Dr. John V. Ioia, MD, PhD

Reprinted from the AKC Gazette Magazine, March 2024

… For our Cavalier Community, the AKC Gazette deadline is three months before publication.  This was written last December immediately following the passing of our good friend Mrs. Carol Rose.  Along with being a breeder of wonderful Cavaliers, Carol was a dental Hygienist and was scrupulous in the care of not only her patients’ teeth but her own and her dogs.  I thought of Carol before writing this.

Dental and Periodontal Disease is one of the most common conditions occurring in dogs and is entirely preventable.   In one study over 80% of dogs over the age of three have active dental disease.

Dogs can get many of the same or similar oral diseases as are seen in people.  However, where the most common human dental problem is tooth decay or cavities, in dogs it is periodontal disease.  In dogs, tooth decay represents less than 10% of all dental problems. The most common dental problems seen in dogs are periodontal disease and fractured teeth.

Other than bad breath, plaque buildup and tooth discoloration, there are few signs of disease.  Professional cleaning and periodontal therapy often come too late to prevent more extensive disease.  Periodontal disease in dogs is generally under-treated and may cause other health problems.  Bacteria buildup can progress to bacteremia, bacteria in the bloodstream and may cause damage to organs including the heart.  This is particularly important to Cavaliers.

Bacterial infection of the tissue surrounding the teeth cause inflammation of the gums, the ligaments that anchor the teeth, and the surrounding bone. If gum disease goes untreated, teeth will be lost due to the loss of their supporting tissues. This is the major reason for tooth loss in dogs.

Gum disease is caused by accumulation of bacteria (plaque) at the gum line.  As the number of bacteria below the gumline increases, bacterial waste products, such as hydrogen sulfide, ammonia, acids, and other compounds, accumulate and damage tissues. The dog’s own response to this infection (inflammation) also causes tissue breakdown and loss of the tooth’s supporting tissues. There are 2 forms of gum disease: gingivitis and periodontitis.

In gingivitis, the gums become inflamed because of bacterial plaque, but the ligaments and bone are not yet affected. The gums change in color from coral-pink to red or purple, and the edge of the gum swells. The gums tend to bleed on contact. Bad breath is common. Gingivitis can be reversed with proper tooth cleaning but, if untreated, may lead to periodontitis.

Gingivitis can be treated by thorough professional cleaning of the teeth while the dog is under anesthesia. This should include cleaning below the gum line. If gingivitis does not improve, the dog should be examined again and maybe more extensive cleaning is required.  When cleanings are completed, your veterinarian may apply a sealant to the teeth to prevent bacterial buildup and improve healing.  Dogs that do not respond to treatment should be evaluated for other disease, such as immune system problems and diabetes.  Gingivitis will reoccur if the teeth are not kept clean and free of plaque. Therefore, at-home oral hygiene methods, such as brushing are important.

In periodontitis, the tissue damage is more severe and includes the gums, ligaments, and bone.  It is usually seen after years of development of plaque, tartar, and gingivitis. It is irreversible and results in permanent loss of tooth support.  Small-breed dogs like Cavaliers usually have more problems than large-breed dogs.  Dogs that have a regular diet of hard kibble develop fewer problems due to the mechanical cleaning effect on the teeth as the food is chewed.  Back teeth are affected more often than front teeth. The upper teeth are affected more than the lower teeth, and the cheek surfaces of the teeth have more disease than the surfaces near the tongue. Gingivitis is often first noticed at about 2 years of age but improves if treated.  Periodontitis usually begins at 4 to 6 years of age and, if untreated, progresses to tooth loss.

Periodontitis is treated with thorough professional cleaning above and below the gum line. In some cases, surgery will be needed to gain access to the root surface for cleaning. Your veterinarian can determine the extent of bone loss by taking x-rays of the jaws. These are often recommended as a part of periodontal disease diagnosis and treatment planning. Extractions may be necessary for dogs with periodontitis. Extractions allow the tissue to heal, and dogs do surprisingly well without the teeth.

Brushing your Dogs’ Teeth is the single most effective means to maintain oral health.  This make sense because the bacteria film known as plaque, is the cause of periodontal disease.  This film is easily disrupted by the simple effect of brushing the teeth.   Frequent brushing – daily, is recommended to maintain dental health.  Almost all dogs will accept brushing.

The key to success is a patient and gradual approach.  Brushing the outsides of the posterior (back) teeth by lifting the side lip at the start and then move to the front and then inside.  Toothpastes made for people should never be used as it contains detergents and fluoride. We spit all that out. Your dog swallows it.  Many veterinary pastes contain enzymes that break down plaque. The paste is meant to be brushed on and left there to continue its work.  The best products are those that have received the Veterinary Oral Health Council (VOHC) seal of approval. The VOHC was founded by a group of veterinary dental specialists who set rigid standards and only accept products with valid research to support their claims.

Nonprofessional dental scaling is gaining in popularity for people fearful of anesthesia and because some are not able to afford professional veterinary dental care.  A major problem with scraping teeth is the mouths’ blood vessels, which can send bacteria into the bloodstream.  Once bacteria enter the bloodstream, they can infect the valves of the heart resulting in vegetative valvular endocarditis.  Hearts with underlying valvular issues are most susceptible.  Turbulent blood flow at the valve surfaces creates a greater likelihood of endocarditis.  Like humans with Mitral Valve Prolapse (MVP), even a small change in flow can produce big problems

While plaque should be removed to care for your dog’s teeth properly, it should be performed by a dental professional. Plaque scrapers are sharp and improper use can damage the delicate gum tissue.  Dental chews, dog food and chew toys designed to address dental disease and reduce tartar development do help but don’t try to replace brushing with these – think of them as an add-on to regular oral care.  If you notice inflamed or swollen gums, missing teeth or even appetite changes, see your veterinarian.

There is one more bit of concern.  Before having a cleaning procedure performed on you dog, particularly if he/she has a murmur, ask your veterinarian about antibiotic premedication prior to the procedure.  In humans Amoxicillin would be the choice followed by Doxycycline or Clindamycin for those who are allergic to Penicillin.

There are other dental and oral issues, like bite or malocclusion and oral tumors but we will discuss these at another time.

I hope that some of this knowledge will benefit the Cavalier owner.  Mouth care is another daily job that is required of us as Cavalier lovers.