Dentistry Interview with Dr. Ken Lee, DVM

Dr. Ken Lee, a DVM practicing at Deer Creek Animal Hospital in Littleton, Colorado, is working towards achieving his official specialty in dentistry.  He is a wealth of knowledge regarding animal dental health and disease, and was kind enough to agree to answer some great questions for everyone.  This is an important read, please forward to fellow dog lovers!

General Questions:

1.     How long have you been a DVM, and what is your attraction to dentistry? 
25 years in May 2012. My older brother was actually my dentist when I was growing up. I also got introduced to Dr. Peter Emily a human dentist that was instrumental in building up the importance of good oral health in the veterinary field.

2.    Often time people surrender dogs because they could not appropriately anticipate the costs of dog ownership.  How much money would you advise people put in their 'rainy day fund' for annual dentistry visits? 
For a complete oral exam and cleaning under anesthesia ~ $300-350 depending on the age and the pre-anesthetic blood work required. However, there are some good pet insurance plans that some of our clients have taken advantage of and depending on the coverage elected can include help with maintenance dental care just like for people. More of our clients are purchasing pet insurance when they purchase their new puppy.  
How does this differ from younger years into being a senior? 
Obviously senior dogs have probably a greater share of dental disease, especially periodontal disease-bone loss around the teeth over time. But the younger dogs, especially the large breeds that like to chew frequently chip their teeth, which can open the porous part of the tooth to infection and cause tooth death.

3.    What do you say to owners who only anticipate yearly blood work costs, with regard to the importance of dental care and why they should make that expense? 
Annual blood work is important because for every year dog's age ~6-7 human years. There are many research studies in human medicine and a handful in the veterinary field that show a direct relationship of lesions developing in the heart, kidneys and liver secondary to periodontal disease, which happens to be the most common disease in dogs. In addition, dental disease can often lead to oral pain yet dogs rarely show signs of pain. They hardly ever stop eating or paw at their mouth. Only after we fix a dental problem that owners then notice an improvement in their dog's attitude.

4.    What are the specific dentistry concerns for Pyr owners, and/or just large breed dog owners in general? 
Fractured or chipped teeth and periodontal disease and oral masses as they age.

5.    At what age do we need to start getting dental prophys performed? 
At Deer creek animal hospital we recommend the first complete oral exam and cleaning under anesthesia ~ 2-2.5 years for small breeds and ~ 3 years for large breeds.

6.    My dog chews bark/sticks.  Should I be concerned? Although bark and sticks are usually not hard enough to break dogs teeth they can sometimes splinter and poke into the soft tissues in the back of the mouth and cause trauma and infection.

7.    What's the real truth about letting your dog chew cooked bones and/or versus raw bones? 
All cooked bones are potentially a problem. Chicken and turkey bones because they're hollow can splinter and cause serious damage to the intestinal tract. Beef bones can fracture teeth. There are some raw diets that I've seen work well with no digestive issues or risk to teeth fractures although there is a higher risk of some potentially serious bacterial infections.

8.    "I just cannot brush my dog's teeth"... what is my 2nd option?
Sometimes like any dog training issues it can take patience and time. Try offering just a finger in your pets mouth with something they like such as chicken flavored dog tooth paste or cheese and let them lick it off while at the same time moving your finger around in the mouth. Then try a toothbrush doing the same thing. This may take a few weeks or longer in some dogs. The gold standard in home dental care whether in people or dogs is mechanically wiping or brushing the goo (plaque) off the teeth. The goal is to wipe it away before it has a chance to form a hard brown covering called tartar or calculus. If your dog won't accept a brush I've had many clients that have been successful by using gauze wrapped around their finger. There are dental diets and dog appropriate chew toys that abrade and help keep teeth clean as other options.

9.    Puppy owners need to be educated about puppy teeth.  What 'teething' toys do you recommend? A general rule I give puppy and dog owners is if you can't break it or bend it or indent your nail into it, it's too hard to give. There is a website www.vohc.org that has appropriate dental chew toys listed that are relatively safe that have been tested by veterinary dental specialists. Also I feel good about the dental chews we have at Deer creek.

10. Ideally I'd brush my dog's teeth every day.  Most owners aren't going to do this.  What is the least amount of recommended brushing? 
Studies have shown that you need to try to do it at least 3 times a week to make a significant difference in preventing tartar build up.

11.  "My dog has a tooth that looks "dead".  It's dark and discolored.  Should I be concerned if it doesn't seem to be bothering him?" 
Dark teeth are a sign typically of a dead tooth with the potential of causing pain. The Hale study in 2001 showed ~92% of these teeth to be dead. Unfortunately, dogs rarely show signs of dental pain that I addressed in question #3.

12. My dog has bad breath.  Can he have bad breath without having disease present? 
Bad breath is the most common sign that dog owners notice and usually means significant dental disease or at least a trip in to your veterinarian to have it evaluated. Sometimes serious infections in the kidneys or liver can cause bad breath too.

Questions from Vicky, Boxer owner:

1. Many of those who feed a raw diet claim that this negates the need for dental care, as the teeth gain a thorough cleaning via the biting through soft bone and gnawing on the harder bones.  Have you seen this to be true? I have seen some positive results in dogs being fed this diet. However, dogs fed these diets can still develop periodontal disease under the gum line and fracture teeth that can cause them pain. A complete annual exam by a veterinarian can catch some of these problems, however since our furry friends don't communicate pain to us well a complete oral exam under anesthesia with dental x-rays is the only way to thoroughly evaluate for these dental problems.
2. Many treats (flossies, rawhides, cookies) and flavored bones of various types are sold in pet stores and claim to be good for dental health.  How much of this is true? Some of them are good, some are not. I refer you to Q#9.
3. What are the dental implications between feeding dry kibble vs. canned? Studies have shown that feeding strictly dry food diets compared to canned food can decrease tartar accumulation by about a 1/3.

Questions from Donna, large breed dog owner and dental hygienist:

1.     What's the best for cleaning a dog's teeth; nylabone, rawhide, greenies, real bones? Nylabones and real bones can break teeth. I refer you to the website www.vohc.org -appropriate chew toys 

2.    My vet's office always tries to get me to buy a liquid to put in my dog's water that is supposed to help keep their teeth clean.  What is it?  Being a dental hygienist I just don't believe there is a product that will really keep tartar from building up.  And if it is really does work why is it not safe for humans?  I'm an over protective dog mommy and I don't want to give my baby something that isn't safe for humans to consume. 
Yes, there are many products out there that are marketed as drinking water additives. Some contain chlorhexidine and/or zinc gluconate which are very good oral cleansing solutions for people and do a good job for cleansing solutions for dogs as well. I personally have not seen any real health issues from these drinking additives in dogs. Probably because they are so diluted ~ 1-2 TSP in a qt of water it doesn't cause a problem. So these products could potentially help with decreasing some bad breath but I have not seen any control studies that have shown a decrease in tartar and gingivitis. I always tell my clients there are only three things our dentists or dental hygienist gives us at our dental appointments. A toothbrush, toothpaste and dental floss. Dog teeth anatomy has significant enough space between them that floss is not needed, thank goodness. Again, mechanical brushing or wiping is the gold standard in preventative dental care in dogs and people.

3.    Also being a hygienist a lot of people ask for my old tools to clean their dogs teeth with.  We always tell them no.  They can do a lot of damage to the dog's gums, gouge the root surfaces, the dog could bite them or they could slip and the sharp instrument could go anywhere, and most of all they can't sterilize the instruments!  Is there any safe way to chip away at a dog's teeth at home? 
I agree with all you mentioned. These tools can cause micro-scratches in the enamel of the tooth and the roughen surface and can increase the tartar accumulation even faster. They also aren't addressing what's under the gum line, which contains the majority of the oral infection. 

4.    In dentistry we insist on putting a crown on teeth that have had a root canal.  The tooth gets dry and brittle and is highly likely to break off at the gum line in the future.  Is it recommended that we crown our dogs teeth post RCT as well?  They chew much harder things than we do.  Are they at risk? 
Yes to all of the above but I think client education on appropriate chew tows and addressing behavior problems is more important. Crowns can help protect a tooth from further trauma post root canal therapy and we do place them for that reason at Deer creek. However, I also have seen teeth broken with the crown still attached to them so a crown is no guarantee, especially with the increase bite power dogs can elicit with their jaw angle.

5.    Angus is a big time poop eater.  What impact does that have on his mouth? 
Other than the obvious nothing much different than feeding canned food.

6.    And just a random thing I've always wondered.  It seems like lapping water is so ineffective.  Should I add water to the dog food to make sure he is hydrated well enough? 
I have not seen problems with dogs hydrating themselves with their normal drinking activities.

Final Question:
If you could give 1 piece of advice to all dog and cat owners regarding dental health, what would it be? Prevention just like in people. Annual oral exams and cleanings starting at 2-3 years of age and consistent home care. Our pets will benefit with longer, higher quality lifespans.

by Shannon Murphy

Brush My Dog's Teeth?--Do I Really Have To?

Article originally published May 16, 2011 on FoxNews.com:
Jennifer Quasha is a writer and most recently the co-author of "Chicken Soup for the Soul: My Dog's Life: 101 Stories about the Ages and Stages of our Canine Companions" and "Chicken Soup of the Soul: My Cat's Life: 101 Stories about the Ages and Stages of our Feline Family Members." Check out her website at www.jenniferquasha.com.

I almost flipped when I returned to my car to find my newly-adopted beagle Sugar eating my pack of mint-flavored tooth flossers.

Perhaps she actually wanted clean teeth? That would be a first. No dog of mine has ever wanted anything to do with getting his or her teeth brushed--chicken-flavored toothpaste or not.

How about you -- how often do you brush teeth? Twice a day, everyday? Promise?

My six-year old son says he brushes his teeth, too. Are you brushing, or brushing?

I have only met one person who told me that she brushes her dog’s teeth everyday. I looked at her like she had six heads.

Yes, she was an empty nester and had an only dog—apparently with clean teeth. Who else would have the time, patience or dedication? (I never did bother checking the dog.)

In fact, the American Veterinary Dental Society says that more than 80% of dogs show some stage of dental disease by age three. That’s pretty bad.

Although humans fear the stigma of halitosis, dogs certainly don’t care, and usually their humans don’t either.

But that doesn’t mean it’s healthy. Unlike in humans, bad doggie dental care can kill. No not you, your dog.

This is what happens:

1. Like with us, old food turns into tarter.
2. The tarter builds up along the gums and below the gum line—which can’t be seen.
3. The tarter collects bacteria, which gets released into the gums and its blood supply--poisoning the dog over time.
4. The bacteria build in the dog’s body, spreading into the heart, the kidneys and throughout. Eventually it can overwhelm the dog’s systems.

So that’s kind of exciting, right? You have to worry about your dog being stolen, running away, getting hit by a car—and brushing it’s teeth?

I decided to watch a web video about exactly how I was supposed to brush my dog’s teeth. I almost died myself—laughing.

No harried, working mother, with pets and kids like me could it pull off on a weekly basis—much less a daily one. 

Maybe if we had nannies, chefs, and/or housecleaners. But if I had all that I would be out shopping and getting my nails done—not brushing my dog’s teeth.

That’s why part of where Americans are throwing their $50 billion dollars spent this year on pet products is to tackle this fearsome problem.

They either spend $150 getting their pet anesthetized and having their teeth cleaned, or they spend $150 by filling up their homes with tooth brushing devices like tooth cleaning gel, a “chew-it-yourself” dental bone, or treats that clean teeth just by being chewed.

Although these tools might help a little, what they really do is make dog owners feel like they are doing something--but they don’t do the job of a good professional cleaning.

I’ve long thrown out my doggie dental detritus, and opted to go to the professionals. I admit I feel a pang of guilt when I pass off my little one to get anesthetized, but that pang has never been stronger than my desire not to brush his teeth every day.

What’s even worse, when he comes out of the doctor’s office walking a little wobbly part of me thinks it’s kind of funny. Bad mommy!