What makes anyone think that a mouth that smells like three-day-old garbage (and frequently far worse) isn’t worthy of treatment? Teeth just get no respect! To get anyone to sit up and pay attention we vets have to start talking about hearts, livers and kidneys—more respectable (albeit, unseen) organs.
Why is it that abscessed teeth get paid no heed unless an animal’s face swells like a balloon in a tooth’s agonizingly painful last gasp? Why does the demonstration of pus dripping into a pet’s mouth not elicit the same reaction? What is wrong with these people?
“He still eats, Doc. Teeth can’t be hurtin’ him if he still eats like a champ.”
Yeah, well, I’ve got a clue for you: Your dog will eat himself into oblivion if you let him. That’s why he weighs thirty pounds over the legal limit for his breed. Did you ever stop to wonder whether he chews or not? Even beagles chew sometimes, you know?
How about the cat who shudders in pain when the vet touches her tooth, but nonetheless consumes whole bowls of kitty food in grateful gulps, completely avoiding the tooth-tapping pain of kibble on raw nerve via a process I call “digestive inhalation.”
Even a month later when the tooth breaks off at the root and the gum swells to the size of a small grape these owners are still clueless over why food is now falling out of their cat’s mouth when she eats. “She’s just about the messiest eater I’ve ever seen, Doc.”
Gee, wonder why…
I bring up this timely topic because we’re headed into February, which happens to be not just Black History Month, Breast Cancer Awareness Month, Healthy Heart Month and a bunch of other months in recognition of some issue or another. February is also (you guessed it)…Pet Dental Health Month!
Though it’s not quite February I thought you might want to get started on making appointments and getting your pets’ pre-anesthetic bloodwork done, among all those other things we vets tell our clients (and remind ourselves) need to be taken care of once a year.
Problem is, when I write about it on Dolittler I’m always preaching to the choir. You guys have probably taken care of this stuff long before I deigned to mention it—much less undertook it for my own creatures (the cobbler’s sons and their shoes and all that).
In case you don’t already know it, you’re the model citizens of the pet world and as such you’re never the right audience for my rants on dental health. Nonetheless, I’ve got to talk to someone and at the very least you’re always a sympathetic ear, reveling in my indignant tone and stirring me up ever more with your outraged comments on behalf of suffering pets everywhere.
So here’s more of my rant:
“But teeth cleaning requires anesthesia! I know pets die of it…”
And pets die of dental disease too, though seldom directly. To this point: Countless studies confirm the reduced life expectancy of pets with untreated periodontal disease. Even self-described anesthephobes don’t forego anesthesia for wound surgeries and other emergencies. That’s why I’m hard-pressed to believe that the risk of anesthesia is the true hang-up in most of these cases.
They just don’t think teeth are worth it.
“Let’s let them rot out of his head, OK Doc? I mean, he’s thirteen years old!”
Think I jest? I have at least one technician who was able to confirm that one client actually spoke these words yesterday.
Me: “Did he really say that?”
Her: “Yes, Ma’am, he really did.”
Then there’s the money thing: “It costs how much to clean her teeth? Gosh darn it, Doc, I don’t spend that much on my own cleanings. (Clearly.)
I don’t know but $160 (for anesthesia, use of expensive monitoring equipment and reliance on dental techs who’ve taken pricey courses offered by our local board certified vet dentistry guru) is a steal compared to prices elsewhere. We keep it low for a reason. People here won’t do it otherwise. Granted, X-rays and extractions are extra but I charge for extractions on a sliding scale based on owner finances. God knows you don’t see that happen often in the human healthcare business (save psychiatry, God bless ‘em).
Despite all my entreaties and exhortations, my words often fall on deaf ears.
Brushing? I still get laughed at routinely.
But that’s changing. I have to admit that my client mix is starting to tip in the direction of the more compliant on this and other issues. With all the writing I do, I’m finally beginning to see the more of the kind of clients who might just opt for annual dentistries (when necessary, of course). It’s gratifying to know that all my venting and choir practice may just pay off in less long run stress. That alone is a great reason to keep preaching. Right?
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Hear hear!
I am an in-training vet nurse (I wrote to you a while ago) and I have found myself with a growing interest in dental work - we get around 3-4 dentals a week and its a bit worrying that most of them are at the critical stage of "that tooth/teeth must come out or there are going to be problems" and some of them are downright shocking. I had my first instance of a general clean with no extractions or problems only yesterday - the cat was being knocked out to drain an abscess and the owner requested that we clean her teeth while she was under. It took me twenty minutes to remove the small coating of plaque and gingivitis and then voila! Problems prevented for another year. If only more people would get it done routinely instead of waiting for an issue to happen.
I am very slightly obsessed with the health of my own cat's teeth - I am not a fan of dentists myself and give my cat the same treatment I do myself. Science diet oral care, brushing her teeth, raw chicken bones, etc.... I want her teeth to reflect her health as much as her coat and behaviour!
Aileen Pettigrew January 19th, 2008 06:22:00 AM
I agree, $160 is affordable. In the city I live in, the clinics charge between $500 to $700 for a small dog, that prohibitive cost unfortunately keeps people from having it done. Even me. On Monday I am driving 2 hours to my old city of residence (and former vet- who is great, btw!) to have her teeth cleaned for $140. Totally worth the drive.
clover January 19th, 2008 07:01:00 AM
Dental prophys at my clinic are just over $200, including mandatory CBC/chem12, cefazolin and ketoprofen injections during, pulse ox/ecg, fluids, office visit fee, etc. I'll admit that I do think they are expensive - I'd personally be okay w/my younger healthy pets going through a 20-minute dental w/out fluid therapy or being screened w/a liver/kidney panel vs. chem 12, but whatever. Also, our techs (including me) have not been specially trained to do dentals...I think we do a good job, but I still sometimes feel my skills are not adequate for severe periodontal cases (unless all but 3 teeth are coming out, like w/the cat I did the other day - wasn't much left for me to clean!). Still, I emphasize to owners that it's a price they have to pay if they're not willing/able/motivated to do thorough home dental care - and I'm guilty of that one since none of my cats are that cooperative. So, I suck it up and pay for dentals when needed, usually once a year. My dogs I think can probably go longer given their chewing habits. Dr. K, does your clinic offer the porphyromonas vaccine, and what do you think about it in general? We just started offering it, but it seems no one is really interested (which I guess just reinforces your whole rant!). I really think some of the small breed dogs that require dentals every six months could benefit from it.
anna January 19th, 2008 07:35:00 AM
$160?!??!?!? Damn, the lowest you could walk out the door for a dental with where I worked was $300, for a cat with no problems. It usually was more like $500. I know of places around here where you can get away with $250. The vet I worked for was very good at convincing people to do the dentals though. She'd very patiently explain how the reason it costs five times as much as your cleaning is that you actually brush your teeth, so it takes much less time and effort, and you sit very still for the nice dentist, so it doesn't take lots of expensive drugs. Jeeez.
Julia January 19th, 2008 10:16:00 AM
Haven't had a dental done since I switched 'em all to a home-prepared raw diet. One of my vets strenuously disapproves of my feeding regimen (has shut up since the multiple agonizing deaths among his commercially-fed patients this spring, but still thinks I'm killing them all). But he cannot deny that everyone's teeth are perfect, shiny, white, no tartar. No bad breath -- the dogs' breath is nearly odorless. Even my oldest bitch, who seems to have a genetic predisposition to accumulate a strange tacky dark tartar. (Her litter-sister, who belongs to a friend, gets it too.)
Let's see -- four dogs, times three years, times $160 per cleaning = a whole lot of frozen chicken necks.
Strangely enough, I've usually been the one concerned about any tooth wear or chipping in the past, and the vets have always told me not to worry about it, nothing needs to be done.
My bitch's grandmother recently had a cracked carnassial that became badly infected. This old girl became really sick. Her owner's vet refused to put her under to pull it because her liver values had some abnormalities, and then inexplicably put the bitch onto prednisone. Huh? Of course she got worse. Visit to a different vet, and the pred was gone and the tooth removed in short order. She's doing fine now at age 13.
H Houlahan January 19th, 2008 11:44:00 AM
I was one of those anesthephobes with my old girl Bonnie. I generally don't fear medical treatments, but she was a sensitive girl to drugs and shots, having a reaction to the super combined vaccine and a nasty case of shock from her spay anesthesia.
When she turned 9, I went off to college, and we stopped her shots and her teeth regimen. I don't regret the former, but the later was really stupid. She developed a crust so thick on her back teeth that it appeared as if the three teeth were actually one long tooth.
Needless to say that when she went in for a fatty cyst, off came the crust and out came a tooth and off came about 3 years of age. She was so much happier after both problems were gone and despite having to learn a new trick (letting me brush her teeth), both of us were much happier about the whole thing.
And that was really my reintroduction to modern vet practice and prices. My dad had stormed out of Alameda East (famous from Animal Planet's Emergency Vets) when the vet started listing all the "and this is $$ extra, and this is $$ extra) as she described her analysis of Bonnie's teeth and cyst. He was furious and convinced that this was just a sham to gouge people. We're a hot blooded family, but I can't recall when I've seen him so furious in public.
The posh re-design of the building (nicer than most new hospitals, a large wall fountain, modern architecture) didn't help the impression of being bled.
But who is to say that the fatty tumor wasn't caused by a colony of bacteria living the good life in her mouth, or even that her eventual Cushing's disease wasn't exacerbated by a funky mouth.
In the end though, I ended up going back to a family vet ($) never to see Banfield once in a blue moon again, and am rather happy to pay the premium price tag.
It was worth every penny when Bonnie's time came at the ripe old age of 14 and some to have a vet who knew her, liked her, and even shed tears with me as she left. I know you wrote about that issue before, and my vet could be your grandfather, but he still sheds a tear too, now and again.
I respect the midset of guys like my father, and terrierman who think that the vet business has gone the way of high priced bloated human medical care... and in part I think it's true. For instance, I'm giving my new litter their first shots myself and saving about $250.
But I can't say that it's for the worse.... after all, I suspect that 10 years ago most dogs with an "ACL" injury would have been put down, now they return to work or play in the field and at dog sport venues in under a year and live happy healthy lives for decades longer. Just about any procedure you find for humans can now be found for dogs.
As the culture shifts and continues to make pets on par with family, then of course the demand for high quality and sophisticated medicine for them follows along. And with demand, comes higher prices but also greater advances.
Border Wars - Christopher January 19th, 2008 01:29:00 PM
This topic of dental care for my pets is one that always makes me sit up and take notice.
I have a Greyhound, an Italian Greyhound and a Chihuahua mix. I have been aware of how important good dental care is for them for a very long time. I brush and give them the Science Diet Oral Care and I had their teeth cleaned faithfully every year during February when my Vet Clinic offered a discount.
I made apppointments for two of my dogs, the Greyhound went first. I had put aside about $500 for the two dental procedures having paid just over $250 the previous year.. So I was stunned when I was presented with a bill for more than $500 when I picked up my Greyhound. I had to cancel the appointment for my IG.
I understand that everything costs more every year and apparently my Vet added some new equipment to make the procedure safer. I definitely don't begrudge my Vet a decent living, he's a good and kind man but I've not been able to afford another dental for any of us. I'm feeling as though I'm no longer a responsible owner, but I live on less than $11,000 a year. I can't bear to give up my wonderful companions, but I know I'm no longer doing right by them.
Connie Cassidy January 19th, 2008 01:32:00 PM
Feline dentals here are $500+ but the RVT that does them is fantastic. The last canine dental we had done was $2,000 at a speciality practice. Giant breed with enamel hypoplasia who needed several extractions. Its been my experience that genetics plays a large part in the condition of their teeth.
Jules January 19th, 2008 02:20:00 PM
Wow, that's a good price. I routinely pay over $300. I've got two scheduled in a couple of weeks for my kitties who have resorptive lesions (they had bad viruses as kittens, and I really suspect that has something to do with it). I am TERRIFIED of the anesthesia, but somewhat reassured by the fact that the place I go to uses ONLY licensed veterinary technicians, and the vet is very experienced and I trust her and they monitor very well. I asked them for sevo instead of iso because of the shorter recovery time but they called me and said they don't carry sevo anymore even for the owners willing to pay. Even though I get nervous about anestheisa, I know their teeth are hurting them, and they won't let me brush, so . . .
Right now, my risk-benefit calculation comes down on the side of getting their teeth cleaned. I think when they are older, if they get systemic problems and are more fragile, my risk-benefit assessment might change. My mom has a really old dog and he has bad teeth but no vet has wanted to put him under to do it, and we aren't pushing. A 14-year old 5 pound Yorkie who is probably on his way out anyway . . . .
Stefani
Stefani January 19th, 2008 03:04:00 PM
I became aware of the extreme importance of good dental health for our pets when I read "Raw Meaty Bones Promote Health" by Tom Lonsdale. He's a huge proponent of raw diets (using whole raw meaty bones, not ground), and his book explains why. The target audience of the book was originally his fellow vets, so it's full of great, in-depth information. It really shows how poor dental and oral health can cause much more damage to the body than what you see happening in the mouth.
Janine January 19th, 2008 03:12:00 PM
"The posh re-design of the building (nicer than most new hospitals, a large wall fountain, modern architecture) didn't help the impression of being bled."
That's a great post topic! Thanks!
Dr. Patty Khuly January 19th, 2008 04:08:00 PM
Anna: On the vaccine issue. I sooo want to use this vaccine but the first two patients we used it on had bad reactions. One is still doing very poorly almost four months(?) later. Neither case may be vaccine related, it's true, but we're still feeling burned and consequently waiting a longer time to see more work on it. Serious perio cases certainly seem to warant it and I'm hoping Pfizer gets some updated info out for us soon regarding its safety.
Dr. Patty Khuly January 19th, 2008 04:13:00 PM
[...Problem is, when I write about it on Dolittler I’m always preaching to the choir. You guys have probably taken care of this stuff long before I deigned to mention it...]
Well, if it makes you feel any better, you've converted this heretic! :-) I'm going to get my dogs teeth done this month. I'll skip the bars tonight and watch a movie --> and put the $'s I save in the dawg fund!
I've never paid too much attention to teeth before because the vet always remarks on how good they look. (I credit the groomer for that..she brushes my dawgs teeth once a month.) But better safe than sorry.
Larry January 19th, 2008 08:34:00 PM
Dr. K - the staff education info that came w/our new batch of porphyromonas vaccine included statistics from DataSavant (Banfield's number-crunchers) and indicated an elevated risk of reaction - I can't remember if they were mild, owner-reported reactions or true anaphylaxis, but a mandatory diphenhydramine injection (at no charge to the owner, surprisingly) is given 15 min. pre-vx. I've only seen a few given so farand they did okay, but I was almost expecting problems given that the targeted pets are usually small breeds that seem more prone to vx reactions anyways...at least at my clinic.
By the way, do you have any recommended reading on feline gingivitis? My 3.5 year old already has chronic gingivitis and some recession despite regularl dental prophys, and he's already lost a tooth to a resorptive lesion. I'm going to amp up my home dental care regimen, but it's just frustrating and my current vets don't really have any answers for me. He's tested negative twice (once as a kitten, recently as an adult) for FeLV/FIV and is in excellent health otherwise. Would appreicate any links you may be able to provide.
anna January 19th, 2008 09:30:00 PM
anna: Our techs are trained by boarded vet dentist Dr. Jan Bellows in Weston, Florida. Here's his website. He also carries a "Smile Series" of books that are tech friendly. Check it out:
http://www.dentalvet.com/Encyclopedia/M01816.htm
Dr. Patty Khuly January 20th, 2008 08:31:00 AM
Anna: btw, we've seen myalgia in our vaccine reactions (pain at the injection site or in the whole body). One of the two also came down with a painful autoimmune disease--though we believe almost any vaccine could have caused it, that's the only vax she got that day. I'm at a conference now and I've been talking to the Pfizer people about it. They, too, say that anaphylaxis is a concern but that the reactions have been limited and treatable. They say that some vets give it routinely with diphenhydramine and Rimadyl or Metacam.
Dr. Patty Khuly January 20th, 2008 08:35:00 AM
I never brushed my Westie's teeth for her first 5 years, but she always ate dry kibble, chewed a weekly rawhide bone, and at her annual check-up, her vet always said her teeth looked very good and didn't need cleaning yet. 3 months after her last annual, I noticed one of her eyes looked swollen, and there was a big lump underneath it. Turns out one of her molars had an abcess, so they put her under, pulled the tooth, cleaned her toofers and with a couple rounds of antibiotics, she's been right as rain. The vet says she still doesn't know why a random tooth suddenly got infected since her teeth looked great, but I'm on the dental bandwagon now and am trying to keep her brushed as often as I can. And yes, she was eating like a champ the whole time.
Shasta January 20th, 2008 12:38:00 PM
It's already been said, but not often enough. It's a rare raw fed dog who has doggy breath and whose teeth need cleaning. I second the reference to Tom Lonsdale's Raw Meaty Bones. It was bad teeth in his patients that led him to raw.
Margot January 20th, 2008 01:50:00 PM
When we adopted Murphy his teeth were a nasty yellow. We took him in and got him examined and the vet said that he'd need to get a teeth cleaning soon -- the appointment was set and what not. It only cost us $90 -- I can't believe the $160 deal, the higher ones are even more insane to me!! lol
Either way-- teeth are important and can't be ignored, even by the country bumpkins. Back when I had a sick rat who wouldn't even gnaw her own teeth down -- we'd have her taken in about once a week to get them clipped.
ashleigh January 20th, 2008 04:00:00 PM
My dog came to me with a sore under his eye - persistent. Multiple rounds of antibiotics helped, but didnt cure it. Then I saw a repeat of a vet TV show, and a maltese terrier had the same problem. As you can probably guess, it was a tooth abscess.
But, it took 5 vets before one of them found it, and fixed it. Other vets put him on antibiotics, and even cleaned his teeth, commenting that one side was dirtier than the other, and a tooth was cracked, but no diagnosis of an abscess there.
Anyway, a week after the surgery and the sore was virtually gone. Cannot even see where it was now. And my dog became friendlier because it no longer hurt to touch his face.
So, its not just the owners who don't look at teeth. Its some vets too that need educating.
Just my two cents.
Robin January 20th, 2008 07:17:00 PM
I take offense to that picture of the hounds. Poor Baxter has to deal with the "dumb southern hick dog" stereotype enough as it is without pictures of hounds with buck teeth fueling the fire. It's not his fault that he's more handsome, much smarter, and way faster than any other dogs, save the occasional sight hound, lol.
We deal with the same thing at the practice where I work, with people asking why they can't skip the pre-op bloodwork, radiographs, etc. Thanks to our staff being very pro-active with their client education efforts, most finally see the light.
As far as the reactions to the suggestion of brushing an animals teeth, I know there are some pets that will never, ever allow this to be done, but patience is the key with most. Dr. Khuly, have you seen the vidoe that the Cornell Feline Health Center produced that shows their 4 week process aimed at feline cooperation in the toothbrushing process?
Here is the link: http://www.felinevideos.vet.cornell.edu/brushing_t...
Brian Hewitt January 20th, 2008 07:25:00 PM
Pepper gets a large raw bone at least every two weeks and sometimes more often (my cousin works at the grocery store meat department, so he keeps an eye out for what would be good for her.) She's five years old and her breath and teeth are wonderful. No offense to the vets, but I'd rather spend the money on the bones to keep her teeth clean than put her under general anesteisa (sp) on a regular basis.
My Persians had tooth issues and had to have cleanings -- Lindsey, my born-feral, is now 10 and never had a cleaning -- and he is carefully checked by my vet. I think genetics definately plays a factor.
I wish I could have convinced the Persians to gnaw on bones -- the Queen of the Universe stared in horror at Pepper the Puppy happily chewing on her bone -- the Queen sent Lindsey to check out the bone later to see what was so special about it -- the perplexed looks between the two cats as they sat there in the living room with the bone between them, completely at a loss as to why this was such a special object, is a great memory, but I wish I could have saved the Queen's teeth as easily!
Dorene January 20th, 2008 10:38:00 PM
I take great care to do the best for my guys. They eat raw. They get exercise. They are loved. But the cost around here for an extraction is about $500, IF you can get them to pull it.
My pittie broke off a tooth, and first vet said he'd be fine, come back if it starts bothering him. And that if he DID need to come back, root canal and crown would be about $1,000. Well it was already bothering him... he wouldn't eat. His ears laid flat. He didn't play. So off to vet nr 2, who said that it needed to come out. He pulled it for $84. It was a canine.
Now silly pit has broken off ANOTHER canine, and he will be getting that one pulled, also. BTW, he isn't breaking them on his raw diet. 1st tooth he broke when he leapt at his springpole and missed it and bit air. This last tooth, he was running full pittie force after a ball and ran smack into the concrete side of the house.....
Now my question...within a 60 mile radius, how is it that there is such a difference in the cost? Granted, the cheaper vet is older and more of a country vet. But still...
And, until I win the lottery, we'll be pulling any tooth that can't be fixed for under a thousand.
agadore's mama January 24th, 2008 10:29:00 PM
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