ASK THE VET

What is the Difference Between a "Teeth Cleaning" and a Comprehensive Oral Health Assessment?

By Tim Banker, DVM, FAVD

 

Comprehensive Oral Health Assessment (or COHA) is not simply a “teeth cleaning.” For years veterinarians have used the term “dental,” but what does it really mean? Think about the visits you make to your own dentist’s of.fice. The hygienist will take regular dental radiographs of your teeth and periodically do a Panorex to monitor all of your teeth, the jaw bone and sinuses. Each time you visit she/he will do a periodontal and dental examination and screen for oral cancer before scaling and polishing your teeth. Then the dentist will review all of the findings. If any problems exist, she/he will create a treatment plan and review the different treatment options to you. This is the exact same way we approach Veterinary Dentistry. We start with a COHA because a proper treatment and diagnosis cannot be completed without a thorough assessment.

What is Included in a Comprehensive Oral Health Assessment?

During the COHA the following are evaluated and completed:

1. Bite Evaluation – The teeth are checked for proper alignment. Many “bad bites” can cause pain and discomfort due to trauma from an abnormal tooth causing trauma to the tooth itself or to the soft tissue/palate.

2. Oral Examination – The entire head and neck area along with all of the structures of the mouth (beyond the teeth & gums) are examined for any abnormalities. This includes oral cancer screening which is a very important part of the COHA.

3. Periodontal Examination – Periodontal disease is the most common infection in both man and animals. A periodontal exam is performed by closely inspecting the gums and probing care.fully around each individual tooth, 42 in dogs and 30 in cats. The periodontal probe detects hidden areas of bone and tissue loss, inflammation and infection.

4. Dental Examination – All of the surfaces of the teeth are exam.ined for fractures, wearing, defects, abnormalities and discolora.tion. Broken teeth and abscessed teeth can be extremely painful!

5. Dental Radiography – Dental radiographs are essential for a com.plete oral diagnosis. Consider that 60-70% of the tooth is hidden below the gum line and cannot be evaluated without radiographs. Many dental conditions can only be found with radiographs. They are used as a diagnostic and screening tool.

6. Additional Oral Diagnostic Tests – Sometimes tissue samples are collected or bacterial cultures taken to be sent out to an outside laboratory for further testing. After all the findings are recorded and charted, a treatment plan is created for each of the oral problems that are found. Sometimes they can be treated at this initial diagnos.tic visit; often follow-up procedures are needed at a later date.

7. Professional Dental Cleaning (Initial Periodontal Therapy) – During the visit all of the surfaces of the teeth are scaled and polished both above and below the gum line. This is done to remove all of the plaque and calculus on the teeth, which is the cause of the inflammation and infection in the gums. The tissues are rinsed with an oral disinfecting solution and then a periodon.tal sealant is applied to all of the surfaces of the teeth to slow down the accumulation of plaque.

When Should My Pet See A Veterinary Dentist?

Just as your own primary care physician may feel the need to refer you to the care of a specialist from time to time, your general practitioner veterinarian may feel your pet needs the additional expertise of a veterinarian who has advanced dental training for certain conditions, such as root canal therapy, oral surgery or advanced periodontal treatment and diagnostics.

 

 

What's the Skinny on Your Skinny Older Cat?

By Jennifer Evans, DVM

 

Regular visits to your veterinarian are essential to the health of any cat, but this becomes especially true of our older feline friends. Many vets will recommend at least annual or biannual lab work to be performed in cats older than 7-10 years of age. Kitties in this age group are at a much greater risk of developing chronic diseases such as diabetes, kidney failure, and inflammatory bowel disease, all of which are often associated with weight loss. A very common yet often lessor known chronic disease that plagues older cats is hyperthyroidism, and it frequently is the cause of a dramatic decrease in a cat’s weight.

Hyperthyroidism is caused by a growth in the thyroid gland. These growths are typically benign, with only approximately less than 3-5% being a cancerous tumor. Normal thyroid glands produce inactive thyroid hormones commonly known as T4, which is then converted by body tissues into the active form called T3. This T3 affects the metabolism of every aspect of the body. During hyperthyroidism, the growths in the thyroid glands cause an overproduction in thyroid hormones, which ultimately causes the entire body’s metabolism to increase.

Since alterations in thyroid hormones can affect almost every body system, there are many clinical signs associated with hyperthyroidism. The hallmark sign is weight loss in a cat despite a normal to increased appetite. Other symptoms that are frequently noted include increased thirst, restlessness, hyperactivity, vocalization, vomiting, diarrhea, and occasionally aggression. Also, your veterinarian may be able to feel one or both lobes of the thyroid gland during a physical exam, which he/she would not be able to do with a normal thyroid. Hyperthyroidism also causes hypertension (high blood pressure) in the majority of cats diagnosed, which can secondarily cause blindness. Furthermore, hyperthyroidism is linked to certain cardiac abnormalities, therefore your veterinarian may discover a murmur when listening to your cat’s heart.

Diagnosis of hyperthyroidism is fairly straight forward most of the time, and is typically discovered on routine lab work that includes a T4 level. Fortunately for cats and their owners, hyperthyroidism can often be successfully managed, especially if diagnosed early. There are four methods in which we manage hyperthyroid patients: 1) radiotherapy, 2) surgery, 3) oral medications, and 4) diet.

Although it can sound scary, the safest and most effective treatment is radiotherapy. Hyperthyroid cats are injected with radioactive iodine just under the skin like a vaccine. This radioactive iodine has the ability to destroy the thyroid tumor without affecting the rest of the body. This method is great in that it is a non-surgical way to cure a cat of hyperthyroidism, and it is typically successful with just one injection. The downside is that this can be expensive, require the kitty to board for several days, and facilities that perform this procedure are limited.

Surgical removal of the abnormal thyroid tissue is also a permanent method to cure cats with hyperthyroidism. This procedure has fallen out of favor compared with radiotherapy as it can often be risky to anesthetize untreated hyperthyroid cats, and the surgery itself can lead to many complications. This type of treatment is usually only used if the owner wants a permanent cure and radiotherapy is not available nearby.

The most commonly utilized treatment for hyperthyroidism are oral medications. In the United States the drug methimazole is used most often. The medication is inexpensive (in the short term), highly effective, and side effects are generally uncommon. The main disadvantage to using methimazole is that it has to be given daily, often every 12 hours for the rest of the cat’s life.

Lastly, there is diet from Hill’s Pet Nutrition called y/d that can be effective at treating hyperthyroidism. This method is used when daily administration of oral medications is not possible or if radiotherapy is not feasible. The problem with using a diet as a treatment option is that the cat cannot have any other form of food, including treats or even a hunted bird/rodent, or it will be ineffective. Also some cats may not find the diet palatable.

The diagnosis of hyperthyroidism in your older cat can initially be quite overwhelming. Your veterinarian will be able to discuss the various treatment options available and help guide you to which treatment will be best for both you and your kitty. With appropriate therapy, a hyperthyroid cat can manage their disease very well and live out a normal life.

 

Ask the Vet columns can be downloaded by clicking on any of the links below:


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