structures of the tooth) is caused by plaque (bacteria). This plaque becomes mineralized and causes calculus.

As time passes, gingivitis (inflammation of the gums) develops and bacteria gain access to the underlying structures of the tooth. This can cause bone loss and damage to the root.

There are numerous blood vessels associate with the teeth and gums. As dental disease progresses, the bacteria associated with the disease can gain access to the blood vessels and circulate through the system.

Research suggests that this can cause disease in the heart, kidneys, liver, and other body systems. Veterinarians will often give animals an injectable form of antibiotic while under anesthesia for a dental cleaning and send pets home on antibiotics to help prevent the spread of harmful oral pathogens.

ATT: Let’s talk for a minute about older pets and dental health. Are there risks associated with age?

DH: I often have clients that have come from other vets tell me that their vets tell them "my cat is too old for anesthesia and the risks outweigh the benefits of the dental procedure." I then ask them to list the specific risks they’re concerned about and any supporting documentation... and they do not have an answer for me.

I guess you could say I have a third pet peeve:  AGE IS NOT A DISEASE!

While it is true that older animals metabolize anesthesia differently than younger animals, age does not preclude a pet from undergoing anesthetic procedures.

Every pet that goes under anesthesia at our clinic (from infant to geriatric) must have a pre-anesthetic blood panel performed. This will often unmask underlying disease that should be addressed before performing anesthesia.

All pets also have a pre-anesthetic ECG (electrical tracing of the heart) to rule out any problems with heart rate or rhythm that might not be heard on a normal physical exam.

Kitty's Pearly Whites (photo: Klauden, Wikimedia Commons)

We tailor our anesthesia protocols for each particular patient, taking into account age, underlying disease, respiratory compromise, etc.

And while under anesthesia, all animals have a continuous ECG, a pulse oximeter reading (oxygenation of the blood), a respiratory monitor, and a blood pressure taken every 3-5 minutes.

This ensures that we have taken every possible measure to keep each pet safe and healthy while under anesthesia. When a pet is recovering they are monitored by a technician for any distress and a veterinarian is always nearby to address any emergent issues.


DH: This brings me to another fact I’d like to discuss: Senior ailments can actually be compounded by dental issues.

Many senior pets suffer from illnesses such as arthritis, kidney dysfunction, liver disease, cancer, etc. that will affect their appetite and attitude. As I mentioned before, dental disease can often cause significant oral pain and can interfere with an animal’s ability and desire to eat.

Consuming a significant quantity of quality calories and protein is essential for a cat that has a systemic disease. If the cat has oral pain, it is often not willing to eat and this will have a negative effect on their ability to fight disease.

Once dental disease is addressed, the painful stimulus in the mouth is removed and the cat will often show a marked increase in food consumption and improvement in their particular disease.

I cannot prove this as being a direct cause an effect relationship but I have seen many senior cats with severe periodontal disease come in with significantly elevated liver enzymes. After their dental cleaning, these enzymes will often be markedly reduced (if not normal).

Next Week: What questions to ask

your vet before a dental procedure

Monday Medical: Epilepsy Awareness Month

Since November is National Epilepsy Awareness Month, we thought it would be a good opportunity to examine what this disease is like in animals. So we interviewed Dr. Eberhardy at Leawood Plaza Animal Hospital about it.

We were not aware that seizure disorders are a pretty common disease in dogs. Or that you don't see it nearly as frequently in cats.

Typically if a cat has a seizure, Dr. E said, there's usually an underlying trigger.  Only 5-10% of seizures that occur in cats have epilepsy as their root cause.

The process of identifying the cause of a seizure varies with a pet's age, we were told.

Andrew Morrell Photography / Foter / CC BY-ND

In a young adult dog, if the dog seemed perfectly normal before the seizure and appears normal in an exam after the seizure, then the diagnosis is most probably going to be epilepsy. And again, in dogs, there's probably a genetic predisposition for it.

In a kitten or a young adult cat, initial suspects are going to be diseases such as toxoplasmosis, FIP or feline leukemia.

On the rare occasion that you find true epilepsy in a cat, it's usually going to be between the ages of 1 and 4.

With older pets, Dr E said, one of the first things to rule out would be brain tumors.

As with humans, one method used in diagnosis is to have the pet's head scanned, by getting either an MRI or a CT scan. And sometimes a diagnosis can be made by performing a Cereberal Spinal Fluid (or CSP) tap analysis.

Seizures can usually be placed  in one of two categories:

• intracranial, where there's a mass, structural changes to the brain, or epilepsy
• extracranial, where the cause isn't originating up in the head - it's a byproduct of another disease that began elsewhere in the body, such as liver disease

What to do if your 
pet suffers a seizure?

Doctor Eberhardy gave us three very good bits of advice to remember if a pet ever suffers a seizure:

ViaMoi / Foter / CC BY-NC-ND

Ensure your pet is in a safe area where he isn't in danger of falling and suffering additional injury. You may hesitate to handle a seizing animal for fear you'll cause additional harm but it's best to go ahead and move the pet to a safe place. (They aren't going to swallow their tongue, so there's no need to worry on that count.)

Calm yourself. Your pet is going to need you at your best when it's time to get to the emergency vet! The good news is that at first onset, seizures in animals are usually brief.

Transport your pet to your local veterinarian (or if the seizure occurred during off hours, the emergency vet) as soon as possible.

How is a pet treated 
for epilepsy?


Although treatment will be dictated by the severity and frequency of the seizure disorder, the actual medications are often the same in animals as they are in humans. Drugs like phenobarbitol or diazepam are often prescribed. And they work in the same manner, too: the drug works to lower the seizure threshold.

And just as in humans, it can make your pet lethargic, too. So the prescription is often adjusted for each animal until you find the 'sweet spot': where it's enough to inhibit seizures while not adversely impacting your pet's mood or behavior.

When you begin treating a pet with anti seizure medication varies based on the animal's condition, the severity of the seizures, and their underlying cause. Comparatively, cats may be started on medication sooner than dogs even if there is a longer interval between seizures, as seizures in cats are relatively rare and often more serious.
Regardless, if your pet suffers a seizure, the best thing to do is seek medical help immediately.

Many thanks to Dr. Eberhardy for teaching us more about seizure disorders and epilepsy.
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If you'd like to follow the stories of fellow bloggers whose pets have epilepsy, check out the links below:
Five Sibes: What's Wrong with Gibson the Husky?  and
http://www.canine-epilepsy.com/living.html.