FREQUENTLY ASKED
QUESTIONS
What is board
certification?
A board-certified veterinary dentist is a
graduate veterinarian who has completed
several years of residency training and has
passed comprehensive written and practical
examinations to become certified by the
American Veterinary Dental College (AVDC). The
AVDC is one of several specialty
organizations recognized nationally by the
American Veterinary Medical Association.
There are currently about 100 Diplomates of
the AVDC practicing in the U.S.
Why see a specialist?
The anatomy and physiology
of teeth and their surrounding structures
differ significantly from any other organ
system; as a result, the disciplines of
medicine and dentistry are taught separately
in the human field. In the same four-year
period that dental students devote
exclusively to the study of oral anatomy,
physiology and disease, veterinary students
must learn about multiple organ systems in
several species. Therefore, the amount of
time spent on oral disease in the veterinary
curriculum is limited, and general
practitioners may choose to refer to a
dental specialist for diagnosis and
treatment of oral disease.
Furthermore, many pets
with dental disease are geriatric and have
multiple medical problems, requiring more
intensive management for anesthesia. A
dental specialist will have undergone
additional training in anesthesia and may
therefore be more comfortable treating a
geriatric or medically-compromised patient.
Why does my pet need a
consultation first? Why can't we just come
in for the procedure?
Although your family
veterinarian may have examined your pet
recently, it is important for Dr. Lommer to
evaluate your pet prior to the procedure for
a number of reasons.
Most importantly, because
general anesthesia is required for all
dental procedures, Dr. Lommer needs to
perform a thorough physical examination on
your pet prior to the procedure. Rather than
taking a "one-size-fits-all" approach to
anesthesia, we tailor the anesthetic
protocol (including the types and dosages of
anesthetic drugs) to each individual
patient. It is important for us to get
to know your pet's medical history, current
physical condition, and personality in order
to select the best anesthetic regimen.
In addition, Dr. Lommer
may identify additional oral problems beyond
those identified on a routine physical
examination by a family practitioner. By
performing the initial examination at a
separate visit, we are better able to
schedule the appropriate amount of surgical
time for each patient.
How much will it cost?
While it is impossible to
give an accurate estimate without first
evaluating each pet for the extent of
plaque, calculus and gingivitis present,
most of our patients who have routine
cleanings (without extractions or advanced
periodontal therapy) have invoices in the
$750-950 range.
Why is it so expensive
to have my pet’s teeth cleaned?
Effective dental cleaning
requires anesthesia, which adds considerably
to the expense of the procedure.
Pre-anesthetic blood tests to evaluate
kidney and liver function, placement of an
intravenous catheter, administration of
intravenous fluids, and monitoring by a
veterinary nurse throughout anesthesia,
while adding to the cost, all decrease the
likelihood of complications. We use of
state-of-the-art ultrasonic scaling and
air-polishing techniques and equipment. In
addition, the cost of cleaning includes
full-mouth radiographs (x-rays) and
diagnostic dental charting, both important
tools in diagnosing oral disease.
 Why do you need to
take x-rays? My pet just needs a cleaning.
Plaque and tartar on the
teeth are not merely unpleasant, they are
often accompanied by inflammation in the
gums and tooth-supporting structures (bone
and connective tissue). Just as with other
organ systems, early diagnosis of problems
in the oral cavity can allow us to slow or
stop progression of the disease process. The
crown of the tooth is really just "the tip
of the iceberg". Intra-oral radiographs
(x-rays) allow us to evaluate the bone and
tooth-supporting structures, where the
majority of oral disease occurs, in addition
to the teeth themselves. (Photograph
by Joe Pettit, National Science
Foundation)
Why does my pet have to
be anesthetized for oral care? Why can't I
just use this spray I found online which
dissolves tartar?
Many "natural" or
"holistic" products claim to restore normal
oral health, get rid of "sewer breath", and
eliminate plaque and tartar from pets'
teeth. There are a number of problems with
these claims:
1. Most of these products
have not been tested for either safety or
efficacy. All medications with FDA approval
have undergone extensive testing to show
that a) they do what the manufacturer says
they do, and b) they are not toxic when used
as directed. For most "natural"
products on the market, there is no
published research to either confirm or
refute the manufacturer's claims that the
product improves oral health.
2. Even if the product
works to reduce surface tartar and plaque,
there's no way it can go below the gumline
or into periodontal pockets. So for pets
with pre-existing periodontal disease (which
must be diagnosed with dental x-rays and
charting under anesthesia), successful
use of such a product may give clients a
false sense of security that everything's ok
when there could be significant disease
below the gumline.
3. Most of these products
are advertised as an ALTERNATIVE to
professional dental care rather than an
adjunct to it. Without anesthesia,
periodontal probing, and intra-oral x-rays,
it is impossible to accurately evaluate a
pet's oral health. Some of these products
may indeed be useful to help reduce plaque
and tartar between professional cleanings,
and may help extend the time between
necessary cleanings by a veterinarian.
However, it is irresponsible of the
manufacturers to suggest that anesthesia is
incredibly risky and that, if you use their
product, your pet will never need anesthesia
for oral care.
What about
"anesthesia-free" teeth cleaning services?
In the San Francisco area,
a number of pet supply stores and grooming
shops are offering "anesthesia-free" teeth
cleaning through an independent contractor.
It is important to note
that tartar and plaque are not just a
cosmetic problem, but often a symptom of
disease. In an awake patient, it is
impossible to remove bacterial plaque from
below the gumline, where the bacteria cause
an inflammatory response which ultimately
leads to destruction of the bone and
tooth-supporting connective tissue. Removal
of tartar and plaque without anesthesia
provides cosmetic improvement, but no
medical benefits. Any
underlying bone loss remains undetected and
untreated, allowing continued progression of
the disease.
Please see
our webpage
dedicated to this subject
for more information.
Aside from these important
medical issues, animals have also been
injured during the "anesthesia-free" teeth
cleaning process; broken jaws and
asphyxiation have been reported, and in at
least one case, an animal has died while
being treated. These procedures are being
performed by personnel with no veterinary
training, and is therefore illegal, in
violation of the Veterinary
Practice Act of the State of
California.
My dog chews tennis
balls, and now his teeth have brown spots in
the center. Does this need treatment?
 Probably not, but it's a
good idea to have dental x-rays taken to be
sure. When the teeth suffer low-grade, chronic
trauma such as frequent chewing on tennis
balls or other abrasive toys, the pulp (blood
vessels and nerves in side the tooth) responds
by creating a protective bridge of "reparative
dentin" (also called tertiary dentin) over
itself. Dentin is the layer under enamel. If
the abrasion occurs slowly, reparative
dentin will prevent the pulp from being
exposed to the environment. Because the enamel
normally present over the dentin has been worn
away, the exposed reparative dentin becomes
stained, usually a dark brown color. This can
be mistaken for exposed, dead pulp on initial
physical examination, and can be
differentiated from exposed pulp by using a
dental explorer. An explorer will glide across
the surface of reparative dentin, but will
penetrate into an area of exposed pulp.
Sometimes the trauma from
abrasion is severe enough to cause pulp
necrosis (death of all of the blood vessels,
nerves and dentin-producing cells inside the
tooth) even if the pulp is not exposed. This
could be detected with dental radiographs
(x-rays), and root canal treatment or
extraction would be recommended.
My pet has a broken
tooth, but still eats fine and acts
normally. Why does she need root canal
treatment?
 When
the nerves and blood vessels (pulp tissue)
inside the tooth are exposed, bacteria in
the mouth invade the pulp tissue, and the
pulp eventually dies. This is called pulp
necrosis. In addition to the pain an exposed
nerve causes, your pet will ultimately
endure a process of inflammation and tissue
destruction in the bone around the root of
the tooth, which results from the body’s
response to the invading bacteria and pulp
necrosis. In severe cases, the infection and
inflammation can lead to disease in vital
organ systems, such as the heart, liver and
kidneys.
While extracting a broken
tooth will solve the problem, root canal
treatment allows us to preserve the tooth.
By removing the necrotic debris and bacteria
from the inside of the tooth, root canal
treatment stops the destruction of bone
around the root and allows healing to occur.
Your pet has the benefit of maintaining a
functional tooth without the high risk of
infection and prolonged discomfort which may
occur without treatment.
What can I do to help
keep my pet's teeth and gums healthy?
Just like we do, dogs
and cats get plaque on their teeth, which
can be removed by toothbrushing. Plaque is
made of proteins (from saliva) and
bacteria. If the plaque is not removed
every day, the bacteria multiply rapidly,
and your pet's immune system responds,
resulting in gingivitis (inflammation of
the gums). If the plaque is not removed,
the inflammation can lead to destruction
of the bone around the teeth and loss of
attachment (periodontal disease).
Eventually, the teeth have no bony
support, so they become loose and may even
fall out.
When plaque is removed by
toothbrushing, the gums and bone around
the teeth will stay healthier. If plaque
is not removed, calculus or "tartar" will
form when minerals from saliva cause the
plaque to harden. Once tartar is present,
professional cleaning is needed to remove
it. You can prevent tartar from forming by
removing plaque every day with
toothbrushing.
How do I brush my pet's
teeth?
Here are some
helpful videos:
Toothbrushing
should be introduced gradually. Don’t
force the mouth open. Start by just
sliding your finger under the cheek and
running your finger along the teeth and
gums. Do this every day for about a week,
and always praise your pet during and
afterwards, or give her a favorite toy
when you are finished. When she is used to
this, begin using a soft-bristled
toothbrush and pet toothpaste.
(Human toothpaste contains foaming agents
which can upset your pet’s stomach.
Fluoride is also not needed, as dogs and
cats don’t usually get the same kind of
cavities people do.) The paste should be
pressed down into the bristles, so the pet
doesn’t lick it off the brush. Start by
brushing just a few teeth at a time,
focusing on the outside surface of the
teeth. Hold the toothbrush at a 45 degree angle so the
bristles go under the gumline. Try to use
a circular motion with the toothbrush if
at all possible. If you find that your pet
licks at the toothpaste and the tongue
gets in your way, try using just water on
the toothbrush instead; it's really the
scrubbing action and removal of the plaque
which provides the most benefits, and the
enzymatic action of the toothpaste
provides a small additional benefit.
Brushing should be done
at the same time every day so it
becomes part of your pet’s daily routine.
Afterwards, give rewards such as a
favorite toy or game, a walk, or lots of
petting and praise. Because we are not
worried about caries (cavities) in dogs
& cats, it is even ok to use food as a
reward after toothbrushing. The goal is to
reduce the bacterial numbers to minimize
their effect on your pet's gum health.
Most dogs and some cats will actually
learn to enjoy this daily ritual, and will
see it as extra attention from their
favorite person.
Molly is a 7-year-old
Labrador retriever who had root canal
treatment with us when she was 2 years
old. Her parents brush her teeth daily,
and as a result she has perfectly healthy
gums and needs only "touch up" cleanings
when she is anesthetized for her annual
recheck radiographs of her root canal
treatment.
Molly is a great example
of what dedicated pet parents can achieve.
With continued home care and regular
veterinary examinations, Molly will enjoy
a healthy mouth for the rest of her life!
What if I can't brush?
Several special diets have been
formulated to help prevent plaque and
tartar build-up. Some have been clinically
proven to reduce plaque and tartar
accumulation and are certified by the
Veterinary Oral
Health Council in the "Helps Control
Plaque" and/or "Helps Control Tartar"
categories. Dental diets are nutritionally
complete, and can be fed as your pet’s
primary diet, which will have the most
dental benefit. They can also be fed as
treats. These diets For a full list of
products which have earned the VOHC seal,
click here.
Is it ok for my dog to
chew bones? How do I choose a good chew
toy?
- Chew toys and treats
can be helpful in controlling plaque and
tartar build-up above the gumline. It is
important to select toys or treats which
are not too soft or too hard. Toys or
treats that are too soft can be chewed
into small pieces, which may present a
choking hazard or cause intestinal
blockage if swallowed. Chew objects that
are too hard, such as antlers, cow hooves,
hard nylon bones, or sterilized real
bones, will break dogs' teeth. Fresh real
bones with meat and cartilage still on
them are generally ok, but they should be
removed after a few hours, because they
become hard as they dry out. Appropriate
toys include firm rubber toys, flexible
plastic or gummy bones (especially those
with rubber nubbies on them), and
compressed rawhide (made of many tiny
pieces of rawhide held together with a
digestible glue and pressed into a bone
shape). Not every chew treat is safe
for every pet. If your pet has a
tendency to take one bite and then gulp
down treats, chew treats are not going to
have much dental benefit, and may cause
life-threatening problems.
C.E.T.
Hextra Chews® and Friskies
Chew-eez™ for dogs are
specially-treated rawhide chews
clinically proven to reduce tartar
when given daily. For cats,
C.E.T. Oral Hygiene Chews® , when
given daily, help reduce plaque
and calculus. Keep in mind that
edible treats may add significant
calories to your pet’s diet, so
feeding should be adjusted
accordingly.
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learn more about veterinary dentistry and
our services.
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