Beware: The Do’s & Don’ts Of Caring For Your Pet’s Teeth | SOP Ep. 19 – Dr. Sharon Hoffman

Veterinary Oral Health Council

American Veterinary Dental College

Coastal Fine Photo

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All footage is owned by SLA Video Productions.

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Beware: The Do’s & Don’ts Of Caring For Your Pet’s Teeth – Dr. Sharon Hoffman

Welcome to Speaking of Pets. I’m Dr. Alice Novotny Jeromin, a board-certified veterinary allergist and dermatologist.

I’m Janet Novotny King. I am not a board-certified allergist and dermatologist. I am Alice’s younger sister, but I’m taller. I’m here as the average pet owner because when she talks, I don’t get it sometimes. I have to ask a lot of questions to better understand all those medical terms or medical jargon. Stick with us.

Janet, you need to start looking in your pet’s mouth. So many people don’t pay attention to their pet’s mouth. They don’t look in there. They don’t open their mouths. It’s a big mistake.

They’re afraid.

Dr. Schoenberg talked about how to open a cat’s mouth when she was on the show. Even if you don’t open it all the way, at least try to inspect the teeth and the tongue. We are very fortunate because a dear friend of mine, Dr. Sharon Hoffman, who is a board-certified veterinary dentist, is with us. She did her undergrad at Michigan State in animal husbandry. Her DVM degree is from Louisiana State. She is a diplomat of the American Veterinary Dental College. She completed a One Health Fellowship in oral medicine from the University of Pennsylvania.

She’s the owner of Veterinary Dental Consulting in Florida and an adjunct faculty member at the University of Florida College of Veterinary Medicine. She’s been awarded the Gold Star Award for Outstanding Contributions to Veterinary Medicine in Florida. That’s fabulous. When she’s not curing our patients’ mouths, she is a photographer at Coastal Fine Photo. She volunteers as the photographer for the Street Dog Coalition in Jacksonville, Florida, which we hope to have on a future show.

Interestingly, her connection between her Coastal Fine Photo and veterinary dentistry is that a portion of the proceeds from the photography sales is donated to the Make Me Smile program. It is a cool program because they provide free equipment and training to shelter vets and techs so that adoptable dogs and cats can leave those shelters with squeaky clean, healthy mouths. Dr. Hoffman, if I may call you that, that is a wonderful way of giving back that you do. What a treat. Some of these small dogs come into these shelters. It must be so gratifying for you to have them be crystal clean as they leave.

It’s always wonderful to put smiles back on my patients’ faces.

That’s a good point. We have had so many audience questions about oral health care. Janet, why don’t you start? I hope we can cover everything.

When we got our puppy with Libby, our vet immediately said to me, “Start getting her used to rubbing with the toothpaste or a brush at a young age.” Is that something that pet owners should do?

It is. It’s a good habit to get into. The whole trick behind that is not to open the pet’s mouth. As soon as you open their mouth, there’s a struggle. They don’t like that. Just lift the lip. Put your finger under the lip and gently massage the teeth at the gum line. There’s no scrubbing. There’s no rubbing. You don’t have to worry about the sides of the teeth against the tongue because the tongue cleans the sides of the teeth. As you pet their faces and their ears, and they are getting used to being touched all over. You’re holding their feet so they can get used to having their claws clipped. Get them used to having your finger in their mouth and gently massage the gums.

We have two cats. We’ve had many cats. It’s hard to get them used to it.

Some cats will be more accepting of that than others. I do teach how to brush cats’ teeth. I have two videos of my cats getting their teeth brushed. I have had other cats. They’re not going to allow it. Ben loves toothpaste. He would eat the whole tube of toothpaste if I let him. We’re going to brush his teeth one side at a time. You don’t need to hold the mouth open. Brush the teeth. Ben has two sides. You have to do the other side now, Ben. What a good boy. Make it pleasurable. In the end, he gets to have more toothpaste.

I watched those. I’ve learned some stuff from that, too, because I always thought, Sharon, that you had to do the inside also, but you can just do the outer side of the teeth.

The sides that the lips are touching.

How do you know when a pet has a mouth problem? How can you tell that they’re painful?

Identifying Signs Of Oral Pain In Pets

They don’t show pain the way you think they might. Sometimes, I see dogs with broken teeth. Clearly, I know that they’re in pain because the pulp is exposed. Someone will say to me, “They’re still eating.” The pet with a sore mouth, a cat or a dog, will still eat. I have seen dogs with broken jaws that are still eating. You don’t want to wait for them to stop eating. Sometimes, there’s a bad odor. That’s an enough sign that there’s a problem.

In cats and dogs that are eating dry food, if they have pain on one side of the mouth, they may only chew on the other. They may tilt their head to get away from the painful side. They may drop food on the floor while they’re eating. In an exam room, when there’s a dog, I will often give a treat and watch them chew to see if they’re avoiding one side more than the other.

The other thing that they’ll do is that a pet will start acting old. They don’t want to play. They don’t want to be social. They don’t want to pick up toys they used to play with. They just act old. When we remove the pain, they start acting younger again. What I often tell my pet parents is we don’t know how much pain they’re in until we take that pain away.

I never thought about acting old. Sadly, there are a lot of clinical issues where people just chalk it up to, “He’s getting old.” As you said, there’s mouth pain, arthritis, and bellies that hurt. It’s sad because getting old is no fun. You still do the things you can do. It’s just less of them. That’s very sad. I never even thought of that.

They’re not up for anything. They’re going to eat because they’re driven.

They’re going to eat because it’s better than starving. They’re suffering in silence.

Once, my son said, “Mom, come here.” She had drool coming out. It was a cracked tooth, and it had to be extracted. They put her to sleep. I’m assuming whenever you extract a tooth like that, you do put the pet to sleep.

The patient is under general anesthesia. There are a lot of concerns about that. It’s interesting when you or I go to the dentist or an oral surgeon for surgery. We want anesthesia, but we don’t want it for our pets. There’s a lot of concern. There are a lot of fears about that. This is probably a good time to address that. Often, the fear or the dread is based on something someone saw on the internet, they heard a story, or they experienced a pet dying shortly after anesthesia or during anesthesia. These are real things.

I talked to a lot of people who have that fear. There are ways that I’m going to talk to you. You’re in my exam room, and you’re concerned about the anesthesia. There are a couple of things we do because many of my patients are elderly. They’re seniors or geriatrics. It is not uncommon for them to be in their late teens or early twenties, or they have a heart problem, a kidney problem, or something else that increases their risk. The things we do to decrease risk are blood tests. We do them within 30 days of a procedure to see how those kidneys are. How’s the liver? What’s the thyroid doing? Is there anemia?

We want to know what’s going on in the rest of the body. If we find a complication, and I hear a heart murmur, I want the patient to have a cardiac evaluation with a cardiologist. It’s because a patient has an illness does not mean we can’t anesthetize. We want to know our risk factors because we can manage them. Some people with pets have had a bad experience, or they have a fear. The pet may be perfectly healthy, but because of the fear, I will have a board-certified anesthesiologist working with me.

I have a team. It’s not just me. I’m in the mouth. The anesthesiologist is there. I have an assistant. We’re a team to provide the safest and best care for that pet. For the pet that has a preexisting illness or comorbidity, we can cater the anesthesia to that pet’s needs. We don’t use the same drugs or anesthesia protocol on all our patients. Every single one gets a customized anesthesia protocol. When we have a fearful pet parent, the anesthesiologist and I talk to that pet parent before the procedure to answer any questions and to let them know we are working as a team.

The patients I see are not general practice patients. I was in general practice for twenty years. I’m seeing the patients that are higher risk, that are older, that have the comorbidities, and that have all these things that the general practitioner wants me to handle instead of them. It’s okay. That’s why I’m there. When we’re in the exam room talking to the fearful pet parent as a team, Dr. McKune, the anesthesiologist, tells them what she’s going to do. I tell them what my plan is until we get under anesthesia. I take X-rays. Guess what? Sometimes, the whole plan changes.

This is how we work as a team. I’ll say, “This is what I have to do.” As we’re working, as time goes by, I ask Dr. McKune, “How is the patient?” She’ll ask me, “How much more time do you think this is going to be?” I’ll let her know. If at any time she’s concerned or can’t manage the heart rate, heart rhythm, body temperature, blood pressure, respirations, or any of those things, she says, “You need to stop.” We can stop when we’re in the mouth. You can’t stop if you’re doing a heart surgery or an abdominal surgery. This is how we work together as a team.

On that note, when you read about these anesthesia-free dental cleanings, that has to be bogus. How can you do a complete, thorough cleaning when the patient isn’t under sedation?

Dispelling The Myth Of Anesthesia-Free Cleanings

People who are fearful will seek out anesthesia-free dental cleanings. This is what I want you to remember. The least important thing that I do as a veterinary dentist is clean the teeth. The most important thing I do is the exam, which cannot be due, as you’re asking, thoroughly, because I have to check what’s going on under the gum. Dental X-rays cannot be taken without general anesthesia. If someone is only cleaning the teeth, even with general anesthesia or without, and X-rays are not taken, we’re going to send the pet home with very clean teeth and disease underneath the gum that hasn’t been addressed.

What has happened over the years is that, because of fears and other things, for pets that have had anesthesia-free cleanings year after year after year, the pet owner feels very good that they’re keeping up with these cleanings. The teeth are nice and white when they go home. Several years down the road, the teeth have to come out because the disease under the gum wasn’t addressed. It’s a cosmetic procedure. It is not a treatment for a disease. Disease goes undiagnosed and untreated.

Why is it that the smaller breeds always seem to have bad mouths?

Let’s define smaller. There are micro dogs that are about 2 pounds. They come in to see me in the owner’s purse. I get them that small. Let’s define. I’m going to say small breeds are 15 pounds and under, just for the sake of discussion. It’s true. The smaller they are, the more we see gum disease, periodontal disease, and tooth loss because of the size of the jaws. The bones are quite small, but the size of the teeth in a 4-pound Yorkshire Terrier is not much different from that of the 20-pound Cocker Spaniel. What’s different is the size of the jawbones. Any bone loss in the jawbone is more severe than in the larger dog. That’s the anatomy.

The other thing that happens is that pet parents see this tiny little dog that comes in the purse. They don’t want to give it things to chew on because it’s too big for their little dog. It’s the same idea as giving a toddler small things, but not too small because they choke. With a small dog, they need to chew as well. Don’t break the treats into something small. They need to chew.

There are two things. It’s the hygiene at home and the anatomy. For the larger dogs, we’re talking about above 15 pounds. The medium-sized dogs and the very large ones, we assume, have broken and damaged teeth, especially our service dogs, the military dogs, and the police dogs. They’re breaking teeth. I don’t see them for gum disease. I’d see them for dental trauma or tumors.

Do those special treats that claim to clean the teeth work?

Some of them. There’s a huge list. We can’t go over a whole list. If you go into a Walmart or a store like that, there are more treats and foods for dogs and cats than there are for babies.

It’s crazy.

How does the pet owner decide what to give? There’s a great resource. We have a link for the VOHC.org, the Veterinary Oral Health Council, which is a nonprofit group. What this group does is they evaluate the claims on the packages of these chews, treats, and foods. If a chew is claiming to help with gum health or help clean the teeth, if they have submitted evidence to the VOHC and the evidence supports their claim, the VOHC awards them a seal. It’s the VOHC seal that can be put on the product. The list is updated regularly. The companies have to resubmit every five years because maybe they changed the formulations of their treat that had the VOHC seal. That’s a guideline.

Here’s something easy. We’re going to talk about dogs. There are a lot of things that hurt dogs’ teeth. I gave a list of some. Many of them are natural. I’m going to give you a short list of things that break teeth that keep me in business, but I don’t need to see broken teeth to keep me in business. There are real, natural meat bones. Cooked or raw, it doesn’t matter. It’s the most common thing that breaks teeth. There are hard plastic toys. A jolly ball would be an example. There are hooves like cattle hooves and nylon bones, any brand. Antlers are marketed as something that dogs like. They do like them, but they break their teeth.

As a matter of fact, the UK took them out of the pet shops because of all the damaged teeth. I’m often asked, “Why don’t the US stores take them out of the pet shops?” It’s because people keep buying them. Buyer, beware. Last but not least, tennis balls. They don’t break teeth, but the fuzz is like a nail file or an emery board. It’s very coarse. Here in Florida, we have a lot of sand. If you throw the ball, it’s wet. The sand sticks to that fuzz and wears down those teeth. We can never get the teeth back. If you’re using a tennis ball, wash it off. I prefer you to use a ball without the fuzz. It’s all about the fuzz. How many dogs love tennis balls?

Dr. Hoffman, you’re going to have to break that to leave your Golden Retriever.

It’s hard. No fuzz. A ball of the same size is fine. Here’s another rule of thumb. When you’re in the pet shop or somewhere you want to buy a new treat because the dog just destroyed the last one, the rule of thumb is if you can bend it with your hands, thumbs up. If you take your fingernail and you can make an indentation in that shoe, thumbs up. If you can’t bend it or you know the dog’s going to chew it, and it’s going to be a little softer, that’s okay if you can’t make the indentation, thumbs down.

Seriously, I’m going to have to clean out our whole toy basket.

The “Thumb Rule” For Choosing Safe Pet Toys

Here’s the other question I get very frequently. A pet will come in that’s a big dog with strong jaws. Think of a Pit Bull or Rottweiler. They love to chew. They chew 24/7. That’s a little obsessive. They go through so many toys. The owner says, “I want the toy that the dog cannot destruct.” I say, “That’s fine. They’re out there, but they will destruct the teeth. The toy that is indestructible will destruct the teeth. You’re seeing me for a root canal or extractions.” Those dogs need more activity. Give them a job, and they won’t chew 24/7.

Speaking of chewing, Janet and I both have rescues. Thankfully, ours don’t, but for some of these rescues that I help out with the rescue groups here, you can tell they’ve tried to chew out of the cage. Are those incisors repairable when they take them down? Sometimes, I can see the pulp. I don’t know. I’m not versed in it like you are.

That’s very common. You’re talking about wear on the teeth, not so much a fracture. They wear down the incisors or the small teeth in the front. Dogs and cats have twelve. People only have eight. They can wear the backs of the canine teeth, the big, long ones, down if they’re chewing on a cage, a kennel, or a fence. It’s common in dogs with separation anxiety, and believe it or not, in the police dogs. We can do something to protect the canine teeth from further wear. I can put metal crowns on them before they break.

Once they break, we need a root canal before we can put a metal crown. For the incisors in the front, we don’t crown those. Sometimes, the pulp is exposed. Sometimes, it’s not. The only way to know if the tooth is dead is to have X-rays because you can’t save a dead tooth unless you’re doing a root canal. Tennis balls will wear down those front teeth all the way to the gum line. It depends on the tooth and how far the damage is, whether it can be protected from further wear. In our military dogs, the ones that are being deployed with the soldiers need their teeth. The police dogs need their teeth. That’s something that we try to save. We’re working on the big eight teeth on those dogs.

What about rock chewers? You know how a lot of Labrador Retrievers will chew rocks. You see a lot of broken teeth from that.

They also swallow them.

That’s another scourgery talk.

They’re selecting something. There’s even a study on Labrador Retrievers about why they even swallow the things they do, including knives. You and I know they swallow a lot of non-food items. They’re trying to figure out the satiety in the Labrador Retrievers. I don’t see a lot of rock chewers with broken teeth. I’m sure they’re out there, but probably the primary care doctor is seeing those.

As you mentioned earlier, those dogs need a job.

They’re bored.

I don’t want to even mention any brands, but I’ve seen some wipes for teeth. Wipes versus brushing versus the finger brush. What’s the deal with wipes? Are those effective?

I recommend them for people who don’t want to brush.

I’m going to tell you. I bought Vetradent wipes. Gidget’s from China. She’s a China rescue Golden. She came to me at a year of age with bad fourth premolars. They’re worse than stained. I wondered if that was effective and if that’s an option.

We, people, brush our teeth twice a day or once a day. Some of us floss. Believe it or not, it is fewer than 10% of us. Shame on us. If we don’t brush every day, in four days, the plaque, which is the gooey stuff and the stinky stuff, becomes mineralized from minerals in the saliva and becomes calculus or tartar. At that point, you can’t wipe it off. You can’t brush it off. It depends on where you’re starting with the wipes. The best time to use a wipe is after the teeth have been cleaned and polished, not right after extractions, because things are still healing. They’re not going to wipe off anything hard.

When I clean teeth, I don’t usually just clean teeth. I usually do a lot of other things unless the patient is a high anesthesia risk. They come to me because I have an anesthesiologist. I tell people, “Don’t even try to wipe or brush until we eliminate the pain, because if you try to wipe and there’s something painful in there, the pet’s going to associate the wiping with the pain. It’s not going to let you in there.”

For people who do want to brush their dog’s teeth, is it essential to do it every day as opposed to once in a while?

It is. It’s so funny because I’ll see some patients every six months. I know that some of our audience will understand this. People get gum disease, which is periodontal disease, the big long word, but they have to go to a hygienist every three months to get cleanings underneath the gum line. It’s very interesting. If I have a periodontal or gum disease patient, I want to see them every six months. We cannot cure this disease.

Same in people. We can only control it. It’s the biggest cause of tooth loss in people and our small-breed dogs. They’ll come to me for the six-month follow-up after we’ve done a periodontal treatment. I’ll say, “How’s the brushing going?” “It’s going okay.” I say, “How often are you doing it?” It’s like a confessional. There’s this guilt because it’s not as often as it needs to be to help the pet. I say, “That’s okay. I just want to know what’s happening because if the pet is unwilling to allow the person to wipe or brush, we have to find something else for them to chew or drink.”

That’s where I give the little handout about the VOHC.org website to find what is proven with evidence to be effective. We’re going to customize the dental home hygiene with a realization of what we should expect. What should we expect if we’re not doing anything at home? When you and I go to the dentist every six months, we’re doing something in between those visits every six months. We’re not waiting for the next visit. It’s important to have realistic expectations.

When you do a crown, you do whatever work to prepare the tooth. Do they get the crown right away when they’re at their first appointment?

No. I have crowns. The audience is going to have crowns. When a pet comes in and sees me, and I see a broken tooth, and the owner’s, policeman’s, or soldier’s desire is to save that tooth, if the tooth is dead and I have enough of the root left, the first step is a root canal. At the time of the root canal, I shape the tooth for a crown. I make an impression and send the impression to the lab. The lab sends me back that beautiful new crown, and then I cement it on. It’s three procedures. There’s the consultation. This is what I see. These are your options. Which would you like? Let’s schedule it. It’s a multi-step procedure.

Does the same lab that does human crowns do veterinary?

I used to use a human lab. There was someone who did for people. He was in South Florida. I went to visit. He says, “I want to do this for you.” He was excellent, but he retired. There are human dentistry labs that are doing some of this for many of the veterinary dentists in the country. There are 200 of us in the US. There are some pet-specific ones.

I would think you’re a proponent of dry hard food for pets.

No.

Is that a fallacy?

It is.

This is why you’re on. Good to know.

Debunking The Dry Kibble Fallacy

I like to dispel them. That’s what we were taught. I can say, Alice, that you and I went to that school in the last century. We can say that. We were taught that dry food is better. It keeps the teeth cleaner. Don’t get the wet food. It’s all gone out the door. Think about this. Think about chewing on a Cheerio. It crumbles. It breaks. It does nothing to clean your teeth. It’s the same thing with dry dog food. They bite the kibble. It breaks. It does nothing to clean the teeth.

The difference between a dental diet, and there are many of them now, and dry kibble is the texture. They’ve got to chew. The texture of that food makes them chew. It’s pushing off the calculus. Some of the chews on the VOHC.org website also do that. They’ve got to chew it like chewing gum. They sometimes tell people, “Chew gum after you eat if you can’t brush.” It’s the texture. It’s not just the dry food kibble.

Canines didn’t ever get braces.

It’s rare. I remember one little Terrier that came to me from the Panhandle, six hours away. It’s a beautiful Border Terrier. They are cute little dogs. She had a lot of teeth in the wrong places. The owner wanted this corrected, instead of having the teeth pulled out. She was a puppy. I have to select the owner. “How willing are you to do this, that, and the other? You’re six hours away. I can’t help you on a weekend if something happens.”

It doesn’t take years in the dog. It sometimes takes weeks to move teeth. I did put buttons and chains on that dog. We moved the teeth. She has a smile that’s not painful. We can move teeth in younger dogs. Sometimes, it doesn’t require buttons and chains. Sometimes, it’s just a splint. We can even do removable devices with a ball to help move things out. The whole idea is not to make a beautiful smile. This is not a fashion show. This is to alleviate and prevent pain.

Owners should not use human toothpaste on their pets. Correct?

Do you know why they shouldn’t use human toothpaste?

It’s because of fluoride.

We have fluoride in our toothpaste. We spit. Unless you can teach your dog or cat to spit, they’re going to swallow the fluoride. We don’t want them to do that. The toothpaste companies have done very well to make it tasty, like a treat. Sometimes, that’s how I teach toothbrushing. You give them the treat of toothpaste. They’ll lick it. I have cats that will lick the whole tube of toothpaste.

I saw your cat video. The cat loved it.

It’s a treat. You brush. They understand why it’s on the brush, and then you give them some more. It’s a good experience.

Janet, Sharon, and I were talking about some interesting diseases. She could probably tell you better than I. When a cat has retained its deciduous baby teeth, they’re associated with a broken kneecap.

For short, they call it teeth and knees syndrome. It’s rare. I have read about it. I know an orthopedic surgeon who saw one. He saw it for the knees and didn’t know about the teeth because we’re a different specialty. The mouth is connected to the health of the whole body. We can’t separate it. As veterinarians, Alice, we’re lucky because we get to learn all the body systems, the skin, the mouth, and the heart.

When people go to medical school to be doctors for people, they don’t learn about the mouth. When they go to dental school to learn about the mouth, they don’t know about all the rest of the stuff that we need for anesthesia. We’re at an advantage. The disadvantage is that we don’t learn dentistry for four years in vet school. It’s something we have to do later if we want to specialize in that.

When you’re doing a dental under sedation and you see some gum pathology, have you ever been unfortunately surprised, like squamous cell carcinoma? Do you know when you’re going in there what you’re going to see?

At first, there’s a consultation in the exam room. The patient’s awake. Some patients are so painful. I can’t do a good exam. There are many surprises, especially the ones that didn’t even let me look in the exam room because they were in so much pain. They’re under anesthesia. I get a look. We take X-rays, and there are even more surprises. We do see cancers. Cats are more likely to be at the age of ten and older, but sometimes younger.

With dogs, we can see it at many ages. There are all different kinds of cancers, such as melanoma, fibrosarcoma, and squamous cell carcinoma. Some of them need surgery. For some of them, it is inoperable by the time we diagnose it. We do surgeries where we sometimes remove the tumor or part of the jaw. Dogs and cats can live for years if we get all of that out of there.

They have puppy teeth. They fall out all of a sudden. Are there issues that pet owners should look for when those puppy teeth are coming out? Is there a red flag?

Management Of Retained Deciduous Teeth

They need to be looking. Remember, I said, “Don’t open the mouth. Just lift the lip.” Get them used to being in there. Sometimes, all of the baby teeth don’t fall out. Adult teeth start coming in where the baby teeth are still there. There should never be two teeth in the same place at the same time. Some people refer to this as sharp teeth because it looks like the dog has 80 teeth in there. They want to look.

Usually, puppies and kittens are seen by the veterinarian every few weeks for puppy and kitten shots. They’re looking as well. All the adult teeth in cats and dogs should be in by six months of age. If they’re not in, or they’re in the place of a baby tooth, the baby teeth need to be taken out, probably at the time of the spay and neuter, if it’s being done at six months. Some are being done much earlier now.

Our son had his baby teeth. Eight of them were ankylosed to the real teeth. He had to have major dental surgery to take them out, and then they put spacers behind his teeth. He essentially had braces that you couldn’t see because they were behind. Everything worked out, but it was something when they took eight of those teeth out.

That’s a lot at one time.

He was sedated in the hospital because I didn’t want to have the anesthesia in the office.

You wanted anesthesia for him.

The funny thing is, my father-in-law, who’s now passed, came to visit. He brought my son that little Whitman’s chocolate box. My son is stoned. What do you think he eats? A caramel. We still talk about it. He then proceeded to throw up.

I have something to share about a senior patient. It was a seventeen-year-old Dachshund that came in. This little Dachshund belonged to a very fearful pet owner who had put off having dentistry for his Dachshund for seventeen years. This dog had a lot of pain, a lot of loose teeth, and a lot of odor. What happens when we start having disease in the top teeth in dogs, especially the canine teeth, is that the bone is destroyed to the extent that there’s now no bone between the tooth roots and the nose. The dog sneezes. This dog had all of that.

We had to get her over the anesthesia. I get it. She even brought an emotional support human with her. Good for her. I talked to her about anesthesia. They always want to know, “What happens if we don’t do anything?” What happens in these small breed dogs, as more and more bone is lost, sometimes, the bottom jaw, left or right, will break. It’ll fracture because there’s not much left. It’s not uncommon for me to see that because of the fear of anesthesia. We had the anesthesiologist. We took a lot of teeth out of this dog.

We had to do a plastic surgery on this side and this side to close the holes that went from the mouth to the nose. One hole was so big. My finger went all the way up into the nose. This dog lived without pain for the rest of his life. When the owner came back at four weeks post-op, she was a new person about the anesthesia. She is now an advocate for dental care for pets. The dog was seventeen. We’re not going to increase the length of his life, but he’s going to live without pain.

How can you tell when your dog’s in pain? My friend has a very old Lab. She pants. It’s a quick, rapid pant. That’s how she can tell. Her vet told her that that’s a sign of pain. She also does this thing where they go paw to paw, almost like tapping.

The interesting thing is finding out what’s painful. Is it the joints? Is it the mouth? Is it the broken tooth?

Yes, it’s the joints. It’s pretty bad.

Her hips are bad. You can see the spine.

It’s because it’s atrophy.

It’s about managing pain. The pet won’t be active if they’re in pain, whatever part of the body. They just want to be still. That’s the acting old behavior. If it’s in the mouth, it’s the same thing. If there’s a broken tooth, we talked about not wanting to chew on that side, dropping food, and avoiding their favorite toys. It’s too painful. We can prevent pain. We can treat pain. We have all these anesthesia advances that allow us to do it safely. I think the oldest patient I had was 21 years old.

Dog or cat?

He’s a cat. I think the oldest dog was nineteen. It was a pug, which is at higher risk of anesthesia. It belonged to the anesthesiologist. I’ve had some other patients that weren’t pets. They’ve been whales, dolphins, and sea lions, but they’re not pets. They all have tooth problems that cause pain.

When you put the whale or the dolphin under general anesthesia, are they in the water?

It’s not under general. I have to do locals. They’re trained to allow me in their mouths. Isn’t that amazing?

Are you in a swimsuit there? How does that work?

I don’t know how much of the pet trail you want to get, but the dolphins are lifted out of the water and put on a foam mattress for me. They can only be out so long.

What problems do they have? Do they have impacted teeth or infected teeth?

They can break teeth. They have toys to play with. Some of them break teeth, so we take care of them. They’re being taken care of.

Are they sweet? Are they nice?

Some of them are.

What kind of teeth do they have? Canines? I don’t even know.

It’s an anatomy question. Whales and dolphins are pretty much the same. They’re cetaceans. We’re not talking about the baleen whales and those things. They only have one shape of a tooth. It has one point. They only get one set of teeth throughout their life. It’s quite different. Whatever species I’m working on, I have to know about the anatomy of the tooth above and below the gum line. For that, I go to museums and study skulls.

The Minimal Necessity Of Pre-Surgical Antibiotics

What’s the status on, for example, that seventeen-year-old Dachshund with a bad mouth? Do you do pre-surgical antibiotics, or is that not done anymore?

We used to think that all these dentistry patients needed antibiotics. It’s the same in people. We have found that in people, there’s an overprescription of antibiotics. As you know, there’s a global problem now, with people and our pets, where there’s antibiotic resistance. There are very few situations in which we even prescribe antibiotics at all for our patients. If we do give it, it’s maybe a single injection a couple of hours before the procedure. If it’s a surgery, there are antibiotics in the bloodstream, but we rarely dispense them anymore. Even patients with heart disease, we just don’t. We know that it’s not effective and it’s contributing to the antibiotic resistance global problem.

Dr. Hoffman, we have to ask you a question that we ask every one of our guests. You’ve already listened to one of our things. What is your pet or human peeve? What bugs you?

That’s so different between pets and humans. People need to spend more time being kind to one another.

Amen.

Understanding, too.

Give everybody a little bit of grace. Maybe you’re having a bad day. You said the car thing. What if they’re honking their horn? We just seem to be a little kinder. For that, we have to press the pause button. We’re all in a hurry. For the pet peeve, it’s some of these myths we’re debunking and the misconceptions. They are still being taught and are still being followed. It’s education. I love to educate in the exam room at the veterinary school because it’s eye-opening. You’ve given me a chance to do that.

That’s why Janet and I started this to correct the misinformation. Look at how many pets suffer from adverse effects from misinformation.

There’s fear. I don’t get to treat the pet.

Social media is responsible for a lot of that. Average Joe is out there saying, “Give your dog a cabbage.” You see the cute dog peeling off the leaves of the cabbage. I’m like, “That can’t be that good for that dog to eat that entire cabbage.”

Now we know about tennis balls, Janet.

Libby’s going to need counseling.

We have behavior specialists.

She likes lacrosse balls.

Can you put your fingernail in there?

I don’t think so. I got to go try.

Is that like a Wiffle ball?

No. With the Wiffle ball, Al, she gets her teeth in the holes.

Wiffle ball wouldn’t be good, according to Dr. Hoffman.

No, it’d be terrible. I can’t give her a Wiffle ball. I have to find a ball that I can put my fingernail in.

Let’s talk about some other things that are good that the police dogs and the military dogs are getting. You may have heard of Goughnut. They can’t destroy it. The police dogs and military dogs are not destroying it. It doesn’t taste good, but that’s not going to hurt their teeth. There are some other ones. They’re a rubber. It’s not a hard plastic.

Whenever there’s a toy that has a hole in it, and the Wiffle ball does, you need to make sure they can’t get their tongue stuck in it because then the tongue will swell. Sometimes, that means an amputation of the tongue. Things we don’t even think about can damage the gums and the tongue. Sticks can get stuck in the top of the mouth between the two upper fourth premolars.

I’ve had that happen. An average non-vet got that thing out with pliers. It was terrifying.

That’s another reason to look in the mouth. That will often cause drooling. A dog can have it in there for months and cause damage to it.

What about KONGs?

KONGs are good, but remember, some of them have holes. Sometimes, they say, “Put peanut butter in there.” Yes, but make sure that the tongue can’t get in there and get stuck. Be careful of things with holes in them.

We have another one that’s dome-shaped. The underside is soft rubber. The underside has a cut in it. I can put a pretty big square treat in there. That’s a big hit with her. I can poke that with my nail, so it’s soft enough.

You know what to do. It’s easy already.

This has been incredible. Poor Libby, though.

They love the balls, but not the fuzz.

I have a question about your photography. I did look at your website. In the ones with the driftwood, was that beach by Amelia Island?

Yes, it is.

I’ve been there. We got up at 4:00 in the morning to make the sunrise. We thought we were nuts. My son, my husband, and I all went. This woman, who was out at the beach, goes, “Go another mile. It gets better.” It’s barely 5:00 AM. We’re walking. It was phenomenal. It’s beautiful. It’s something to see all that driftwood. It was magical.

That’s what I do when I’m not in the OR. I’m out there at the beach making magic.

I’m going to go through those toy baskets right now, Janet.

This has been so helpful. Thank you so much. Thank you for the work you do to give back.

I know our audience got so much information. That’s the whole reason we’re doing this. We can’t thank you enough. Janet, what do you say? Should we wrap it up?

Don’t forget to like, review, and share the show. We appreciate that. We love those thumbs up. Thank you so much.

Thank you, everyone. Have a great day. Kiss the pets for us and check their mouths.

Bye from the Novotny sisters. Thank you, Dr. Hoffman.

Thanks, Dr. Hoffman.

Important Links

• • Dr. Sharon Hoffman on LinkedIn
  • Coastal Fine Photo
  • Veterinary Oral Health Council
  • What is an Anesthesia-Free Pet Dental / Teeth Cleaning?

About Dr. Sharon Hoffman

Dr. Sharon Hoffman has a BS in Animal Husbandry from Michigan State University, a DVM degree from Louisiana State University, is a Diplomate of the American Veterinary Dental College, and has completed the Sollecito One Health Fellowship in Oral Medicine from the University of Pennsylvania.

She is the owner of Veterinary Dental Consulting in Florida and adjunct faculty at the University of Florida School of Veterinary Medicine. She has been awarded the Gold Star Award for outstanding contributions to Veterinary Medicine in Florida.

When Sharon is not relieving pain in the mouths of her patients, you will find her behind her camera as the photographer of Coastal Fine Photo (www. Coastalfinephoto.com, @coastalfinephoto). She also volunteers as the photographer for The Street Dog Coalition in Jacksonville, Florida.

The connection between Coastal Fine Photo and Veterinary Dentistry is this: a portion of proceeds from photography sales (Coastalfinephoto.com) is donated to the Make Me Smile Program (https://veterinarydentistry.org/make-me-smile/). This program offers free equipment ad training to shelter veterinarians and technicians, so adoptable dogs and cats can receive dental care before adoption into their forever homes.