Thursday 18 July 2019

Orthodontics for pets - ensuring healthy mouths

Jimmy plays with a ball in an effort to move his canine teeth.
Jimmy plays with a ball in an effort to move his canine teeth.

Pete Wedderburn - Animal Doctor

I saw Jimmy, a Collie, recently, with an unusual dental problem: one of his lower canine teeth (the large pointy one at the front of the mouth) was directed inwards, so that it was pressing directly onto his hard palate.

The tooth was meant to point half an inch further to the outside, so that it wouldn't be pressing on anything at all. The malposition meant that every time he closed his mouth, the point of the tooth pressed against the soft fleshy tissue of his hard palate. There was already a dent in his hard palate, and it would soon start to cause pain and discomfort.

Action needed to be taken, but what could be done? If he was a human, he'd visit a dentist with a special interest in orthodontics. But he was a dog. How could I help him?

Orthodontics is the science of correcting dental malocclusions i.e. abnormal alignment of the teeth. The word "orthodontics" is derived from the Greek words for "straight" or "proper" ("orthos") and "teeth" (dontics).

Nearly 30% of humans have malocclusions severe enough to benefit from orthodontic treatment. It might be unusual for people to have teeth pressing directly into the hard palate, like this dog, but plenty of people have teeth that are in the wrong place, and that need to have their position tweaked.

Human treatments are typically braces, applying pressure to the teeth, gradually moving them into the correct place.

The field of orthodontics in animals is relatively new, and it's different to human orthodontics. In humans, the cosmetic appearance of our teeth is important: we don't like having crooked or gappy teeth. In pets, appearance is not important apart from, perhaps, in the show ring, and it isn't seen as ethical to carry out orthodontics for this reason.

In animals, the focus is to ensure that every pet has a comfortable and functional bite. If teeth are crooked or misplaced, they can press on the soft tissues of the mouth, causing pain and ulceration, as in the case of my patient Jimmy. In some cases, a physical hole can be created because of the pressure caused by a misplaced tooth. In some cases, this can even create an open passage between the mouth and the nasal cavity, so that when the animal eats, food ends up inside the nose.

As well as obvious physical injuries like this, crooked teeth can cause pain in the jaw joints as well as in the gums, lips, cheeks, and teeth.

Why do these problems happen? Many factors are involved, including genetics, nutrition, and the environment.

Genetic factors account for severe over or under bites, as well as overcrowding of the mouth with too many teeth, which is common in short-muzzled (brachycephalic) breeds. Dog breeders have a responsibility to ensure that the puppies they produce have healthy adult teeth, and this starts by ensuring that only adults with healthy dentition are used for breeding.

The effect of nutrition is easy to sort out: ensure that growing pets are fed a balanced diet. All commercial pet food is legally obliged to be nutritionally balanced, so problems with deficiencies and imbalances that can affect the teeth only happen when people feed imbalanced diets (such as pure meat, or nothing but porridge).

The impact of the environment is more complicated: this includes factors like dogs playing vigorously with rope chews or chewing objects which apply strong, regular pressure to their teeth.

Veterinary orthodontics aim to correct crooked teeth so that pets can live, eat and carry objects in their mouths without pain.

If an owner suspects their pet may have an orthodontic problem, the first stage is to discuss the situation with their local vet: a referral to an orthodontist may or may not be needed.

A range of orthodontic procedures are available for pets, including glue-like acrylic resin which is stuck to the teeth, as well as metal plates, grids and wires. Surgery may be needed to extract teeth and even sometimes to cut and realign the flesh and bone of the jaws.

As you can imagine, these procedures are complex, time-consuming and expensive, but sometimes, there's no choice. For the animal to have a comfortable life, it just needs to be done.

Early use of orthodontics is important. The first year of life is a busy time inside a pet's mouth, with baby ("deciduous") teeth coming in, then falling out, and adult teeth emerging. If orthodontic intervention is needed, youth is the best time to do it. Everything is still growing and moving. Once the animal is a fully grown adult, it's far more difficult to shift the shape and position of the teeth.

My patient Jimmy is just four months old, so there's still time to help him. The initial plan is to use a simple, non-invasive technique known as "ball therapy".

Jimmy will be encouraged to play with a rubber ball that will apply apply gentle (passive) force to the canine teeth, pushing them outwards, and hopefully correcting their position. If this technique does not work, he'll either need more complex (and expensive) techniques, or in the worst case, the offending tooth may need to be extracted completely.

Pets have teeth just like humans, so it's no surprise that they sometimes need dentistry and orthodontics.

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