Services

Dr. Hale and his assistant treat a dog at his Guelph clinic.	Introduction Dr. Hale provides a wide range of dental and oral services for dogs and cats (as well as some other companion and exotic animals). In the bad old days, little attention was paid to pet’s teeth. They were largely ignored until they were seriously loose and then they were extracted. Over the past few decades, pet animals have taken on an increasingly important role in people’s lives. As a result, owners and veterinarians came to realize that quality dental care could provide the same benefits for pets as it does for humans. Early detection and treatment of dental and oral problems can not only save teeth, it can also dramatically improve the quality of life. Think about it from the pet’s point of view. They use their mouths to eat, as we do. But they also use their mouths in much the same way we use our hands – for work and play and to interact with the world around them. When their mouths are diseased or injured, it is as painful for them as it would be for us. Competition and natural selection have ‘taught’ them to carry on bravely and keep eating, despite the pain, but you can rest assured that dental pain in pets is very real. Here are some of the dental services provided by Dr. Hale. (The terminology is the same as in human dentistry.)

All dental work starts with an oral exam, with the animal fully conscious. Not all animals cooperate this well!	Oral Examinations All work done by Dr. Hale starts the same way – with a referral from a general veterinary practitioner (either at their suggestion or at the owner’s request). After a review of the pertinent medical history and a telephone consultation, an appointment is made and the pet is examined at Dr. Hale’s Guelph office. Early on in the visit, Dr. Hale will do as through an oral examination as the patient will allow. This pre-operative examination allows Dr. Hale, in direct consultation with the owners, to develop a tentative treatment plan and an itemized estimate of the cost. If the owners consent to proceed, the animal is anesthetised and a much more detailed oral examination, with dental radiographs (x-rays) is carried out. The treatment plan and estimates then are revised as needed in light of any new findings, again in direct consultation with the owners. Treatment of the problem(s) follows immediately. Therefore, diagnosis, treatment planning and treatment are all provided in one visit. The animal is typically discharged within an hour of the end of the procedure.

This dog has severe periodontal disease with lots of gum recession and infection below the gum line. Almost all of the teeth had to be extracted.	Periodontics Periodontics deals with the tissues that support the teeth – gums, bone and periodontal ligament. The most common disease in pet animals is periodontal disease – it affects about 90% of dogs over five years of age and a similar number of cats. Periodontal disease often starts as simple gingivitis (inflammation of the gums), which is reversible if treated early. If left alone, gingivitis will often progress to involve gum recession, periodontal bone loss and pocket formation. Eventually, the teeth may fall out, but that takes years. In the mean time, aggressive bacteria are allowed to enter into the bloodstream through the diseased periodontal tissues. This can lead to damage to the kidneys, liver and heart valves, as well as being a constant strain on the immune system. Prevention is the best approach, but once periodontal disease is established, appropriate treatment can often save teeth and reduce the risk of other serious health problems.

The crowns of this cat's lower canine (fang) teeth have been broken. As a result, the inner pulps were exposed to oral bacteria, became infected and died. Treatment options were extraction of the teeth or root canal treatment to save them. The owner chose the latter treatment. Here, we're starting the procedure by cleaning the root canals with special files. For more detailed and technical information on endodontic anatomy, physiology and pathology, click here. There are also some client education sheets on the subject.	Endodontics Endodontics involves treatment of the pulp of the tooth – the nerves, blood vessels and other soft-tissue inside the tooth. Animal teeth are subject to wear and fracture from playing, chewing and accidental trauma. When the crown (visible part) of the tooth is damaged (fractured or worn down), the pulp often becomes exposed to bacteria. The result is infection and death of the pulp and then infection extends through the root into the bone surrounding the root tip. For teeth with endodontic disease, there are two options only – either extraction of the tooth or some form of root canal treatment. Leaving an endodontically diseased tooth alone is not an option. For very recent fractures (less than two days) in young animals (less that 18 months), it is often possible and desirable to keep the pulp alive and healthy by removing just a portion of it and then sealing the tooth to prevent bacterial invasion of the remaining pulp. In older injuries and older animals, it is usually wisest to do a full root canal treatment (remove all of the pulp and fill in the entire pulp chamber). After root canal treatment (and often before it as well), the tooth is dead on the inside, but it can still remain in the mouth and be perfectly functional and comfortable for many, many years. Sometimes a tooth will suffer an injury that does not fracture the crown, but that still causes inflammation and death of the pulp. These teeth are recognizable by the discolouration of the crowns. Teeth that are pink, gray or tan in colour (not just staining on the surface), have dead pulps and also require extraction or root canal treatment. Otherwise, chemicals leaking from the dead pulp cells will ooze out through the root tip and cause inflammation in the periodontal ligament space and surrounding bone. This is not only chronically painful, but also provides a safe haven for bacteria that may be circulating in the blood-stream.

This dog's lower molar has a cavity. Treatment involved removing the decayed tissue and filling the hole with a bonded composite restorative.	Restorations Though cavities are not as common in dogs as they are in humans, they do occur. When they occur, they are treated in exactly the same way. The diseased portion of the tooth is removed and the defect filled with a restorative. Amalgam has been used by some, but bonded composite restorations have several advantages. When a tooth has had root canal work done, there is a hole in the crown that was used to gain access to the inside of the tooth. These holes are also filled with bonded composite resins. Dogs may also have congenital defect of the enamel on the crowns of the teeth. Not only unsightly, these defects can expose the underlying dentin, which is sensitive. Bonded restoration make the teeth smoother so they look better and are easier to keep clean, but more importantly, they act as a bandage to protect the sensitive tissues below.

This lower canine tooth in a dog has been fractured and the pulp exposed. Rather than extracting the tooth, the owner wanted it saved, so we did a root canal (an example of endodontics). To protect the tooth from further damage, a palladium alloy crown was placed over the remaining natural crown structure (an example of prosthodontics).	Prosthodontics Prosthodontics is that branch of dentistry dealing with false crowns, bridges and implants. Most of what is possible in a human mouth is possible in a dog’s mouth as well, though it may not always be practical. Each case has to be looked at carefully when considering a prosthetic device. In cases where a dog has fractured the crown of a tooth due to some long-standing habit or occupation, following root canal treatment, it may be important to protect the tooth from further damage. This is best achieved by covering the remaining natural crown with a cast metal crown. Though they may not look as pretty as a ceramic crown, they will withstand far more abuse and have a good track record.

This poodle had an orthodontic problem that caused her lower left canine tooth to dig into the roof of her mouth. We installed an acrylic appliance to slowly tip the tooth forward and out. A month later, after the appliance has been removed, the dog can close her mouth without causing damage to the upper jaw.	Orthodontics It has been said that not every animal needs a perfect bite, but all deserve a comfortable and functional bite. Most pets develop perfectly normal and healthy bites (that is, their teeth and jaws all fit together properly). Some animals, however, develop problems as they grow. One jaw may be too long or too short, one or more teeth may be out of place or crowded. In cases where these orthodontic problems are causing abnormal tooth-to-tooth or tooth-to-soft tissue contact something needs to be done. Treatment options may include selective extraction, crown height reduction or use of an orthodontic appliance to move teeth to an acceptable position. Each case must be evaluated very carefully to determine the right course of action, considering the problem, the animal’s personality and the owner’s expectations. Treating orthodontic problems raises some interesting ethical concerns. Many orthodontic problems are genetic and can be passed on to future generations. Therefore, affected animals should be neutered to prevent the passing on of the "bad" genes. Some show-dog owners, looking to maximize their chances in the ring may request orthodontic correction. To make an abnormal dog look normal for the show ring is fraud and Dr. Hale will have nothing to do with this.

This young dog has a fracture of her lower jaw. The left canine tooth and the three left incisor, along with their supporting bone, have been tipped out toward the lip and there's a dark hole between the tongue and canine tooth. After gently cleaning the wound, the fracture segment (bone and teeth) were manipulated back into position. The soft tissue was sutured and the jaw stabilized with a wire and acrylic splint.	Oral surgery Trauma and tumors of the oral cavity require surgical treatment. Examples would include fractures of the upper or lower jaw, benign and malignant growths and congenital defects such as cleft palates. Extraction of teeth is also considered an oral surgery.

This cat has a chronic oral inflammatory disease. Though surgery is often indicated for these cats, the problem often also requires periodic medical management.	Oral medicine Some oral problems are the result of body-wide or local diseases that do not fit other categories. For example, cats with FIV (feline immunodeficiency virus) and diabetic patients often have more trouble with periodontal disease than normal animals. Some pets have other metabolic and immune system problems that need to be considered and managed when dealing with their oral problems. Recognizing that the signs seen in the mouth may be the result of disease states elsewhere in the body and putting the pieces of the puzzle together fall under the heading of oral medicine.

This is an x-ray of the same cat with broken canines (shown above under endodontics). The pulp chambers show up as dark spaces in the middle of the teeth. The bone is less dense (darker) around the root tips, indicating that infection was leaking out into the jaw bone (see arrow).	Anaesthesia and Radiography Virtually all dental and oral work requires that the patient be anesthetized. Even the detailed examination and radiographs (X-rays) require anesthesia. However, advances in anesthesia (drugs, monitoring, life-support…) have made general anesthesia a very reasonable risk for the huge majority of pets. Certainly we do not want to give an anesthetic for no reason, but if there is a dental or oral problem that requires attention, anesthesia is an invaluable tool. Radiographs (X-rays) are an essential diagnostic tool in dentistry and oral surgery/medicine. Much of the tooth lies hidden below the gums and encased in bone. The only way to accurately assess the root structure and surrounding bone is with intra-oral dental radiographs. We use the same type of film as your own dentist uses, placing it right in the mouth to get detailed images of the area in question.

This puppy's deciduous canine tooth is broken (white arrow) and the pulp exposed. The red spot above the first premolar (gray arrow) is a fistula where the infection caused by this broken tooth is draining. For more information on Juvenile Dentistry, click here.	Juvenile pets The mouths of young animals should be watched closely from a young age by both the owners and the veterinarian. If deciduous (baby) teeth get broken, they should be immediately removed, because leaving them in place will allow the pulp (soft tissue inside the tooth) to become infected and the infection can then spread into the jawbone. As well as being painful, this can also cause damage to the permanent teeth that are forming inside the bone near the root of the deciduous teeth. Orthodontic problems usually develop as the animal is growing. Catching the problem early and taking appropriate steps can often reduce the significance of the problem. Deciduous teeth that do not fall out on time should be removed right away. If the adult tooth comes in and the deciduous tooth is still in place, there are two teeth occupying space meant for one tooth. This causes crowding and can lead to all sorts of problems.

This photo shows a resorptive lesion on a lower premolar. The bright red tissue is the inflamed gum covering the defect in the tooth. For more information about "Neck Lesions", click here.	Cats Domestic cats are prone to a rather enigmatic problem sometimes called "Neck Lesions". They do not occur on the cat’s neck, but tend to arise at the neck of the tooth (where the crown and roots meet). The cause of these lesions, more accurately called Feline Odontoclastic Resorptive Lesions (or just resorptive lesions) is not known, but various surveys have shown that over half the cats alive today have one or more. In this disease, the cat’s body starts to attack and absorb its teeth. This begins below the gum-line and so is not usually detected until the problem is quite advanced. These painful lesions are almost always best treated by extraction of the affected tooth.
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