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Questions for Dr. Shawn - Dental Care, Oral Health, Liver Disease

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Note:
Dental disease is the most common infectious disease in dogs and cats, and it is easily treated. For more information on great products I highly recomend for daily oral health care and treating bad breath, please visit my oral health page for complete details.

 

"Dear Dr. Shawn:
"I have a 15 year old cat. During her recent veterinary visit, her doctor suggested she have her teeth cleaned. I am scared that at her age she would die under anesthesia. I just want her to be comfortable. Do I really need to have her teeth cleaned at her age?"

Answer:
”The kind of cancer Alex has if very common in both dogs and cats. Fortunately, it is one of the “better” cancers in that while we can’t usually cure the pet, with proper therapy the pet can live up to 2 years following diagnosis. In some cases, I have had patients live even longer.

"Yours is a question I deal with regularly. While I congratulate you for doing such a great job to have your cat reach the ripe old age of 15, she still may have several good years left. I treat many cats that are 17-18 years of age, and a few even make it to 20 or slightly beyond! Dental disease is the most common infectious disease in dogs and cats, and it is easily treated. Yes, a proper dental cleaning does require anesthesia. If your doctor takes a holistic approach to your cat, and takes special care with her, I don't think she would have any problems.

In my practice I do a good exam and laboratory testing (blood, urine, etc.) to see if the pet has underlying problems that could increase the risk of anesthesia. Many of my patients have underlying problems such as heart or kidney disease. We still clean the teeth under anesthesia, but simply alter our normal procedure for these "special-needs" pets. You mention you want to make your cat comfortable for whatever time she has left with you. Believe me, living with the pain of a periodontal infection for several more years is not going to be comfortable with her. I think all pets regardless of age benefit from a dental cleaning. I've had a number of people tell me how youthful their pets acted following a dental cleaning. That's really not a surprise, when you consider that a pet with a chronic, painfully infected mouth is not going to feel good.

Here's what I suggest: if your doctor can use extra care with your cat, altering anesthesia as needed for any special problems that may show up in a preoperative blood profile, I would expect your cat to do well. If her teeth are really bad, short term use of antibiotics during and following the procedure will help prevent infection in other organs. Your doctor can even apply antibiotics directly to the infected teeth and gums to get good local control of the infection. Following the cleaning, you might suggest to your doctor the use of several supplements that can help pets with gum disease. Consider short term use of antioxidants or coenzyme Q-10 to decrease inflammation of the gums; these can be given orally as well as applied directly to the gumline. Also, to improve her overall health, get her on a good natural diet, and minimize the use of vaccines. Good luck with her, and I hope she is around to give you pleasure for several more years!"


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"Dear Dr. Shawn:
”I love my dog, but his breath can be less than pleasant at times. Are there natural remedies that can help?"

Answer:
”Bad breath is usually caused by oral problems, mainly periodontal disease. However, since other problems such as kidney disease or anal sac disease can also cause bad breath, a thorough examination is important before attempting treatment. Periodontal disease is the most common infectious disease of dogs and cats. In my practice, over 90% of pets between 1-3 years of age already show signs of the disease as yellow-brown tartar accumulates on the surfaces of the teeth. Some of these pets also have gingivitis, evidenced by inflammation (reddening) of the gums. If not treated, teeth become loose and may need to be pulled. The best way to prevent having teeth pulled is for your pet to have regular (at least 1-2 times per year) dental cleanings done under anesthesia. If your pet is in good health, there is no increased risk to having anesthesia regardless of your pet’s age (talk with your doctor about a holistic approach to anesthesia to minimize the amount of anesthetic needed.)

There are several things you can do to minimize dental problems and bad breath. Regular, ideally daily, brushing of the teeth using a product prescribed by your veterinarian is the most important preventive measure you can take. Applying Oravet, a prescription bonding gel, repels bacteria and slows down the development of dental disease. The best and easiest system I’ve seen to keep your pet’s teeth clean and breath fresh is made by Oxyfresh. Their dental gel is easily applied to the pet’s teeth and gums with a toothbrush or your finger, and their oral hygiene solution is simply added to your pet’s water each day. Finally, if your dog will chew bones this can also help. Check with your veterinarian first as some bones or chew products (including cow hooves, pig ears, and many rawhide products) are not suitable for dogs.”


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"Dear Dr. Shawn:
”Can you discuss dental disease in dogs and cats? Is it really that big of a deal?”

Answer:
”Absolutely. Dental disease is the leading cause of chronic inflammation and infection in dogs and cats. Without treatment, dental disease can lead to problems with the heart, lungs, GI system, kidneys, and overall health. In people, chronic dental disease can cause elevated levels of C-reactive protein, which can contribute to arterial plaque and heart disease. What does this mean for our pets? Chronic diseases such as valvular heart disease and kidney disease are very common in pets; chronic inflammation and infection from periodontal disease, are also very common and contribute to these disorders. This presents further evidence that regular dental cleanings are critical in reducing levels of CRP that may harm our pets’ bodies. Regular (usually annual) dental cleanings done under anesthesia are essential to minimize infection and inflammation and prevent unnecessary tooth loss.

Owners often express concern over the use of anesthesia for dental cleanings, especially in older pets. A proper dental cleaning does require anesthesia. In my practice I do a good exam and laboratory testing (blood, urine, etc.) to see if the pet has underlying problems that could increase the risk of anesthesia. Many of my patients have underlying problems such as heart or kidney disease. We still clean the teeth under anesthesia, but simply alter our normal procedure for these "special-needs" pets. The pets do well, and feel much better after the dental cleaning. I think all pets regardless of age benefit from a dental cleaning. I've had a number of people tell me how youthful their pets acted following a dental cleaning. That's really not a surprise, when you consider that a pet with a chronic, painfully infected mouth is not going to feel good.

I addition to a manual cleaning, natural therapies can be useful to control associated problems with dental disease. Natural therapies can assist in healing inflamed teeth and gums. Antioxidants, especially coenzyme Q-10, reduces inflammation. Antibacterial herbs and supplements such as olive leaf extract and garlic oil may be helpful to reduce bacterial levels in the sockets of the inflamed gums. Immune-boosting herbs such as astragalus and Echinacea as well as colostrum can be used in older pets whose immune systems are overworked by chronic dental infections. Finally, diet may be helpful to reduce the incidence of dental disease. In my practice, pets who eat homemade diets including large bones to chew seem to have fewer problems. And of course, owners who can brush their pets teeth on a regular basis report the need for less-frequent professional cleanings.


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"Dear Dr. Shawn:
”I really enjoy your column and was just wondering how you feel about C.E.T. dental chews and spray to prevent tartar build-up?! One of my dogs is really prone to dental problems. How about OraVet applied to their teeth/gums once a week?”

Answer:
”Since dental disease is the most common disease in dogs and pets, anything we can do to minimize this is helpful. In general, I don’t like rawhide, pig ears, or cow hooves. Rawhide is not digested by the pet, and while extrememly rare, it could pose a problem if an obstruction in the intestinal tract results. Additionally, there have been some reports of both rawhide and pig ear products being contaminated with bacteria, which poses a health risk to the owner and pet. Cow hooves are too tough and can easily cause broken teeth when chewed by the pet.

The C.E.T. brand of rawhide chews contain medication to decrease tartar accumulation on the teeth. Due to processing, bacterial contamination is unlikely to cause a problem. Using small amounts of the chews also is not likely to cause GI obstruction. The spray products that decrease tartar and bacteria on the teeth and gums that are commercially available are usually effective. Oravet, a dental bonding product applied weekly to the teeth, also has been shown to decrease dental disease. Having said this, the BEST thing you can do is regular brushing of the teeth. Think of the chews, sprays, and Oravet as additional efforts you can take to help control dental disease in pets.”


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"Dear Dr. Shawn:
"I really enjoy your column and find it to be informative and very helpful. I wonder if I could ask you a question regarding my 10 year old dachshund, Lucy. I took her for an exam last week to precede a full dental cleaning (and possible extraction of a problem tooth) and her blood tests revealed her liver enzymes to be elevated "four fold". The veterinarian would like to do a follow up blood test in a few weeks before proceeding with the dental cleaning. Should I be concerned? She is presently overweight but on a successful diet (Hill's r/d), so the weight will come off. Do you think the weight could cause the elevated liver enzymes?"

Answer:
”Preoperative laboratory testing, including blood tests, are very important as you can tell. You don’t mention which “liver enzyme” was elevated. I’m assuming it’s a test called ALT. Some doctors mistakenly call the ALP a “liver enzyme,” and recommend a liver biopsy. However, the ALP test more commonly indicates adrenal gland disease. Assuming the ALT is elevated, I would agree with your doctor’s recommendation to retest Lucy prior to the dental cleaning. If the test is still elevated, I normally prescribe supplements to help heal the liver and try to reduce the enzyme levels. If this doesn’t work, additional testing (X-rays, ultrasound, etc.) might be needed to determine the exact cause.

The good news is that most mild elevations of the ALT do not indicate a serious disease and can be managed using complementary therapies (there are no conventional drugs to help with most liver enzyme elevations.) Once her liver enzymes are stable having the dental cleaning done is important. It is also possible that the infection from the mouth might be causing mild liver disease, and removing the diseased teeth might help bring her enzymes back to normal as well. Regarding Lucy’s diet, I would suggest switching her to a more natural diet once her desired weight loss has been achieved. I’m not a big fan of most commercial foods and prescription-type diets for long term use, as many contain by-products and chemicals and are not as healthy as many natural diets. Good luck!”


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"Dear Dr. Shawn:
”I have a question about dental cleanings for dogs. What should I be concerned about when taking my dog in for his dental cleaning? He is a 15 pound poodle who is currently 11 years old. For example, should I request gas or injectable anesthesia (any pros/cons I need to know would be appreciated.) What about preanesthetic lab testing?”

Answer:
”Good question. Because every doctor does procedures differently, I strongly encourage pet owners to discuss these topics with their veterinarians. Here’s the way I approach anesthetic procedures. First, I think it’s important to make sure that the pet is healthy prior to performing any anesthetic or surgical procedures. Except in emergency situations, most anesthetic and surgical procedures are elective procedures that can be performed any time. If the pet is not in the best health prior to the procedure, it’s usually best to improve the pet’s health then move forward with the procedure. This means a thorough examination and lab testing, such as blood, urine, or radiographic testing, should be done prior to anesthesia. Since many pets have 1 or more abnormalities on the exam or lab testing (most of which do not necessitate postponing anesthesia but may cause problems later,) this pre-anesthesia evaluation is important. Assuming nothing on the pre-anesthesia evaluation postpones the procedure, the type of anesthesia is important.

In our practice, we use a balanced holistic approach to anesthesia so that pets go to sleep quickly, wake up quickly (most are ready to go home within 5 minutes of the procedure,) and experience no pain. For dental cleanings, gas anesthesia administered via an endotracheal tube placed in the pet’s throat is essential (veterinary dentists consider it malpractice to perform dental cleanings if this is not done.) Discuss these concerns with your doctor to make sure the procedure is done safely and quickly. One final note:age is NOT a reason to skip cleaning your pet’s teeth. Most older pets, using a holistic approach, are safely anesthetized and do very well.


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"Dear Dr. Shawn:
”I have an old Maltese, Daisy, with horrible teeth. Several have been pulled and she has had bad breath all of her life. What kind of soft food would you recommend for her?”

Answer:
”Dental disease is the most common infectious disease of dogs and cats. In my practice, over 90% of pets between 1-3 years of age already show signs of the disease as yellow-brown tartar accumulates on the surfaces of the teeth. The best way to prevent having teeth pulled is for Daisy to have regular (at least 1-2 times per year) dental cleanings done under anesthesia. While 8 years old makes Daisy a senior pet, she should have another 8-12 years of life left IF you keep up with her basic medical needs (regular examinations, blood and urine testing to screen for disease, regular dental cleanings.)

Unless you think Daisy can’t eat hard food, it really doesn’t matter what form of food she eats. There are several natural brands of food I like, including Nature’s Variety, Life’s Abundance, Eagle Pack, Halo, Flint River, and Wysong. These foods don’t contain the harmful byproducts and chemicals so commonly found in many of the popular brands of pet foods. I wouldn’t recommend a particular one for her without knowing more about her medical history. It’s possible a special diet would be better for her, depending upon results from an examination or laboratory testing. The diets I mentioned should serve as a starting point for you and your veterinarian to discuss.

Finally, many of my holistic clients like to prepare homemade diets for their pets. You can find a number of recipes in my book, The Natural Health Bible for Dogs & Cats. Good Luck!”


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"Dear Dr. Shawn:
”My cat of 13 yrs recently passed away after a dental cleaning She was fine until the 3rd day following the procedure and she then collapsed She was rushed to the hospital and diagnosed with high blood pressure and tachycardia with pulmonary edema. She passed away next day and I was told she most likely had a prior heart condition (hypertrophic cardiomyopathy) that she probably lived with for few years without any clinical signs. Why did the dental procedure make her heart condition worse?”

Answer:
”I’m sorry to hear of your loss. Many pets do have undiagnosed heart disease, and sometimes it isn’t apparent until a stress, such as boarding or an anesthetic procedure, takes place. This is a major reason why I recommend annual checkups for pets under 5 years of age, and twice annual examinations for pets 5 years of age and older. When heart disease is discovered during the exam (a heart murmur or abnormal heart rhythm is heard when listening to the pet’s chest,) it is imperative that further testing take place BEFORE the pet becomes ill. ALL pets with heart murmurs need further evaluation, which includes and EKG, chest X-rays, and a heart ultrasound. In my practice, most pets do not have significant heart disease at this stage and respond well to supplements rather than conventional medications. Waiting until the pet has severe heart failure makes no sense, as the heart (and the pet) is dying at this stage. In your cat’s case, she probably had heart failure but was compensating for this. The stress of anesthesia was enough to bring on the edema (fluid in the lungs) and subsequent death. I should point out though that pets with heart disease and controlled mild heart failure can and should still have their teeth cleaned, and usually suffer no harm from the procedure.”


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"Dear Dr. Shawn:
”I have a miniature schnauzer, 5 years old, currently in remission from lymphoma. He had been getting his teeth cleaned on a regular basis before the lymphoma diagnosis. He did not have his teeth cleaned last year or this year as his oncologist advised against it. There is significant plaque buildup, his breath is disgusting, and I know dental disease can't be good for him either. I have tried brushing his teeth but he fights and resists. What would be your recommendation? He is a wonderful pet and companion and I want to do the best for him.”

Answer:
”I’m happy to hear that your pet is doing well with his cancer treatment. I hope, that in addition to his chemo protocol, you’re also following the dietary and supplement recommendations in my book The Natural Vet’s Guide to Preventing and Treating Cancer (New World Library, 2006.) Regardless of what kind of treatment you use, if you don’t support his immune system with diet and supplements he will die quicker from his cancer. Another thing that’s so important for pets with cancer is to keep infections away. Cancer by itself, and certainly when combined with chemotherapy, weakens the pet’s immune system (hence the need for diet plus supplements) and we must prevent infections whenever possible.

I would hate for your pet to survive his cancer only to become ill or even die from a systemic infection caused by dental disease. You don’t say why your oncologist was against the dental cleaning, but maybe the timing was not appropriate. I would suggest checking with the specialist again, but based upon what you’ve told me I don’t see any reason not to do the procedure, and see plenty of reasons to perform this procedure. There shouldn’t be any increased risk simply because he’s had cancer, and I think the benefits far outweigh any negatives in this situation.”


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"Dear Dr. Shawn:
”My neighbor just had her dog’s teeth cleaned. She told me about a new bonding product that is supposed to help control tartar in pets. This sounds like a good idea since my dog can’t stand having his teeth brushed. Do you know anything about this bonding? Is it safe for pets? Is it something I should consider using for my dog?”

Answer:
”The product she mentioned is called Oravet. It is a new product that in my opinion is probably the best thing to help with dental disease to be developed in a long time. The Oravet system is a 2-step system. The first step involves the professional application of the product by the veterinarian immediately following the dental scaling and polishing. This application of the Oravet bonding gel lasts for about 2 weeks. The second part is administered by the pet owner 2 weeks after the professional application. Each week the owner applies the gel to the teeth once a week until the next professional dental treatment (most pets have the teeth professionally cleaned annually, although some need it more often.)

I like this new treatment for several reasons. First, it’s very cost-effective: the professional application costs about $15 and the at-home treatment applied by the pet owner costs about $25 (this is for a supply of bonding that lasts 8 weeks, although in many cases it actually lasts twice as long if you’re conservative with the application.) Second, it’s very easy for owners to apply this product. While many owners can’t or won’t brush the pet’s teeth regularly, everyone can apply this gel to a pet’s teeth. All you do is put a small amount on your finger (or brush contained in the kit) and wipe it right onto the surfaces of the teeth. If your pet won’t let you apply it to the teeth, no problem! Simply put the gel (it’s tasteless) on a treat, piece of dry food, or (a favorite with many clients) a chew bone. By chewing the treat or piece of food the pet actually applies the bonding material to his own teeth.

Keep in mind that brushing of the teeth can still be done even when using the bonding material. However, since so many owners don’t do any home care for their pets’ teeth, this new therapy will decrease plaque accumulation on the teeth and decrease the severity of dental disease. Finally, the bonding material is very safe and I’ve not seen any side effects when used as directed. I would encourage you to ask your doctor for this treatment at the time of your dog’s dental procedure.”


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"Dear Dr. Shawn:
”I have a wonderful 11-year-old feline who eats well and seems happy and normal. But my vet my cat needs a dental cleaning and possible root canal on one chipped canine tooth. I want to do what is best for my kitty, yet since she loathes the car ride and vet visits, and I am very worried that she will not tolerate the procedures, I am torn as to whether to put her through all this at her age. Is there an alternative?”

Answer:
”As you know, dental disease is the most common infectious disease of dogs and cats. In my practice, almost 100% of cats and dogs over the age of two have dental disease, also call periodontal disease. Periodontal disease starts as invisible plaque on the surfaces of the teeth. With time the bacteria-rich plaque hardens and forms tartar or calculus, that dark brown substance that is cemented to the surfaces of the teeth. If not removed under anesthesia by your pet’s veterinarian, the bacteria and their toxins star to eat away at the deeper tissues of the teeth, gums, and supporting jaw bone, resulting in tooth loss.

Not only does dental disease cause local problems, but the bacteria and their toxins spread throughout your pet’s body. This can cause infections elsewhere in the body, including the heart, kidneys, liver, and other organs. Chronic periodontal infection also leads to a state of chronic toxicity and inflammation.

Many years ago I foolishly believed that periodontal disease was merely a cosmetic problem. Then I heard a lecture by a veterinary cardiologist. He stated that the most important thing to do for pets with heart disease is clean their teeth frequently, even several times a year if needed. Once I started doing more dental cleanings at my practice, I saw many very old dogs and cats who once acted sickly regain their youthfulness. It was as if I had discovered the fountain of youth! This is not surprising when you consider that these pets had been living a toxic, painful life for many years. Once the source of pain and toxicity were removed, I commonly heard statements from pet owners saying I had given them their puppy or kitten back.

I agree with your veterinarian that your cat should have its teeth cleaned as long as your pet is properly evaluated prior to the procedure, with a complete examination and necessary laboratory testing, and the appropriate anesthetic and monitoring procedures are used. Most older pets can be safely anesthetized to for procedures like this. In my practice the average age of pets which receive dental cleanings is 15 years old, and all do very well with our holistic approach to this procedure.

One word of caution: some people, mainly groomers, are advertising “anesthesia -free dental cleanings.” These are not true thorough professional dental scaling, but are simply a brushing of the teeth and a hand scaling. This can be painful and if not done correctly can damage to tissues of the oral cavity. Additionally, large amounts of bacteria are suddenly released into your pet’s blood stream, which can be dangerous. I would recommend simply finding a veterinarian who is comfortable doing geriatric anesthesia to do the procedure correctly.””

 

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