[Updated December 18, 2018]
Cooper, my service-dog-in-training, trotted briskly at the side of my power wheelchair as we headed to the veterinary clinic, a mile from home. He was overdue for a routine dental cleaning, and my regular veterinary clinic was not within rolling distance. I decided to take a chance on a new vet, since it was just a standard dental cleaning. I dropped him off and rolled back home, relieved that I was finally able to afford the procedure.
Later that morning, my cell phone rang. The new veterinarian called to let me know that Cooper, a 7-year-old Papillon-mix, had advanced periodontal disease, and needed 11 teeth extracted. Already numb with shock, I shuddered with disbelief when she added that six more teeth were starting to get loose, and would need extracting within six months.
Seventeen teeth? It was a death-knoll of hope for a service dog career, since his primary job would be retrieving items for me. With 17 missing teeth, his career was ending just as it was starting.
How could I have not realized his mouth was in such poor condition? His breath smelled rank, but I thought it was just mild gingivitis. I’d noticed some redness and swelling of his gums, and a small line of tan plaque at the gum line. I had been certain that it was nothing that a professional cleaning wouldn’t take care of. I had noticed he was no longer interested in playing with his soft toys, and that he was shunned dental chews, but I thought it was just because his gums were sore. The damage, however, had been happening beneath the gum line, where I couldn’t see.
How Cooper Got Periodontal Disease
I’d let his mouth go without a professional cleaning for a couple of years, because Cooper was the youngest and healthiest of my four dogs. I had three retired elder service dogs living with congestive heart failure, each of whom required expensive medications and blood work, which had depleted my bank account. My focus was on helping the elder dogs through the last years of their lives. They still were able to do retrievals for me at home.
My time with Cooper was spent training for public access, helping him to be stress-free and comfortable in every possible environment. Cooper enjoyed every training outing, and was quiet, biddable, and reliable in stimulus-rich environments. I’d planned to start his task-training once the elder dogs’ lives had ended.
I was finally able to schedule Cooper’s dental cleaning after the last of my elder service dogs had passed away. I had also started work on Cooper’s task-training. His personality and calm demeanor convinced me he’d be a fine service dog for me.
But my hopes crumbled like a stale cookie as the vet delivered the heartbreaking news that Cooper had advanced periodontal disease. I’d let my dog down in the worst possible way. And that $150 routine dental cleaning was now estimated at $1,200, with a recommended followup dental in six months estimated at another $1,000.
Like many people who’d struggled to care for multiple dogs in today’s tough economic times, I could see no way to stretch my budget any thinner. I told the vet that I could not afford the extractions at that time, and to just do the cleaning, root planing, and polishing. She replied the teeth were not abscessed, just loose from bone loss, and that some teeth would probably fall out on their own in a few months’ time. She agreed that Cooper could likely go six more months without being in tremendous pain, but would need to be put on a soft diet.
A Second Opinion Saved My Dog
I had no idea what to do, so I called on a personal friend, a veterinarian in the process of retiring and closing her practice in another state. I explained my dilemma, and she told me to take a deep breath; she would help get me started on trying to save as many of Cooper’s teeth as possible.
My friend explained that she had saved many dogs’ teeth that other veterinarians had given up on, and that diligent mechanical care in brushing, combined with oral antibiotics, could do wonders, as long as there was enough bone left to hold the teeth in. She said that while the soft alveolar bone that held the teeth in the mouth would not grow back, she’d often seen enough fibrous scar tissue form to hold the teeth in place.
My friend further explained that it would require a twice-daily commitment to a strict home care regimen, but she felt that many, if not most, of the teeth could be saved with dedicated effort on my part.
My relief was palpable. I was willing to devote whatever it took to keep as many teeth as possible in Cooper’s mouth.
My veterinarian friend had already explained that an oral antibiotic was critical in helping save the teeth and stop the progression of periodontal disease. The antibiotics would work to keep the infection from restarting down deep in the pockets where the bone had been eaten away, and where a toothbrush could not reach. She also advised giving the antibiotics as “pulse therapy” – in which the antibiotics are given for a week to 10 days, then stopped for three weeks, and this on-and-off again regimen is repeated.
Armed with all this information, and filled with resolve, I contacted the young veterinarian who did Cooper’s dental cleaning. She was not familiar with antibiotic “pulse therapy,” and was skeptical about it. She said she normally only used antibiotics when teeth were extracted, but she finally agreed to prescribe Clindamycin, an oral antibiotic routinely used to treat soft tissue, dental, and bone infections, on my veterinarian friend’s recommendation.
Research on Canine Periodontal Disease
To help me feel comfortable that I was doing the right thing, I began researching canine periodontal disease. I read every website published by board certified veterinary dentists. I studied canine dentition, and learned a whole new vocabulary.
Unfortunately, the veterinarian who had performed Cooper’s cleaning did not have dental x-ray equipment, so I could not see the extent of the bone loss. I could only go by the chart she had provided that identified each of Cooper’s loose teeth. Researching online helped me to see what I was up against.
One expert had a standout website: Dr. Jan Bellows, a board-certified veterinary dentist practicing in Weston, Florida. His website offered the most detailed information about canine dentistry and home care, with photos, illustrations, and x-rays. The “12 Steps of the Professional Teeth Cleaning Visit” page in particular provided step-by-step instructions on how to perform the most effective home oral healthcare for pets.
I emailed Dr. Bellows, and he gave me permission to reprint anything on his website, explaining that he felt strongly that home healthcare was a key to a healthy mouth, and the more people who understood how to do thorough oral home care, the happier he’d be. He offered to answer any questions I might have on the information shared on his website. It was clear that he cared about all dogs, not just his own clients’ dogs, and he encouraged me to share the information.
Dr. Bellows’ clients are not just sent home with a pet toothbrush, toothpaste, and rinse after a dental procedure; instead, each client is given a hands-on lesson on proper brushing techniques with her dog, and how to treat problem areas. The client practices the brushing techniques under supervision before they are sent home with their dog.
Dr. Bellows mirrored much of the advice my friend had given me, and was also was an advocate for antibiotic pulse therapy to combat periodontal disease. I was on my way! Maybe I could save most of Cooper’s teeth. Maybe I couldn’t. But I was committed to the challenge, and I would give it my all.
Starting My Dog’s Oral Hygiene Routine
Twice a day, I brushed, irrigated, and rinsed Cooper’s teeth. I thought about how I might be able to get down into the pockets between the teeth, where the infection had destroyed the bone. I had used interdental (also called interproximal) brushes on my own teeth, to get into tight spaces to clean between them and under bridgework.
Interdental brushes are very narrow spiral bristle brushes, available in several shapes and sizes. I picked up a package of every size, to help get that antibacterial enzymatic rinse down into those hidden infected areas where bacteria multiplies and thrives. Normal dog toothbrushes cannot reach down that deep under the gum line.
Dr. Bellows’ website explained that the most critical areas are the upper back teeth on the outside surface, and to concentrate on keeping these areas especially clean.
I read that, “Proper technique involves applying the bristles at a 45-degree angle to the gingiva (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 do not have the buildup of tartar on the palatal or lingual (tongue) side of their teeth as people do.”
Cooper’s lower teeth were also a problem, with furcations already visible without probing. A furcation is the area between multi-rooted teeth where the bone has already dissolved, leaving a hollow area between the roots. This becomes an ideal environment for bacteria to thrive and quickly multiply, which rapidly destroys the bone.
Once the dental cleaning was completed, and Cooper’s gums were given a few days to heal, I was able to use the interdental brushes to keep these areas clean, allowing the scar tissue to help fill in the hollow areas where the bone had been destroyed.
The furcations and pockets between the teeth where bacteria multiply can be easily seen on the x-ray of a few of Cooper’s teeth. The dark areas show the bone loss. I’ve added a line where the bone should be, showing just how much bone loss is already present.
My Home Dental Kit
My home-care dental kit includes a long-shanked double-ended toothbrush made for dogs. The long shank helps reach the back teeth easier. I use the wide bristled end for all the teeth except the front incisors. I use the narrow end for cleaning the upper and lower incisors (front teeth).
Cooper likes the taste of poultry- and meat-flavored enzymatic canine toothpastes. Human toothpaste should not be used on dogs, as it contains foaming agents that cause upset stomachs, vomiting, and diarrhea. Human toothpaste is meant to be spit out and the mouth rinsed with water afterwards. Toothpaste made for dogs is made for swallowing. There are many brands available at veterinary offices and pet supply stores.
Saliva is slick, and using fingers to pull back the lips can be difficult. A gauze pad, a small piece of terrycloth or a dental mirror can be used to make it easier to hold the lips away from the teeth so the brush can reach all the way back to the carnassials – the back molars.
I also have a three-sided toothbrush, meant to clean both the inside and outside of the teeth at the same time. It’s a U-shaped brush with bristles on the sides and bottom. I use this only once a week, knowing the tongue does a good job keeping the inside areas of the teeth clean.
An antibacterial enzyme rinse made for dogs is also an important part of my dental kit. I pour a bit of the rinse in a small bowl, and dip the toothbrush and interdental brushes into it, once I have finished cleaning the teeth with the toothpaste. I also use a small piece of terrycloth dipped in the rinse to wipe and polish the teeth at the end of the dental routine. Cooper likes the taste of this, and gets to lick the bottom of the bowl as a treat when we’re finished.
Finally, I keep a small bottle of 3 percent hydrogen peroxide in my kit to soak the brushes for a few minutes after each cleaning, as advocated by microbiologist Dr. Philip Terno, who also advises this for human toothbrushes.
In the beginning, I spent about 15 minutes twice a day working on Cooper’s teeth and gums. Now it takes about five minutes per session, as the scar tissue is filling in, and I don’t have to use as many different sizes of interdental brushes, only the thinnest one. I’m also building up more skill and facility at doing a thorough job in a shorter amount of time.
Cooper’s Periodontal Disease Recovery
Cooper had a second dental cleaning done six months later by my regular veterinarian, Dr. Bullard, who owns the dental clinic where I normally have my dogs treated. He took a full set of x-rays to give me a “roadmap” of the problem areas. With these x-rays, I can easily see where I need to concentrate my cleaning efforts, and it will also be used to compare the x-rays that will be taken on the next visit, five months from now.
Dr. Ballard called me during the cleaning, and said there was only one tooth (a lower front incisor) that needed to be removed, as about 70 percent of the bone had been lost and the scar tissue was not holding it in firmly. He said the rest of Cooper’s teeth were stabilizing fine, and he found no tartar or calculus anywhere. He praised my home-care regimen, and told me I’d done a spectacular job, and that he’d never seen a cleaner set of teeth.
He removed the one very loose incisor, but said everything else looked very good, and he thought most of the teeth could now be saved, as long as I kept up my twice-daily regimen. I beamed with joy, not expecting to hear such great news. Home care was working!
Today, Cooper is again able to eat harder food without pain, and is carrying around soft toys, shaking and playing with them. I have not begun to have him attempt to hold harder objects yet, as I want to give the scar tissue a chance to continue filling in the areas of bone loss, for more comfort and stability.
I won’t be able to have him do any tugging using his front teeth, because even though they are stabilizing, there is not enough bone for the front upper and lower incisors to safely be used. Instead, I will train him to tug sideways, from behind the canine teeth on the premolars and molars. He’ll be able to open doors and drawers outfitted with a pull rope by grasping the rope in this crosswise manner.
Prevent Periodontal Disease for Your Dog!
Dr. Bullard said that by the age of two, 80 percent of the dogs he sees already show signs of periodontal disease. Starting a daily tooth brushing regimen can extend the time between professional cleanings, and can prevent periodontal disease when started on puppies.
Teaching a dog to relax, and starting the brushing slowly, a few teeth at a time in short sessions, helps the dog learn to accept cleaning without stress. Behaviorist and trainer Donna Hill has a very helpful video showing how to shape a dog incrementally to accept and enjoy tooth brushing, and includes teaching the dog rest his chin in the palm of her hand. Donna’s YouTube video can be seen here.
If your dog has not had a dental cleaning recently, and you see any signs of swelling on the gum tissue, bleeding, plaque accumulation, or foul breath, then your dog needs a professional cleaning under anesthesia before you start a brushing routine. Without a thorough scaling to remove the hardened plaque (calculus), and polishing so that new plaque finds it harder to form, brushing will be painful to the dog, and could cause the dog undue stress over a daily procedure that should be painless and pleasant.
If you have multiple dogs, provide each dog with his or her own toothbrush, as contamination of bacteria can be spread from one dog to another.
This routine will pay off greatly in the dog’s senior years, when illnesses can prevent the dog from safely undergoing anesthesia. If the teeth are kept clean, senior “trash mouth” can be avoided.
Both my retiring veterinarian friend and Dr. Bullard note that small dogs with misaligned teeth are among those at greatest risk of having periodontal disease early in life, and worsening rapidly. I now realize that, to keep a dog healthy for life, daily tooth brushing is right up there with a healthy diet, exercise, mental stimulation, problem-solving games, walks and sniffs, training, and unconditional love.
The value of daily brushing is threefold: It will save money on dental cleaning bills, extend the time between professional cleanings, and it will save teeth and gums. It’s a winning trio.
Debi Davis is a retired professional calligrapher and service-dog trainer. She is a former faculty member of Clicker Expo, and has presented at service-dog training seminars and workshops. Debi is an advocate for reward-based training, and enjoys being an informal ambassador of goodwill in the service-dog and disability communities. She currently lives in Las Vegas with her husband and service dog in training.