SPEAKER 1: Everyone, thanks so much for coming. We're really happy to have you for our newest Baker PET Talks. Dental hygiene is a super important issue for our pets. And it's just as important for their overall health as it is in humans. So, we're really excited to have been able to find not just one, but two experts from right here at Cornell that can teach us all some home care strategies on how we can better help maintain our pets' health. I know personally, I've spent thousands of dollars on dental cleanings for my cats. So, it'd be nice to kind of get some skills to avoid that happening every year. Without further ado, we've got Dr. Lindsey Schneider, and Dr. Kevin Ng. Thank you.
DR. KEVIN NG: Hi, everyone. Thank you so much for having us today. I really looked forward to being here to talk about dentistry and oral surgery, our service, as well as the sort of strategies and skills that we can give to you in order to keep your pets healthy in terms of their oral cavity, as well as what to look out for in case something goes wrong and what to do, and a little bit of basic advice as to how to look after your pets' oral health as much as possible.
So, Dr. Schneider and I are both residents at the dentistry and oral surgery section at the hospital. It's a three year program. And essentially, our caseload at the moment is split about 50% between what we would normally consider to be under dentistry. So, periodontal cleanings, cleaning teeth, some root canal treatments. And then the other 50% is actually a huge amount of oral surgery as well. So, we take a lot of pride in being able to treat not just problems that are wrong with the teeth, but problems that are wrong with almost the entire face. So, jaw fractures, tumors involving the lips and jaws, that sort of thing as well.
So, what I want to do today is to essentially give you skills so that you can actually look inside your patient's mouth. You can get a rough idea of what's going on and recognize what's normal versus what's abnormal, as well as some basic strategies to try and encourage good home care practices at home. And when we talk about good home care practices, we often think about, oh my goodness, how on earth am I going to get into my pet's mouth? And there are a couple of little tips and tricks that we can show you, and show you that it is very, very possible. And obviously, in a small subset of patients or in a small subset of our pets, especially cats, that might be a little bit more difficult to do. And we also have alternatives for that, too.
The other thing I want you to be able to take away from today is, if you check your patient's mouth on a regular basis and you notice that something's moved into out of the ordinary, get you a little bit of an idea about what's happening so that you, one, don't panic, and you know roughly what to do, who to call, so on and so forth.
I also want to talk briefly about what's involved when you go to a veterinarian and you say to them, my pet's mouth, my pet's breath smells. What can I do about it? And they say to you, well, I think your dog should have a dental. And I think that that's a little bit of a misleading term. It's like kind of going to your doctor and saying to you doctor, I need a medical. It's not very specific, now is it? Or going to your surgeon saying, well, I need a surgeon. And your surgeon's sitting there going, what's he talking about? Which surgery? Is even in the right place at the right time? So, on and so forth.
As well as to talk about a little bit of some sort of controversial issues with regards to providing oral health care in the veterinary profession. As well as, in general, the PET services area as a whole. And then we're going to do something fun to end the day with, and we're going to show you what we do, some nice photos, as well as the scope of what we do at the hospital. Not just at the hospital, but also elsewhere. We make some trips to some rather spectacular places, and we get to treat some rather spectacular patients.
So, when you're looking in a pet's mouth, how often do we do that? I think that we should be doing it about once a week, once every couple of weeks. And start at a young age, as well. And I think it's important to realize the number of teeth in a patient's mouth and what function they serve, as well as to recognize when it's abnormal. So, dogs have 42 teeth, and dogs have 30 teeth. And you'd actually be surprised as to the number of times the client has said to me, you have to remove how many teeth? How is he going to eat? And sometimes when I remove a few teeth, two or three, I get asked that question. And I have to kind of smooth things over with my clients and say to them, well, your dog's got another 30 or 40 more teeth to go. So, it's not going to be a big deal. Don't panic. Essentially what we're doing is in the best interests of your pet.
Cats have a few fewer teeth. They have about 30 teeth. And we tend to spit teeth up into four groups. So, there's the incisors, which are these guys up here. And their function in dogs, they're kind of like scissors. They want to cut things. They also are used to pick up objects in some way. And dogs in particular use them to scratch themselves, too. The canine teeth, which are essentially the fang teeth, these are sharp and these are pointy. They're used for grasping. They're used for self-defense.
The premolars, as you can see, they have this sort of nice, jagged edge to it. And they're used for shearing. They're used for tearing. The analogy would be a fork. And lastly, the molars would be kind of like your mortar and pestle. And they live at the very far back, and they're use for crushing things. So, dogs and cats, dogs in particular, have a wide variety of these teeth. So, they can do pretty much everything. The molars in cats are not particularly well-developed, so they're not really designed to crunch a lot of things. They're mostly designed for shearing.
So, what is on the inside of the tooth? When we look at a tooth, we only see the very outside, the very top surface of it. And the structure is actually quite interesting. It has a hollow cavity which is a pulp. And that's probably the most important part of the tooth because it has living tissue in it. It's got blood vessels. It's got nerves, which means that when the pulp's exposed, patients tend to feel discomfort and pain. And it's hollow, OK? So, can you imagine if, say, for example, you broke a tooth. You snapped it off there, and you have this sort of hollow opening into the mouth.
And you think about what's in your mouth, it's not particularly clean. When you think about what's in your dog's mouth and the things that they do with their mouth, they lick their butt. They eat poo. They're chewing everything and anything. They've gone outside and they found that two week old squirrel carcass that you buried in the backyard. So, imagine that, and then imagine if they broke a tooth. And essentially, what they have is this hollow straw that's been stuck in through their gum and then into the bone of their jaw. And they've got all that horrible bacteria, everything in their oral cavity, and it's got this sort of pathway that goes down into the bone of their jaw. So, you can imagine that. And that gives you a good idea of why we get concerned whenever we have a fractured tooth, and we feel that we need to do something about it.
One of the common misconceptions that we have, and we have to try and address as veterinarians, is that a broken tooth is not a problem. And as you can see, just based on what we're seeing here, based on the anatomy, that it truly is, and it truly can be. And it truly does cause our patients significant discomfort. So, we want to talk about that, and try to address those things as well.
So, the outer layer is called the enamel, and that's the white stuff that's hard. And it also has a little bit of a dentin layer, which is the middle layer, so to speak. And it's porous, so it's a little bit hollow. It's kind of like a little bit of a sponge. We won't go into too much of a huge detail about that, but just to give you an idea of the complexity of the anatomy. And then we have the supporting structures, which is the bone, the ligament that holds the tooth in position, as well as the gingiva, which is also known as the gum.
Now, the most common problem that we see in our patients is actually gum disease. So, when your dog, your cat, has bad breath, unless they've been eating that two week old carcass, that's probably an indication that they have bacteria in high enough levels that you've got these really aromatic substances floating around. And I use aromatic in a very sarcastic manner, obviously. So, what we tend to see is, we tend to start off with a little bit of a layer of bacteria on the surfaces of the tooth. And they can harden to form calculus.
And the problem with it hardening into this sort of brown material is that we're not going to be able to get it off with toothbrushes easily. And it's a little bit abrasive, so it's irritating. And it also keeps the bacteria in constant contact with the gum tissues themselves. And what happens is, that causes inflammation. And if we don't treat that inflammation, with enough time it's going to cause destruction to the underlying bone. And as we have further and further bone destruction, this tooth becomes a little bit more mobile, a little bit more wiggly.
And if we can remember when you were seven and you had your baby teeth that were coming out and your adult teeth were coming through, whenever you had a wiggly tooth, it hurt. You couldn't eat apples that much. And exactly the same thing with our patients as well. When your teeth get mobile, it becomes painful. And that's when we start to see them go off their kibble. It's when they start to see them, we don't want to chew things anymore. And the horrible thing about it is, this takes a long time. This could take place over months. It could take place over years. And because of that sneaky sort of nature to it, we might not notice something straight away. Say, for example, if a dog started limping the next day, we'd go, oh, that's definitely a problem. But what if we have, over a three year, four year period, where our dogs preferences with regards to chewing subtly change? And that can kind of sneak up on us a little bit.
Now, worst case scenario. What happens if this goes untreated is that, as I mentioned, we see destruction of bone. And if we leave that untreated and we don't do anything about it, what's going to happen is, that bone is going to continue being destroyed. I'm not saying that this will happen in every patient. I don't want to scare you. But in some patients, especially really small breed dogs, what might happen is that the jawbone might weaken to the point where your dog's playing fetch and they break a jaw just like that. And we do see that frequently. And commonly it's in old patients, and frequently in really small breed dogs. And frequently what we tend to see is, we tend to see that they had really bad gum disease.
So, I want to talk about the next most frequent thing that we tend to see, and this is endodontic disease. And what it involves is a disease of the inside of the tooth. And this involves a fracture of the pulp itself. This is the exposed pulp here. And you can imagine it's kind of like that straw analogy that I was talking about earlier. There's also lots of other causes. Sometimes cavities, which is the most common problem in people, but we don't tend to see a huge amount of, as well as gum disease, as well as well as sometimes we see it for no apparent reason at all. The tooth itself dies.
And these are the signs that we might see. We see sometimes that the tooth looks different. Sometimes there might be a loose tooth fragment. Bad breath and pain, sometimes we see those. And sometimes all we see is a little bit of discoloration. And remember that straw analogy? This is what happens when you have bacteria traveling down that straw. You start to get infection at the tip of the root. So, this is the patient's tooth. These are the roots of the tooth. And this is, a good analogy would be an abscess or a sign of infection.
Now, oftentimes people say to me, well, I didn't notice there was a problem. And that's true. The vast majority of our pets that come in to see us, they have had very minimal clinical signs. So, oftentimes, there can be no sign of a problem at all. And that's really important to know. And that's why I say to my clients, make sure that you get your pet's oral cavity checked out once a year while they're getting their vaccinations, or with their annual health exam.
These other signs are less common, and they include rubbing, chewing on one side, rubbing on one side of the face, drooling, eat more slowly. The biggest thing that I tend to see is, all of a sudden their food preferences change. And that's something to keep in mind, is that all of a sudden they don't want to eat their kibble anymore. They want soft food all the time. And you hear about those dogs all the time. And unsurprisingly, a lot of them have gum disease. Sometimes we see a little bit of weight loss. And sometimes we see shaking or flicking of the head. But again, big thing is, oftentimes we don't see anything at all.
Now we want to talk about home care. And I'm going to hand over my little cursor to Dr. Schneider, and she's going to show you some cool things that she's prepared for you.
DR. LINDSEY SCHNEIDER: Yeah. So, now that Kevin scared you a little bit about all the things that could happen to your pet, I want to talk a little bit about preventing these things. So, you know the saying, an ounce of prevention is worth a pound of cure. And that is certainly the case with veterinary dentistry. So, we really want to encourage you to try working toward home care with your cats and dogs. So, as Kevin mentioned earlier, ideally you should be looking in your pet's mouth at least once a week, maybe even once a day when you're doing tooth brushing. And I'll discuss that a little more in a minute.
If we're doing daily preventative care at home, we're hoping to minimize the plaque biofilm build up on that tooth. And that is what is the source of that gum disease. Also as Kevin mentioned, yearly check-ups and professional dental cleanings are recommended. And this varies a little bit by pet. Some small breed dogs, for instance, might be more prone to dental disease, and they might need to have a check-up every six months to every eight months. Other pets might just have their annual exam and the vet says, wow, the teeth are looking great. You're doing a great job at home care. You don't need a professional cleaning this year. But certainly should you having an exam by a veterinarian at least once a year. And then also looking in your pet's mouth at least once a week.
So, when you're looking in your pet's mouth, the biggest tip I can give you is to go slow and make it enjoyable for your pet. Certainly we don't want to traumatize them by trying to crank open their mouth and take a look in there when they already have pain in their mouth. So, I think if you can start slow and start at a young age, that's the best. But let's say you adopt an older dog from the shelter, and you have an 8-year-old dog that's never had their mouth dealt with before. How are you going to introduce this new home care routine?
Well, I recommend kind of starting really basic. You can start by petting their face, palpating their ears, rubbing their ears, rubbing their cheeks and just making it enjoyable, giving them treats while you're rubbing their face. And in some patients, they might already be cooperative, and you can already move on to the next step. Other animals, they might be really head shy, and they might have pain and not tolerate this. So, you might need to do this over the course of weeks, just gradually working your way up.
We also encourage you to kind of go from the least invasive to the most invasive when you're doing the steps of the at-home exam. So, don't try to open their mouth right away. You can assess a lot externally. So, first, take a step back, look at their face. Look for symmetry. Is one side of the face looking a little more swollen than the other? That could certainly indicate some dental disease going on in the mouth. Look at their eye position. If you note that one of the eyes seems to be pushed forward a little more than the other, that could also be a sign that something is going on in the back of the mouth and applying a mass effect to the back of the mouth.
So, there's a lot of information that you can gain just by looking at the outside of their face from a distance. You might also see draining tracks, or little pinpoint areas where it looks like it's almost like a zit or something coming out through the skin. That could potentially be a sign of a tooth that's diseased in the mouth. As Kevin mentioned earlier, the breath can also be an important clue as to what's going on. Now certainly, our pets can eat things that smell bad and that can give them bad breath. But if you're noticing kind of chronic, ongoing bad breath that's getting worse, that's usually one of the first and most obvious signs you can see.
And then, after you've taken a look at the external parts of the face, then we go to looking in the mouth. And we start by just kind of gently lifting the lips. You don't try to open the mouth right away, as I mentioned. You can just kind of gently retract the lip. I find in cats, sometimes I can actually use the whiskers as a little bit of a handle. They'll let you kind of gently pull on the whisker slightly, and that will allow you to retract the lip enough to see the tooth and the gums. And finally, rewarding your pet after this, and during this process, is a really big, important part. Some dogs might like to get treats. Other dogs, it might be cuddles and snuggles. My own dog, she's very toy motivated. So, when I was working up to doing oral exams on her, I would reward her by, let's play fetch for a few minutes after you've let me look in your mouth. So, find what works for your pet. And go slow.
So, here's an example of someone gently lifting the lips of their dog's mouth. You can look at the front and the sides. And then, once you've worked your way up to gently lifting the lip, the last thing you want to do is open the mouth. And they'll only usually tolerate a few seconds of this at most. So, you kind of have to be somewhere where you have good lighting, you can get a good glimpse in there. And things you are looking for, as Kevin mentioned with their kinds of different periodontal or endodontic disease, we're looking at changes in the tooth shape, swellings, masses, things like that. Anything that looks different than it did the week before, that could be cause for concern. And then finally, giving them a reward, whether that's a treat or playing with them. Like I said, whatever works for your pet.
So, there's many different products out there on the market. If you go to Petco or PetSmart, you might see an entire aisle of different dental products. And it's really hard to know which ones are effective and which ones aren't. Fortunately, we have an organization called the Veterinary Oral Health Council. They have a website here, vohc.org. And that's a good place to get some basic information about products that might be beneficial for your pet. This is a group of veterinary dentists and oral surgeons that have gotten together, and they've looked at these different products and tried to evaluate whether or not there's any scientific evidence behind whether or not the products are effective.
Sometimes we have to take that with a grain of salt. Some of the scientific research is performed by the company selling the product, so there might be a financial interest involved in that research. However, this group of veterinarians has gotten together and tried to critically evaluate that. And they've made a list of products. So, if you go to their website, you can click on a link that has product recommendations. And those products have kind of their seal of approval. So, some of these products include water additives, chewable treats, diets, toothpaste, things like that.
Ultimately, toothbrushing is really the best thing that you can do. And that's something you're going to have to do very gradually. And I'll have a little more information on that here in a minute. You can use a toothbrush. Ideally, a soft bristled brush. I personally like to use a children's toothbrush that I get at Walmart or Target, just any store like you would go to get your own toothbrush. You can just buy a children's toothbrush and use that. Other people like to use little finger brushes. They find that it's easier for them to get their finger in their pets mouth than to get a foreign object in there, and that's fine as well. Some people even use something as simple as a wash cloth. It has a little bit of that terrycloth abrasiveness, and that's good for getting some of that plaque off the tooth as well.
Daily chewables can include diets or treats. Some examples of diets that are available include the Hills T/D. Royal Canin also makes a dental diet. Some examples of treats include the canine Greenies. I think there's also some feline Greenies on the market as well. And these diets, as well as the treats, work by abrasive action. So, it's when the pet's chewing that, the mechanical action of them chewing is helping to abrade and remove the calculus or tartar buildup on their teeth. We like to mention the caveat that you should supervise your pet when they're eating these treats. Certainly, we don't want them to break off a big chunk of a hard treat and swallow it and choke on it. So, whenever you're getting the pet a chew treat, definitely supervise them while they're having access to that.
Water additives, while not as effective as tooth brushing, are kind of a next best option if treats or brushing is not an option for your pet. If you've tried and they're just so resistant that you're worried about getting bitten, then water additives might be another potential benefit for your pet. There's a product called Healthymouth that is on the Veterinary Oral Health Council's list of recommended products. And these water additives work to chemically prevent the plaque and calculus from forming. Ideally, they're best used with diets, treats, and brushing. But like I said, if it's the only option, it's better than nothing.
A lot of people will ask, well, what about bones? That's something hard that my dog likes to chew on. And we really don't recommend bones. There's a lot of problems that are associated with chewing on bones. Probably the biggest one that we see on the dentistry and oral surgery service is fractured teeth. Bones, antlers, hooves, things that are hard are more likely to fracture the tooth when they bite down on it. But there can also be other problems, such as constipation, pancreatitis, upset stomach, or intestinal blockages that can be associated with feeding some of these bones, antlers, things like that. And there are safer alternatives, as I mentioned. That Veterinary Oral Health Council website has a list of dental chew products that are a little safer for your pet to chew on. So if you do decide to give bones, you're kind of using that at your own risk. Like I said, we don't recommend it.
So I made a little video last night of myself brushing my dog Pancake's teeth. She was very tolerant. I think this is actually the third take. We had to do a few videos to get the camera positioning right. So I'm going to play this here in a second for you and just kind of show you how I do it with my own dog. Now, she's 10. We've been doing this almost every day for the past 10 years, so this did take a lot of practice to work up to this level. I don't expect you all to go out there and be able to do this right away.
So you can see she's kind of licking her lips in anticipation. She sees me coming with the toothpaste. And the toothpaste itself is enjoyable for her. I use a C.E.T. brand, and it comes in lots of different flavors. There's flavors like beef and chicken that make it enjoyable for your pet. And then like I said, I use that soft bristled toothbrush. And so, I'm gently lifted her lips and using the toothbrush to kind of slide in between the lip and the cheek. And I'm trying to get all the surfaces of the tooth.
I recommend starting with just the external surfaces, not worrying too much about opening the mouth and getting the internal surfaces of the tooth because that's a little bit more stressful for them. But you can start by getting all the outer surfaces, getting all the teeth just like you brush your own teeth. Just these little back and forth motions at the gum line, little circular motions as well. And it's OK if they chew on the toothbrush. That's also going to have a little bit of abrasive action. And you can see she likes to lick the toothpaste right off the toothbrush when we're done. So, she was very cooperative for this. Yes, good job, Pancake. She even tolerates flossing her teeth. I'm probably the only person that I've ever met that flosses their dog's teeth, but that's because I have a particular interest in her oral health.
AUDIENCE: I would like to see that video.
DR. LINDSEY SCHNEIDER: I unfortunately didn't make a video of that.
AUDIENCE: I'd like to see a cat video. Do we have a cat one?
DR. LINDSEY SCHNEIDER: We don't have a video of a cat. Unfortunately, I don't have a cat, so I didn't have the ability to take a video of a cat brushing. But cats are certainly a little more challenging than dogs. They tend to be a little bit more finicky about having their mouths messed with.
SPEAKER 1: Dr. Schneider, can I jump in with a question that is actually pretty well-timed with that awesome video?
DR. LINDSEY SCHNEIDER: Definitely.
SPEAKER 1: So, someone watching online is asking, can you please demonstrate ways a pet parent can brush her dog's teeth if the dog is always trying to lick the toothbrush?
DR. LINDSEY SCHNEIDER: Yeah. So, that's OK. If they're licking the toothbrush, that can be a good sign that they like the toothbrush. And so, we have a little model over here of a skull. And I have a toothbrush here, I can try to just switch over to that. Let's see if it's focused. So yeah, if your pet's licking the toothbrush, that's OK. You just want to try to, like I said, slip it in between the cheek and the tooth. I don't know if this is focused or not. But as they're licking it, let them lick the toothbrush. They might like the taste of the toothpaste, and that's good. You can use the opportunity when they open their mouth to lick the toothbrush, you can kind of try to slide the toothbrush in and get some of those inner surfaces.
Kevin, do you have any additional advice on when they're licking the toothbrush, how you might cope with that?
DR. KEVIN NG: Well, I guess the other thing is, if they are licking that toothpaste itself and they're really enjoying the toothpaste, you can remove that, and you can just use water. The toothbrush actually performs about 95%, 98% of that abrasiveness. And the toothpaste is mostly for flavor, and mostly it's a source of motivation for them. So, if we find that they're a little bit too motivated with the toothpaste, it might be worth kind of cutting back down on it a little bit or removing it entirely.
The way that I often say to my clients and those patients that are really motivated by the toothpaste is to motivate them by massaging their face and making it pleasurable in a physical sense rather than for their taste buds. So that might work for certain patients. That might be worth a try if we have a little bit too much licking, and if we can narrow it down to the toothpaste being the problem.
DR. LINDSEY SCHNEIDER: Yes? Go ahead.
AUDIENCE: I've heard different things from different doctors or students at the community practice service. We've been told to, if the dog likes peanut butter, which she does, my dog will kill for peanut butter, use peanut butter on the brush. Another one said, well, that's kind of defeating the purpose of brushing their teeth. So, is that good? Is that an OK replacement for toothpaste? Is using peanut butter not a good idea? What do you think?
DR. LINDSEY SCHNEIDER: Personally, I feel that, initially, to kind of get them introduced to the activity of tooth brushing, it's OK to use that as a treat. Nowadays, there's peanut butter that has lots of sugar added to it, so it's important to kind of read the labels. Xylitol is kind of a sugar replacement that can be toxic for pets, so you want to check and make sure that the peanut butter doesn't contain Xylitol. But for the first few weeks, using peanut butter as a reward, I think, is OK. Ideally, we would transition to doing the brushing without the peanut butter so that we're not adding substances that could be cavity-inducing, although cavities are much less of a problem in our pets than in people. But ultimately, just getting them into the routine of the tooth brushing is important. And so, I think whatever treats and motivation you can provide initially, that can be helpful.
AUDIENCE: Is following up the brushing with a chewable treats of some kind kind of defeating the purpose of doing the brushing?
DR. LINDSEY SCHNEIDER: Not at all. So just the chewing action itself can be the abrasive. The abrasiveness can help eliminate the tartar. So yeah, it's fine to give them chew treats after brushing.
DR. KEVIN NG: And the other thing that's important as well is to make sure that they're rewarded for it. And I tell my clients to brush their teeth before a meal and feed them a meal after. Because for them, the reward is more important than being able to make sure that we don't eat straight after.
DR. LINDSEY SCHNEIDER: Yeah. And you know, if your pet doesn't like toothpaste, kind of another caveat, if they don't like the taste of the toothpaste, it's OK to just use water on the toothbrush as well. Like Kevin said, the brushing action is what's doing the majority of the work, not the toothpaste. The toothpaste is more to motivate them for the flavor aspect.
SPEAKER 1: So, Dr. Schneider, there's actually a relevant question that just came up also. Someone was inquiring if you had any recommendations to make a natural toothpaste. They're a little concerned about the commercial formulas having some kind of toxic or not friendly ingredients. Would you have any recommendations, or would you just say, go ahead, use some water and a soft bristled toothbrush?
DR. LINDSEY SCHNEIDER: Yeah. I personally use products that's made for pets. We definitely don't recommend using human toothpaste. Those products aren't meant to be swallowed. They have a lot of fluoride in them, and they can be harmful to our pets. But yeah, if you're concerned about what you're putting in your pet's mouth, even just water and the toothbrush itself is a good option. Kevin, do you have any suggestions for that?
DR. KEVIN NG: So not with regards to a replacement product, but I think that if you're going to take away something that motivates them, then you need to motivate them with something else, ideally. And generally what I would do is, I would make sure that I give them a lot of TLC during the brushing procedure itself. And that really tends to help. So what I'll do is, I'll often massage my pet's face while I'm brushing their teeth, or in between brushing, and give them lots of praise. And then, obviously feed them afterwards as well. And that's just a little bit more motivation, rather than the toothpaste itself.
SPEAKER 1: Let me make sure I get this mic over to you just so the audience can hear you as well.
AUDIENCE: I have a multiple dog household with five dogs. Is it important for each dog to have their own brush? I mean, I wouldn't share with anybody I live with.
DR. LINDSEY SCHNEIDER: Yeah, so they're going to be sharing a lot of bacteria, kind of licking each other. So, it's not a huge deal if you're sharing the brush. But almost for our own personal level of comfort, I think certainly we like the idea of having our own brush and not sharing between people. So, certainly, you can do that with your pets as well, have them each have their own brush. Also, if one pet likes to chew on the bristles a lot more, it might kind of wear that brush down faster, so you might need to be replacing the brush more frequently.
SPEAKER 1: We have another question up here.
DR. LINDSEY SCHNEIDER: Yeah?
AUDIENCE: Is there anything in an approved toothpaste that actually has a beneficial chemical effect on the bacteria growth? Or is it basically all just for the pleasure in eating, the pet, and enjoying the experience?
DR. KEVIN NG: That's a great question. Essentially, there are some toothpastes that have enzymatic components to it. To be perfectly honest, we don't know how much that enzymatic component actually plays a role in plaque reduction because oftentimes these tests are performed with a toothbrush as well. So, I don't think that there's any harm in it. I think that if you've got an enzymatic toothpaste, great. Would I naturally preference an enzymatic toothpaste over a different one? To be perfectly honest, I find whichever toothpaste my dog will tolerate better.
SPEAKER 1: I'm coming right here. Here you are, sir.
AUDIENCE: Are there any special techniques or anything associated with cats who have already had teeth removed? I have a couple of cats who have had 10 teeth taken out, six teeth. So they've obviously had problems in the past. Those teeth are gone, so I don't know if there's extra pain associated with brushing there, or extra possibility of infection from too vigorous gum action.
DR. KEVIN NG: Thanks for the question. Essentially, no. So, the biggest problem with losing teeth is that the pet's not going to be able to chew as well. So essentially, with the chewable treats, the diets that are specifically designed to reduce plaque levels, they're not going to be as effective in those patients, and they're going to have to rely a little bit more on brushing. So if the extraction sites have healed completely, then it shouldn't be a problem. If there is some residual disease, such as gum disease, that hasn't been completely treated, I think that as long as the patient's not showing any signs of discomfort with you brushing their teeth, that should be fine.
In certain cats, there is a condition called tooth resorption. And if your cat has a tooth with tooth resorption, that can be quite painful in brushing. Essentially, I would remove that tooth, and then you shouldn't have a problem after the extraction sites have healed. Does that answer your question?
DR. LINDSEY SCHNEIDER: And Kevin had mentioned one thing about how he likes to do the tooth brushing before a meal to use the meal as a reward. I mentioned my dog's not very food motivated. So I found that, for me, it was just kind of making it routine, doing it at the same time every day. And so, we always do it right before bed time when she's kind of relaxed and comfortable. That's when I brush her teeth. And I think just getting it into a routine, both part of your routine as well as your pet's routine, is really key. So whether that's in the morning before their meal, right before dinner time, right before bedtime, try to be consistent about it.
All right, moving on. So, you've gone to your primary veterinarian and they've recommended that your pet has a dental procedure. And as Kevin said, that could entail lots of different things. But typically when they say a dental, what they're referring to is periodontal treatment. And so, some of the things that that entails includes cleaning, whether that's cleaning the superficial plaque and calculus or tartar buildup from the teeth, as well as a deep cleaning below the gumline.
Also what might be included is an oral surgery. Extractions are, unfortunately, very common in our pets. We actually require that so you get them to a level of oral health that will make them comfortable and make them amenable to home care. So, it's not the end of the world if your veterinarian tells you your pet needs five teeth extracted. Think of it as a way to get them to a state where you can then provide adequate home care to hopefully minimize the need for extractions in the future. It can be very difficult to do these oral home care strategies when they already have painful teeth in their mouth. They're going to be a lot more resistant to letting you put a toothbrush in their mouth. So if we can extract those teeth that are causing them pain, give them a few weeks to heal, and then kind of start afresh, that's ideal.
Also part of that dental procedure will, ideally, be dental radiographs. Similar to when you go to the dentist, we like to take x-rays of all the teeth to see what's going on below the gum line. There's a lot of disease processes that we can't see just on our conscious exam, or on an exam if we're just looking in the mouth. We need to really be able to assess what's going on below the gumline. So we'll take those full mouth x-rays. And we also do probing and charting, much like when you go to the dentist. We take a little dental probe and go around each tooth and check for pockets, check for mobility or wiggliness. We check for furcation exposure. So if it's a multi-rooted tooth, if we can get our probe in between those two roots, that's usually a bad sign. So those are some of the things that we'll be checking for during that dental procedure.
Another question we get very frequently when we call our clients after we've done our anesthetized oral exam and we say, your pet needs five extractions, they say, do they really need those teeth extracted? And I like to say it's like that old saying, it's like pulling teeth. We don't enjoy doing this. We enjoy taking care of your pet's mouth, but we don't get extra pleasure out of putting the teeth. It's actually really quite difficult. So, if we're recommending an extraction, it's usually because there's a critical defect, something that we think is going to continue to progress and going to continue to cause pain.
So we make the decision on a tooth by tooth basis, in most cases. As I mentioned, we take the x-rays, and we do the probing and charting. And then we combine those findings to determine whether a tooth has critical defects, things like severe bone loss and mobility. If the tooth has a pocket of a certain depth, usually six millimeters or more, we know that we can't keep that pocket clean just by home care. So we're going to need to do some advanced treatment, whether that's extraction or a more advanced periodontal surgery.
Fractured teeth, depending on the degree of fracture, or how much of the tooth is involved or missing, we might need to extract for that. If the fracture's extending below the gumline, that irregular surface below the gum line is going to be very plaque retentive and lead to progression of gum disease. So that's kind of one of the critical criteria for when we need to extract a tooth. Or if the nerve is exposed. That requires treatment, whether that's extraction or, potentially, root canal. Those are some of the options.
Do you want to talk about this subject, since you put the slide together?
DR. KEVIN NG: Sure. So, one of the more controversial topics at the moment is something called anesthesia-free dentistry. It is available in some states. In some states, they have actually legislated against it because it's not in the patient's best interest. We have, I guess, quite strong feelings about it, and there's a couple of reasons for that. We don't recommend it, and we think it's below standard of care. And the reason for that is because when we are cleaning a patient's mouth, we often use a scaler, and it often creates some aerosol or a spray. And this spray can include bacteria from the oral cavity.
Now, our patients, they don't know. When you go to a dentist and you're having your teeth cleaned, you're breathing through your nose, really. I hope you're not breathing through your mouth. And the reason why we do that is because we don't want that aerosol getting into our lungs. When a patient is having this performed, if they are awake, they might be in a situation, or they might be in an environment that they're not comfortable with. They might feel uncomfortable. They might be panting. They might be a little bit stressed. And theoretically speaking, it could increase the risk of breathing in some of these bacteria. And if there's a problem with your dog, if they are unwell and not in the perfect health, they might not be able to fight off these bugs. So we want to protect the airway. And to do that, we need to completely anesthetize our patients, and actually place a breathing tube or an endotracheal tube.
The other reason is a little bit more practical. Like, imagine that when you go to a doctor, you need to sit still. And when they use a probe to actually examine your oral cavity, sometimes it hurts, and we flinch. So, our patients are unable to really tolerate that. And they don't understand that they have to sit still. And if they're not sleep, we're not going to be able to get a decent look in their mouth. I mean, imagine the difficulty with looking at our patients' mouths while they're already asleep. Now, if we need to be able to detect really subtle diseases, or if we need to be able to take an x-ray to have a look underneath the gum, we're not going to be able to do that in an awake patient. So having our patients asleep actually helps us in terms of our accuracy with diagnosis and making sure we don't miss anything.
Lastly, a lot of my clients have concerns with our anesthesia. And let's be perfectly honest, anesthesia is not a benign procedure. We are giving patients drugs to keep them still. They're going to have side effects. And I think that it's really important to recognize that, and really acknowledge that for what it is. It is a risk, and we need to talk about that risk, address it appropriately. And in a two-year-old dog that's perfectly healthy, that risk might be perfectly acceptable. But what about in those older patients that are compromised? They have underlying disease. They might have a heart murmur, and so on and so forth.
So my advice for my clients is to get all of these problems assessed. Get them assessed. And then with a cardiologist, or with someone who is maybe a specialist in their field, depending on what the problem is and how severe it is-- there are some problems that can be appropriately assessed by a regular veterinarian, absolutely. And then, base the decisions on that as to whether or not they need to have that procedure performed.
The other thing is that the vast majority of patients, even if they have an underlying problem, can be an anesthetized in the right hands. So, the young, healthy patient may be fine for the vast majority of practices. A patient that has heart disease or severe heart disease and they have a history of either renal disease or heart failure, then that patient may need a specialist boarded anesthetist to be anesthetized. So, there are ways of mitigating these risks. And I find that too frequently we just say, OK, this is a problem. Let's never anesthetize the patient again. Whereas I think that what we need to do is, we need to address the severity of the patient's gum disease or fractured teeth, determine how much of a problem that is, and weigh it with the anesthetic risk.
Once we have all that information on board, then we can really make a decision. And I find that I think that, as long as we're not making decisions too hastily, we are able to anesthetize the vast majority of patients, even the ones where they've been told for years that anesthesia is not an option. You'd be surprised how many of them come in my door and we end up saying, this is definitely possible. Your patient's gum disease is causing them pain. Let's address it.
Let's talk a little bit about emergencies and when we really need to actually say, OK, it's time to go to the vet, or it's time to go to the vet urgently. There are a couple of categories. As dentists and oral surgeons, we picked this discipline probably because there isn't a huge amount of after hours. You know, I don't have to spend nights in the hospital very frequently. But there are some conditions where I would definitely like to see your pet within a reasonable time frame, and one of them is broken teeth. So, oftentimes, if a tooth is fractured and the pulp is exposed, we might not notice that for days, weeks, sometimes even months. So if it's something that's old, that's not really an emergency.
But say, for example, if you have a young dog, so a dog that's less than 18 months, and they were playing with a baseball in the backyard and they got hit in the face by a baseball bat, and you look in their mouth and they've got a bleeding tooth. Now, that's something that we should see within a day or two. And the reason for that is because we can actually cap that tooth. If we left it any longer, we would have to perform a full root canal treatment. A full root canal treatment means that the tooth is no longer alive, and we have to remove the entirety of the pulp. Whereas the capping means that what we can do is, we can disinfect that area. This area here, we can disinfect it. And essentially, we can just put a dressing and a restoration on the top of that. It's a lot less invasive, it takes a lot less time, and it's cheaper than a full root canal treatment.
So, I know this is a little bit of a gory slide. I apologize in advance. But I think that if you have a broken jaw, definitely needs to be something that needs to be seen by a vet. Definitely needs to be something that should make a trip down straightaway. Essentially what you might see is, you might see that the jaws no longer meet where they used to. There might be a little bit of misalignment. And essentially, there might be some bleeding from the oral cavity, or bleeding from the nose, so on and so forth.
Sometimes if patients have had other injuries as well, then they might need a trip to the emergency vet, and the might need to be stabilized before the fractures are repaired. If we don't do anything about it, what's going to happen is, these injuries are going to become infected. A patient's not going to be able to eat, and that becomes a serious problem. And obviously, it's very painful as well.
And then, the last major emergency that we want to talk about is, we want to talk about teeth that have been loosened because of an injury. And so, they've been knocked out of place. If left untreated, what's going to happen is, that tooth is going to become infected and we're going to end up losing it. Whereas, we can actually save these teeth by pushing them back into position and kind of splinting them into position. But I do need to see these patients typically within the same day preferably, and preferably within a few hours.
There are circumstances where I might not be able to save the tooth, and I might have to extract it. But in a lot of these cases, we can save the tooth as long as we get to see them within a few hours. I would make a trip, again, down to the vet straight away, or even call the hospital directly and say, look, this is the problem. I will get out of bed for these cases for sure.
So, I think we'll just finish up with a little bit about our team and what we do. And we'll go through it really quickly because I believe we are out of time. So this is my team, except for this gentleman in the middle here. He's no longer part of the team. We kicked him out because he finished his program, and he did really, really well. We wanted to kind of Photoshop Dr. Schneider in there, but we ran out of time. So I apologize to Dr. Schneider directly. These are our faculty, Dr. Peralta and Dr. Fiani. This is a fatter version of myself. And these are our two technicians, Bethany and Callie. So this makes up our team.
And this is what we do. So, we do a lot of periodontal treatments, which is what a lot of veterinarians do, as well. We clean teeth. We extract teeth, as well. We perform various periodontal surgeries. But that's only a very small part of what we do. And that's why I got out of general practice and I came to do this residency program, is because the wide variety and sort of the growing discipline of dentistry and oral surgery. So, we do root canals. So, these are phials that go into the teeth. And what we're doing here is, we're moving infected pulp, and we fill it with this white material.
Now, what makes this so special and why this is so interesting is for veterinarians, a human truth is about two or three centimeters long. This tooth is five centimeters long, and it's a lot wider. And this isn't even the largest tooth we deal with. Like, some of our big cats that we might visit at the zoo, they have teeth that are 10 centimeters long. And they don't make instruments in the human profession that are able to treat these teeth. So, we need to get instruments specifically designed and made to treat some of these teeth.
The other thing that we do that people don't know about is, we put crowns on the top of teeth. And in case you need a-- does anyone need to scare a burglar? So, it doesn't serve that purpose, but it can be quite scary when you look at some of these patients. So, what we do is, we take a Play-Doh like material that hardens, and we stick it onto a tooth that's been prepared after a root canal treatment. So, we make a stone model, or we send it off to a lab to make a stone model. And they use the stone model to make one of these things. So, a metal crown. The purpose of it isn't to scare burglars, despite what I said. The purpose of it is actually to protect the root canal treatment. And in some patients, such as, for example, the working dogs from the police force, they need to have this done in order to protect the root canal treatment.
The other that we do is, we put braces on dogs, too. In some circumstances, absolutely, yeah. So, this tooth here is a canine tooth. And normally, it lives here. But as you can see, it's sticking underneath the gum. And what problems that causes is that most of the tooth is buried, and that's going to make it more prone to getting gum disease. So, what we do is, we sort of move the tooth into a normal position with this elastic band. And it typically takes about four to eight weeks to perform. But yeah, we do put braces in dogs as well.
And that's just a small subset of what we do. We do cool stuff, too. So, we remove tumors such as this. So, this is a small tumor. This is an example of the size of the tumors that we sometimes see. So, that's it there. OK, so this was a two-year-old dog. So, this was a two-year-old dog with an unusual sort of tumor on the side of the face. And in the vast majority of cases, this might not necessarily be removable. But in this case, it was. So, let's go to the next page. So, this is a 3D reconstruction of a CT scan. And we use it occasionally to make one of these things. So, I'm not sure if anyone wants to pass this around. So, this is a 3D model that's been 3D printed, and it helps us to kind of plan for surgery. So I'm going to pass it around so everyone can have a look at it.
We also repair fractured jaws. And this is, again, a CT scan of a patient with a fractured jaw. You can see the break right there. And what we do is, we do exactly the same thing that they do in people. So, what we do is, we wire their jaw. We bring it back into alignment. And sometimes we put little plates in it, too. And this patient went on to eat pretty much the next day after the fractured jaw. So, they heal remarkably well as long as they've been repaired, and their bite has been restored to normal.
We also see patients with cleft lips and palates.
DR. KEVIN NG: Yeah, I know. Cute little fella, isn't he? So, this is a bilateral cleft lip, as you can see there. And this is a cleft palate. And what problems this is going to cause is, you're going to get food material into the nasal cavity. These patients are at risk of developing serious chest infections. They get chronic nasal disease, chronic nasal discharge, infected nasal cavities because we're not supposed to have foreign material up in there. Sometimes they get sticks and stones and pieces of plastic and pieces of toy stuck up in there as well.
So what we do is, performing these surgeries really helps with the patient's quality of life. And what we do is, we remove tissue from one side of the mouth, and we actually put across the top of the middle, and we seal up the nasal cavity from the oral cavity. And what happens is that these patients go on to lead almost normal lives. They no longer have nasal infections. They have a reduced risk of chest infections. They do really, really well.
And that's just in the cats and dogs that we see on a day to day basis. We also see rabbits. We see chinchillas, guinea pigs as well. And this is a tapir in Belize. This tapir had a bone infection, and we removed the infected fragment of bone. This is a tayra. And this tayra had, I think, a couple of fractured teeth. And then, these are not so interesting wild animals. Obviously, we want to see patients like this, like large cats. Obviously, they're the ones that make the most buzz. And this patient's getting an oral examination. This is Dr. Romano. Dr. Romano was our previous anesthesia resident. She's now at Florida.
And lastly, we see very big cats, as well. So, this is a Bengal tiger. They're typically about 500 to 800 kilograms. And they can be as large as 1,200 kilograms, as well. And this patient, Dr. Peralta here is performing a root canal treatment on this patient because it fractured a tooth. But we get to travel to fancy places, such as Belize, from time to time. And we get to go to the Syracuse Zoo to treat animals, too. So we are growing the discipline in terms of broadening what we see and the patients that we treat. And that's it.
SPEAKER: So, if I could just jump in with one quick request. Can you either demo or explain to us what the proper way to brush is? Is there a certain angle? Is it supposed to be around in circles? Up and down? Is there a way that you would recommend? You start from the front or the side? How do you manage to get into the back of the mouth? And if there's a different approach if you're working on a cat versus a dog.
DR. KEVIN NG: Do you want to use this one?
DR. LINDSEY SCHNEIDER: I think if we use this.
DR. KEVIN NG: Maybe a small one, right?
DR. LINDSEY SCHNEIDER: Yeah. So, it's much like when you brush your own teeth. We want to kind of focus on the gumline in particular. I like to kind of angle the toothbrush slightly so that it's kind of going up into the gingival sulcus, or the little space between the tooth and the gum. And you can do a back and forth, or in little circles. Usually you're a little bit limited in time with your cat or dog patient. So kind of do whatever works best, kind of just get in there. I like to actually kind of put my thumb in between the cheek and the tooth just to kind of retract the cheek to allow my toothbrush to slide in there a little better.
And I can go back to the video I had, too, of myself brushing my dog's tooth. I think that shows a little bit of how I retract the lips. There we go. So, I like to start by kind of putting my hand over the muzzle, or over the nose of the mouth, and kind of gently pulling the lips up. And then, you can see I kind of slide the toothbrush right in between the cheek and the tooth. And I to kind of start in the back and work my way forward because those back teeth are where the majority of that tartar buildup is going to be. But you can kind of do whatever your patient or your animal tolerates best.
And I kind of do both sides. I start on the outsides of the teeth because that's usually less stressful. And then I move to the insides of the teeth once I've already done all of the outsides of the teeth. And that's something that might take months to work up to, being able to get onto the inner surfaces of the teeth. And I mentioned earlier, with cats, sometimes I'll gently lift the lip by using the whiskers to kind of use as a hand hold. Their lips sometimes are a little thicker and harder to get a good grasp on, so using the whiskers as a little hand hold is one technique that might help. Do you have any suggestions, Kevin?
SPEAKER: That was great.
DR. LINDSEY SCHNEIDER: Perfect.
SPEAKER: One question?
DR. LINDSEY SCHNEIDER: Yeah.
AUDIENCE: Since a cat's mouth is so much smaller than a dog's, is a finger brush a little bit easier? The few times I've tried to brush a cat's teeth, I've used a finger brush. And maybe you could give some advice on how not to get bitten when you're using a finger brush.
DR. LINDSEY SCHNEIDER: Yeah. Certainly, I find that many of my clients that have cats at home do prefer the finger brush. They find it a little easier to get the finger in there than an entire tooth brush. You don't have cats either, Kevin, do you? So, neither of us have cats, so we don't deal with this at home. But as far as avoiding getting bitten, that's certainly a big concern. We want you to be safe about this and kind of go slow. That's one benefit of using a toothbrush over your finger, is that you're less likely to get bitten if you're using a toothbrush.
And you kind of just have to be careful. I would say try to stay as far to the side as possible. And you can kind of position your fingers in a way where you can hold in areas where there aren't teeth that occlude, or the teeth that come together. So, kind of by holding right behind the canine teeth, that's usually a good area where you can stick your fingers without getting bitten. Here on the cheek teeth, or the teeth further back, those have a lot of shearing force. So if your finger gets caught there, you're much more likely to get an injury from that. So, just kind of sliding along the side, but trying not to put your finger right in the line of where the teeth contact each other.
DR. KEVIN NG: As Dr. Schneider said, essentially, if you feel that you're at risk of getting bitten, I wouldn't brush your cat's teeth, or even your dog's teeth. And the reason for that is because oftentimes they can become quite serious infections, particularly in cats. So, I think that, as pet owners, we know our patients the best. So, you know your own pet the best. And if you think that you're at risk, don't do it. That would be my advice.
Saying that, I think that just regarding finger brushes, there's two types of finger brushes. There are the ones with the rubber bristles, and there are the ones with the actual plastic bristles, like the brush bristles. And those brush bristles are way more effective than the rubber bristles. One of my clients who was a really prolific cat tooth brusher, she had a really nice cat, and she waited until he was asleep. And then, while he was asleep, she would brush his teeth then. And he tolerated that really, really well. And there are just those cats that, as long as you take it slowly and you train them onto it. There are those cats that really complain.
Cats are more difficult to brush than dogs. I remember there was one of my colleagues that was instructing her clients in a huge amount of detail, and float them up, and figured out how many of her clients were actually successful. And they were about 80% successful in dogs and only about 50% successful in cats. So just keep in mind that cats can be a little bit trickier, absolutely. And that's just their nature.
SPEAKER: Kevin, I have another question.
AUDIENCE: Based on research that you guys have gone through and stuff, is there any relation between an increase in dental issues with dry food versus wet food?
DR. KEVIN NG: I can't recall off the top of my head. To be perfectly honest, anecdotally, absolutely. Anecdotally, if a dog is on wet food alone, and a dog also hasn't had any appropriate home care, such as brushing, we do see more severe periodontal disease in those patients. Now that I recall, there is one specific study that looked at food types and severity of gum disease. I think it was conducted out of Europe. I can't remember who the author was, but there was a correlation.
There is also some confounding factors into it, which means that other factors play a part, as well. And that small breed dogs also tend to have more severe gum disease. And small breed dogs are also the dogs that are more likely to get those little sachets of wet food. So it's multi-factorial, and I think that a lack of abrasion, or a lack of tooth brushing and home care, definitely plays a large part. And then, the diet that the patient's on, as well. And it's mostly because of the abrasion. So, kibble is more abrasive. And we know that kibble actually does reduce plaque levels more than wet food does. That has been proven scientifically.
AUDIENCE: I have a very small mouth pug, probably not much different than a cat. And it was suggested to us recently that using a finger with a gauze pad wrapped around is a good way to clean the teeth, rather than trying to use a toothbrush. Is that as effective as a toothbrush? She seems to not mind having my finger in her mouth with a gauze pad around it.
DR. LINDSEY SCHNEIDER: I think, ultimately, the toothbrush is probably going to be a little bit more effective because you're able to get the bristles of the toothbrush into the gingival sulcus, or the little space between the gum and the tooth. But if they tolerate the gauze around your finger much better than the toothbrush, by all means, anything that's going to allow you to do routine home care is better than nothing. So you kind of have to play it by ear on a pet to pet basis, and do what's best for your pet. But personally, I find that the brush is a little bit more effective in getting into that space under the gumline.
AUDIENCE: And do you have to be real careful about a gag reflex in a dog, too, the way you do in a person? You have to make sure you don't stick the brush far back. It'll cause a problem.
DR. LINDSEY SCHNEIDER: Yeah. So, the gag reflex is kind of their protective reflex. They do have that. But it doesn't usually cause any problems. It might make them a little less cooperative if you're sticking in the brush that far back and stimulating that gag reflex. So I try to just avoid going back that far. You don't have to worry about brushing a dog's tongue, things like that.
AUDIENCE: Because I find myself having to think, well, how far can I stick this brush in? How far do I need to stick the brush in? And having to be real careful about it because she does have a relatively small mouth.
DR. LINDSEY SCHNEIDER: Yeah.
DR. KEVIN NG: So, you should be fine as long as you stick to the teeth you can see and feel. So, the gag reflex is typically when you go over the back of the tongue and you go past the oral cavity into the area close to where their windpipe is. So, that's typically when you'll see the gag reflex. So, if you're stimulating a gag reflex, you're much further than you need to be. So, you just need to stick on the surfaces of the teeth in the oral cavity on either side of the tongue.
SPEAKER: We've got one last question before we rap it up. Right in the back.
AUDIENCE: Thank you. I have a couple questions, sorry, but they're quick ones. Do you need a prescription for the C.E.T. toothpaste?
DR. LINDSEY SCHNEIDER: No. So, you can order that. I get it online. You can find it. Many veterinary clinics will carry it in the clinic, as well as some pet stores. But the C.E.T. toothpaste is over the counter toothpaste.
AUDIENCE: And the same for the Healthymouth that you put in the water?
DR. LINDSEY SCHNEIDER: Correct. The dental diets, however, those are considered prescription diets. They can be used in the vast majority of our patients, unless your cat or dog has some other underlying systemic illness. Like kidney disease, for instance, they might need to be a special diet for their kidney disease. But most pets can use those dental diets safely. However, you would need to talk to your veterinarian to get a prescription for the dental diets, like the Hills T/D, or the Royal Canin Dental. But the other veterinary products, for the toothbrushes, the chew treats, most of those are over the counter.
AUDIENCE: All right. And then, we have an 18-year-old toy poodle that we adopted when she was 10. And she doesn't have many teeth, and she's on soft food. And it seems like whenever she eats any hard type food, which is very rare, or her pills that we have to give her-- she's on quite a few of those-- she tends to swallow them versus any chewing at all. So, any tips for a dog that doesn't eat anything hard, or doesn't want to? And she hasn't been very successful cleaning her teeth. And so, once a month, we give her a treatment of clindamycin hydrochloride drops. Yeah, so talk about that. Because she does have liver disease. You made a face.
DR. KEVIN NG: So, I think, in a patient like that-- which, thank you for the detailed history-- it's very difficult for me to make accurate recommendations without seeing her directly. So I can give you a general idea or some generalizations. So, swallowing food is not a problem. So, if she doesn't want to eat kibble, that's not a problem, especially in her age. At her age, as long as we're getting adequate nutrition into a patient such as that, that's what I would do.
I guess we need to determine whether or not she actually has any disease that's causing a problem itself. So, whether or not she's got gum disease, whether or not she needs to have teeth that needs to be extracted, for example. And then, we balance that with how healthy she is and how capable she is of going under anesthesia. Even though she's 18, she might be able to tolerate an anesthetic depending on its length, depending on what is required.
Now, you mentioned an antibiotic. And in general, we are moving away from administering antibiotics to patients for gum disease. We don't actually recommend it in our service, especially if there's no swelling or swelling of the face, for example. So, we don't use antibiotics as a preventative measure because the risk of developing antibiotic resistance, as you probably have heard in the media, is quite serious. So, essentially, if we develop an antibiotic resistant bug, then that antibiotic is no longer going to be effective. If an infection becomes more serious, then our treatment options are going to be limited, OK?
Giving an antibiotic on an intermittent basis, so without a full course to treat a specific problem, is called pulse antibiotic therapy. And we're trying to advise our veterinarians and trying to advise our clients and patients away from that. Because what we've found is that what we really need to do is, we really need to treat the underlying condition.
AUDIENCE: So, are you taking new patients?
DR. KEVIN NG: Sorry?
AUDIENCE: Are you taking new patients?
DR. KEVIN NG: Yes, we are. So, we take new patients all the time. Essentially, you can have a discussion with your veterinarian about organizing a referral. Alternatively, you can call our service and ask to make an appointment. We will definitely communicate with a regular veterinarian about a patient's history and get a little bit more information. And then what we do for all patients that walk in the door, no matter their age, is, we work them up for any systemic illnesses. And then we talk about, essentially, what the risks are of anesthetic for a particular patient. And we make a decision that's as educated as possible.
AUDIENCE: So, do I need a referral from my primary vet?
DR. KEVIN NG: We definitely like to work in conjunction with your primary veterinarian. If you call us directly to make an appointment, you will be able to get through and make an appointment. But I would definitely keep your veterinarian in the loop as well. And we will definitely keep them in the loop as well because some aspects of after care, some aspects of ongoing management, we definitely love to work with our associate veterinarians just to make sure that we have continuity of care.
AUDIENCE: OK. We'll call Monday. Thank you. Thank you
SPEAKER: All right. Well, thank you so very much. I'm sure everyone would agree that this was super informative and, actually really enjoyable and entertaining. Thank you all. Thank you for coming.
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Looking for home care strategies to help you maintain your pet's dental health? Has your vet recommended a 'dental'? What does that involve? In this session of Baker Pet Talks, Drs. Ng and Schneider will teach you: home care strategies to maintain your pet's dental health; how to identify signs of oral pain in cats and dogs; and advanced procedures that might be recommended for your pet.
Presenters: Dr. Kevin Ng, BSc, BVMS (Hons) and Dr. Lindsey Schneider, DVM, Residents, Dentistry & Oral Surgery, College of Veterinary Medicine, Cornell University.