Dental Disease in Dogs and Cats: Does Treatment Improve Health?

A reader recently asked me about the evidence supporting recommended therapy for dental disease in dogs. This is has become a common question given the increasing awareness among pet owners that dental disease is a real and important health problem, and the availability of high quality prophylaxis and treatment.

The American College of Veterinary Dentistry, the organization of board-certified veterinary dental specialists, has a great site with information for pet owners about dental disease. I also find a lot of clear and pretty evidence-based information on the site of Dr. Frasier Hale.

Dental disease is unquestionably common, with some research suggesting it is the most common disease in pet cats and dogs, vying with obesity for the top spot. It primarily takes the form of periodontal disease, and unfortunately it is very difficult to detect or evaluate the severity of this problem in an awake dog. Dogs and cats show few overt symptoms of dental disease. Probing of the tooth sockets and x-rays are necessary, just as they are for humans, to accurately characterize the type and severity of dental disease and determine the appropriate treatment.

Unfortunately, our pets almost never get twice daily brushing and flossing or semi-annual dental cleanings, and they often have very abnormal occlusion (the arrangement and interaction of the teeth in the mouth) as a result of breeding. Toy breed dogs and those with foreshortened faces are at especially high risk of severe dental disease due, in large part, to the same anatomy that makes them appear cute to humans. So proper diagnosis and treatment of dental disease requires general anesthesia, and it is very often necessary to remove infected teeth because the disease is advanced or because the level of care needed to preserve them cannot be accomplished.

Naturally, owners are often anxious or reluctant to pursue care that involves general anesthesia and likely extraction of teeth, due to worries about the safety and comfort of the pet and also due to the high cost of appropriate care. The fact that our pets rarely show recognizable symptoms, even with a level of disease that we know would cause tremendous discomfort in people, also makes it more difficult to convince people that dental care is necessary and beneficial for their pets. While the most obvious reason to pursue this care is that the disease is almost certainly painful, it is sometimes helpful to consider the secondary health risks associated with untreated periodontal disease. I recently took a quick look at the evidence concerning these.

There is pretty strong evidence in humans that untreated periodontal disease is associated with other health problems, notably cardiovascular disease, diabetes, respiratory disease (including infections) and pre-term low-birthweight deliveries. Treatment of periodontal disease leads to clinical improvements in several diseases as well. It is plausible that a similar relationship between dental disease and general health would hold true for cats and dogs, but there is little direct evidence.

At least two studies have identified pathological lesions in specific organs, including the liver, kidneys, and heart (1,2). This demonstrates that periodontal disease is associated with detectable abnormalities in the tissues of these organs. It seems likely that this could also affect the function of these organs and the well-being of the individuals with such lesions, but this was not evaluated  by these studies.

At least one study has taken the next step and evaluated the association between periodontitis and actual disease in another organ system (3). A strong, linear association was identified between dental disease and chronic kidney disease, and while this does not prove dental disease causes kidney disease, it suggests that untreated periodontitis may be an important risk factor for kidney disease in dogs.

A similar study also suggested that periodontal disease may be associated with cardiac disease as well as pathologic lesions in the heart (4). However, there were significant methodological problems with this study, and other investigations have not found a link between dental disease and heart disease in dogs, so there is still controversy about this potential association (5,6).

Finally, one study has looked at common bloodwork variables and measures on inflammation in association with periodontal disease and its treatment (7). A few significant associations were identified, but there was no clear pattern suggesting a causal relationship between periodontitis and any particular disease.

Bottom Line
Dental disease, especially periodontal disease, is very common in dogs and cats. Though affected pets rarely show obvious or severe symptoms, periodontal disease is undoubtedly a source of significant discomfort. The only accurate way to diagnose, characterize, and treat periodontal disease is with a thorough oral examination, dental x-rays, and appropriate cleaning and often extraction or endodontic treatment of infected teeth. This can only be accomplished under general anesthesia.

There is good reason to believe proper prevention and treatment of periodontal disease makes dogs and cats more comfortable. In humans, it is also clear that such prevention and treatment improves health and reduces the risk and severity of other specific diseases. It is likely this is also true in dogs and cats, but the current research evidence regarding this claim is extremely limited.

References

  1. DeBowes LJ, Mosier D, Logan E, Harvey CE, Lowry S, Richardson DC. Association of periodontal disease and histologic lesions in multiple organs from 45 dogs. J Vet Dent 1996; 13:57-60.
  2. Pavlica Z, Petelin M, Juntes P, Eržen D, et al. Periodontal disease burden and pathological changes in organs of dogs. J Vet Dent 2008; 25: 97-105.
  3. Glickman LT, Glickman NW, Moore GE, Lund EM, Lantz GC, Pressler BM. Association between chronic azotemic kidney disease and the severity of periodontal disease in dogs. Prev Vet Med 2011; 99: 193-200.
  4. Glickman LT, Glickman NW, Moore GE, Goldstein GS, Lewis HB. Evaluation of the risk of endocarditis and other cardiovascular events on the basis of the severity of periodontal disease in dogs. J Am Vet Med Assoc 2009; 234: 486-494.
  5. Pavlica Z, Petelin M, Juntes P, Erzen D, Crossley DA, Skaleric U. Periodontal disease burden and pathological changes in organs of dogs. J Vet Dent. 2008 Jun;25(2):97-105.

  6. Peddle GD, Drobatz KJ, Harvey CE, Adams A, Sleeper MM. Association of periodontal disease, oral procedures, and other clinical findings with bacterial endocarditis in dogs. J Am Vet Med Assoc. 2009 Jan 1;234(1):100-7.
     
  7. Rawlinson JE, Goldstein RE, Reiter AM, Attwater DZ, Harvey CE. Association of periodontal disease with systemic health indices in dogs and the systemic response to treatment of periodontal disease. J Am Vet Med Assoc 2011; 238: 601-609.
This entry was posted in Science-Based Veterinary Medicine. Bookmark the permalink.

18 Responses to Dental Disease in Dogs and Cats: Does Treatment Improve Health?

  1. Rita says:

    Oh great, the day before I have to go to the dentist myself 🙁

  2. skeptvet says:

    I’ve had more than my share of dental work, but every time I think how much worse it would be without it! Good luck.

  3. Diane S says:

    Interesting how the same things happen in dogs/cats/humans. My dog is diabetic, taking insulin 2x a day, and I’ve been wondering about dental work on him. The only drawback is he is a 15 year old dog, and the vets say that anesthesia on an older dog is more dangerous. I guess time to get out the Poultry Toothpaste that we have the new kitten on, and start brushing his teeth.

  4. Art says:

    Evidence based human dentistry is a good read. Polishing is done for non medical reasons, suture after extraction questional, dental cleaning without gingivitis evidence is like the annual exam with unproven promotion, treating cavities with floride rather than fillings, use of antibiotics before and after, silver filling that last longer than new white ones, use of sedation rather than anesthesia in mentally challenged patients and putting teeth back in that have been ripped out all are good reads when one looks for evidence. Attempts in Florida to require dental X-ray machines for pets got no where. Imagine deep cleanings and extractions in human medicine with no X-ray documentation. What vets need is a test for dental pain.
    Art Malernee Dvm

  5. v.t. says:

    Art said: “What vets need is a test for dental pain.

    Beyond xrays, (limited) exam, appearance and flinching by the pet in pain, drooling, anorexia, grinding teeth, head tilting etc, what more could there be?

  6. Art says:

    Word on the street the boarded dental vet pulled out of this study when he did not agree there was no pathology missed. I loose a lot of clients because I do not do the “proprietary move”. I had my dentist do a root clean on one side of one tooth of mine and it hurt without a local anesthetic. The study needs repeated ASAP and the controversy about pain somehow addressed.

    http://www.ivcjournal.com/research-studies/professional-outpatient-preventive-dentistry-popd-can-it-be-done-safely-and-effectively-without-the-use-of-general-anesthesia/

  7. Diane says:

    That is fascinating. I’d love to hear what the boarded dentist had to say. I was just at the human dentist myself a few weeks ago for my first cleaning in 2 or 3 years, and even though I had no gingivitis or visible tartar, routine hand-scaling of the subgingival tartar was extremely uncomfortable, and the tartar was so significant that it required two separate sessions. I wouldn’t do that to an animal.

  8. Art says:

    Once we collated the raw data there was a significant amount of pathology missed on their side. Unfortunately we could not agree how to interpret the results and after three revisions of their manuscript I asked them to take my name and association off the study.

  9. Peter Pienkowski says:

    Maybe dental issues could have a revisit, been a while since you covered them. I’m wondering about your opinion on Oravet Chews (and generally delmopinol vs other chews) versus standard brushing, etc. Thanks again for the great blog and work!

  10. Art Malernee Dvm says:

    did the vet school at Pennsylvania ever finish the anesthetic free dental study? All we have is the positive prospective study Jan bellows did that ended in a food fight with others in the study.

  11. skeptvet says:

    Thanks, I’ll add this to my list of future topics.

  12. art malernee dvm says:

    Chlorhexidine is considered the Gold Standard for topical oral disinfection.

    Chlorhexidine was removed from the Veggie chews made by Virbac and it did not change the VOHC approval. I have lost even more confidence in VOHC approval. VOHC said the change in formula would not change approval.

  13. L says:

    I brush my dogs teeth every day with excellent results, however, my 9 pound 8 year old has a bad tooth in the back, it’s loose and causing some pain….

    I have an appointment for Wednesday for a quick extraction (the rest of her teeth look pristine) I am a little nervous because the vet says he will use gas as it will be a 10 minute procedure. Is this okay? I guess I’m just looking for a little reassurance.

    She went through this about a year ago, but I got lucky and the tooth fell out, root and all, on it’s own! I am hoping this may happen again before Wednesday. Any thoughts from the vets out there? Thanks in advance.
    I love this site and find it extremely helpful 🙂

  14. L says:

    Ps: I just moved the appointment for the extraction up, going in on Monday.

  15. L says:

    Update
    All went well!

  16. skeptvet says:

    This may be sufficient if there is truly only one tooth that is a problem. However, the periodontal disease that causes loose and painful teeth is under the gum line, so it cannot be seen by looking in the mouth. An effective evaluation of dental health requires x-rays, which is why we have this done regularly when we go to the dentist. And if teeth are to be extracted, there should be x-rays taken before and after to evaluate the bone health and make sure no root remnants are left to cause problems. I recommend not just symptomatic removal of the tooth with the obvious problem but a thorough evaluation, including x-rays, which is likely to take longer than just a few minutes. And I don’t recommend dental work without intubating (placing a tube in the airway to control anesthesia and oxygen levels and protect the airway from blood, saliva, and other fluids and debris). As you know from your own experience, dentistry is wet and messy, and while we can protect our own windpipe durin dental treatment because we are awake, anesthetized pets cannot and so should be intubated.

    Doing dentistry properly is more time-consuming and expensive than taking shortcuts, but I believe it is better for the patients.

  17. skeptvet says:

    Glad to hear it. Sorry I was out of town and didn’t get back to you in time.

  18. L says:

    Thank you. I went along with what was recommended. The next time, I will ask for x-rays.

Leave a Reply

Your email address will not be published. Required fields are marked *

This blog is kept spam free by WP-SpamFree.