Friday, February 3, 2017

Oral Pain in Companion Animals #17

Centers for Oral Care
New England & New York
Animal Dental Health Services
No. 17
DH DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Oral Pain in Companion Animals

Oral pain in companion animals is REAL!  It can never be ignored!  There are two types of oral pain!
#1-Acute Pain-obvious and easily demonstrated by any dog or cat; very obvious to the pet owner than pain is present-i.e. crying, screaming, major behavior changes; not eating; whining; bleeding from mouth; and/or pawing at the mouth.
#2-Bad pain or Chronic Pain-pain that is not visible—i.e. your cat or dog lives with pain thinking pain is normal.  This is one of the greatest tragedy scenarios of modern animal pain control. I have coined the term “pain hunt!”  Close observation combined with a clinical intraoral exam by an animal dentist will REVEAL bad pain in a diagnostic “pain hunt” utilizing oral radiology under general inhalation anesthesia.
See Table One-Signs of Oral Pain in the Cat and Dog~~~ signaling a need for an animal dentist intervention:
Table One: Signs of Oral Pain
Changed Patterns of contact with pet owner
Disturbances in sleep patterns~~~~a pet waking up pet owner in the middle of the night asking to go outside that normally sleeps through the night
Reduced grooming in cats or increased frantic pet grooming
Changes in eating behavior-avoidance of dry food and biscuits
Changes in food preference: refuses pet foods only wants people food and soft treats
Food tossing: eating foods whole without chewing and the “toss-back” of foods into the back of the mouth
Chewing on one side of the mouth only
Smacking of lips
Teeth chattering or grinding

As a pet advocate, it is a major responsibility to monitor your pet’s food intake; eliminations; and subtle changes in behavior.  It is better to schedule a check-up than to miss “bad-pain”!  There is no “wait and see” with “bad-pain”!  No diagnosis can be made by looking at the gums and teeth.  Oral X-rays under general inhalation anesthesia is the key to all oral diagnostics.
Signs and symptoms of Advanced Periodontitis
In the earliest stages, periodontal disease causes few signs or symptoms. As the disease progresses, gums become soft and bleed slightly.  As the disease progresses, you may notice more-serious changes, including:
  • Swollen, bright red or purple gums
  • Gums that are tender to your pet when touched
  • Pus under the gum line
  • Persistent breath odor –oral malodor
  • Loose teeth-not always apparent in the awake patient-general inhalation anesthesia and probing is most often necessitated to evaluate
  • ORAL PAIN-remember “Bad Pain” is hard to determine in many breeds that are stoic to pain
Abscessed tooth root in mesial root of mandibular molar #409 in a dog
Types of periodontitis in the dog and cat that cause oral pain are: 
·        Chronic Periodontitis. This most common type of gum disease is characterized by progressive loss of the bone and soft tissues that surround and support the teeth.
·         Periodontitis as a manifestation of systemic disease. This usually develops at a young age and occurs in conjunction with another health problem.
·        Necrotizing Periodontal Disease. A severe form of periodontitis, this causes the death of gum tissue, tooth ligaments and even bone.
·        Aggressive Periodontitis-the most common form of periodontal disease in dogs with a direct familial relationship.  These patient have the inability for plaque control because of a characteristic immune system that cannot fight bacterial pathogens

Periodontitis begins with plaque. Dental plaque is a biofilm or mass of bacteria that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it is not removed by mechanical brushing it forms tartar [i.e. calculus- mineralized plaque].  Left unchecked gum recession and oral pain develops from local inflammatory pathology.
Plaque on your pet’s teeth forms when starches and sugars in food interact with bacteria and saliva in your pet’s mouth. Plaque that stays on your pet’s teeth longer than two or three days can harden under the gum line into tartar (calculus), a substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. Only a professional cleaning with daily homecare can remove and control return.
Without professional care and homecare ongoing inflammation eventually causes pockets to develop between your pet’s gums and teeth that fill with plaque, tartar, and bacteria. In time, the pockets become deeper and more bacteria accumulate, eventually causing irreversible damage and oral pain.
These deep infections cause a loss of soft tissue and bone destruction. Unnecessary pain and tooth loss can be avoided by proactive intervention by your veterinarian or consult with an animal dentist.  All patients with advanced oral pathology must have oral x-rays prior to tooth removal.  Many teeth can be saved with modern techniques in animal periodontal care.  Ask your local doctor of veterinary medicine to consult with an animal dentist if the pet that you love has advanced mouth odor; evidences drooling, lip smacking, teeth grinding; difficulty eating dry foods or biscuits; avoids favorite toy play; or seems to be eating less and losing weight.
Ask your local doctor of veterinary medicine, LDVM, to perform detailed pre-anesthesia testing prior to referral to an animal dentist.  Modern gas inhalation animal anesthesia is very safe if the patient is presented with a quality pre-anesthesia testing work-up that is within normal range.  No anesthesia comes without minimal risk.  Risk factors can be decreased or lessened with the proper pre-anesthesia testing being completed.
Young animals without heart murmurs or any difficulty breathing will need blood work and a detailed physical exam by your LDVM.  As the patient ages, chest x-rays, ECG, and blood pressure are important pre-anesthesia tests to complete.  As the patient reaches the later geriatric years a sonogram of the heart-echocardiogram is another important pre-anesthesia evaluation diagnostic tool to rule out heart disease.

Never ignore your pet’s oral health because of age.  Never fall into the “trap” of thinking……”my pet is just getting old and doesn’t need oral care!”  All pets deserve a pain free quality of life not matter what their age.  If you are 8 or 88 you do not want to live with oral pain that can be corrected by a visit to your dentist.  In the same way, a pet should never live in oral pain if the oral pain can be simply removed by an animal dentist trained to find and remove target zones of pain.

Your pet supplies unconditional love.  As part of the magic of the human-animal bond return their love with an attention to eliminating oral “bad-pain”!  Whether it is your faithful dog or your loving cat, it is time to begin the “pain hunt” to eliminate oral “bad-pain” from the pet that you love.

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