February is National Pet Dental Health Month
Have you looked at your pet’s mouth lately? Have you smelled your pet’s breath? Would you want to kiss someone whose mouth looked and smelled like your pet’s? February is National Pet Dental Health Month, but honestly, every month should be.
We humans brush our teeth daily and still, when we go to our dentists every 6 months for regular professional cleanings, the hygienists are able to scrape off significant amounts of tartar and calculus from our teeth. The same processes that lead to tartar and calculus and dental disease in the human mouth also occur in the mouths of our pets.
Even if you are doing the best home dental prevention program - which would include brushing your pets’ teeth daily (with an approved enzymatic pet toothpaste), feeding the best dental diet (like Hill’s T/D or Royal Canin’s Dental Diet), and offering appropriate dental health treats (like Oravet chews or Greenies), your pets’ teeth will still accumulate some tartar and calculus, and eventually will develop significant oral disease. Unless they see their veterinarian regularly for oral exams and for routine preventive dental cleanings, they will develop periodontal disease and be in danger of tooth loss, gum infections, systemic infections, kidney disease, heart disease and other complications of dental disease. We recommend all pets start getting annual preventive dental cleanings after 2 years of age.
Some people think that when they bring their pet to the groomer and get their pet’s teeth brushed as part of a grooming that they are getting a professional dental cleaning, but a groomer can only do the equivalent of the same tooth brushing that we can do every day at home ourselves. When humans go to the dentist, we have to sit still for long periods of time with our mouths uncomfortably wide open while a hygienist scrapes and pokes and prods and polishes our teeth. Occasionally we get a break to rinse and spit. Our pets will not willing to do any of those things. A professional dental cleaning on your dog or cat requires putting them under general anesthesia in order to do a thorough and effective job.
Many people are discouraged from pursuing dental care for their pets because they fear general anesthesia. With modern anesthetics, proper monitoring, and preanesthetic blood screenings, general anesthesia can be quite safe. In fact, your pet has a greater risk of dying because of complications from dental disease than from complications of anesthesia. In a strict risk/benefit analysis, there is no question that dental cleaning under anesthesia provides benefits that are worth the very low risk.
So what exactly happens during a dental cleaning at Milford Animal Hospital? First we recommend pre-anesthetic bloodwork for all pets undergoing anesthesia who are over 6 years of age or have any illness history. Often we will try to schedule a dental cleaning shortly after a pet’s annual preventive exam when we are typically doing their annual blood work. Other times we will do the lab work the morning of the procedure. Assuming all is well with the lab findings we move forward with the dental procedure. We do these procedures first thing in the morning, Monday through Friday. We ask families to withhold food after midnight before the procedure, but access to water is still allowed. This is because sometimes pets become nauseated with anesthetics and we don’t want them vomiting before, during, or after the anesthetic event.
The pet is dropped off at 8:00 AM and is examined by the doctor, They are almost immediately given a sedative and pain reliever to make them comfortable and relaxed, and to alleviate any fear they might have of being in the hospital. Often an IV catheter will be placed in one of the legs to allow administration of drugs and fluids for patients who are expected to be under anesthesia for a prolonged period of time or who have pre-existing illness. We place the pets on a warming pad covered by a towel on our special table/sink designed for keeping pets clean, warm, and dry while we are working in their mouths. We give them an induction agent which makes them fully relaxed and unconscious, and then place a tube with an inflatable cuff (like a balloon) at the end into the patient’s windpipe. The tube is connected to oxygen and gas anesthesia. In addition to delivering the oxygen and anesthetic, the tube provides protection of the airway and lungs from any debris we loosen off the teeth during the procedure. (We don’t want any of that nasty stuff being inhaled.) While under anesthesia, the patient is being monitored (EKG, blood pressure, blood Oxygen and CO2 levels, and body temperature). We use an anesthetic monitoring machine that is similar to what is used in human hospitals.
Once the pet is safely under anesthesia and has reached what we call a “stable plane” of anesthesia, we begin the procedure. At this point the veterinary technician takes the role of dental hygienist and scrapes off the dental calculus and tartar using curettes and an ultrasonic scaler and irrigator. She then polishes the teeth using the same type of polisher and fluoride toothpaste that is used in a dentist’s office. And finally she applies a fluoride treatment to help seal the tooth enamel. While she is working, the veterinarian is serving as the anesthesiologist and is monitoring the anesthesia and making sure the pet is comfortable and safe.
Once the teeth have been cleaned, then the veterinarian will probe the gumline looking for periodontal disease in the form of pockets or separations of the tooth root from its support structures. If there is no periodontal disease then the anesthesia is turned off and the pet is closely monitored while they awaken.
If periodontal disease is found then we have a few ways of handling it. If the disease is mild, then we can sometimes seal the gum tissue back to the tooth root with a special biologically active epoxy that has antibiotic in it. This epoxy acts like a glue to adhere the gums back to the tooth root, fight any infection in the gum tissue, and provide a framework for the body’s immune system to make a new seal between the gum and the tooth root.
If the periodontal disease is too severe, then it is better to extract the tooth than to leave it as a source of pain and infection. In those cases, we use tools similar to human dental tools and drills to extract the teeth and surgically close the root sockets. Pets that need extractions are given additional pain medications in the form of local blocks, injectable analgesics, and oral analgesics for the period after they go home. These pets are also generally given antibiotics via injection and occasionally need additional antibiotics for when they are home.
Once the procedure is done the pet usually takes a few hours to completely metabolize the anesthetic and fully wake up. Once we know they are safely awake, comfortable and ambulatory, we send them home- usually by 3:00 PM. We ask families to feed their pets softened food for a couple of days after a routine cleaning and for a couple of weeks after a complicated procedure.
Once the gums have fully healed we usually recommend maintaining them with a dental diet (like Hill’s T/D or Royal Canin Dental Diet). What makes a dental diet? Dental diets are specially formulated with calcium binders to keep calcium in saliva from adhering to the biofilm on the tooth surfaces which is what makes tartar and calculus. Dental diets also are a large dry kibble that is formed in a special way that prevents the kibble from crumbling and requires that the pet actually chew the food to promote scraping of the tooth surfaces and removing the biofilm as much as possible with chewing alone. Samples of the dental diets are available on request.
We also recommend daily brushing for those patients that will cooperate. Do not use human toothpaste on your pet, as they will not rinse and spit and the fluoride in human toothpaste is toxic if too much is ingested. The best pet toothpastes use enzymes to digest away the tartar and biofilm on the teeth. These nontoxic enzymes are digested in the stomach, causing no adverse effect.
We also recommend dental chews like Oravet chews or Greenies to help keep calculus at bay. These products are not as helpful as brushing the teeth, but are a good secondary option for pets who won’t cooperate for teeth brushing.
For patients with periodontal disease we may sometimes recommend different oral gels or rinses that help disinfect the gums and promote gum health. Your veterinarian will make recommendations for these products when it is appropriate, but if you have questions, do not hesitate to ask.
If you have read this far, I thank you for your perseverance. Dental care for pets is just as complicated and important as it is for people. If you have any questions about your specific pet’s dental condition, please set up an appointment for an oral exam. We will be happy to explain what is going on in your pet’s mouth and how to best keep their teeth and gums as healthy as the rest of their body. And remember, just because February is Pet Dental Health Month, don’t think we only focus on it one month out of the year. Proper dental health requires care all year long.
Tango (on the left) with Marco (Emily's puppy) on the right.
So who is this french bulldog wandering round Milford Animal Hospital? Tango has been my sidekick for 10 years now. He is one of my many pets and possibly the best dog I've ever owned. He loves to come to work with me and greet people at the door. He will be present most of the time that the hospital is open as he rarely wants to be left at home. In many ways he has become the mascot of Milford Animal Hospital.
Things you should know about Tango:
Welcome to the new Milford Animal Hospital website. You'll notice some changes. A new hospital logo, a new chief veterinarian and a new commitment to modern communications at the hospital. Dr. Heller built a wonderful practice here and has overseen the care of numerous pets for the last 39 years and I am honored that he chose me to carry on his legacy. At 74 he is still working today although he is cutting back his hours and only working a few afternoons per week at this point. I only hope that I will have his stamina and dedication when I reach his age. And I hope that we will continue to have his wisdom and experience to draw upon for a long time to come.
So, who am I? My name is Jonathan Augusto, DVM. I graduated from the Virginia-Maryland Regional College of Veterinary Medicine in 1995. I spent my first year out of veterinary school working in a mixed large and small animal practice in Seekonk, MA. I did one year of Pathology residency at Angell Animal Medical Center in Boston. I then went on to work as a relief veterinarian until 2004 when I bought a Banfield Pet Hospital franchise in Millbury, MA. I started that hospital with myself and 3 veterinary technicians working 60 hours per week providing medical care and advice to all comers from the back of that PetSmart store. I dedicated 10 years of my life to building that hospital up to a thriving 4 doctor practice and employer of nearly 20 veterinary technicians. I also aided in the training of numerous Becker College veterinary technician students during their externships at my hospital. And I also hosted numerous veterinary students as they came to my hospital for clinical rotations and summer job programs. After the 10 year franchise agreement expired, the Banfield corporation took over my practice, and I became an employee of the corporation. I continued to lead the hospital in Millbury but I knew I needed to strike out for myself again as soon as possible.
Way back in 1999, when I was doing relief work, I did some work at Milford Animal Hospital for Dr. Heller and I told him back then that when he was ready to retire he should keep me in mind because I loved everything about his hospital. Here we are, nearly 18 years from our first meeting and Dr. Heller chose me to succeed him as owner and chief of staff at Milford Animal Hospital. In many ways it feels familiar. I'm back to working 60+ hours a week again and working with a staff of three wonderful technicians. But it also feels like a brand new world with open possibilities and freedoms that I could never enjoy as a franchise owner. I also feel a great responsibility to live up to legacy and reputation that Dr. Heller has built here.
So what has changed here besides having me as the main doctor? Well, we have a new logo and new web presence and a new Facebook page. We've installed a hot beverage nook so clients can have refreshment while they wait for lab results from our new in-house laboratory. We've updated much of the hospital equipment to more modern amenities so we will have better laboratory instruments, anesthetic monitoring, surgical, and dental tools. We are converting from paper records to computerized records to allow us to provide more consistency and the legibility of typed rather than hand written medical notes. (No one should be forced to read my handwriting and Dr. Heller's is not much better!) The new computerized records will mean I can access patient info even when I'm away from the office. If a client needs veterinary advice after hours, they need only email me and as long as I'm awake I'll respond within a few minutes to hours and be able to access their pet's info and give the best possible advice.
What is staying the same? The wonderful staff that supported Dr. Heller is still here. Lisa, Allissa and Emily are fixtures here at the hospital. I can't imagine a better group of people to work with and I hope they weather all the changes and continue to offer me the same expert assistance that they gave to Dr. Heller. We are keeping the same hours. We will have the same commitment to compassionate care and client education and community support that Milford Animal Hospital has always been about.
I hope you will find that we are keeping the commitment to tradition even as we move to modernize. We are open to client feedback so if you have questions, requests or ideas for things you'd like to see as we move forward, please feel free to share them. I am truly honored to be here at Milford Animal Hospital and very excited about its future. I look forward to meeting new faces and welcoming familiar clients who come seeking me out. Thank you to Dr. Heller for giving me this opportunity. I promise to strive to live up to, and hopefully one day exceed, your high standards.