If there is one area that all dog owners, including dog mushers, tend to overlook while trying to provide top quality care for their dogs, I would suggest that the inside of the mouth is among the most common. We feed top quality food, spend endless hours bending over caring for feet, are quick to spot any small stiffness or lameness, but rarely take a good thorough look in the mouth to look for trouble.
Part of the problem with this is that dogs simply don’t manifest oral pain as dramatically as humans. Even the most astute, observative owner often will tell me that the dog shows no signs of pain whatsoever when I point out a significant problem in the dogs mouth. It is not until AFTER the problem is corrected and the dog’s behavior changes for the better that it becomes noticeable. Sled dogs are, for the most part, notoriously stoic, and give you very little evidence of trouble, so it is important for to be on the lookout for it, even in young dogs that appear completely normal.
Dogs have forty-two teeth that are designed to take a beating, and the abuse they put them through makes that a necessity. Normal behaviors such as chewing and playing set them up for tooth fractures that are painful and lead to infection. Everyday plaque buildup leads to formation of dental tartar (also known as dental calculus), which results in gingivitis (inflammation of the gums). From there, the inflammation extends where it cannot be seen, under the gumline and along the attachments of the tooth root to the bone in the maxilla (upper jaw) and mandible (lower jaw). This is called periodontal disease, or periodontitis. As this process progresses, deeper pockets form between the tooth root and the bone, to a point which the tooth requires extraction.
Gum Disease in Dogs
It is extremely important to realize that periodontitis can occur even when there is NO calculus present. The tip off that this is present is halitosis (bad breath). While no one can ever describe dog breath as pleasant even in dogs with a healthy mouth, there is a distinct stink present when periodontal disease starts, and if you have dog with halitosis, don’t let a lack of obvious calculus or tooth fractures convince you that all is well.
One of my house dogs with very clean teeth required eight tooth extractions for this very reason… all of the disease was up under the gumline, out of sight, and were easily identified on dental xrays and gingival probing. His teeth looked clean, but the odor was present. He felt a lot better when those bad teeth were extracted.
Therein lies the danger with hand scaling your dog’s teeth or the current craze of anesthesia free dental cleanings: it is easy to convince yourself that you are doing a good job when in fact you are just polishing the tip of a very foul iceberg. We recently had a patient who was new to Alaska, whose owner had proudly invested in anesthesia free cleanings every year. The smell from the dog’s mouth was detectable when you walked in the room. We examined the dog and recommended an oral health assessment and treatment (OHAT), which requires general anesthesia. Oral radiographs (aka dental xrays) showed severe periodontal disease and fourteen teeth were extracted. The odor disappeared, the dog felt better, and the owner realize that while at first blush the anesthesia free cleanings seemed worth it, she ended up paying considerably more because too many problems are missed that way. Earlier detection of the periodontal disease, treatment and follow up would have enabled her dog to keep those teeth healthier for much longer.
Maintain Oral Health
Maintaining oral health keeps the entire body healthy longer; it is well known that chronic periodontitis is one of the primary causes of heart and kidney disease in dogs. Additionally, performance in harness is adversely affected by chronic pain. The dog simply does not feel well and has no way to tell you, unless you take the time to look.
I also want to address chewing and proving things like bones for dogs to chew on to try keep clean teeth: while the bones will help scale calculus from the teeth, there is a very real risk for tooth fractures. I do give my sled dogs raw beef bones to chew.. large enough that they cannot break pieces off and swallow them, as obstructions are also a risk. While it keeps their mouths cleaner, I absolutely have issues with fractures, especially of the 4th upper premolar (“carnassial tooth”), which require extraction. Current dogma from dental specialists recommends only brushing and give soft things to chew. Sled dogs being what they are, soft chews will typically rapidly result in an intestinal obstruction, and their desire to chew while be directed at their kennels, dog houses, rocks, etc, so something must be provided as an outlet for this behavior. If you are in a position to do it, brushing weekly with oral cleansing wipes, or dog toothpaste applied to a wet clean cloth, will remove plaque buildup and keep teeth healthier longer; this is safest and most effective, but requires a dedicated time commitment. Don’t use human toothpaste; dogs can’t rinse and spit, and swallowing toothpaste can result in fluoride toxicosis.
Examine Your Dogs Teeth Once Year
At least once a year, take a good thorough look in your dogs’s mouths. Lift the lip and visually inspect teeth for: calculus buildup, discoloration, environmental debris caught between teeth, and cracked, broken or missing teeth. Look at the gums, lips and tongue for redness, ulceration, abnormal lumps, blood or pus. Gently open the jaw and look at the tongue and the roof of the mouth for same. It generally not possible to assess the inside of the lower premolars well as the tongue is in the way. Get close and take a sniff: dogs with trouble will almost always have significantly worse breath than their healthy team mates.
The truth of proper dental care is that the best you can do is preventative care and monitoring. If problems are noted, it likely requires veterinary care to address it properly. Dental care available in general veterinary practice varies very widely at this time in terms of available equipment. The best equipped practices offer dental radiographs, and have the drills and scaling/polishing equipment suitable for extractions. Estimating costs for dental work can be challenging, as it is not until radiographs and gingival probing have been performed that a plan can be finalized.
Unlike humans, who have tooth roots that converge together at the tips, dogs have divergent roots, which are like the roots of a strong tree. This makes extraction a more involved surgical procedure. That carnassial tooth has 3 big roots; to extract it, I have to surgically elevate the gum away from the maxilla, drill the bone away from the tooth roots, and then split the tooth into three pieces so that the roots can the be elevated and extracted one at time. After that, the bone is smoothed with the drill, and the gingiva is sutured back together with dissolvable suture material. Post extraction care by the owner includes giving prescribed drugs for pain relief, feeding a soft diet for seven to fourteen days, keeping chew toys out of reach for the same period. Simple extractions, such as for incisors (the small teeth in the very front of the mouth) will heal quickly; canine teeth and the larger premolars and molars need more healing time. In terms of return to athletic condition, the same time period of rest would be needed as well.
I want to mention CUPS (Chonic Ulcerative Paradental Stomatitis), also now referred to as contact mucositis. This is a very painful condition for which sled dogs seem to be over represented compared to other breeds. The cause is not known; what happens is an over reaction of the immune system to the bacteria that are in dental plaque and calculus. The mucus membranes (gums, lips and teeth) touching these surfaces become dramatically inflamed, and then ulcerate. They bleed easily when touched and may be oozing pus. The foul odor is terrible, and these dogs do manifest pain in the form of drooling, slow eating, and flinching or ducking even with very gentle attempts to lift the lip and examine the mouth. Periodontal disease progresses very rapidly in these dogs. Getting these dogs comfortable requires aggressive and dedicated management: extraction of all teeth is often the only thing that resolves the pain completely; if teeth are left, daily brushing is an absolute requirement as the slightest buildup of plaque, which only takes days, results in the same problem. Left untreated, it is very common for these dogs to develop issues with their heart valves or kidneys as the months go by.