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

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.
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Wikivet blog: oral hygiene – the key to a healthy mouth in pets

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It's well known that regular home care of pets' teeth is the only way to ensure optimal dental health, but it's also well known that most owners find this challenging. Dental experts have identified that there are two methods of home care, depending on an owner's ability to get involved: active and passive.

Brushing your pet's teeth a) Active home care is “hands-on” where the pet owner is physically involved with removing plaque and maintaining oral hygiene. Tooth brushing and applying anti-plaque agents directly into the mouth fit into this category. Active home care is the ideal answer, but it isn't always easy. It's known as the "gold standard" of preventive dental care. Clara, a Cavalier King Charles Spaniel, is a ten year old dog who is an ambassador for active home dental care. Her owner started to brush Clara's teeth when she was a pup, and has built tooth-brushing into her daily routine. Clara knows that before she can tuck into her dinner, she has to sit still for a 30 seconds while her owner whizzes around her mouth with a toothbrush and some chicken-flavoured toothpaste. The results of this daily routine are astonishing. Most ten year old dogs have advanced dental disease, with gingivitis, accumulations of tartar and missing teeth. Clara, in contrast, has teeth that are as healthy as a two year old's. Clara provides a good example of the power of active owner dental care. "Letting your pet clean their own teeth" b) Passive homecare refers to aspects of an oral hygiene program that help to reduce plaque in the mouth, but do not require the owner to get involved with the hands-on tooth-brushing or mouth-handling. Examples of passive home care include giving a special type of diet that helps to keep the teeth clean, or offering a dental chew to help reduce plaque accumulation. Jake is a ten year old terrier who has been given a daily dental chew for the past five years. His owner originally tried to brush his teeth, but he wouldn't let her. Many owners have this experience, and this has created a niche in the market that has been occupied by a wide range of commercial products. Jake's owner discovered that he loved the taste and texture of a dental chew, designed to be given once daily. Jake gets this every evening, as a treat before bed. His owner has reduced his daily food ration to take account of the calories in the dental chew, and he's stayed at his ideal weight. Jake did originally need a dental clean up and polish, to remove the build up of tartar that had occurred before he started his dental chews. But the daily chew regime has worked wonders for his back teeth (the molars), and they're as clean as Clara's. The front teeth (canines) have accumulated some tartar (Jake doesn't use these when chewing), but the problem is a minor one that doesn't need any intervention at this stage. Home dental care is an important part of a pet's daily routine, whether you choose an active or passive approach. To find out more, read the Wikivet section on dental hygiene, by clicking here.
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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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Keep Your Rabbits Gnashers Gnawing Gnaturally!

Bunnies cropThe most common cause of illness in rabbits is poor dental health, they suffer terribly with their teeth and problems can become so severe, it is not unusual for bunnies to be euthansed because of them. However, the news is not all bad because it is actually very easy to keep a rabbits gnashers gnawing gnaturally! Rabbits have teeth that grow all the time and are kept short by both a natural diet of tough, woody grasses and also by the upper and lower sets grinding on each other. However, since bunnies have been domesticated their diets can be very different from the wild, often consisting of more soft rabbit food and vegetables than hay and grass, and this is what causes the problems. Firstly, because the teeth aren’t worn down by these softer foods and secondly because they can become calcium deficient; leading to the jaw bones softening, the teeth shifting and no longer being in alignment with each other. This problem is particularly prevalent when the rabbit is fed the muesli type diets, which they tend to selectively eat by picking out their favourite bits and so they don’t get a balanced diet. When they over-grow, the molar teeth can develop sharp spikes that dig into the sides of the mouth or tongue and cause a lot of pain. The incisor teeth can become extremely long and curl out of the mouth (which makes them easy to spot) or, worse, into it and dig into the flesh and bone. Again this is very painful and makes it almost impossible for the rabbit to eat. Also, the roots of the teeth can become impacted because of the back pressure and as well as being very sore, can also become infected; causing nasty abscesses which can be extremely difficult to treat. Spotting dental problems is not always easy because rabbits will hide when they are poorly but checking their weight regularly, examining their mouths and carefully monitoring their appetite are all good ways of picking up on issues. To check your bunny’s mouth, hold them on your lap and gently lift their lips up to have a look at the incisor teeth. These should be smooth, even and short. It is more or less impossible to check the molar teeth without a special scope but by feeling along the upper and lower jaw bones you can pick up abscesses and swellings. If you are at all concerned you should take your rabbit to your vet. The treatment of over-grown teeth can be a challenge and once they have developed them, many bunnies need to go in regularly for them to be trimmed, which can require an anaesthetic. Over-long incisors can be removed, which is a good idea because it solves the problem and the rabbit will still be able to eat without problems. However, by far the best thing is prevention rather than cure and this is done very easily by making sure your bunny’s diet is as similar as possible to that of their wild cousins; lots and lots and lots of chewy hay and grass!
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Looking after the Older Horse

When I was training as a vet, a 20 year old horse was considered really quite old. Now, however, I regularly find myself working with healthy horses in their late twenties and thirties - even a few that go on into their forties! That said, horses don't age uniformly - one may be sprightly and fit at 30, while her paddock mate is really feeling his age at 20, so there's a lot of variation. The challenge is maintaining them at the best quality of life for as long as possible. To do so, we need to consider three things: • Work and exercise • Preventative health (worming, dental care etc) • Disease management and medication I'll deal with these in sequence, although really they are of course all interconnected. Work and Exercise PerryI'd like to introduce Perry, a horse I've known for many, many years. Born in 1986, by 2002 Perry was a successful Eventer, competing on the Affiliated circuit, and usually well up in the places. However, by then he was starting to slow up a bit, and his then-owner decided it was time to reduce his workload. He was struggling in particular with the dressage and show jumping, so they sold him on to a friend of mine as a Pony Club horse for Tetrathlon. All he had to do was carry his (fairly novice) rider round a cross country course - the phase he enjoyed the most anyway. Relieved of the need to work in an outline, or in collection, he flourished at Tetrathlon, going on to compete at the National Championships. Of course, in time, his low-grade arthritis (which I'll talk about more later) meant that he was struggling with the cross country requirements, and he moved into a semi-retirement as a hack. He'd seen it all, done it all, and was as close to 100% in traffic, tractors and low flying aircraft as any horse could be. For most horses, as long as they can work, they want to - generally (and there are always exceptions!), it isn't in a horse's best interests to take him out of work one day and retire him to a field. A gradual wind-down over several years is kinder, and helps to keep him interested and alert. So, by changing career, Perry had an extra five years of competition, and then many more years of useful work - simply because his various owners were wise enough not to over face him, but to play to his strengths. Preventative Health I've talked before about the importance of regular dental work - in the older horse, it is doubly important. As the horse ages, his teeth undergo a number of changes. Although it appears that teeth grow constantly, that is in fact an illusion - the adult teeth are pretty much a fixed length, but most of the tooth is hidden away within the gums (the reserve crown). As the tooth is worn down by chewing, more of this reserve is extruded (which is, by the way, the basis of ageing horses by dentition). However, sooner or later, this reserve is expended, and the teeth "cup out", becoming small, loosely held, concave structures, of limited use for chewing. Good, regular dental care can help delay the onset, and can help the horse to manage as the teeth cup out. Remember, as long as there are a few pairs of teeth in occlusion (i.e. Facing each other), the horse can still chew, he'll just be very slow about it! In my experience, teeth generally start to cup out about 30-35 years of age, but it depends on their dental history - more use and wear and tear means the teeth are ground down faster. Worming is also inceasingly important in the older horse, simply because although they may have higher immunity to worms (this is still debated, but does seem likely), they also have less reserves to cope if they have a heavy infestation. The spring is a particularly risky time, as sometimes large numbers of small redworms can emerge all at once, causing massive gut wall damage. It is important to make sure that at some point over the winter, you use a wormer that is active against hibernating (hypobiotic) worm larvae - currently, the only wormers on the market that have this activity are a full 5 day course of Panacur, and (reportedly) Equest. Foot care is always important, as older horses can suffer some terrible hoof capsule problems if left untreated. I always recommend that people keep up vaccinating their horses, even if they're not competing or going out. Equine influenza probably isn't essential in a stay-at-home horse or pony (although they can still contract it if they're in contact with a younger friend who does go out and do), but Tetanus vaccination is essential. Just because a horse is old doesn't mean you can stop vaccinating, because tetanus kills horses of any age just as easily. It's also a really useful opportunity to have a general "MOT" and get your vet to check the horse over thoroughly, to detect and problems before they become too serious. Disease Management Although many horses lead a long and healthy life, the probability is that as they enter old age, they will suffer from one or more "chronic diseases". These are generally low-level conditions, and in the older horse are usually manageable rather than curable. Probably the most common are arthritis and Cushing's disease, but malabsorbtion diseases and some tumours aren't that uncommon either. The key factor is managing the disease in such a way that the horse doesn't suffer from the symptoms, and is able to keep up as much work as possible, for as long as possible. Arthritis is perhaps the commonest condition of older horses, and those that aren't so old. In most cases, it is due to simple wear and tear on the joint surfaces. The harder a horse has worked, the more rapid the onset of arthritic changes. It's often the case that, initially, a horse will have trouble working in an outline, and perhaps with show jumps, but hacking and cross country, with it's more open jumping style, is less of a problem. This of course was exactly the case with Perry. Managing arthritis is a lot more than just monitoring exercise, however - nowadays, we no longer need to just accept "a bit of stiffness" in the older horse. It's often best to use several different strategies. I generally recommend a combination of joint supplementation (feed supplements such as Cosequin and Newmarket Joint Supplement are the most popular, while injectables like Adequan are more expensive but possibly more effective) with analgesics (bute and/or Danilon, usually) as required. Although painkillers like bute don't address the underlying disease, they reduce the inflammation and associated pain. Although there can be side effects, it really isn't fair to put a horse through the pain and discomfort of arthritis without some pain relief; if side effects are a particular concern, Danilon has a much lower risk, although it seems to be a little less effective. Its usually best to start out using bute only as required, and then build up the dose as necessary. Perry, for example, started using bute about 10 years ago, but just a sachet or so immediately after a competition. As he's got older, he uses more, and at the moment he's on an average of 4-5 sachets a week - enough to keep him comfortable (and galloping round his paddock like a yearling!). Cushing's disease (hyperadrenocorticism) is most common in older horses, and is caused by a micro-tumour in the pituitary gland. This results in an excess of circulating cortisol (a stress hormone), that causes the characteristic symptoms of abnormal fat pads (typically over the eyes and as saddle-packs), excessive drinking and urination, and increasing susceptibility to minor infections and laminitis. Ironically, the "classic" shaggy coat of the Cushingoid horse isn't entirely due to cortisol - the presence of a tumour in the pituitary causes a malfunction in the part of the brain that controls body temperature, causing retention of a winter coat for longer. Cushing's isn't curable in horses, but symptoms can be partially controlled by management (regular clipping, diet and exercise control and remedial shoeing), or largely eliminated with some medications - Cyproheptadine (Periactin) may be of some use; however, Pergolide (Prascend) is highly effective, and is licensed for the treatment of Cushing's. Gut problems of one sort or another are also more common in older horses - these may be malabsorbtion issues, caused by thickening of the gut wall, or an increased susceptibility to colic. This may be due to a diffuse Lymphoma (a cancer of the white blood cells) which is the commonest tumour of older horses. In these cases, the key is to feed a highly digestible, high feed value ration, possibly with a probiotic to enhance digestion. Tooth loss is also a problem in the older horse - as I discussed earlier, eventually the teeth "cup out", at which point there's little more that can be done, dentally. The next phase is that the tooth falls out, leaving naked gums. I remember once doing a regular tooth rasping on a 38 year old mare - I put a hand in to have a feel around, and four teeth fell out in my palm... (she actually did better once the teeth were out than she had in months!). An edentulous (toothless) horse needs a soft, ultra-high fibre diet; typically a mash made from fibre pellets or pencils. Horses can live healthily for quite some time on such a diet - however, once your horse has reached this stage, it is probably time to consider how long you can fairly keep him going. If you can stay on top of all these points, you have every chance of keeping your older horse going for a long, healthy life - as Perry has had, and indeed continues to have. If you are worried about any symptoms your horse or pony is showing, please talk to your vet or check how urgent the problem may be by using our Interactive Equine Symptom Guide written by expert equine vets.
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