Featuring Miu Miu’s Story

Veterinary dentistry has come a long way in the past 20 years, as we have learned more about the impact of oral health on overall health. No longer is it considered normal for calculus (tartar) to build up as a pet ages, nor is it acceptable to just wait for their teeth to fall out. 

Despite the fact that we do not see painful behaviors from our pets, like changes in appetite, we know from our own reactions to oral pain that this disease is painful. While a person with a very mild tooth root abscess may only be able to eat a liquid diet, many of our pets do not take the time to chew their kibble or are fed canned food. This means that their appetite is not likely to decrease due to oral pain, unless it is really severe. However, in talking with many of our clients, our pets slow down prematurely as their oral pain begins to affect their quality of life. We also see this by the number of clients that tell us their senior dog is acting like a puppy again after addressing their oral health.

Periodontal disease involves the loss of gum and bone around the roots of the teeth and is severely inflammatory for the body. In fact, both the body and bacteria on the teeth make inflammatory molecules that can spread throughout the bloodstream and cause further inflammation throughout the body. The statistics can be staggering. According to a study from Banfield in 2016, 76% of dogs and 68% of cats have some degree of periodontal disease after 3 years of age. However, about half of all cats and dogs between 1-3 years of age have signs of periodontal disease. This can be as mild as gingivitis (inflamed and bleeding gums) or severe enough to lead to tooth loss. This is even more concerning when considering that, in 2015, 80% of all cats and 82% of all dogs seen at Nevada Banfield Pet Hospitals were noted to have periodontal disease (Banfield Pet Hospital). 

Here at Highlands Animal Care, we believe in starting care early. This usually means around 1 year of age in small dogs and cats, 2-3 years of age in larger dogs, and continuing care regularly, typically every 6-12 months depending on the degree of periodontal disease found during routine care. 

Recently, Dr. Francher had the opportunity to take care of Miu Miu, a 3 year old female spayed pomeranian. 

During her pre-anesthetic visit, Miu Miu was head shy. This meant her veterinary care team was unable to get a full awake assessment of her teeth. However, her owner does attempt to brush her teeth daily. Usually Miu Miu only allows for her front teeth to be brushed. Some brushing is still better than no brushing in most cases. Her can team also collected blood for her pre-anesthetic lab work at this visit. 

The results of her labs were available within 48 hours of her appointment and since they were normal, Miu Miu was able to be scheduled for her comprehensive oral health assessment and treatment (COHAT). This is what many people consider a dental for pets. However, it goes beyond just anesthesia and cleaning teeth. 

At Highlands Animal Care our COHAT involves the following stages:

• Anesthesia for full oral evaluation – looking at teeth and their gingival (gum) attachment, evaluating the tongue, cheeks, and the throat for any masses or lesions that cannot be seen when most of our patients are awake.
• Full mouth dental radiographs on all patients – this allows the veterinary team to assess the degree of subgingival (below the gumline) periodontal disease. There can be disease hiding below the gums that is not detectable on even an anesthetized evaluation. It also allows for evaluation of the inside of the tooth and the pulp canals. The pulp canal can give information on the overall health of the tooth and let the veterinarian know if the tooth is alive or dead. 
• Thorough cleaning of teeth, both the crowns (what is seen) and in the gingival sulcus (just below the gumline). Anesthesia-free dental cleanings are unable to clean the gingival sulcus and by doing so you end up with a mouth that looks clean when the majority of disease is still left to fester under the gumline. 
• Treatment of any periodontal disease found. This treatment can vary based on the type of disease and its severity. In many cases the best option for severe bone loss and abscessed teeth is to remove the affected tooth. This allows the infection to be removed from the mouth and slows or even prevents spread of the disease from one tooth to the next. In mild cases of periodontitis, treatment can be implemented by deep cleaning of the tooth root and instilling local antibiotics. These antibiotics help to reduce bacteria below the gumline and have mild anti-inflammatory properties to inhibit the inflammatory molecules that are associated with disease. This can save some teeth, but is not appropriate for moderate to advanced disease states. Treatment options are discussed with pet owners once the anesthetized oral assessment and radiographic assessment are complete. This happens while your pet is under anesthesia. There are some advanced treatment options to save teeth that can only be performed by a board certified veterinary dentist. If this happens your pet will be referred to Dr. Hewitt, the local board-certified veterinary dentist for further care. 
• Once treatment is complete, the gums are sewn up to allow for less painful and more rapid healing. The teeth are then polished and a dental sealant can be applied to the gingival sulcus. At our hospital we use SANOS, which helps to reduce the spread of bacteria under the gumline and can lessen the development of periodontal disease with regular care. 

During Miu Miu’s COHAT, Dr. Francher found that Miu Miu was missing many teeth. She had a total of 34 teeth, and seven of them were baby teeth that should have fallen out by 6-8 months of age! The normal amount of permanent teeth for a dog is 42 (it is only 30 in a cat). Thankfully, Miu Miu’s baby teeth were not crowded among a normal amount of adult teeth. This can lead to more severe periodontal disease as crowding means less secure root attachment and more space for bacteria to eat away at the bone. However, Miu Miu’s radiographs showed bone loss and infection of 13 teeth. Only 2 teeth had disease that could be managed by leaving the teeth in her mouth. The other 11 had such severe disease that extraction was the one treatment option for her. This means she lost nearly a third of her teeth at the age of three!

It is possible that, had Miu Miu started routine dental care with an anesthetized COHAT every 9-12 months, many of these teeth could have more likely been saved. For those that might not have been able to be saved, she hopefully would have lost fewer at a time. This is not to say that Miu Miu will not live a long, healthy life. By reducing the inflammation and infection of her mouth, and keeping up with regular COHATs we can continue to keep her mouth healthy from this point forward. 

It is also important to remember that we are feeding our pets, they do not have to hunt. This means that with a reduced number or even no teeth in their mouth, they can still eat and thrive. They will just do so without the pain of periodontal disease. 

Testimonial sent in by Miu Miu’s owner, Ariel:

“Miu Miu was starting to have bad breath even though I brush her teeth nightly, so I knew I had to take her to get her teeth checked and cleaned. Looking at her teeth, I never saw any serious decay so I did not expect her x-rays to show extensive dental disease.

After her deep cleaning and extractions, I noticed an increase in her playfulness and mood. Before her dental work, she was more ‘calm’ and did not look like she was in any pain, however, after her procedures, she was acting like a playful puppy again! She eats better and seems to have much more energy now; Miu Miu plays with toys more often and even likes tug-of-war with ropes, which she didn’t like to play with before!

I’m very grateful for the care that Dr. Francher and the team at Highlands Animal Care provided for Miu Miu and now I know the importance of regular dental checkups for my furbaby!”