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The Art of Pet Dentistry

Show Notes

Did you know February is Pet Dental Health Month? Vets clinics across North America dedicate their marketing programs to raising awareness about the importance of oral hygiene in our pets.

Just like us, our pets can suffer from such dental issues as plaque buildup, gum disease and tooth decay.

If we take proactive steps, though, we can prevent these and ensure our pets’ overall well-being.

I’ve been fortunate with Bella. Dental care is a priority at our vet clinic.

And then … a couple of months ago, I went to a networking event at — of all places! — a dentistry clinic for pets.

Elevated Pet Dentistry recently opened on Sprague Avenue in Spokane Valley with Dr. Madelynn Mayes running the ship.

Maddie has been a veterinarian for 13 years, after graduating from Washington State University in 2010. She was one of only 40 students selected to take an online dental course and wet lab, sparking her interest in dentistry.

She started her career as a rural mixed animal practitioner and then transitioned to small animal-only work.

But a specialization, a niche, kept calling to her.

She nurtured her passion by completing numerous advanced dental training courses with specialists across the country. Her learning helped her improve her technique and proficiency in all areas of general and advanced dental care.

What to listen for

3:26 The impact of dental issues on our pets
8:33 Which breeds are more prone to dental issues
10:02 Dental issues that are common in cats
13:18 What we can do at home to care for our pets’ teeth
17:19 How often our pets should have their teeth cleaned

Where to find Dr. Maddie Mayes

Elevated Pet Dentistry website

Instagram

Transcript

Angela    

Hey, good morning, Maddie! May call you Maddie?

Maddie

Yes.

Angela

OK, good. I was gonna go with Doc but that’s too cartoonish. How are you today?

Maddie 

Doing well. Enjoying the nice cold air.

Angela  

Yeah, it’s … Wait, I looked it up earlier I think it’s minus 11 Fahrenheit. Yeah, that’s what it is and minus 20 Celsius here in Spokane today it’s … but the sun is shining.

Maddie

The sun makes all the difference, I’m fine with negative whatever, as long as the sun is shining.

Angela  

Yeah, as long as we don’t have to go outside. Our dogs can poop in the backyard this time.

Maddie 

They … quickly.

Angela

So you are, um, you’re a specialty veterinarian. Tell us about your specialty. Tell us about you and how you got into your specialty.

Maddie 

All right. So I guess first of all, I have a special interest in dentistry. I am not a board-certified dental specialist, which is a thing. Maybe when I grow up one day, I will achieve that title. But for now, I’m kind of focusing on a midground between what the average general practitioner likes to do for dentistry and what the specialists do. They’re amazing and they do things that I dream of one day, but there’s a lot of middle ground in there that I feel gets kind of pushed to the side a little bit or not explored as much because general practitioners are super busy, and they do an amazing job, but they have a lot of things they’re pulling from and so I thought with my love of dentistry, I would put that at the forefront and kind of focus just on that. And we’ve had a really good response so far.

Angela    

Where does your passion for dentistry come from?

Maddie 

You know, I, I think it’s mostly because of how satisfying it can be and how quickly you can improve the quality of life for a pet. When I was in school, we were taught dentistry, but it wasn’t a very long subject. It was an online elective as far as diving deeper into dentistry, that only about half the class was able to participate in. And then it had a couple wet labs. And that was about it. And so I got a lot of my learning after school by going to continue continuing education programs and being lucky enough to work in that hospitals that really had a strong focus on dentistry and actually worked with some dental specialists. And from there, I just saw how amazing it was. And I like surgery. And so it was kind of like the best of both worlds doing some really good, high quality medicine for the health of the patient and still kind of being able to explore that surgical aspect that I really enjoy.

Angela  

When I visited your shiny brand new clinic a couple of months ago, you told us a story about a particular success case. Can you share that? The removal of the teeth in this little dog?

Maddie 

Oh yes. So you know, it’s just amazing. And there’s quite a few patients who kind of fall into that case, I think you’re referring to the pet we highlighted at our open house, Oatmeal. And Oatmeal is kind of your typical, super sweet, middle-aged, little white dog with lots of teeth and a tiny jaw. And unfortunately our small breed dogs are very prone to periodontal disease because of the crowding that occurs in their mouth. It seems like nature shrunk the jaw but it didn’t shrink the teeth at the same rate and so we get a lot of overlap and rotated teeth and they ended up getting periodontal disease really early. You know even as early as like two or three years of age, they can have teeth that need to come out.

But in this case we ended up having to take I want to say it was like 14 or 15 teeth and a dog naturally or normally is supposed to have 42 teeth so I mean they still have a lot but that is still a significant number of teeth to take. And afterwards, you know, Oatmeal was so much happier because of that chronic pain being removed. And our pets are so stoic and just kind of used to dealing with whatever’s going on that then once that chronic pain and infection is gone. The dogs are so much happier and we see that as a dog who’s more energetic, who’s more, you know, social, they play more, they’re more interactive. And of course, their breath smells NICER as well. So we’re more open to all those kisses.

Angela   

Could we get through a day without a good dog kiss? Hey. So what are the common dental issues that we see senior pets face?

Maddie 

With senior pets, I think the biggest thing we probably see are the periodontal disease. So teeth with pockets where there’s bone loss and infection has gotten down in there creating, you know, pain, inflammation and sometimes loose teeth. Because it gets so bad. We also see broken teeth. So especially, you know, dogs who chew on really hard products, so like antlers and real bones, and really hard nylon chews, anything that you can’t flex with your hand has the potential to break a tooth. And so we’re also trying to help educate people on what appropriate chew toys are to limit that. So broken teeth or periodontal disease, and then in senior pets, we do have a higher chance of seeing, like a tumor, you know, either in the jaw or in the tissues of the mouth.

Angela 

Yeah. And how does that all impact the overall well-being of a pet, especially a senior pet?

Maddie

You know, especially in our senior pets, because as everyone ages, the immune system tends to not maybe function quite as well, you know, the body ages, and so does the immune system. So when you have chronic disease of any kind, but especially a chronic infection in the mouth, where it can, you know, have potential to have constant bacteria getting into the bloodstream, that can actually affect, you know, the whole body health. So you can have changes in the kidneys from dealing with chronic inflammation. There are cases of bacteria settling in the heart valves, which can also, you know, lead to heart disease. And I think especially in like our patients who maybe have diabetes, or other chronic illnesses, that pain and stress that causes on the system actually makes it harder to regulate their diabetes, because cortisol is the enemy of glucose. And so the body doesn’t respond to insulin as well because of that. You also get chronic infection in the mouth. And if these dogs have skin allergies, or, you know, are itchy, they’re grooming themselves with this infected mouth, which then can predispose them to more skin infections and things like that. So there’s, you know, whole body effects that the mouth plays in addition to just being uncomfortable.

Angela

Yeah, so it’s not just pain. There’s some very serious things that can be going on if we don’t take care of our dog’s teeth.

Maddie 

Exactly. Yeah. And a lot of people don’t even think to really look up there. I mean, even probably before I was in vet school, like I remember my pets, maybe having one or two dentals when they were old, because of their bad breath, but it was never like, you know, you should brush your dog’s teeth. You should look under that lip and see what’s going on.

Angela

Yeah, um, you know, my first dog, he lived to 12 and a half, and he never had his teeth done. Probably never had his teeth brushed, for that matter. So, but it’s always different for every dog, right?

Maddie   

Yeah, and of course, just like with people, you some, some diets that we’re on or some metabolic conditions that we have make it more likely that we’ll have inflammation or will build tartar more quickly. We do see the same thing in dogs. Certain breeds seem to be more likely to have dental conditions as well. We know for sure that dachshunds are very prone to bone loss on the inside of their incisor or inside of their upper canines, and more prone to things like oral nasal fistulas, or like a passageway between the nasal and oral cavity. Boxers tend to end up with more commonly gingival hyperplasia, so they get extra gum tissue growing up over their teeth creating what we call pseudo pockets. So instead of bone loss, those dogs seem to create extra gingiva and then you get these, you know, tissue pockets over the tooth where food and things can get wedged up under and then make them more prone to periodontal disease. So a lot of breed characteristics.

Angela  

Yeah, so other than like that really stank bad breath that they can get in. We all know what I’m talking about. And maybe some pawing at the mouth or something like that. How does the normal pet owner know that something is wrong.

Maddie

It can vary. And it really depends on you know, I don’t like to say how observant an owner is, but some people pay more attention than others just to dental health, whether they’ve had, you know, issues in the past, I always say commonly we see things like, you know, sometimes pawing at the mouth or noticing that they’re only chewing on one side of their mouth. If there’s a painful tooth on one side, then the opposite side will have, you know, the chewing power and actually have cleaner looking teeth because they’re using them more. Sometimes we’ll see drooling, even just a loss of appetite. And that’s actually probably something that’s more common in cats is you’ll see them start to maybe take one or two bites of food and then leave where they maybe used to sit at the bowl and kind of just chow down.

Cats are a little bit unique in the fact that they also end up with a very common condition called tooth resorption, where we believe it’s a response to the plaque like an auto immune response to that plaque, where they actually will start to dissolve the enamel and dentin off of their tooth, exposing the nerves underneath. And eventually those teeth might completely just dissolve away. But it’s a very painful process for them. And cat being cats, they’re not going to show it to you until you know, unless you’re looking or unless it happens really acutely and causes significant pain right away.

Angela  

Who is it easier to do an exam on? A dog or a cat?

Maddie  

I’m really it’s a tossup, there are some amazing cats who will let you do you know the full on like lion jaw licking their mouse, and they’re great with it and there are some you know, dachshunds or any breed but the little dogs can be a little bit more ferocious, where you can’t get them there until they you have under sedation. There’s good and bad from all of them.

Angela  

You did allude to it but what role does nutrition play in helping us maintain good dental health for our pets?

Maddie

Um, you know, I think just if you think in general, dogs, and cats don’t tend to get cavities the way people do because they don’t have sugary food generally. But nutrition can play a role. And I think with anything, you know, a balanced diet is going to be the most important for them. There’s a lot of information out there about dry versus wet food. And there are benefits and cons to both. You know, a lot of people will say, oh, they’re on dry food. So they’re getting that abrasive action when they’re chewing. But a lot of kibble will just break apart before it’s even, you know, scraping the teeth. Or they’re not even chewing the kibble some animals do, they inhale it. And so it’s not really going to do anything in that regard. But we have found that some mineral balances can make a difference as far as the formation of tartar, there are specific prescription dental diets out there that do show to have, you know, good effects. But I think mechanical action is the best thing we can do for maintaining dental health. So brushing teeth, wiping them something to help prevent that plaque and tartar from forming.

Angela  

What’s the easiest way for a pet guardian to brush their dog’s teeth or get their dog’s teeth clean, if you have the kind of dog that doesn’t like that kind of stuff?

Maddie  13:29 

Right. So as far as oral care, the earlier you start the better. So if you start them as puppies, they’re more likely to find it rewarding experience. I think starting with a healthy mouth makes a big difference as well because you don’t want to have a dog who already has painful teeth and then start to try to brush because you’re going to be causing pain every time you touch it and make that an enjoyable experience and make brushing hard in the future. So I think as far as starting early, so if we have pet start, you know when puppies or kittens and doing either the oral wipes tooth brushing, the more frequently the better. You know we’re supposed to do hours twice a day and you know, ideally we would do that with our pets too. But that can be difficult. And working up slowly to it’s not just going in and starting to you know full on scrub everything in that mouth the first time you try it. We usually recommend starting with even just putting some of the pet toothpaste on your finger and letting them lick it off while you’re rubbing in making that an enjoyable time and then working up to you know, gently rubbing the gums maybe with your finger or really soft baby toothbrush and then working up to a bristle brush once they know that this is something kind of fun and they get rewarded with snacks and treats for it.

Angela  

Should we be alarmed and panicked if we see blood on the toothbrush or the wipe?

Maddie

Not necessarily so when you’re first starting there is going to be a degree of gingivitis. And that goes for people to I mean, if you haven’t flossed in a week or two and you jump back into it, you might notice a little bit of blood on the floss. And that’s pretty normal. The same with our pets. So if we’re starting, and we’re getting a little bit of blood here and there, and the animals not reacting like it’s causing a lot of pain, then it could just be that normal, getting the gums healthy again, if it is something where the dog or cat is reacting, like it’s painful, then I would say, an oral exam with your veterinarian would probably be recommended. But yeah, a little bit of blood here. They’re especially if they’re chewing on toys, or a new dental stick, things like that is pretty normal and common because of that mild periodontal gingival disease they may have.

Angela  

How often should we be having oral exam checkups with our vets?

Maddie

For our smaller breed dogs? Well, for everybody, I would say at least once a year when they’re young, as they get older, potentially every six months. And if you know your dog or cat is one that is very prone to building plaque and tartar, sometimes we do those more regularly. But I would say at least annually would be a good place to start.

Angela 

I have a tough question for you.

Maddie

OK.

Angela

Brace yourself, how is it that one vet can look at the same mouth and see a different level of need for a procedure?

Maddie 

That’s a really good question. And I think part of it depends on the training that that that has had, it could also depend on how cooperative the pet is being that day. So you know, we all have good and bad days and one day, you’re fine if somebody looks up your lip and goes for it. And if you’re stressed because of a really long car ride or something before that you might not be as open to that. So it could be what the pet is allowing for the exam that day. And things can sometimes change quickly. So if it’s been three or four months in between two different exams, things can change with a broken tooth or progression of a condition. And sometimes it comes down to what the original exam was for. So if they’re in for a sick ear infection, they might not get a full oral exam because of time or temperament of the pet that day.

Angela  

OK. And so, to follow up with that, how often do you think and it’s probably an as necessary thing, but how often do you think we need to bring our pets in for an actual cleaning?

Maddie  

Again, I would say probably at least annually starting at, you know, two to three years of age maybe earlier for our small breed dogs. So essentially anything with a smushed face, so our pugs or Boston or Frenchies, dachshunds, you know, all of those little dogs, you know, build up and develop periodontal disease really early. I’ve taken up to 10 teeth out of a three year old dog before because it had already progressed that much. So starting early and then doing home care can really help with that.

So I would say probably at least annually. You know, our dentists recommend we come in every six months and that’s with us, potentially brushing our teeth and flossing daily. And if our pets aren’t having their teeth brushed, and they’re not, you know, getting in for biannual or annual cleanings and it’s pretty easy to see how things can build up quickly in them.

Angela  

That’s fair. A lot of concerns revolve around the need for sedation. Is sedation always necessary and is there a reason for pet guardians to fear sedation for their pets?

Maddie 

You know, anesthesia, dentistry, there’s … so dentistry with anesthesia and there’s anesthesia free dentistry. The Veterinary Dental College does not recommend the nonsedation dentistry, because there’s so many things that could potentially be missed or go wrong. So when we’re doing … so at our clinic when we’re doing a full exam, we are putting them under anesthesia. And of course, there’s always a risk that we can get back to but anymore, we have a lot of great anesthesia options and we have some amazing monitoring. So they are really well watched and the anesthesia protocols are developed for individual pets.

And then we do the full mouth dental Xrays. So we can see above and below the surface of that tooth because in our pets, three quarters of that tooth is actually unvisible, it’s below the gum line and so we can see it on a visual exam and then doing 360-degree probing around every tooth with a probe to check for pockets or areas of bone loss. And that can be uncomfortable and painful. So If you’re trying to do that in an awake pet, you could cause them to bite you, they could snap on your tool and cause trauma to their mouth. And when we’re using scrapers, so or curets and things like that, to scale the, the tartar from under the gum line, which is actually more important than the stuff you’re visually seeing on the tooth, there’s a lot of potential to cause trauma if that dog would work outward to move while you’re, you know, doing that procedure.

And again, you’re not doing Xrays on an awake animal. So you can’t really see what you might be missing below the gum line or within the crown of the tooth sometimes.

But getting … sorry, getting back to your original question about the anesthesia, you know, there are risks and as pets age, it might be something that people are more concerned with. But if we’re doing appropriate preoperative blood screening to assess liver and kidney functions, know what their protein levels are, and then basing our drugs on, you know, we base them on the weight of the animal, what else is going on with them, and then we actually titrate the drugs to effect. So just because we calculated this dose for your dog doesn’t mean they’re getting all of it. And then using multiple different drugs to work together so that you actually need less of all of them.

Angela    

And I’m assuming all that is explained to the pet guardian at the time to put her heart at ease.

Maddie   

Yes, of course. And if people do have additional questions, we always will go deeper, or recommend additional testing, if that’s something they want to be sure of. You know, older pets might have a heart murmur. That doesn’t mean anesthesia is unsafe for them. But we maybe we would recommend having an echocardiogram done ahead of time. So we know for sure if there are any changes that would make anesthesia more risky.

Obviously, despite our best efforts, we can’t guarantee that nothing will ever happen. Because even in a perfectly healthy patient anesthesia can have an adverse event. But we are trained to respond to those and have medications that can be reversed. And I think the good thing about dentistry especially is a lot of it, if we’re partway through and a pet starts not doing well, we can, you know, stop where we are, finish up what we’re doing, and come back and do the rest another time, which sometimes we need to do in our little older pets because they just can’t tolerate as long as procedures potentially.

Angela   

Can dental issues indicate other problems, other health … underlying health issues in a pet?

Maddie

They can, you know, sometimes we’ll see, like an oral tumor, it could be a primary tumor or having spread from somewhere else. We might also see, you know, in cats, we always worry about if we’re having really bad stomatitis. So inflammation in that mouse that there could be a viral cause associated so feline leukemia or feline FIV virus. There are also times when there is a hormonal issue like a parathyroid disease where you actually can have bone loss of the jaw, and we see … it’s called rubber jaw, they lose the ossification of the bone. And then when that’s treated, it can actually be restored. There’s some pretty cool papers out there. I’ve never seen a case of that, which is fine by me. But yeah, so there can be other things going on, that maybe show up in the mouth.

Angela  

Has there ever been occasion for you to deliver some dire news to a guardian?

Maddie   

Unfortunately, yes, you know, there are times when we go in expecting a routine, you know, mouth extractions or tooth extractions, and then on our Xrays, we actually find that there could be a tumor in the jaw itself. And so I’ve definitely found tumors within the mouth. And, you know, we talk about those ideally ahead of time, if we have suspicion, but sometimes they’re unexpected, in which case, we then would call and discuss, you know, with the pet guardian at that time, what some of the options are, and I never want to push somebody into any hasty decisions, you know, because a lot of us can make a knee-jerk reaction in the middle of receiving bad news.

But if we give ourselves time there are treatment options potentially out there. They might require a referral to a specialist like an oncologist or to another dental surgeon, dental specialists for you know, advanced surgeries or things like that, but there are options but unfortunately, we do sometimes find things that don’t have a great long-term prognosis.

Angela

How do you manage delivering that news to your client?

Maddie 

I think the biggest part of that is just being empathetic. But also not trying to sugarcoat anything. I mean, I never want somebody to feel like I gave them false hope, because I was afraid to tell them that it was something that could be really bad. I would much rather have them prepared for something bad and find out that I’m wrong, and it’s actually not a bad thing. Then tell them, Oh, it’s probably nothing and it turns out that it is something really bad.

So I think just being kind to people, being empathetic and giving them time to understand and not hopefully rushing them into anything, you know, sometimes pets under anesthesia, we have to be aware of time. But you know, there’s a lot of things that we can do with modern veterinary medicine these days, even if it’s not something that every person wants to pursue, which there’s nothing wrong with that. But I kind of always think about it, this is how I would deliver something to my grandma. So how do I want them to feel? Right, we want to make sure that they feel like they understand, they are feeling cared for, and know that it’s OK to be upset.

Angela  

Yeah. I’ve had the pleasure of meeting your staff too and they’re lovely. And so I’m wondering how a day like that might impact your staff, you and your staff and how you manage that for yourself? And them?

Maddie  

Yeah, you know, I do have a great staff, and I’m so lucky to have them all. But yeah, it does hit us hard. So you know, when we do have to tell somebody that, you know, they’re sweet, sweet, wonderful, I swear, it’s always like, the really nice ones. It’s never the one who’s like trying to eat your face. You know, it’s always the nicest, you know, pet with the nicest owner. And they, it’s hard for everybody. So you know, we don’t like giving that news. And you know, when your pet is here, it gets loved on, it gets, you know, becomes part of our family for the day and long term. And so it’s hard, but I think we’re open to just talking about it. And you know, acknowledging that it’s sad, and it’s hard sometimes to do that. And just being there for each other, when sometimes a day might be harder.

Angela  

Mm hmm. We’re coming up on pet dental health month. What … what can you tell us about our need to get this done for our pets?

Maddie 

I love that February is pet Dental Health Month, but I also don’t want people to wait till only February to do their dental care for their pets, it should be a year-round endeavor. But if that’s what kind of reminds you to get that taken care of I think that’s fantastic. And just you know, February is not here yet but because of that being the month, the clinics might be filling up a little bit more quickly with dental care. Some clinics offer specials, some don’t. We don’t because our prices are kind of set to be more affordable, they’re still out of reach for some, but we want to make that as accessible as possible. But bringing awareness to it and just knowing oh, you know what, talk to your vet or, or us about, you know, what can I do for home care if my pet doesn’t maybe need a dental yet? Or when can I get them in? Or what should I be looking for? So making those discussions a priority? Or it’s a good time when it’s cold outside and you’re hanging out next to that stinky mouth.

Angela  

What is one last piece of advice you can give us about managing our pet’s health, dental health care at home?

Maddie 

I think the biggest thing is making sure that you’re using products that are known to work. So the veterinary Oral Health Council, vohc.org, is curated by veterinary dental specialists and they have products submitted to them that they then review and say that they actually do what they say they do. So it’s nice to have that reassurance that the product is effective and safe for your pet. I think the biggest thing is also using appropriate chew toys. So if you can’t flex it with your hand, or you can’t indent it with your thumb. tooth can be broken on that. So setting your pet up for success by not providing things that even though it’s marketed to be appropriate, may not be.

Angela

Yeah, with two broken molars, we will never have antlers in our house again. We have learned our lesson the hard way.

Maddie  

Unfortunately, a lot of people do that. I did that so I’ve been, I’ve been there, I get it, done that.

Angela

All right, Maddie, thank you so much for joining us today. If you hang on for one second, we can say our goodbyes, but I appreciate you coming.

Maddie

No, thank you so much for having me and highlighting the importance of dental care, especially in our senior pets.

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