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I have a spoiled rotten,10 yr old neutered male Shih Tzu, named Kuro. He's also blind, but still my sweet baby! 

Although it's only him and me now, there's a lot of talking around our house. I didn't realize he knows so many words! Some people say it's repetition, but I prefer to think he's that smart....... 
We moved to Michigan from Indiana 4 years ago, and for the first 7 years of Kuro's life, the only expense I had was vaccinations, grooming,and buying toys. ( Lots of toys) 
But time passes on and age starts taking a toll, and he started having problems: bladder, tumor on paw,liver enzymes too high, dental work, eye problems,and for the past few months, skin problems. 
Dr. Dhaliwal has done all of Kuro's surgeries, and worked with me on the other problems. He never loses his patience, and stays calm while I am asking my 100 questions . 
Dr. Dhaliwal is definitely in the correct profession. It seems he has a passion for not only helping animals, but he takes every opportunity to learn new techniques so he can help them even more. 
The staff is also very nice. They greet you with a smile, take the time to talk, explain meds,etc. and if Dr. D. doesn't call to check on Kuro after a procedure, the staff will, and that means a lot to me. 
Michigan Avenue Animal Hospital is a caring place, and everyone makes sure your pet is given the best care. Whatever it takes to make you and your pet "HAPPY!"


Judi Perdue

FAQs-Pet Dentistry

Frequently Asked Dental Care Questions and Their Answers

 Healthy Mouth = Healthier Life

Each year, February is designated as Pet Dental Health month. We all promote pet dental health awareness campaigns. February isn't the only time to think about good oral health though. Keeping your pet's teeth and gums in good shape has many health benefits in addition to the sparkling fresh breath. Now is the time to schedule that checkup for your pet to ensure the best dental health possible.

My pet has bad breath. Are bad teeth and gums the cause?
Most likely, YES. However, it is very important to schedule a visit to the veterinarian. In rare cases, some diseases or situations can cause bad breath in the absence of, or in addition to, tooth/gum disease. Conditions such as kidney failure, diabetes, nasal or facial skin infections, cancers, or situations where the animal is ingesting feces or other materials, can cause bad breath with or without periodontal disease.

What actually causes the bad breath when tooth/gum disease is present?
Bad breath, medically known as "halitosis", results from the bacterial infection of the gums (gingiva) and supporting tissues seen with periodontal disease (periodontal = occurring around a tooth).

What is the difference between plaque and tartar?
Plaque  is a colony of bacteria, mixed with saliva, blood cell, and other bacterial components. Plaque often leads to tooth and gum disease. Dental tartar, or calculus, occurs when plaque becomes mineralized (hard) and firmly adheres to the tooth enamel then erodes the gingival tissue.

What is Periodontal disease?

Periodontal disease is an infection of the tissue surrounding the teeth that takes hold in progressive stages. It starts out as a bacterial film called plaque. The bacteria attach to the teeth. When the bacteria die they can be calcified by calcium in saliva. This forms a hard, rough substance called tartar or calculus which allows more plaque to accumulate. Initially, plaque is soft and brushing or chewing hard food and toys can dislodge it. If left to spread, plaque can lead to gingivitis, an inflammation of the gums, causing them to become red and swollen and to bleed easily. As plaque and calculus develop below the gum line, professional cleaning will be needed to help manage it. If the plaque and tartar buildup continues unchecked, infection can form around the root of the tooth. In the final stages of periodontal disease, the tissues surrounding the tooth are destroyed, the bony socket holding the tooth in erodes and the tooth becomes loose. This is a very painful process for your four-legged friend, but these problems can be averted before they even start.

What can happen if my pet's teeth aren't cleaned?
Both plaque and tartar damage the teeth and gums. Disease starts with the gums (gingiva). They become inflamed - red, swollen, and sore. The gums finally separate from the teeth, creating pockets where more bacteria, plaque, and tartar build up. This in turn causes more damage, and finally tooth and bone loss.

This affects the whole body, too. Bacteria from these inflamed oral areas can enter the bloodstream and affect major body organs. The liver, kidneys, heart, and lungs are most commonly affected. Antibiotics are used prior to and after a dental cleaning to prevent bacterial spread through the blood stream.

But my pet is only 3 years old! Isn't this an "old dog/cat disease"?
No - dental disease is NOT just for the senior pets

"Without proper dental care, 80 percent of dogs and 70 percent of cats show signs of oral disease by age three."

My pet doesn't seem like s/he is in any pain. Do they experience oral pain?
They may not verbalize or complain like a human would, but animals most likely feel pain with periodontal disease. The pain levels may be low, or very noticeable, and it varies with each animal. Obvious signs of oral pain may include: "chattering" teeth while eating or grooming, drooling, crying out, and refusing to eat.

My pet lost a tooth the other day. S/he seems fine. Do I need to do anything?
Yes - please see your veterinarian as soon as possible to check the pocket and other teeth. Exposed tissue can be very painful and are open to infection.

My vet has recommended a dental for my pet. What should l expect?
If your pet has a lot of periodontal disease, your vet will likely prescribe antibiotics for a few days prior to the dental. This will reduce the infection in the mouth and the spread of bacteria via the bloodstream. Pets need to be anesthetized for a full dental cleaning. Hand scaling tartar can be done while awake, but for a thorough oral exam and cleaning, animals must be anesthetized. Scaling tartar on an awake animal, without polishing the teeth, leaves a rough surface to the tooth, predisposing the tooth for more plaque and tartar accumulation, quicker. Most vets strongly urge pre-anesthetic blood work to ensure that everything else is OK with your pet.

Your pet will be anesthetized, any medications or fluids will be administered, and the vet or veterinary technician will scale the teeth, examine the gums (and any pockets), extract diseased teeth*, and polish the teeth. The equipment used on your pet's teeth is much like you would find in a human dental office.

*There are other options - such as root canals, crowns, etc.  Those are referred to a veterinary dental specialist.

How can I care for my pet's teeth at home?
It is important to use products specifically designed for dogs and cats. Do not use human toothpaste on your pet's teeth. Products are available for cats and for dogs. Your veterinarian or veterinary technician can show you the proper techniques for your pet. Some animals do well with a toothbrush, some do not. Other products include finger swabs, tooth 'cloths', and mouth rinses. Talk to your vet about what type of product would work best for your pet. Ideally, the teeth should be brushed daily, as with humans. Even once every few days will be a big help.

It is important to watch the treats, too. The soft, gummy treats can be especially bad for the teeth - they are soft, sticky, and full of sugar. Treats such as raw carrots for dogs are a much healthier choice. There are many "dental treats" on the market now to reduce plaque and tartar buildup.

Dental care for dogs is essential in maintaining your pet healthy. You need to reserve time for your dog's dental hygiene and visit the vet on a regular basis for a dental exam.

How Often Should I Brush My Dog's Teeth?

Ideally, a dog should get his teeth brushed once per day. If you cannot do that, try to brush your pet's teeth at least once in 2 days to prevent the buildup of plaque and tartar.

Can I Use Human Toothbrush or Toothpaste?

Use a special pet toothbrush or get a children's toothbrush.

Purchase some special pet toothpaste that will be appealing for your dog. The toothpastes for pets are meat or fish flavored.

Don't use your toothpaste for your dog.

Clients often ask, "doesn’t hard food keep teeth clean?"

 Some believe when their dog or cat chews on hard food or biscuits, mineral deposits are broken down and the teeth stay clean. This is not true. True, animals on soft diets accumulate plaque more readily than those on dry foods, but the only way to keep teeth clean above and below the gum line is by daily brushing.

 

How to Brush the Dog's Teeth?

Use the pet toothbrush. Place a drop of toothpaste on your finger and allow the dog to smell it or lick it. Take some more paste and spread it on your dog's teeth and gums. Use the brush and hold it at a 45 degree angle. Brush gently and make sure you clean in the back of the mouth and below the gums also.

Dogs don't enjoy tooth brushing, so you need to reward your pet with treats or play time after each brushing. Create a habit out of tooth brushing, so that your dog gets used to this routine.

How Important is Kibble Food?

Kibble food may help removing the plaque from the dog's teeth. If your dog has a diet based on dry food, he is less likely to develop dental problems. However, if your dog has a wet diet, offer him chew treats and chew toys that will scrape the plaque off his teeth.

How to Prevent Bad Breath?

Bad breath, also known as halitosis, is caused by tooth decay or bacteria that may be located in your dog's mouth. Inspect your dog's mouth to make sure there are no dental abscesses. If your dog has no dental problems, bad breath may be prevented with dental chews that will freshen up his breath. You may also add a few drops of lemon juice in his drinking water.

 

Do I Need to Visit the Vet for Dental Care?

Even if you brush your dog's teeth daily, you still need to get a professional cleaning once or twice per year. The vet may also detect any incipient problems.

Why should I brush my pet's teeth?
Daily removal of plaque is the key to an effective oral hygiene program. Unless your pet's teeth are brushed daily, plaque, which is an accumulation of bacteria, will build up at the gum line. Eventually, calculus forms, further irritating the gums, causing infection that progress to destroy the attachment around your pet's teeth. In addition to creating loose teeth, infection under the gum line can spread to the liver, kidneys, and heart.

How can I brush my pet's teeth?
It is usually a very easy and fun procedure. First, pick a soft-bristled or finger toothbrush. Next, get toothpaste from your veterinarian. Do not use toothpaste intended for humans because it has detergents that should not be swallowed. Apply a small amount of toothpaste on the toothbrush and brush the outside of the upper check teeth. Concentrate on the area where the tooth meets the gum line.

How often does my pet need to have its teeth cleaned by the veterinarian?
It depends on the degree of plaque and tartar accumulation. Examine your pet's teeth monthly. Look for an accumulation of yellow or brown material at the area where the tooth meets the gum line. Pay particular attention to the check teeth and canines.

Once you notice plaque or tartar accumulation, it is time for a professional cleaning. Do not wait. Attached to the tartar are bacteria that are irritating gum tissues. When treated, inflammation will be resolved. When gingivitis is left untreated, it will progress to periodontitis, which is nonreversible.

The intervals between teeth-cleaning procedures will depend on how often you can brush your pet's teeth. Once daily is optimum. If you cannot brush your pet's teeth consider a special diet by Hills called T/D. This food has an oversized kibble your pet must bite, resulting in a wiping effect on the whole tooth.

Can I just take my fingernail or a dental scaler to remove calculus?
Dental disease occurs below the gum line. By removing calculus from the visible part of the tooth, you are not removing disease below the gum line. In order to help your pet, plaque and calculus must be removed from below the gum line.

How to get the pet to accept tooth brushing?

 Proper technique involves applying the bristles at a 45 degree angle to the gums. Use small circular motions around the outside of the teeth, being sure to get the bristles under the gum line. It is not as important to brush the inside of the teeth, as dogs and cats do not have the buildup of tartar on the palatal or lingual sides of their teeth as people do.

 

Do you have to use anesthetics to clean my pet's teeth?
Anesthesia is necessary when performing teeth cleaning. Anesthesia provides three important functions: immobilization in order to clean below the gum line, pain control and the ability to place a tube into the windpipe so bacterial products do not enter the respiratory system.

I am concerned about anesthesia. Is it safe?
We take every effort to ensure anesthetics are safely administered. We use the safest of anesthetic agents. All dogs and cats are given preoperative test, depending on their age and condition, to qualify then as candidates for anesthesia. Finally, while anesthetized, all animals are monitored with pulse oximeter and respiratory monitor.

How much does a tooth-cleaning procedure cost?
It is difficult to quote what the procedure will cost because we do not know what state your pet's teeth and gums are in. There are three levels of teeth cleanings at our hospital. The range of fees is based on severity plus fees for preoperative testing, anesthesia, necessary therapy, and medication. The doctor or staff will be happy to give you an estimate once you bring your dog or cat in for the examination. We offer no charge dental exam & provide written estimate.

What is best to feed my pet?
There are special diets specifically manufactured to help keep dogs' and cats' teeth clean (Hills T/D). Feeding these special diets in conjunction with regular brushing is the best way to keep the teeth clean. Diet alone will not control plaque, but it will help.

What toys should I avoid to protect my pet's teeth?
Chewing on objects harder than the tooth may lead to dental fractures. Be especially careful with cow and horse hooves. They commonly cause fractures of the upper check teeth. Do not play tug-of-war games, especially with young dogs and cats, because they can move growing teeth to abnormal locations. Throwing dogs Frisbees can also cause trauma to the teeth resulting in pulpitis (discolored teeth).

What are cat cavities?
Many cats get painful lesions at the gum line that invade the teeth. The lesions are referred to as feline odontoclastic resorptive lesions (FORLs). Recent research indicates that in cats over 5 years of age there is a 72% chance he or she may have a FORL.

How can I tell if my pet is suffering from periodontal disease?
The leading sign is bad breath. Dogs and cats should not have disagreeable mouth odor. Bad breath comes from infection. If your pet's breath does not smell like roses, let us examine its mouth and advise care.

What types of tests are done to diagnose dental disease?
If periodontal disease is present or if your pet has a fractured tooth, an oral exam is performed while the pet is under anesthesia. A periodontal probe is used to evaluate bone loss around each tooth. Radiographs are taken to evaluate if teeth can be saved or need to be extracted.

When do I have to start worrying about dental problems with my pet?
As soon as puppy or kitten teeth emerge, it's time to start brushing. Although baby teeth are replaced with adult teeth, the puppy or kitten gets used to the brushing procedure, which continues for life.

What can be done if my pet has periodontal disease?
Periodontal disease occurs when tooth support structures are affected by infection. In the beginning stages, cleaning above and below the gum line as well as removal of calculus attached to the tooth will help restore periodontal health. In advanced cases, either periodontal surgery or extractions are performed. Antibiotics given monthly also help to control the progression of periodontal disease.

Which animals are at the most risk for periodontal disease?
Smaller breeds are more prone than larger because the teeth are closer together in small dogs, and these dogs usually live longer. Terriers, Maltese, Schnauzer, Cocker spaniels, and Shih Tzus are especially prone to periodontal disease.


What can you do to fix a broken tooth?
If your dog or cat breaks its tooth, there are two treatments: root canal therapy to save the tooth or extraction. Leaving the tooth alone with an exposed nerve is not a humane option. In addition to pain, infection will develop, which can spread to vital organs.

 

Brushing Teeth in Dogs

Why should I brush my dog's teeth?

It is estimated that over 2/3 of dogs over the age of three have periodontitis, an inflammation or infection of the tissues surrounding the teeth. Periodontal disease starts as gingivitis and progresses to involve the bony tooth sockets. Left untreated, periodontal disease leads to loss of teeth.

 

When should I brush my dog's teeth?

Ideally, you should brush your dog's teeth daily. Daily brushing is most beneficial and will help to establish a routine for your pet. For many dogs, once brushing becomes a part of their routine, they will begin to expect it. Brushing twice a week is acceptable if your schedule cannot accommodate daily brushing.

"The ideal time to teach your dog to accept tooth brushing is while he or she is still a puppy."

In the beginning, teaching your dog to accept the brushing of its teeth will take some training, but once he or she becomes accustomed to the process it will be relatively easy. The ideal time to teach your dog to accept tooth brushing is while he or she is still a puppy. If you have an older dog, the training process may take a little longer.

What steps do I need to follow to teach my dog to accept tooth brushing?

In order to be successful at brushing your dog's teeth, you must make it a positive experience for the pet and you must be patient. You can make the experience positive by praising your dog throughout the whole procedure, and reassuring him or her throughout every step.

 

For best results, follow these steps:

  • Choose a quiet time and place to start the brushing.
  • If your dog is small enough, hold your dog securely in your lap, with its head facing away from you. If your dog is larger, you should sit on a chair and have your dog sit beside you so that you can comfortably handle the mouth and teeth.
  • Start by rubbing your finger or a soft cloth over the outer surfaces of your dog's teeth, using a back-and-forth motion. Be careful to stay on the outside surfaces of the teeth to avoid being bitten by accident.
  • For the first few lessons, it is a good idea to only rub the cloth along a few teeth rather than the whole mouth, especially if your pet is unsure or nervous about the process.
  • Once the dog is comfortable with you rubbing the teeth, let him or her taste a little bit of toothpaste from your finger.
  • Once your dog has accepted the taste of the toothpaste, apply a small amount to the cloth and rub it over the teeth.
  • Once your dog is completely used to you rubbing the teeth with a cloth, it is time to start using a toothbrush.

 

What type of toothbrush should I use?brushing_dog1

Commercial toothbrushes are available that are specifically designed for use in dogs. These include brushes with angled handles, brushes with multiple heads (so that you can simultaneously brush the inside, outside and top surfaces of the tooth), small brushes that fit comfortably in your hand, and finger toothbrushes (designed to fit over the tip of your finger). For some dogs, it is acceptable to use a very soft toothbrush designed for use in human babies. 

The type of toothbrush you use depends a little on the size of your dog and a little on your own dexterity. Many pet owners find it easier to use a finger brush, especially when first beginning to brush their dog's teeth.

No matter what type of toothbrush you use, it is important to be gentle and go slowly, since it is easy to accidentally poke the tip of the toothbrush against the gums and cause some irritation, especially when you are first starting to brush your pet's teeth.

 

Is it okay to use human toothpaste?

No, absolutely not. Many human toothpastes and oral hygiene products contain xylitol, a sugar substitute that is safe for use in humans but highly toxic in dogs (for further information, see our handout "Xylitol Toxicity in Dogs").

Even if the human toothpaste does not contain xylitol, it will still contain ingredients that should not be swallowed. If it is swallowed, it can cause an upset stomach or digestive disturbances. Human toothpaste often contains higher levels of sodium than your pet requires, which is another reason why it should not be swallowed. 

 

My friend recommended that I use baking soda. Is this okay?

No. Baking soda is alkaline and if swallowed can upset the acid balance in the stomach and digestive tract. In addition, baking soda does not taste very good, and may cause your dog to be uncooperative when you try to brush its teeth.

 

Why is pet toothpaste recommended?

Pet toothpaste is available in a number of different flavors that are appetizing to dogs; depending on the brand of pet toothpaste, you may be able to find flavors such as poultry, beef, malt, or mint. By using a product that tastes good, your pet will be more likely to enjoy the whole experience.

If that the doggy toothpaste contains enzymes, they will act chemically to help break down plaque, thereby reducing the amount of actual abrasive brushing that you must perform.

 

Exactly how should I brush my dog's teeth?brushing_dog2

Apply a small amount of toothpaste to the toothbrush. Gently raise your dog's lips on one side. You can either do this by pushing up on the lip with the index finger of your free hand as shown in the diagram, or by placing your free hand over your dog's head with your thumb and index finger on opposite sides of your dog's upper jaw and lifting the lips.

If you are using a rubber finger toothbrush, place it along the gum-line and rub the tooth in a circular motion. If you are using a regular toothbrush, you may find it easier to use a back and forth motion. Start from the back, brushing the large upper cheek teeth on their outside surfaces. Work towards the front of the jaw.

In order to brush the lower teeth, you will need to open your dog's mouth just a little. This can be done by gently tilting your dog's head backward while holding onto his or her upper jaw with the thumb and index finger of your free hand.

At the beginning, concentrate on brushing the large cheek teeth and the canine teeth, the teeth where plaque and tartar accumulate the most quickly. Gradually work up to brushing all of the teeth (this will probably take several days or weeks). 

Do not worry about brushing the tips or insides of the teeth unless your dog is very cooperative. Most of the periodontal lesions occur on the outer surfaces of the teeth and this is where you should direct your efforts. In addition, the dog's tongue tends to remove a lot of the plaque from the inner surfaces of the teeth, reducing the need for brushing these surfaces. 

 

How long should I take to brush my dog's teeth?

Try to brush for approximately 30 seconds per side.

 

What else can I do to maintain my dog's dental health?

Plaque or biofilm is a gummy substance that begins to accumulate on the teeth within hours after a meal.  Within a day, plaque combines with salts that are present in the saliva, mineralizing to become tartar.  You can feed your dog a special dental diet that is designed to reduce the accumulation of plaque on the teeth, and give your pet special dental chew toys or treats that help remove plaque buildup. In addition, you can use an oral rinse designed for use in pets (can be safely swallowed) to help reduce the bacterial count in the mouth, reducing the formation of plaque and resulting in improved breath.

Finally, have your veterinarian perform a complete oral health examination and prophylactic dental cleaning and polishing under general anesthetic on a regular basis, such as annually. 

 

Is there anything else I should know?

Yes. A dog's mouth contains plenty of harmful bacteria, so it is extremely important that you wash your hands thoroughly with soap and water after you are finished. Also, rinse the toothbrush thoroughly before putting it away, and replace the toothbrush regularly. If you have several dogs, you should have a different toothbrush for each of them.

Brushing Teeth in Cats

When should I brush my cat's teeth?brushing_your_cats_teeth

Teaching your cat to accept the brushing of its teeth will take some training, but will be relatively easy once he is accustomed to the process. Daily brushing is most beneficial and will help to establish a routine for your pet. Brushing twice a week is acceptable if your schedule cannot accommodate daily brushing.

"It is best to teach your cat to accept brushing while he or she is still a kitten."

It is best to teach your cat to accept brushing while he or she is still a kitten. If you have an older cat, the process may take a little longer.

 

What steps do I need to follow to teach my cat to accept tooth brushing?

  • Choose a quiet time and place to start the brushing. Hold your cat securely in your lap.
  • Start by rubbing your finger or a soft cloth over the cat's teeth in a back-and-forth motion. Be careful to stay on the outside surfaces of the teeth to avoid being bitten by accident.
    "Human toothpaste should not be used, as it designed to foam, and is not meant to be swallowed."
  • Once the cat is comfortable with this, let him or her taste a little bit of toothpaste from your finger. Pet toothpaste is recommended for several reasons. The flavor is very appetizing to most cats and may make brushing more enjoyable for them. Pet toothpaste often contains enzymes to help clean the teeth, thereby reducing the amount of actual abrasive brushing that you must perform. Human toothpaste should not be used, as it designed to foam, and is not meant to be swallowed. If swallowed, it can cause an upset stomach; it contains higher levels of sodium than your cat needs.

medical-toothbrush_small

  • Once the cat has accepted the taste of the toothpaste, apply a small amount to a toothbrush. Place your free hand over your cat's head with your thumb and index finger on opposite sides of your cat's upper jaw. Gently raise your cat's lip on one side and begin by brushing one or two of the cheek teeth. A rubber finger toothbrush works well for most cats. This type of toothbrush should be placed right along the gum-line and used in a circular motion. Start from the back and work toward the front of the jaw. In order to brush the lower teeth, you will need to open your cat's mouth just a little. This can be done by gently tilting your cat's head backward while holding onto his or her upper jaw with the thumb and index finger of your free hand.
    "The cat's abrasive tongue tends to remove plaque from the inner surfaces of the teeth, reducing the need for brushing these surfaces."
  • Do not worry about brushing the tips or insides of the teeth unless your cat is very cooperative. Most of the periodontal lesions occur on the outer surfaces of the teeth and this is where you should direct your efforts. The cat's abrasive tongue tends to remove plaque from the inner surfaces of the teeth, reducing the need for brushing these surfaces.
  • Gradually work up to brushing all of the teeth (this will probably take several days or weeks). Make sure you reach the big teeth at the back of the mouth.
  • Try to brush for approximately 30 seconds per side.

 

Remember - A cat's mouth contains plenty of harmful bacteria, so it is a good idea to wash your hands and the toothbrush thoroughly when you are done.


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