How To Treat Dog or Cat Dental Disease Without Getting Ripped Off

I work primarily with non-profit organizations, shelters, animal rescues and on Sundays, I work at vaccine clinics in pet stores. My interactions with the public during these Sunday clinics have made me realize there is a great deal of confusion about dental disease in pets amongst the general public. Many owners are unaware of the severity of the disease and suffering their pet is experiencing. Many of these pets get vaccines year after year from these pet store vaccine clinics, and have not entered a full service veterinary clinic for a complete and thorough exam and veterinary advice for many years, if ever.

When I point out the severity of their pet's dental disease and explain how they need to go to a full service veterinarian for treatment, people are often reluctant to take my advice because they are worried about the cost. They ask me if there are any products they can use at home instead. Unfortunately, when tartar and plaque build up too much, and the pet has gingivitis and gingival recession have set in, trying to treat with products at home becomes a futile task. In this article, I will discuss how to get the most value out of dental care for your pet.

As a veterinarian who works for non-profits, and is heavily involved in animal welfare, my goal is to be able to help as many animals as possible, provide them with the best care for the lowest cost. I seek no financial gain in making these recommendations, I don't profit from performing dentals, these are just the facts and my goal is to reduce animal suffering and improve the human-animal bond.

Dental disease is a huge problem causing pain and illness for the pet, as well as bad breath that can limit the closeness you feel towards your pet. Because of this enormous problem, many companies have started to crop up in an attempt to capitalize on this “pain point”. Beware though, many of these new products will just waste your money and not help your pet, and some can do more harm than good.

Before dental disease takes hold, the gold standard in preventative dental care is daily tooth brushing. Be sure to only use toothpaste intended for pets, not human toothpaste. Start when they are young and that will make the process easy and enjoyable. For step by step instructions on how to brush your dog’s teeth visit http://www.veterinarypartner.com/Content.plx?P=A&A=171. Here is a great video about how to examine and brush your dog’s teeth https://www.youtube.com/watch?v=PsNlLLSBWLU.

Additional products such as food, gels, water additives and treats that promote dental health can be effective as well, but beware of those products that don’t work at all. To sort through the weeds visit the Veterinary Oral Health Council (VOHC) website (http://www.vohc.org/accepted_products.htm). The VOHC is a group of veterinary dentists and dental scientists that seeks to recognize products that meet standards of plaque and tartar reduction. Their goal was to find an effective means of recognizing products on the market that actually work. Unfortunately though, they are veterinarians and scientists, they don’t know anything about marketing, and sadly their website shows it. But, it contains good information, just no glitz or glamour because they are not trying to sell you anything!

Many products without the VOHC seal of approval can actually be dangerous for your pet. Many water additives available at pet stores have xylitol in them which is toxic to dogs! One good water additive, with the VOHC seal of approval is HealthyMouth, you can check this product out at https://www.healthymouth.com/.

At your yearly veterinary exam, your veterinarian will closely examine your pets teeth. Let them know if you have noticed any changes in your pet’s mouth or breath. If your veterinarian sees build up of tartar, plaque, gingivitis, fractured teeth or other problems, they will recommend a “dental” under anesthesia to investigate further. Severe and prolonged dental disease can lead to bone loss around the teeth, fractured mandibles, heart, liver and kidney problems. Many scientists believe chronic inflammation in humans can lead to cancer formation. Likewise, chronic inflammation in the mouth of your pet may also put your pet at risk for cancer.

For a great list of frequently asked questions about dental disease in pets please visit this page: http://www.wellpets.com/faqs/#15 I am not affiliated with him in any way, but he does have a fantastic website with great content.

Many owners will state that their pets acted years younger after a dental cleaning and treatment. Before the dental, they were living with chronic pain, and their owners never realized it. After the treatment, and painful teeth were treated, the pets suddenly appear happier again.

When preparing for a dental cleaning and treatment for your pet it is important to understand what you are getting for your money. The cost of the procedure can vary widely depending on the level of care your veterinarian is able to provide, and a $200 procedure may not be the same as a $1000+ procedure.

In the past, anesthesia was more risky, you may have even heard of a pet dying during or after a dental in the past. Nowadays with modern technology, anesthesia is relatively safe, but you want to make sure your veterinarian is up to date on the current standard of care. Many older veterinarians, even some with television shows, are not performing dentals using modern standards that increase safety. Modern techniques prevent common problems with anesthesia that include: hypothermia, dehydration and pain. Pre-anesthesia bloodwork is important to determine if your pet’s organs can handle the anesthesia medications and metabolize them effectively. Underlying organ disease can cause problems with anesthesia.

    The following list are the bare minimum services a dental procedure should include:

• - a full set of dental radiographs

• - pre-anesthesia bloodwork

• - an IV catheter and IV fluids

• - endotracheal intubation, oxygen and inhaled anesthetic

• - patient warming during anesthesia with circulating warm air (a BAIR hugger or similar)

• - anesthesia monitoring including SPO2, ECG, temperature and blood pressure

• - supragingival scaling, subgingival scaling, polishing and lavage of gingival sulcus.

• - pain medication during and after the procedure

• - local blocks (like novocaine) if any extractions (removal of teeth) is performed.

Take the above list with you and talk with your veterinarian about what they offer.

Why Does My Pet Need Dental Radiographs?

Many veterinarians point out that dental radiographs increase the cost and make it less likely that owners will be able to afford a much needed dental for their pets. Many veterinarians feel that even if owners are unwilling to pay for dental radiographs, they can still do a decent job and help the pet feel more comfortable while limiting the cost to the owner. This is the nature of the veterinary profession, to want to help animals while limiting the cost to the owner. We want to make it as affordable as possible because we want to be able to help the pet.

However, studies have shown that in a large percentage of cases, dental radiographs uncover clinically significant findings in what would appear to be superficially normal looking teeth. How awful would it be to have just spent hundreds on a dental for your pet and then a week or two later your pet's face is swollen because there was an abscessed premolar that looked normal at the time of the dental, but dental radiographs uncovered that it should have been extracted? Dental radiographs do increase the cost, but it is usually 10-20% of the total cost of the procedure and well worth it. The pet is already under anesthesia for the dental, you might as well do it right. 

To read more about the studies showing the benefit of dental radiographs click here. 

Why are dentals so expensive?

Dentals take a lot of time and expensive equipment, there is no way around that. Many believe veterinarians are getting rich off of recommending unnecessary dental procedures and that just isn’t the case. There are too many animals that need real care and too little time to make up problems that don’t exist. Veterinarians got into this field for the love of animals, not to make money. If they became veterinarians to make a lot of money, they were very unwise. The average salary of veterinarians is declining, while student loan debt and the cost of equipment and medications has gone up.

The average salary of a veterinarian is about $91k a year according to the 2011 Bureau of Labor Statistics. Becoming a veterinarian takes 8+ years of schooling, and most new graduate veterinarians have $150,000+ in student loans and 8+ years of lost earning potential while in school. Veterinarians make the same amount as physician’s assistants and many nurses which takes less education.

The cost of supplies for veterinarians has increased dramatically. For example, just 3 years ago, the cost of a box of IV fluids was about $20, now it is around $100. Many generic antibiotics such as doxycycline have skyrocketed in price by 10x. The cost of anesthesia monitoring equipment and anesthesia machines can cost $10,000 and need to be serviced and replaced periodically. Dental radiograph equipment can also cost $40,000+ and ultrasonic dental scaling and polishing machines and tools can cost $5,000+ and need to be serviced and replaced regularly.

Most veterinarians wish they could provide their services free of charge, and all the supplies, equipment, labor and real estate that goes into providing care would not cost any money, and all pets could be treated for free, but unfortunately, that is not the case.

You can read more about the financial problems facing veterinarians in this article: http://www.newswise.com/articles/view/627812/?sc=swhr&xy=5025791.

Anesthesia-free pet dentistry (AFD) is becoming more prominent. Unfortunately, this service is doing more harm than good to pets. It is tempting to believe their claims because it offers a cheaper alternative, and no anesthesia. But, if it is too good to be true, it probably is. For more information, you can visit Dr. Tony M. Woodward’s website, where he posted a fantastic article on AFD and documented cases he has seen of pet’s suffering from the aftermath http://www.wellpets.com/anesthesia-free-vet-dentistry/.

• Click here to see a picture of a dog that had undergone anesthesia free dentistry. You will notice that the teeth are pearly white, but there is gingivitis and dental calculus build up at the gumline. All of the incisors were loose to the touch and painful.

Why Aren't There Low Cost Dental Clinics Like Low Cost Spay/Neuter Clinics?

I work for low-cost non-profit spay-neuter clinics and have often pondered if it could be possible to set up a low-cost dental clinics. The goal would be to decrease the cost to pet owners and provide the valuable dental treatments these pets need. I have run the numbers and I do not think it is possible to perform this service better and for less money than what full-service veterinary clinics are currently providing without a significant multi-million dollar endowment from a generous donor.

Non-profit spay neuter clinics are able to exist and provide spay/neuter services at dramatically reduced costs and/or free because of generous donations as well as many tax-payer funded programs. When you take your pet to a low cost spay neuter clinic, even if you pay for it, you are likely only paying a small portion of what it really costs to spay and neuter your pets and your friends, family and neighbors are paying the remaining portion. This has all been made possible because the public has realized that intact animals lead to pet over-population, bite injuries, damage to property, and massive expense due to having to house and euthanize these millions of unwanted and sometimes dangerous animals in animal shelters. The public has come to realize that funds spent to spay and neuter your friends and neighbors animals is ultimately, more affordable than the alternative of unwanted litters and hoards of unwanted animals roaming the street wreaking havoc.

Unfortunately, dental disease does not have the same massive public health implications, so funding is not available to start low cost dental clinics. Often your local SPCA, may be able to help you out if you are low-income and on government assistance, but they are being stretched thin.

Luckily, dental disease is usually not an emergency, and is a predictable expense in the life of your animal. So while you have a cute little puppy with healthy teeth, start putting away some funds for the inevitable day when a big veterinary expense will come up. I highly recommend Trupanion insurance, I have it for my own dog, and I am not sponsored by them in any way, I do not profit by recommending them. However, Trupanion and other insurance companies will probably not fund routine dental cleanings, so that is something you will have to save and plan for.

I hope you enjoyed this article. It is a work in progress. If you have any questions, or would like me to clarify anything please comment or email me at vetharmony@yahoo.com.

The Truth About Spaying And Neutering Dogs and Cats

dog licking testicles

Spaying and neutering those in your care is an important part of caring for dogs and cats. Overall, you are likely to have a more rewarding and longer relationship with them if they are altered at a young age. Unfortunately, some poor quality studies out of UC Davis have added a level of confusion about the topic. Those who sexually exploit animals for profit are now telling folks not to spay and neuter and citing these studies as proof of their position. This advice can be extremely detrimental not only to the individual, but the population as a whole.

Dogs and Cats Will Likely Live a Longer and Happier Life After Neutering

These studies are flawed, and those of us who take care of animals should be careful when conclusions from this information. Poor information has spread through the media, leading many to express concern regarding spaying and neutering. Media reports claim these studies prove that altering dogs can cause cancer and joint disease.

My goal of this blog post is to help explain to lay folks, the problems with these studies, how the conclusions they have reached could lead to people making choices that could lead deleterious consequences for their those in their care and why it is important to spay and neuter, and what age it should be performed.

The two studies in question are Long-Term Health Effects of Neutering Dogs: Comparison of Labrador Retrievers with Golden Retrievers, authors Hart, B.L et al. and Neutering Dogs: Effects on Joint Disorders and Cancers in Golden Retrievers by Hart, B.L et al. Lead investigator Benjamin Hart, professor emeritus in the School of Veterinary Medicine says “We found in both breeds that neutering before the age of 6 months, which is common practice in the United States, significantly increased the occurrence of joint disorders – especially in the golden retrievers.” The study’s data shows that neutering before the age of 6 months in Labrador Retrievers doubles the rate of joint disorders from 5% to 10% of dogs. And neutering in Golden Retrievers before 6 months of age increased the incidence of joint disorders 4 to 5 times. Hart explains these findings by suggesting “the effects of neutering during the first year of a dog’s life, especially in larger breeds, undoubtedly reflects the vulnerability of their joints to the delayed closure of long-bone growth plates, when neutering removes the gonadal, or sex, hormones”. Undoubtably? He says? Not so fast.

Flawed Research Threatens Animal Health

The major flaw with this study is that it was performed at a teaching hospital. This skews the data quite a bit. Teaching hospitals attract high end clientele that have generally more money to spend on someone in their care, have had the foresight to obtain health insurance, or are generally more closely bonded to those in their care. Teaching hospitals have access to orthopedic surgeons and have the ability to treat CCL (cranial cruciate ligament) tears, hip dysplasia, and elbow dysplasia. These surgeries cost thousands of dollars.

From my own experience as a veterinarian, those with spayed and neutered individuals in their family are generally higher income clients, are more closely bonded to their family members and/or have higher education levels overall. They are more likely to accept my referral to a teaching hospital for surgical treatment of their dog’s orthopedic disease. On the contrary, owners of intact animals are usually lower income, or choose to spend less money on their animal’s veterinary care, are less likely to have pet insurance, and are not as closely bonded to those in their care, possibly due to the animal’s undesirable hormone-influenced behavior. Many of these folks did not even want to pay to have the dog or cat altered in the first place. They are far less likely to accept my referral to a teaching hospital, so these animals would never be counted in this study’s numbers. Very rarely, an intact dog may be a champion show dog or a valuable breeder, but these are a very small percentage of the intact dog population.

The study’s data also shows that spaying female Golden Retrievers at any age over 6 months of age elevated the risk of 1 or more cancers 3-4 times the level of non-spayed females. “The striking effect of neutering in female golden retrievers, compared to male and female Labradors and male goldens, suggests that in female goldens the sex hormones have a protective effect against cancers throughout most of the dog’s life,” Hart said. Again we have the same problem. The teaching hospital is not a true snapshot of the population as a whole. For these numbers to be accurate, we need to look at what general practitioners are seeing in their practices, and even then, we might not get an accurate view, because there are many dogs that never come into contact with a veterinarian, and these are more likely to be intact dogs.

Mammary Cancers and Pyometras Kill Unspayed Dogs

The authors of the study claim spaying dogs has little effect on the incidence of mammary tumors in Golden Retrievers, which is not consistent general practitioner experiences. It should be noted that they did exclude dogs that were older than 9 years old for this study, which is an interesting choice, given that they are studying joint disease and cancer, likely in attempt to decrease noise from confounding age related factors. They also excluded dogs from the study who they could not confirm the date of alteration, so they were also excluding neutered pets from the study.

Growing up, my family had two intact Golden Retrievers die of mammary cancer, and unfortunately, my family would not have taken them to the teaching hospital for further treatment or surgery, so these dogs would have not been included as part of the study. In general practice, we see quite a few cases of mammary cancer in all breeds and I personally have never seen a case of mammary cancer in a dog that was spayed before one year of age. The mammary tumors we see are in intact dogs, or dogs that were spayed later in life. Mammary tumors represent 42% of the tumors found on female dogs (Johnson, 1993). Previous studies have shown spayed dogs had a 3 to 7 times lower incidence of mammary tumours than the intact ones (Mulligan 1975; Priester 1979; Hahn et al. 1992; Alenza et al. 2000). Studies have also shown that if a dog is spayed before their first heat, the chances of developing mammary cancer later in life is 0.5%. If a dog is spayed between their first and second heat, their chances of getting mammary cancer are 8%, older dogs have a 26% chance of getting mammary cancer if spayed after their second heat (Misdorp 1988; Schneider et al. 1969).

It is estimated that 60% of Golden Retrievers die of cancer, which is more than twice the average rate for all other breeds (Haven).While there are no studies looking at cancer rates among European vs American Golden Retrievers, many believe that the reason American Golden Retrievers have such high rates of cancer has more to do with genetics than whether or not they are intact or altered. European bred Golden Retrievers appear to have lower rates of cancer than American Golden Retrievers. Many point out that Europeans are less likely to spay and neuter their pets, so that is the reason for the lower rates of cancer. However, Australian Golden Retrievers are derived more from European lines than American lines, and Australians are more likely to spay and neuter their pets at rates similar to the United States, but their incidence of cancer is similar to that of Europeans. Therefore, cancer tendency appears to have more to do with genetics.

Pyometra Is Expensive To Treat And Life Threatening

And then there are pyometras, one of the most common diseases of intact dogs. A pyometra is a potentially life threatening infection of the uterus. One study found on average, 19% of all insured Swedish bitches were diagnosed with pyometra before the age of 10 years (Jipean et. al. 2012). Pyometras can be very expensive to treat and result in significant morbidity and mortality in affected dogs.

Urinary Incontinence Is Only Weakly Associated With Spaying And Can Be Treated Medically

    Many of us who have dog family members are concerned that spaying our dogs could lead to acquired urinary incontinence. Several studies have been published that suggest that spaying dogs, especially large breed dogs, could result in urethral sphincter mechanism incontinence, or estrogen responsive incontinence. A recent 2012 review by Beauvis et.al. indicates that the evidence to support this is lacking. The review of the literature concludes "there is only weak evidence that neutering bitches, particularly before the age of three months, increases the risk of urinary incontinence." Unlike mammary tumors and pyometras, urinary incontinence is not a life-threatening disease and can be treated with medication. Therefore, the decision not to spay a dog, should not be based on the risk of post-spay urinary incontinence.

Behavior Problems In Intact Dogs Leads To Pets Being Relinquished To Shelters

I have spoken to many caring, intelligent owners who have looked at the work done by Hart et. al. and Torres de la Riva et. al. and were considering not altering their animals based on this information, and unfortunately, that would be a huge mistake. For female dogs left intact, the risks of mammary cancer, pyometras and unwanted litters and possible dystocias, are a huge concern that will lead to severe morbidity, mortality as well as expense. For male dogs, the risks of behavior problems such as aggression, roaming, marking behavior, diminished human-animal bond due to testosterone related behaviors are issues that should not be overlooked, as well as the morbidity and mortality caused by prostatitis and perianal adenomas. For both sexes, remember that lifespan has been shown to increase by 1.5 years if the animal is altered (Hoffman et. al. 2013).

The fact is, 83% of companion dogs are spayed or neutered in the United States, but only 10% of those entering shelters are spayed or neutered. Looking at these numbers, one could say that unaltered animals have a much higher rate of entering the shelters, and 31% of dogs that enter the shelter are euthanized according to the ASPCA (American Society for the Prevention of Cruelty to Animals). Many factors could lead to this finding. Those caring for intact animals are more likely to have lower incomes, spend less money on those in their care, be less bonded to them due to their undesirable hormone-influenced behaviors, and therefore more likely to give up their animals to the shelter when any barrier occurs, such as difficulty finding housing, a family member does not get along well with the pet, and medical problems.

Intact Individuals Have The Hormonal Drive To Breed

   Is it fair to to leave them with the hormonal drive to breed and then not allow them to breed? Well then, why not let them breed? Unfortunately, the unwanted companion animal population is a huge problem in this country. There are more than 70 million homeless dogs and cats in the United States. Of these homeless animals, only 6-8 million enter shelters every year, and 2.7 million pets are euthanized in shelters every year. Spaying and neutering, a long with educating humans who care for animals, can help mitigate the massive homeless dog and cat problem in this country.

    Many ask, is it fair to them to remove their sexual organs, because I wouldn't want my testicles removed! I believe this belief is mostly formulated by societal influence and has nothing to do with our innate characteristic. There are intact many castrated males and female humans today and throughout history that have lead normal and fulfilling lives. Remember what life was like before you reached puberty, when you got to live under only minimal influence of sex hormones? For many it was a wonderful, carefree time in our lives. What would middle and high school be like if all children could go through it without the influence of sex hormones? In fact, at Guide Dogs For The Blind, all dogs are spayed and neutered before they enter formal training.

Why You Should Not Consider Gonad-Sparing Procedures At This Time

     Many veterinarians are considering spaying dogs but leaving in the ovaries, and just removing the uterus to prevent the chance of post-spay urinary incontinence. When I contacted the California Veterinary Medical Board about this procedure, I was informed that this procedure was performed in the past, but due to the incidence of stump pyometras (infection of the uterine stump left behind) and mammary cancers, this procedure has fallen out of favor in the veterinary profession. Additionally, this procedure has not been well studied and it is not recommended at this time. The dog will still come into heat, and attract male dogs, and hormonal behavior problems (fighting amongst intact female dogs in the same household, which results in one of the dogs ending up in the shelter) will still be a problem. So while this sounds like a good idea, because it appears that you get the best of both worlds, the sterilization effect as well as maintaining the sexual hormones, it is not a good idea.

     Male dogs also have gonad sparing procedures available to them such as vasectomies and Zeuterin injections. A vasectomy prevents the dog from transferring sperm to a female dog but he maintains the ability to produce testosterone. He will still want to mate and will still have problems with aggression, marking, roaming (running away) and attraction to female dogs, but he will not be able to breed. Because of these undesirable male behaviors you still have the problem of owners not being satisfied with their dog, not gaining a close attachment to them and relinquishing them to the shelter. The roaming behavior is also still a problem and results in expensive veterinary costs due to dog fights and hit-by-car injuries.

      Zeuterin is a compound injected into the testicles that causes scarring and decreases the testicle's ability to produce sperm, some testosterone production is spared though, so you have the same problem as vasectomized dogs.

      Overall, these gonad sparing procedures leave the dogs with the ability to continue to produce sex hormones, and these sex hormones result in a shorter lifespan and poorer quality of life.

Please let me know what you think of this article and how you think it can be improved, and please share with your friends with dog and cat family members. This is a work in progress, thank you for your help!

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Beauvais, W., Cardwell, J. M. and Brodbelt, D. C. (2012), The effect of neutering on the risk of urinary incontinence in bitches – a systematic review. Journal of Small Animal Practice, 53: 198–204. doi:10.1111/j.1748-5827.2011.01176.x http://onlinelibrary.wiley.com/enhanced/doi/10.1111/j.1748-5827.2011.01176.x/

HAHN, KA, RICHARDSON, RC, KNAPP, DW 1992: Canine malignant mammary neoplasia: Biologic behavior, diagnosis, and treatement alternatives. J Am Anim Hosp Assoc 28: 251-256

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JOHNSON, SD 1993: Reproductive systems. In.: SLATTER, D (Ed).: Textbook of small animal surgery, 2nd edition. Saunders, Philadelphia, pp. 2177-2192

MISDORP, W 1988: Canine mammary tumours: Protective effect of late ovariectomy and stimulating effect of progestins. Vet Q 10: 26-33

MULLIGAN, RM 1975: Mammary cancer in the dog: A study of 120 cases. Am J Vet Res 36: 1391-1396

PRIESTER, WA 1979: Occurrence of mammary neoplasms in bitches in relation to breed, age, tumor type, and geographical region from which reported. J Small Anim Pract 20: 1-11.

SCHNEIDER, R, DORN, CR, TAYLOR, DO 1969: Factor influencing canine mammary cancer developments and post surgical survival. J Natl Cancer Inst 43: 1249-1261

Torres de la Riva G, Hart BL, Farver TB, Oberbauer AM, Messam LLM, Willits N, et al. (2013) Neutering Dogs: Effects on Joint Disorders and Cancers in Golden Retrievers. PLoS ONE 8(2): e55937. doi:10.1371/journal.pone.0055937 

Post-Declaw Pain Syndrome: Why you should not declaw your cat

Dr. Marty Becker just posted this fantastic piece on post-declaw pain syndrome in cats. Please read it and share with any friends who are considering declawing their cats. There are other options available!