It seems unbelievable how quickly summer has flown by. The high temperatures have been challenging for our pets but, thankfully, we have seen very few heat related issues over the last couple of months. The practice has been as busy as ever, we have been grateful to have welcomed Iva onto the team, although sadly for only a short time. Iva came all the way from Italy to experience working in the UK veterinary world and help provide us with much needed holiday cover. In September we welcome a new full-time member, Tia, to our office team.
Practice improvements are slow and steady. In the next few weeks we are hoping to have the new designated cat only ward and theatre fully up and running, before we move on with extending and improving the dog ward. Watch out for future post sharing the images of the new improvements as they develop.
For this newsletter we have chosen to look at the common issue of dental health care in dogs, cats and rabbits. Our second article looks to help pet owners understand the cancer lymphoma. As always the authors are willing to consider requests/suggestions for future articles on conditions owners would like to see.
What do I need to know about the teeth of dogs and cats?
Adult cats have 30 teeth, adult dogs have 42 teeth, which by 6-12months of age should have fully erupted.
Teeth are composed of a central sensitive pulp chamber (including the root canal) which provides nutrients to the surrounding dentin. The dentin is covered by a layer of hard protective enamel. The part of the tooth visible in the animal’s mouth is termed the crown, whilst the hidden section is called the root. The tooth root is securely attached to the mouth bone by the peridonteum, which is comprised of hard substance called cementum and the periodontal ligament. The soft tissue overlying the base of the tooth crown is called the gingiva. Dental disease occurs when one or more of the tooth components is damaged.
It is thought that nearly 80% of small animals are affected by dental disease where part of the tooth anatomy is diseased or damaged. Dental disease is most common in smaller breeds and older animals. Predisposed animals include brachycephalic breeds, which suffer from overcrowding of their teeth, Yorkshire terriers, sight hounds (Greyhounds etc.), Dachshunds, Siamese, Persian and Burmese cats as well as pets with retained baby (deciduous) teeth.
What are the signs of dental disease in cats and dogs?
Some pets can have dental disease yet have no symptoms or signs that are easily missed; therefore, issues may only be detected when they are examined by a vet. Signs that owners may become aware of include halitosis, messy eating, picky eating, pawing at mouth, poor appetite, weight loss, change in behaviour, facial swelling, excessive drooling, red and bleeding gums, vocalising, teeth grinding (especially when eating) or teeth falling out.
Poor oral health affects a lot more than just teeth, studies show that bacteria associated with periodontal disease can circulate around the body affecting the cardiovascular system, liver and kidneys.
What causes dental disease in our pets?
Plaque is soft and sticky film of bacteria. Plaque mixed with food and saliva hardens off over time to form tartar, a hard yellow brown substance. Tartar is porous and encourages further plaque build-up. If not removed from the tooth plaque bacteria can damage the tooth and surrounding structures and result in:
- Gingivitis- plaque bacteria cause inflammation of the gingiva, tartar can cause trauma to the gumline. Gingivitis can cause pain on eating. It is worth noting that in cats certain viral conditions can also lead to gingivitis including FeLV (feline Leukaemia), FIV (feline aids) and calicivirus. In some cats gingivitis can become chronic and severe resulting in the whole gingiva and oral mucosa becoming severely and painfully inflamed.
- Periodontal disease – when plaque persists on teeth it can damage the peridonteum which, over time, can lead to the tooth becoming loose, a painful tooth root abscess can form as the bacteria penetrate deeper around the tooth root. Deep penetrating plaque can also invade the adjacent bone and weaken it, a condition known as osteomyelitis, which in severe cases this can predispose the animal to mouth fractures. Once the peridonteum is damaged it can never be repaired.
- Feline odontoclastic resorptive lesions (FORLs)- cats can suffer from painful FORLs. In some instances FORLs develop as a consequence of periodontal disease, in other cases the cause is unknown. Inflammation starts at the gingiva and gradually penetrates deeper into the tooth structure resulting in a hole in the tooth along the gum line, affected teeth become very weak and painful. In teeth affected by FORLs the crown can snap off leaving the root retained which can be resorbed or persist, the latter potentially resulting in significant jaw pain. Unfortunately FORLs are a common issue affecting approximately a third of adult cats. The teeth affected with FORLs need removing.
- Dental caries-Caries lesions are cavity like lesions that occur often in the pits of molar teeth (the large grinding teeth at the back of an animal’s mouth). They are caused by the raised acidity, which can occur when bacteria break down sugars and carbohydrates. This acid causes damages the enamel and dentine creating a dark brown coloured soft lesion. Caries are rare in dogs and even rarer in cats. For patients suffering with this condition, similar to humans having a filling or root canal, the area can sometimes be repaired by a specialist veterinary dentist. The tooth damage is often so severe and extensive that the tooth must be surgically extracted.
Tooth fractures -Some dogs and cats may suffer from tooth fractures due to trauma, this may from a blow to the mouth or the animal chewing on hard objects including over hard toys, stones etc. When the enamel is broken severely it causes the pulp to be exposed which is very painful. In some instances fractured teeth can be salvaged by a root canal procedure carried out by a specialist veterinary dentist but more commonly the fractured tooth needs to be surgically extracted.
How do I prevent my pet developing dental disease in my dog and/or cat?
Home care is the best way to try and prevent or slow the progression of dental disease in your dog or cat. It is important to note in some pets whilst home management slows down build up of plaque and tartar regular veterinary checks and cleaning may still be necessary.
- Daily brushing with a pet safe toothpaste is the best way to keep your pet’s teeth clean and healthy. We appreciate that introducing your dog or cat to brushing can be challenging, and it does require time and patience. Like with all training it is best to expose pets to tooth brushing at a young age. Teeth are best cleaned with a specially made pet toothbrush which has soft bristled and is shaped better for a pet's mouth, or a finger brush to give you more control. Start by introducing your cat or dog to the pet toothpaste (DO NOT USE human toothpaste which is toxic to pets) almost as a treat, pet toothpaste is flavoured to make it enjoyable for them. Once your pet is happy to lick the toothpaste off the soft bristled or finger brush you can start to build a positive experience with the brush and they can get used to the flavour. Training any animal takes time so ensure you move at your pet’s pace and give lots of praise. Start with only a few teeth at a time and move in circular motions along the gum line. Many helpful videos on pet tooth brushing are available to view online including by Cats protection and PDSA.
- For pets that already have some degree of plaque and tartar enzymatic toothpaste is available for dogs and cats to helps to break down the existing plaque and tartar. However once tartar is established on the teeth a surgical descaling needs to be performed by your vet to remove it.
- Pet mouthwash (chlorhexidine mouthwash) are also a good way to help reduce plaque bacteria. They can be syringed directly onto the gums or smeared onto the gums with the help of a toothbrush. Products that go in water are also promoted to reduce plaque on teeth but should not be used a substitute to teeth brushing.
- Dental diets are available with specific shaped kibble and formula designed to help reduce accumulation of plaque and tartar.
- Dental chews can be used alongside brushing, there are many different designs and formula that are supposed to aid your pet's oral health. It is best to go for chews that have no added sugar as this can attribute to weight gain.
Regular check-up at vaccinations can help to identify signs of dental disease early. Where dental disease has established in your dog or cat, he/she will need to undergo surgical dentistry to fully assess the mouth, remove any severely diseased or broken teeth, as well as clean up all other teeth to remove damaging plaque and tartar.
Let's not forget rabbits
Rabbits teeth and rabbit dental issues are very different from those of cats and dogs. Rabbits have 28 adult teeth which are constantly grow so need to be constantly worn down to maintain good dental health. A healthy, well-bred rabbit has teeth that occlude well and are ground down evenly as they eat an appropriate long fibre diet. Looked at simply rabbit have incisor teeth at the front of their mouth for pulling food in and cheek teeth for grinding.
Rabbits with dental disease most commonly present off food and drooling, tooth grinding, depressed, anorexic, with weight loss, difficulty grabbing food and/or dropping food, overlong incisors may also be recognised. Dental problems can be very serious in rabbits and cause them to become very unwell, an anorexic rabbit is at risk of bloating and death. Symptoms occur due to uneven growth of the rabbit’s teeth which can be caused by an inappropriate diet and/or poor breeding. Trauma to the mouth can also result in poor teeth alignment. Affected cheek teeth can develop spurs which can ulcerate the tongue, overgrown incisors can also cause trauma to the opposite side of the mouth and make it impossible for the rabbit to properly grab food. Unhealthy rabbit teeth can develop root abscesses causing great pain, uneven teeth wear can also result in teeth growing in the wrong direction and irreversibly damaging structures of the head. Surgical management can temporarily alleviate dental disease symptoms in some mildly affected rabbits but sadly in some severely affected rabbits the changes are too extensive and too painful that the only option is euthanasia.
It is important to feed a rabbit an appropriate diet high in roughage to best help maintain good dental and gut health. Muesli should be avoided as its use has been linked to the development of dental problems in rabbits. A balanced diet of grass, hay, some leafy greens and a small amount of nugget or pellet food is ideal for rabbits. Rabbits’ teeth should be routinely checked to identify any issues early, corrective dentistry can then, hopefully, be performed before the issues become too severe.
What is lymphoma?
Lymphoma is a cancer that originates from white blood cells called lymphocytes. Lymphoma can affect any tissue in the body. A dog with lymphoma most commonly presents with multiple enlarged lymph nodes/glands, externally and/or internally, the spleen and/or bone marrow can also be affected in some cases. In cats intestinal lymphoma is the most common form seen. The severity of lymphoma is influence by the tissue affected and how many organs are involved from stage one, involving a single lymph node, to stage five where the blood and bone marrow are affected.
What causes lymphoma?
As with all cancers why some animals develop lymphoma and others don’t is not fully understood. A combinations of factors is likely to be involved in any one case, including genetic and environmental influences. In cats FeLV (Feline leukaemia virus) has been associated with the development of some cases of lymphoma.
Which pets are most likely to be affected by lymphoma?
Lymphoma can affect any animal of any age but middle-aged to older dogs (6-9 years) are most commonly affected. Boxers and Rottweilers are amongst the breeds reported to be suffer a higher incidence of lymphoma. Older cats (9-13 years) are most commonly affected by lymphoma but mediastinal (in the chest) and peripheral lymph node presentations tend to be seen in young cats (2-4 years). Lymphoma is most commonly diagnosed in Domestic short haired cats (DSH), however Siamese cats appear to be more likely to develop mediastinal lymphoma.
What are the symptoms of lymphoma?
The symptoms of lymphoma vary greatly depending on the tissue affected and the stage of disease
- Multicentric lymphoma- enlarged lymph nodes can be felt, most often under the neck. Dogs may appear otherwise well or may have signs including anorexia, weight loss, increased thirst and urination, vomiting, diarrhoea, swollen abdomen, breathing difficulties or fever. If the bone marrow is affected (Stage 5) then blood changes including anaemia, bleeding and risk of sepsis can be present.
- Gastrointestinal lymphoma - signs may include vomiting, diarrhoea, weight loss, anorexia, increased thirst and lethargy. In cats your vet may be able to palpate a discrete mass in their abdomen.
- Mediastinal – difficulty breathing, increased thirst, exercise intolerance, with large tumours dogs may develop regurgitation and/or oedema (fluid swelling) around the head, neck and front legs.
- Extra-nodal lymphoma – Skin lymphoma can be small nodules or large inflamed areas of skin; CNS (central nervous system) lymphoma can present with seizures or paralysis; Eye lymphoma can be seen as changes to the shape of or within the eye, pain and/or loss of vision; nasal lymphoma can cause noisy and/or difficulty breathing, sneezing, nasal discharge, watery eyes, facial pain and/or deformity; renal lymphoma -cats may present with anorexia, weight loss, increased thirst, your vet may be able to palpate an enlarged sometimes irregular kidney/s.
How is lymphoma diagnosed?
Lymphoma is diagnosed by examining a sample of the affected tissue. Samples may be collected via a needle or surgically. These samples can be used to identify the abnormal lymphocytes in the tissue. Specialist tests can be performed on the samples to more accurately classify the type of lymphocyte (B or T) involved, which will affect the choice of treatment. Blood tests are performed to help evaluate how the lymphoma is affecting the blood and organs. Imaging may be needed to identify and lymphoma that is present within the body. Imaging can also be used to stage the disease but may not change the treatment options. Bone marrow samples may be discussed if there are serious changes in the blood.
How is lymphoma treated?
In the majority of cases lymphoma is treated using chemotherapy. There are a variety of different protocols that have been developed using a number of different products, in each case the treatment needs to be tailored and adjusted to the individual needs. Generally, the most effective chemotherapy protocols, giving the best survival times, involve a combination of drugs used to kill the cancer cells. Close monitoring is required during chemotherapy treatment with regular vet visits and blood tests. Some lymphomas respond better than others, generally dogs with B cell lymphoma have a better response and longer survival than T cell lymphoma. In rarer cases of solitary, or indolent lymphoma, surgery can be curative. In cats nasal lymphoma is best treated with radiation therapy.
What are the side effects of chemotherapy?
The side effects of chemotherapy vary depending on the treatment protocol the animal receives. These can include anorexia, vomiting, diarrhoea, tiredness, panting, weigh gain, blood in urine, weakness, coat changes, affects on the heart. Chemotherapy drugs affect all rapidly dividing cells which means they cause damage to some normal cells as well as the cancer cells, immune cells are most commonly affected. Animals on chemotherapy are monitored closely to ensure the normal cells have time to respond after each treatment but if an animals immune cells go too low then they are at increased risk of infections. In the majority of cases side effects are mild and/or manageable with the addition of supportive therapies.
Can my pet recover from lymphoma?
In the majority of cases we hope to achieve clinical remission when treating our pets with lymphoma. It is important to remember that, as with any cancer case, how an individual will respond to treatment and for how long cannot be guaranteed. As an example, for a dog with multicentric B cell lymphoma treated with steroids alone may survive 1-2 months, with a medium intensity protocol a 5-6 month survival is hope for, with the most intense protocols mean survival is expected to be 10-12 months with up to 25% of cases still alive after 2 years. In cats 5-6 months survival is hoped for with large cell intestinal lymphoma but for small cell lymphoma a survival of 2 years is not uncommon. Less common solitary or indolent lymphoma can be cured with surgery.
What else do I need to consider when treating my pet for lymphoma?
Special precautions must be taken when handling the excreta (urine, faeces, vomit, saliva) of pets on chemotherapy, as they can contain traces of the drugs which can affect human health. Owners must wear gloves when handling chemotherapy medication and pet excreta. Faeces and vomit should be double bagged before disposal, urine washed away with copious water and if someone is exposed to saliva this should be washed off well as soon as possible. Pregnant women or women trying for a baby, growing children and immunosuppressed individuals should avoid contact with a pet on chemotherapy. Interaction with pregnant or young growing animals should also be avoided.
Chemotherapy can be expensive with specialist drugs and regular tests needed during treatment monitoring, the costs can quickly add up. For a dog on one of the most intensive chemotherapy protocols treatment costs are likely to be in the region of £4000-6000. It is important to remember that treatment is tailored to the individuals needs, adjustments may be required as the treatment progresses, and so additional costs may be incurred, but cannot be predicted. It is important to consider at the outset whether this is a cost you as an owner are able to afford.