Tuesdays with Shlomo

Dental health

Dr. Shlomo Freiman
February 27, 2024

How important is dental health for your pet? A few decades ago, it wasn’t even a thing. Now, however, it’s become a prominent part of caring for your pet. At the pet store, you’ll find everything from treats to enzymes to finger-mounted toothbrushes to help keep your pet’s teeth clean.

How do you keep track of it all? What works, what doesn’t? Do you need to brush your dog’s teeth every day? Your cat’s? What kind of professional care should your pet be getting?

In this edition of Tuesdays with Shlomo, Dr. Shlomo Freiman answers all those questions and more. While we don’t delve into more specialized topics like, say, large animal dentistry, Dr. Freiman does a great job demystifying oral care for both dogs and cats. If you, like many pet parents, want to protect your pet’s teeth and gums but don’t know where to start, start here.

First off, what are the main issues pet parents should be worried about with regard to dental health? Are there any signs or symptoms people should be looking out for at home?

From the pet parents’ perspective, things like odor can tell you something is wrong. Visually, pet parents should look at the amount of inflammation of the gum and the amount of buildup or tartar on the teeth. As I always say, it’s good to look on a regular basis so you know what normal is. You also want to pull back their cheek and check all the way in the back, not just upfront by the incisors, because those are the most vulnerable teeth, and they are the most hidden ones. Now, if things are really bad, you might be seeing blood on the food or your dog might be having issues with chewing. Ideally, we would catch anything before it came to that.

Is dental health in pets something we have become aware of or more mindful of recently? Because I feel like when I was growing up, dental health was not really a part of pet health. I remember seeing maybe a couple of chew toys that said something about helping make your dog’s teeth strong, but I certainly didn’t hear of anyone brushing their dog’s teeth.

That’s a very good question, and I think the answer is multifactorial. The first part of the answer is that as pets became more a part of the family and more of a companion, rather than just running around in the barn, we started to want to do more for them. Plus, with pets spending more and more of their time in the home, we’re smelling more and more of their breath! Another factor is that, just like for humans, our understanding of oral health is not the same as it was — I don’t know — 80 years ago.

Very true.

To some degree, the pet world is just catching up with the human standard. Part of that is happening on the veterinary side as well, as more and more veterinarians are equipped to provide dental x-rays, dental cleanings, and so on. This used to be something that was just at the edge of services that regular family veterinarian provides, but now almost all veterinary clinics have the right machines and training.

So veterinarians are essentially doing double duty as dentists and doctors for pets?

Yes. In a lot of practices, dentistry is a big part of their philosophy and what they do. As far as procedures go, I will tell you a little secret: most practices these days probably do more dental procedures than they do spay and neuters.

Wow, that is surprising.

Definitely more than surgery.
I mean, it makes sense. It’s non-invasive and it’s probably something that needs to happen pretty frequently, right? It’s mostly cleanings, I’d imagine.

That varies based on the specific practice. But in general, dental procedures mean anything from a routine dental cleaning like you and I get to extractions to treating gum disease or even doing oral surgeries for tumors. A lot is going on in the mouth! But yes, for the most part, it is cleaning. The idea is to be proactive and prevent having to do an extraction or oral surgery.

Our favorite theme is being proactive and preventative! I think we’ve said, “It’s so much better to catch it early,” once in every edition of this. But to that end, what are some things people can do besides just checking their pet’s teeth? Like are there special diets or toys or treats or stuff like that that work well?

Firstly, by the time you have a problem that’s noticeable when you check their teeth, there’s probably not much that you as a pet parent can do at home. And while there are a lot of things you can do proactively, I also want to make sure to say that genetics are a big factor here. Some pets are just going to have gum disease or bad teeth; you can’t change genetics. I’ve seen little chihuahuas that are very prone to dental disease and have been fine with no intervention, and then I’ve also seen big dogs that typically don’t have many dental problems exhibit major issues early on. But on the topic of what pet parents can do, I think routine oral care is very important. This can be anything from brushing your pet’s teeth to using special toys and devices that create friction to essentially brush their own teeth. I like a product called Bristle Bone. There’s also diet. The brand Hill’s makes a line of food called TD Dental that has special fibers that create friction. Anything that’s creating friction is achieving essentially the same effect as your toothbrush.

There are also supplements you can add to your pet’s water that can help with oral hygiene, by creating the right type of bacteria in the mouth. There are some chews with enzymes. But ultimately, a lot of it comes down to creating an oral care routine for your pet, just like the ones you and I have for ourselves. We floss, we brush.

We do, but are people expected to brush a pet’s teeth every day now? Or twice a day, even?

I mean, every time I go to the dentist, there is some new gadget they want us to use. And I use them all. I probably spend 20 minutes before bed and in the morning on the teeth cleaning routine. But not everyone can make that commitment for their pet. And even for ourselves, when we do give that much attention to our oral health, we still need to get our mouths professionally cleaned once a year.

Or twice.

Yes. Similarly, even if you do everything “right” for your pet, you still will have to get their teeth cleaned on a regular basis. That’s the best kind of advice that I can give. They need to get a dental cleaning on a somewhat regular basis. But you asked me about brushing. How often? Well, look, I tell people you have to be realistic. Whatever it is that I recommend, it’s easier said than done. For some people, it’s not a problem. They can brush their dog or cat’s mouth twice a day. Excellent. Do it! I have clients in assisted living, and for them, their pet is their life. They spend all day with their pet, so spending that extra time is no issue. But for most people, it’s not that easy. The main thing is to do the best you can and be consistent. Try to stick to it. Maybe it’ll be twice a week in your situation. Maybe your pet won’t let you brush at all. That’s okay. Try some of those alternatives like the Bristle Bone and just make sure they get their regular cleanings.

So, are there animals that are really resistant to brushing? I haven’t had a dog since I was a kid and I think Catticus would have taken my entire arm off if I tried, so I’ve never tried. But I guess Catticus’ temperament kind of answers that question.

Exactly. Some pets would not let anyone do it. Not only the brushing but even just trying to open their mouth and check their teeth. Certain breeds of dogs, especially with the “smoosh” face like pugs or certain bulldogs, where they already have issues with breathing, really don’t like people messing with their faces because it makes them even more anxious about breathing. In general, I recommend that when people get a kitten or a puppy, they start handling their pet’s mouth early. That way the pet is used to it. You can even make it a fun thing by giving treats. I would advise to start by putting peanut butter in there as a snack. You can move on to kind of scrubbing their teeth with your finger and eventually to a brush. Did you know they make flavored toothpaste for pets? Don’t try it yourself, of course, but there is tuna-flavored toothpaste!

Okay, not going to lie, I would probably try it once.

[Laughs] Good luck with that! But anyway, if you do all of these things, you have a reasonable chance of providing your pet with a good dental health routine. Do as much as you can, do as much as your pet is comfortable with and, if you can’t brush their teeth, make sure they’re getting some sort of friction when chewing. Either through toys, diet, or both. Besides that, it’s just the regular cleaning that you need to think about. You should pay attention to your pet’s oral hygiene, but you don’t need to be obsessed.

Earlier you mentioned differences in kind of innate or genetic health between certain breeds of dogs. Are there similar differences in cats? And then more broadly, are there differences just between dogs and cats in terms of what their dental issues are?

There’s some similarity between dogs and cats. Plaque is plaque, and gingivitis and oral gum disease are similar to both, but there are unique things that we see in dogs that we don’t see in cats, and vice versa. Cats often have a lot of erosion of the teeth. It’s very painful and that might not be obvious to the pet parents. Not to be a broken record, but that’s another reason why doing a regular or annual evaluation of the oral cavity is so important. A cat’s teeth can look perfect from the outside, but when you take an x-rays you’ll often see a lot of erosion. In the canine world — and I’m making some generalizations here — there are breed predispositions. Overall, the smaller the breed, the more likely they’re going to have teeth issues earlier in life. But it’s not always that way. Greyhounds are not small dogs, but they typically have horrible teeth. And it can also vary from individual dog to individual dog.

You mentioned tooth erosion in cats and it got me thinking about dry food. Are there any issues with animals eating hard kibble or is that generally fine up until they have a problem with their teeth?

With cats, it’s a little bit of a dilemma because dry food is better for the teeth because it creates friction, but wet food is better in other ways, e.g. it has a higher moisture content, higher protein content usually, and key carbohydrates. I usually advise clients to give wet food but maybe add some dry food as a type of dental supplement. Mix it in. It is a bit of a dilemma, what’s good for the teeth is not necessarily good for overall health. You know what’s funny though? The best diet for a cat is actually rodents. They’ve got everything: crunchy stuff, soft stuff, lots of moisture and they’re in high protein. But for most people, it is obviously not practical to feed only rodents. I have had clients that have done it. It’s possible — you can go to a pet store and get the same frozen mice you would feed to reptiles — but it’s a bit… eccentric.

No way.

Way. I’ve had a handful of clients over the years who did that for their cats.Well, that’s certainly an interesting diet tip. Sadly, I could never get Catticus to eat a rodent. He was a strict bird eater. Only things with wings! Moving on, you mentioned age as a factor in how many issues they might have. Is it similar to humans, where at some point as we age, our teeth just age, and replacement or removal is inevitable?Yeah, there’s a lot of wear and tear on teeth and gum tissue. But just like in humans, taking care of your oral hygiene both, at home and with a professional can make a huge difference. Plenty of people are very old with healthy teeth, but it takes a lot of effort. The same strategy applies to dogs and cats. A good routine combined with regular checkups can go a long way.

You said earlier you’d talk about what “regular” means for pets. How regular is regular?

You and I usually go to the dentist once or twice a year, right? However, for dogs and cats, you have to put them under anesthesia to get the teeth cleaned. There’s a controversy around non-anesthetic dental care. I want to say that I’m strongly against it. I don’t think, unfortunately, you can do a good job deep cleaning their teeth without anesthesia. You can’t truly get to all of their teeth while they are awake and you definitely cannot take x-rays. The good news is that it’s an extremely safe procedure with modern anesthetics and monitoring. The newer drugs we use get out of the system very quickly. Having said that, it’s still expensive. To me, it’s not something you want to be doing automatically once or twice a year. Some dogs might need a cleaning that frequently, but for the vast majority, it’s more of a case-by-case basis. The oral cavity should be visually evaluated by the vet every year, of course, but the regularity of the full cleaning and x-ray procedure should depend on the dog, their lifestyle, their genetics, and so on.

That makes sense. So, the last thing I wanted to ask about is maybe more for the pet parents than the pets. You mentioned bad breath as a sign or a symptom of dental issues. If you are taking good care of your pet’s oral health, can you as a pet parent expect to see a reduction in bad breath? Can you even expect to eliminate the issue of smelling your pet’s bad breath completely?

There’s a short and long answer. The short answer is yes. The long answer is that in most cases the smell comes from bacteria in the mouth, so if you have a lot of bacteria and plaque (which is bacteria) you’re going to have more smell. All the good oral hygiene we talked about — the cleaning, the brushing, maybe supplementing the water — can help. But at the end of the day, some oral health issues are genetic and there is innate variability in the composition of bacteria and the smell of the oral cavity. Mondo, my Jack Russell Terrier, whom we’ve talked about many, many times, had the best oral care you can get. He was a chewer and he would be on his Bristle Bone all day. He got his teeth cleaned a couple of times a year because it was easy for me to do it myself. Even so, he had unbelievably bad breath. That’s just the way he was. And guess what? He loved to give kisses. So for Mondo, having good teeth didn’t really help his breath, but in general, if you keep good oral hygiene then, yes, it will make a difference.

There is some hope.

There is some hope, absolutely.

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