By Kim Campbell Thornton

From bad breath and periodontal disease to broken teeth and oral tumors, dental problems are among the most common problems veterinarians diagnose in pets. They are also among the most preventable and treatable problems, but sometimes getting clients to take dental care seriously is, well, like pulling teeth.

Educating clients about dental care and the effect it has on overall pet health can not only improve dog and cat oral health, it can also have a healthy effect on your bottom line as well as the human-animal bond. The secret is helping clients recognize what kind of care their pets need.

"I think most clients love their pets and none of them like bad breath," says Liz Bales, VMD, in Philadelphia. "It can come as a surprise their pet's mouth needs regular dental care, like tooth brushing and regular dental cleanings, just like they do."

Pet dental stats

It's estimated by the time pets are three to four years old, 80 percent of dogs and 70 percent of cats may have periodontal disease, according to the American Veterinary Medical Association (AVMA). Other common oral health problems include broken teeth and roots, abscesses and other infections, oral tumors, malocclusions, and palate defects.

A Swedish survey of pet owners, published in Frontiers in Veterinary Science in 2020, found the ability of owners to assess a dog's dental health varied significantly depending on age, weight, breed, breed group, sex, and concurrent disease. Other factors that influenced owner assessment of a dog's dental health were age, education, urban or rural environment, and whether or not they were breeders.

"Dog owners with smaller dogs, older dogs, and certain breeds predisposed to periodontal disease assessed their dogs' dental health as worse than their counterparts, which is in agreement with previously reported higher prevalence of dental disease in these groups," researchers reported. The results, they wrote, highlight the need for routine professional assessment of periodontal health, as well as education of dog owners and training of dogs to accept dental care procedures.

"I think, as a profession, we've done a lot better about talking about dental disease," says Heather Skinner, DVM, at Indian Trail Animal Hospital in Spokane, Wash. "Either they smell the bad breath or they take their dogs to the veterinarian and we tell them. I do still get clients here and there that I show them the dog's mouth and they go, 'Oh, I had no idea. I've never looked in their mouth.'"

Head start

Better dental care starts with alerting clients early on to the importance of oral health. They need to know inflamed gums and infected teeth are painful, even if pets don't show it. Periodontal disease or broken teeth can limit a pet's ability to eat and enjoyment of food. No pet lover wants that. Further, according to AVMA, periodontal disease isn't limited to the mouth. It is also thought to be associated with changes in the kidneys, liver, and heart, although to date few studies have been published on this topic.

"It's all about client education from an early age," says Kelly Byam, DVM, owner of Abel Pet Clinic in Elk Grove, Calif. When people bring in puppies or kittens, she talks about the need to provide oral health care, including tooth brushing, and how it contributes to an increased lifespan. She reinforces the message by checking the teeth at every examination and instructing owners to "flip that lip" once a weekend and give teeth a good look. That way, dental care becomes established as part of a pet's regular health care.

Clients may laugh when you recommend brushing a pet's teeth. Dr. Skinner tells them she's no hypocrite. Brushing her own dogs' teeth is part of their daily routine.

"It can be very simple, from wiping the outside of their teeth with a cloth to using just a basic toothbrush that you can get from the dollar store and using a little bit of a pet toothpaste, and just focusing for 10 seconds on the outside of those big teeth in the back and the canine teeth in the front, and that alone can go a really long way and can prevent having to do dentals yearly or even every other year," she says.

Don't forget cats. It's even more important to establish a home dental routine for them at an early age. Kittens will be more amenable to accepting tooth brushing if it is introduced while they are still young. Cats are less likely to be brought to the veterinarian for regular checkups, so getting owners started on caring for their teeth while kittens are cute and easily trainable can help to keep their teeth and gums healthy and get owners in the habit of looking in their mouths regularly and noticing problems before they become serious.

Whether patients are dogs or cats, talking about dental care early is the best way to emphasize its importance, Dr. Byam says. "Dental disease, just like in humans, will shorten lifespan. We do think it's important if clients want pets to have a long and healthy life to have adequate dental care."

Silver bullets?

Clients often wonder if there's an easier way to care for pet teeth than daily brushing. It's still the gold standard, but other types of products may also contribute to good oral health by breaking down plaque through enzymatic or mechanical action or preventing plaque from adhering to teeth. Dental diets, too, may help a little bit, Dr. Bales says, noting not every animal is amenable to tooth brushing.

At VCA Woodland Central Animal Hospital in Tulsa, associate veterinarian Allison Ruicker, DVM, shares spreadsheets of products approved by the Veterinary Oral Health Council and sends home dental samples with pets who need at-home dental care, encouraging clients to try different products to find the ones their pets like best.

"I have found a nice handout on how to train dogs and cats to allow their teeth to be brushed and educate clients we need to train dogs and cats to allow teeth brushing in order to be effective," she says. "I also share which products I have used on my pets and my experience with each product."

The best products, she says, are those a client is willing and able to use every day and a pet will tolerate.

"If we are not using products daily," she says, "there is often limited benefit."

Professional cleaning

When clients don't brush pet teeth on a regular basis, professional cleanings must stand in for that dental care. Clients may balk, however, not only at the cost, but also at the necessity for general anesthesia. Explaining what a professional cleaning involves can help to assuage concerns in both areas.

Let clients know a professional cleaning does more than just provide pets with a pretty smile. An oral exam, complete with radiographs, can turn up fractured teeth, tooth root abscesses, and oral tumors. When clients know a professional cleaning can be an opportunity to identify painful or serious conditions, they may be more amenable to making an appointment.

When pets are reluctant to enter veterinary clinics or exam rooms, let alone have their mouths examined or undergo a professional cleaning, low-stress, Fear Free or cat-friendly techniques can help. Dr. Ruicker prescribes pre-visit pharmaceuticals for these patients. At the clinic, she makes use of pheromone therapy and calming music. Prior to surgery, pets are housed in quieter areas conducive to relaxation.

Fear factors

Often clients are resistant to professional cleanings because they are concerned about anesthesia risks, especially with senior or geriatric animals. Bales is sympathetic.

"When my pets undergo anesthesia, I worry, too," she says. "But the risks of dental disease on our pets' overall health are far more common than anesthetic incident."

To minimize client fears, she recommends a full CBC/chemistry and physical exam prior to a dental so they know she's aware of any special needs or underlying conditions.

Ruicker also relates to clients who are concerned about anesthesia risks. She has three senior pets, two of which are brachycephalic breeds.

"Anesthesia is always a risk, so showing empathy and building rapport with clients is helpful to build trust," she says. "I try my best to educate clients on what anesthesia entails, the monitoring involves, and the risk of leaving periodontal disease."

Skinner reassures clients by outlining the basic anesthesia protocol and explaining the multimodal approach, as well as monitoring protocols.

"We're using small amounts of different drugs, so overdosing is very difficult," she tells them. A technician monitors heart rate, blood pressure, temperature, and breathing throughout the procedure. "I assure them our anesthetic protocols are something we've been working on for years and they've become very safe and efficient. The risk of anesthesia is always there, but it's not really something we worry about often."

Clients may ask about non-anesthesia dental cleanings. Dr. Byam conveys the procedures are cosmetic only. Veterinarians may be unable to perform a thorough oral exam, including radiographs, which could turn up serious problems. The AVMA advises procedures such as periodontal probing, intraoral radiography, dental scaling, and dental extraction be performed under anesthesia.

Make a plan

Pet owners may feel overwhelmed or take it personally when told their pet has dental issues. Assure them they're not alone. As with humans, pets need dental care throughout life. Work with them to develop a treatment plan and a manageable preventive care plan.

Bales assesses what clients are willing to do and creates a dental care routine that includes home care and annual veterinary dental cleanings if possible. She suggests videos to help with tooth-brushing technique.^{1, 2}

Sometimes cost of professional cleanings is a concern for clients. Help them plan for it.

"We try and talk about prevention first, just like with anything," Dr. Skinner says, "but sometimes I will, in an annual exam, sit down with a client and say, 'Hey, your dog's teeth are not bad, but we don't want them to be. Here's a dental estimate, and you can spend the next year or so saving up because I know this is a big-cost procedure.' That kind of thing can be helpful."

When it comes to talking to clients about dental care, don't give up, Ruicker says.

"I often discuss realistically when a dental cleaning under anesthesia needs to occur, but also discuss dental care at home. Also, advocating for dental care at each visit can show clients how important dental care is since we are discussing this at every visit."

WHAT'S LIVING IN A CAT'S MOUTH?

A cheek swab can tell you a lot about a feline patient's oral health. The oral microbiome—the bacteria, fungi, viruses, and more living in a cat's mouth—differs between healthy and unhealthy mouths. Liz Bales, VMD, says a new test by Basepaws, called the DentalCat Kit, can be used to evaluate a cat's oral microbiome by identifying microbial signatures associated with certain dental conditions in cats. The screening test provides risk scores for periodontal disease and tooth resorption and suggests appropriate clinical care for individual cats.

Kim Campbell Thornton is a frequent and longtime contributor to Veterinary Practice News. She is a Southern California-based freelance writer who specializes in pet-related topics.

References

1. https://www.youtube.com/watch?v=wB3GIAgrTPE.
2. https://www.coastviewvet.com/how-to-brush-your-pets-teeth-the-fear-free-way/