Dental disease is the most common problem I see in dogs and cats. During physical examination, I look for large accumulations of tartar, inflammation of the gums, masses, fractured teeth and other problems. Pictured below is the mouth of a dog before having a complete oral examination including dental X-rays and treatment.
See the severe accumulation of tartar on the upper premolar and molar? The tip of the large canine tooth as well as the back surface is worn creating a large defect in the enamel. Now look on the inside of the teeth on the other side of the jaw. The premolars and molars located on the right side of the picture are stained and covered with tartar.
After dental X-rays were taken to look for problems below the gum line, the treatment could finally begin. The first step was to remove the large chunks of tartar or calculus from the surface of the teeth. (Calculus is pictured below.)
Then an ultrasonic scaler was used to remove smaller pieces of tarter. The tip must be kept moving at all times to prevent damage to the enamel surface of each tooth. After the crowns (exposed surface of each tooth) is cleaned, the area below the gums are scaled by hand to remove calculus and infection. In my opinion, if this step is not performed, the dental is worthless. The last step in the dental is polishing all the surfaces and treating all problems that were found. This dog has periodontal pockets of infection that were cleaned, polished and packed with an antibiotic gel.
In this ‘after’ picture, note the bleeding along the gum line of the premolar and molar. The tartar extended under the gums causing severe inflammation and infection. The damage gums bleeds after treatment but will heal if kept clean. If the area under the gums had not been cleaned, the infection would have spread up the root. The dog would have been in extreme pain until the tooth was removed. That is why I consider anesthesia-free dentals malpractice. Cleaning the crowns make the teeth look good but does nothing for the areas under the gums – the roots. Also, without anesthesia it is very difficult to clean the inside surfaces of the crowns and polish. I have seen an image of a cat who had their tongue almost ripped-off during an anesthesia-free dental. The damage was so severe that the cat couldn’t eat and was euthanized.
Chagas disease or American Trypanosomiasis is caused by Trypanosoma cruzi. This flagellate is transmitted by insects like the Mexican kissing bug that infest bedding. They feed on people and dogs while they sleep. When the bug defecates, the immature form of T. cruzi is released into the environment. If the dog or human has defects in their skin, the immature form called a trypomastigote can gain access. It likes to migrate into the reticuloendothelial system as well as the striated muscle of the heart. The trypomastigote mature into intracellular amastigotes. Eventually, the amastigotes form pseudo cysts that will destroy the cell. When the cell membrane ruptures, T. cruzi invades other cells causing massive destruction.
Clinical signs start with weight loss, lethargy and anorexia. As time passes, infected dogs may faint, have respiratory problems, heart problems, vomiting, diarrhea and paralysis. Sudden death may also occur.
There are three phases of infection:
- Acute – Dogs can be asymptomatic during the initial stages. Others will have an enlarged spleen, liver and lymph nodes. Their gums are often pale and many have diarrhea. As the disease progresses, some dogs become paralyzed. Sudden death is also possible from abnormal heart rhythms.
- Latent – This phase lasts one to four months. Most dogs show clinical signs in this phase.
- Chronic – This phase is characterized by slow progression of heart disease to heart failure. The heart dilates and has trouble contracting. The right side of the heart is usually affected first. Fluid backs up on the abdomen causing distention. Eventually, the left side of the heart is also affected causing fluid to accumulate in the lungs and respiratory problems.
Currently, there are no effective treatments for Chagas disease. Strict hygiene and pest control are the key to prevention.
Source: Snell, Linda. American Trypanosomiasis (Zoonotic) VIN.com, Associate 12/22/2010.
Good nutrition is vital to keeping your pet healthy. The right food can prevent many problems and diseases while the wrong food can actually cause them. With so many companies and varieties to choose from, selecting which food to purchase can be difficult. The following list are factors to consider when selecting one for your pet. It is my take on the recommendations made by Dr. Susan Wynn, a boarded veterinary nutritionist who practices at Georgia Veterinary Specialists in Sandy Springs Georgia.
- The food must have an Association of American Feed Control Officials (AAFCO) statement. If the manufacturer did not take this very basic step to determine the nutrient content of their food, you should avoid it. Please note: An AAFCO statement does not guarantee the product is good. AAFCO is a voluntary program.
- The food company must have a good track record. In general, I wait a year with all products, food and drugs, to see what happens before recommending or prescribing them to my own patients. As part of their track record, I look at recalls. Of course, it is best to see recalls initiated when potential contamination exists before animals have been harmed as opposed to recalls started after many animals have suffered. The former is a sign that the quality control effort is robust.
- The company must have a boarded veterinary nutritionist on staff. I am not a fan of using consultants who may spend limited time with a given product.
- Claims made on the label must be backed-up with clinical trials. For example, if a diet claims to prevent arthritis, I want to see a thoughtfully designed scientific study with a large number of participants to support this claim.
- The food must be appropriate for the pet. This includes the dog or cat’s age, lifestyle and environment.
- The pet must like it! I want pets to enjoy their food as much as I do.
For more information on nutrition, I recommend visiting Dr. Wynn’s website at www.susanwynn.com.
Pictured below is the mouth of a friendly Labrador Retiever who needed dental X-rays and a periodontal treatment. When he was being intubated, examination of the back of his throat revealed an abnormal right tonsil. While I was examining the tonsil for a good place to biopsy it, I found the abnormal structure being held with the forceps. Examine the image and then answer the following questions: What is the mass? What caused it? How is this condition treated?
Diagnosis: Fibromucosal Polyp
The mass held with forceps is a fibromucosal polyp that was attached by a band of connective tissue to this dog’s right tonsil. Although this is a benign condition, it is very uncomfortable for the dog. This large mass hung in the back of his throat making it difficult to breathe and eat. He coughed, cleared his throat and gagged a lot. These polyps are caused by chronic irritation usually from trauma, an infection or a foreign body that is stuck in the tonsil. Surgical removal is curative as long as all of the polyp is removed. The good news for this dog is that the margins were clean. Here is the picture of his throat taken with the polyp removed. The tonsil is outlined in red and the sutured stalk is highlighted in yellow.