Browsing tag: bad breath

Sometimes it’s not teeth – other causes of bad breath in pets.

mouth

What can cause bad breath?

Bad breath, or halitosis, is very common in dogs and cats; however, there are a wide range of possible causes. Some are simple to treat; others less  so – but bad breath is almost always symptoms of an underlying problem.

There is one, harmless cause of halitosis – eating something rotten or smelly (much more common in dogs than cats)! Some dogs love eating      faeces or rotting food; this may be habit, or greed – but in a small percentage of cases is due to a condition called pica. This is when the animal        will eat pretty much anything, whether or not it is actually food-like, and may be due to mineral or vitamin deficiencies or certain brain diseases. In  most cases, however, eating rotting or smelly things isn’t due to a disease condition (although it may well lead to a nasty episode of vomiting and  diarrhoea!).

Metabolic diseases can also cause bad breath – especially diabetes and kidney failure. These conditions are both associated with changes in urination and drinking, and often weight loss. If untreated, both are potentially fatal. In diabetes, the breath may smell sweet (because of the excess sugar in the bloodstream); sour (because of increased bacterial growth, as the bacteria feed on the sugar); or musty (as yeasts grow in the mouth). In kidney failure, the breath may smell metallic (due to a build-up of toxins and waste products that the kidneys aren’t filtering).

Diseases of the respiratory tract such as sinusitis, nasal infections, and nasal tumours may also lead to bad breath. This is caused by the production of pus (dead, dying and decomposing white blood cells, bacteria and blood) in the nose, which trickles down into the back of the throat.

Some diseases of the gastrointestinal system can also cause halitosis, particularly megaoesophagus (where the gullet becomes swollen and dilated so food pools in it) or persistent vomiting (e.g. due to a blockage of the bowel, gastritis, kidney or liver disease). Infections of the mouth or the lip folds (e.g. in spaniels) may also cause it.

However, by far the most common cause of bad breath in dogs and cats is dental disease. Unless we regularly brush their teeth, most (although not all) dogs and cats will develop tartar and plaque on their teeth. This material is a mixture of salts from the saliva and masses of bacteria, living off the food in the mouth. While this is on the ends of the teeth, it isn’t a major problem (although it may smell a little); however, once it reaches the gum line, it rapidly becomes dangerous. When these plaques of bacteria touch the gum, they cause inflammation and infection of the gum tissues (called gingivitis). If untreated, this will spread down into the sockets of the teeth (periodontal disease) and lead to damage to the ligaments of the teeth. In some cases, infection may even penetrate the bone causing a tooth root abscess (which may burst through into a sinus causing sinusitis) or even osteomyelitis (infection of the bone). Even simple gingivitis is a risk factor for heart disease and kidney failure as the bacteria can easily enter the bloodstream – in severe cases, they may even suffer from blood poisoning and septic shock. In addition, a dog with severe gingivitis or periodontal disease will be unwilling to eat, and may eventually starve to death. If untreated, gingivitis will almost inevitably progress (the speed is variable; the fact of progression is not). As you’ve found, in many cases by the time the problem is diagnosed, the affected teeth cannot be saved.

So how do we know what’s going on?

In bad breath cases, you really do need to find out what’s causing the problem! For that, you’ll need to get him seen by your vet. Kidney disease is easily detected on a blood test (elevated levels of urea and creatinine, two waste substances normally filtered by the kidneys); it can also be detected by certain tests on the urine (urine protein/creatinine ratio, or UPC; and specific gravity). Diabetes may be apparent on a single blood test (as a raised blood sugar level) – however, if the patient is very stressed (more of an issue in cats), you can get a false positive result. For a definitive diagnosis, it is often best to send away a blood sample for a fructosamine test (which will show the average blood sugar level over the last few weeks).

Respiratory disease is usually easy to recognise (snotty nose, sneezing, coughing, facial deformity in the case of some tumours or polyps), although actually working out what’s causing it often requires advanced imaging (X-rays and endoscopy). Similarly, it is very unusual for bad breath to be the only symptom of a dog or cat with a significant gastrointestinal problem – vomit or diarrhoea, or regurgitated food matter, is a more common finding. Lip fold dermatitis is easily recognised on examination, as when opened out, the lip folds are red, sore and often smell musty.

As I said above, dental disease is the most common cause. Often, a simple visual examination will reveal significant plaque and tartar; and gingivitis may be obvious just by looking at red or swollen gums. Occasionally, there is a tumour or other disorder of the gums, but again, this is usually clear to see. Your vet will be able to tell you what the chances are that dental problems are causing your pet’s bad breath.

So what can be done about it?

That, of course, depends what the underlying problem is… Diabetes cannot usually be cured (although some cats, if caught early enough, can go into full remission if treated appropriately and aggressively), but can be managed with appropriate, diet, insulin injections and good blood-sugar monitoring. The same applies to chronic kidney failure – this can be managed with appropriate diet, ad lib access to water, and sometimes medication (ACE inhibitors).

Respiratory and gastrointestinal disease does need diagnosis and treatment – if the underlying cause is treated, the halitosis will usually resolve at the same time.

If the dental disease is significant enough to cause bad breath, it does need treatment. It is important to remember, however, that old pets can, perfectly safely, undergo anaesthesia for a dental as long as there aren’t any underlying heath issues. Old age is not a risk factor for anaesthesia per se, it just means it’s more likely that they’ll have some medical problem that is! In older patients (cats and dogs) use of a fast, modern anaesthetic gas (e.g. sevofluorane), intravenous fluids and good, careful monitoring means that their risk isn’t that much greater than a young pet, assuming they are otherwise healthy (and if they aren’t, bad breath is the least of your worries).

Fortunately, however, in many cases the vet will be able to remove the worst of the tartar by hand without needing a full dental under anaesthesia. Often, the dental disease can also be controlled (not cured, but kept manageable) by regular and diligent tooth brushing and the use of appropriate mouth-washes.

David Harris BVSc MRCVS

Ask a vet online – My pets breath is bad, but teeth are fine – help!

Question from Sarah Knight:

My Scottie has horrendous breath, teeth are fine, have changed her diet, she also has charcoal on her meals, any other ideas truly welcomed!

Answer: Bad Breath

Hi Sarah, thanks for your question about your dog’s bad breath. To answer it, I’m going to run through the possible causes of halitosis, along with any other symptoms they might show. I’ll then talk about the most likely reasons, and where to go next with diagnosis and treatment options.

Causes of Halitosis

Halitosis, or “bad breath”, is defined as an “offensive odour emanating from the oral cavity”. There are a number of possible causes, some of which are more common than others.

1) Diet

You say you’ve modified her diet, but a lot of dogs (especially terriers!) eat unpleasant things given half a chance – particularly faeces (those of other dogs, horses, livestock etc), or dead and rotting things (often mice or birds found lying in the undergrowth when out on walks). Inevitably, eating anything like this will lead to bad breath.

2) Metabolic disease

We’re particularly talking about diabetes or kidney failure here – both of which can lead to halitosis. In diabetes, the body produces ketones as a fuel supply for the brain, which have a strong smell (with overtones of pear drops – however, not all humans have the gene required to be able to detect this); in kidney disease, the build up of nitrogen waste products in the blood may result in oral lesions and/or smelly breath. In both cases, you’d expect to see increased thirst and possibly weight loss, but the signs can be pretty subtle in the early stages.

3) Respiratory disease

Infections of the nose and sinuses often lead to foul smelling breath, as can tumours of the nasal cavity. Sometimes, in fact, there are no other symptoms, although I’d usually expect some nasal discharge (a single snotty nostril that doesn’t clear up is the classic sign). Have you noticed any wheezing or sneezing? These can be signs that there’s something amiss as well. Sometimes dogs can get foreign bodies such as grass blades stuck up their noses – these result in inflammation and infection, and the tell-tale smell.

4) Oesophageal disease

Some conditions of the oesophagus (the gullet or “food pipe”) can result in halitosis – particularly some tumours or a condition called megaoesophagus, where the gullet is stretched and doesn’t function properly. However, these are usually associated with regurgitation of food or difficulty swallowing.

5) Skin disease

Although I wouldn’t say it was especially common in scotties, infections of skin around the lips (lip fold pyoderma)  can occur in any breed, and can smell quite unpleasant – if the skin around her mouth looks sore or is painful, this is a distinct possibility that will need intervention. Pyoderma like this can also be a result of an allergic condition.

6) Dental disease

This is by far the most common cause of halitosis! Most dogs develop some tartar and plaque as they get older; in some its much worse than others. You say her teeth appear fine, and I’m sure they do, at least at the front; however, plaque is much more common towards the back of the mouth where it’s much harder to see. In addition, dogs can get what’s called a biofilm, where the teeth are covered in a thin membrane of bacteria, but may look normal. In addition, tooth disease doesn’t have to be above the gums – a healthy-looking tooth may have severe gingevitis (gum infection), or periodonitis (infection and inflammation of the roots) which is a common cause of bad breath.

I have to say that, without seeing her, I think some degree of dental disease is the most likely explanation.

Where do we go from here?

Firstly, it’s always worth checking to see if she is picking up faeces from something, and if so, preventing her from having free range in that area. If she’s eating her own, there are products available (e.g. Copro-Nil) that make a dog’s own faeces much less appetising.

Assuming that isn’t the (nice, simple!) cause, check to see if she is showing any other symptoms – snotty nose, sneezing, regurgitating, drinking more, losing weight etc. Measuring water intake over a 24 hour period is really useful; as a rough rule of thumb, more than 90ml per kg per day is an abnormally high amount. If she is showing any of these signs, or you are at all concerned, you should see your vet for further investigation. Blood and urine tests can be used to diagnose kidney disease and diabetes, and X-rays are commonly used for nasal and oesophageal disorders.

The next step is to check for dental problems. It is virtually impossible to do a full dental examination on a conscious patient, but your vet will probably have several tricks up their sleeve that let them get a good look around to pick up the obvious. For a full dental examination, however, an anaesthetic is needed (and I have to say, it’s pretty rare not to find any issues at all in an adult dog). A “dental” (so-called) is a very routine procedure, and would be my favoured way forward, unless you and your vet can be pretty confident that there aren’t any underlying dental issues.

What happens in a “Dental”?

Essentially, the dog is anaesthetised, then their mouth and teeth can be carefully examined (without risk to fingers). Any loose or diseased teeth are removed, and the remainder are scaled and polished to remove any plaque or tartar (just like a visit to the hygienist for us). Normally, the dog will go home the same day.

Is there anything else I can try first?

Yes – if there aren’t any other symptoms, and you can’t see any signs of gum disease or plaque, you can (and really should!) start brushing her teeth. In fact, even if your dog has just had a dental, if at all possible start to brush afterwards – bacteria attach to the freshly cleaned tooth within 6-8 hours, and mineralise (forming dental calculus or “plaque”) within days.

Get a soft tooth-brush suitable for her size (a children’s brush, or a specialist dog one), and some dog tooth-paste (DON’T use human paste – the mint flavour is really nasty for most dogs). Just as you would brush your teeth, gently brush hers, a little at a time until she gets used to it. I would strongly advise every dog owner to brush their pet’s teeth – it would avoid a lot of problems later on.

I hope that helps and that you can get her smelly breath under control!

David Harris BVSc MRCVS

Ask a vet online-‘I have an 8 year old Maltipoo who has had teeth and gum problems for the last 4 years.’

Question from Mary Collins O’Hara:

I have an 8year old Maltipoo who has had teeth and gum problem for the last 4years. He had 8teeth pulled, including some teeth on the bottom front, so now he drools all the time and he has the worst breath. I have done several rounds of antibiotics, I brush his teeth but his gums are so tender, he cries. I don’t know what else to do. Please help.

Answer by Shanika Winters

Hi Mary and thank you for your question regarding your dog’s ongoing mouth problem.  An adult dog usually has 42 teeth which are made up of four different types:

12 Incisors which are for nibbling

4 Canines which are for grabbing and puncturing

16 Premolars which are for cutting and shearing

10 Molars which in theory are for grinding up food

Most dogs over the age of 3 years have some form of dental disease, this may be as mild as inflamed gums (gingivitis) and plaque through to infected tooth roots with gum recession.  Along with the functions listed above the teeth help hold the dogs tongue inside its mouth and keep the shape of its mouth by holding the cheek flaps out.  Many dogs cope extremely well after major extractions where they are only left with a few healthy teeth.

The diet may need to be changed so as to make it easier for the dog to eat it, in some cases wet food may be advised. Generally however we recommend some dry food is fed as this helps to keep plaque levels down just by the fact that the food is crunched and scrapes on the surface of the teeth.  There are specially designed dental diets which have fibres in each nugget arranged so as to have maximum scraping effect on the teeth.  As most dog owners are aware not all dogs crunch up their food it is wolfed down rather fast and in such cases dental diets may have little effect on keeping the teeth clean.

You have already mentioned that you are brushing your dog’s teeth, that is an excellent way to keep them clean by slowing down the build up of plaque.  It is important to use tooth paste that is designed for dogs, which is both palatable to them and not high in fluoride as are human toothpastes.  It is also advisable to use specially designed dog tooth brushes, these tend to have a smaller head with a longer handle so it is easier to reach all around the dog’s mouth.  Only light pressure should be applied when cleaning your dog’s teeth, it is easy to be too firm and hurt the gums.

Antibiotics are often used in cases of dental disease to reduce the presence of bacteria in your dog’s mouth.  The bacteria may be present; as part of tooth root infections, attached in the plaque, and even in what appears to be a clean mouth can still contribute to bad breath (halitosis).

Why does my dog have mouth problems?

In order to determine why your dog is drooling, has bad breath and sore gums it is essential that he has a full examination by your vet, there can be underlying diseases that are causing your dog’s symptoms such as poor immunity (ability to heal and fight infection), underactive thyroid gland (Hypothyroidism) and over production of steroid (Cushings disease) to mention a few.  Many of the underlying illnesses can be picked up on blood tests which are done on a sample of your dog’s blood collected by your vet and then sent to a laboratory for analysis.

What can be done to help my dog?

Once your vet has ruled out any underlying diseases, then a close look at your dog’s mouth is necessary, there may be further dental disease needing treatment such as further extractions, sometimes your vet will suggest performing x-rays to check if there are infected tooth roots where the piece of the tooth visible appears healthy.  Some dogs have skin folds around their mouths and these can trap saliva, the skin becomes inflamed, infected and smelly.  The skin folds can be treated by use of antibiotics, trimming the hair from the skin fold and cleaning with an antiseptic solution.

If there is no need for any further dental treatment, then some dogs benefit from the use of antiseptic mouth sprays or drinking water additives to help reduce bacteria levels in the mouth.

Regular courses of antibiotics can be used under the direction of your vet, in some cases this is the only way to keep some dog’s mouths clean and healthy.

So where there are any ongoing dental disease issues it is vital to work with your vet to find the best plan of action to keep your dog happy, healthy and comfortable.  I hope that this has helped to answer your question.

Shanika Winters MRCVS (Online Vet)

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