Client Information
The following information can be found here:
Further helpful information is available on the frequently asked questions section.
Emergencies in Dentistry and Oral Surgery
The Emergency Service can be contacted 24 hours a day at (215) 746-V911 or (215) 746-8911. Our Dentistry and Oral Surgery Service clinicians have traditionally not only taken care of patients with dental problems, we are also responsible for primary care of patients with oral and maxillofacial pathology due to infection, cancer or trauma. Certain emergencies affecting the teeth, mouth and face require immediate veterinary medical attention and include (but are not limited to):
- Very recent tooth fractures (if there is interest in saving the tooth, animal should be put on antibiotics until referral to the veterinary dentist or oral surgeon).
- Tooth luxations and avulsions (true dental emergencies; put animal on antibiotics and place avulsed tooth in milk until referral to the veterinary dentist or oral surgeon).
- Mandibular and maxillary swellings associated with oral and maxillofacial tumors.
- Swellings around the nose, mouth, jaws, face and neck associated with inflammation/infection.
- Jaw fractures, temporomandibular joint luxations, symphysis separations, acute palate defects.
- Acute inability to open or close the mouth.
- Sharp or blunt head trauma injuries, including lip and tongue lacerations, oral bleeding, gunshot injuries.
Making an Appointment with Our Service
The Dentistry and Oral Surgery Service sees new patients on Monday or Wednesday mornings. We are booked about 1.5 to 2 months in advance. Please call (215) 746-VETS or (215) 746-8387 for an appointment.
Directions to Our Hospital
Directions to the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania (MJR-VHUP), 39th & Spruce Streets, Philadelphia, PA. For any areas not covered, please call the appointment desk at (215) 898-4680. Parking at a reasonable fee is available next to the hospital entrance.
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Home Oral Hygiene Instructions
Daily Tooth Brushing
An effective home oral hygiene program consists of daily tooth brushing, provision of appropriate diets, and use of various oral health care products (e.g., chlorhexidine-based rinses/gels, chew toys, dental treats, etc.). Periodontal disease is the most common disease occurring in dogs and cats and is defined as plaque-induced pathology of any part of the tissues that hold the tooth in the mouth - the gingiva, periodontal ligament, alveolar bone, and cementum. Plaque is a soft biofilm which contains bacteria and toxins and accumulates on the surface of teeth within hours after a dental cleaning. When accumulation of plaque is prevented by effective oral hygiene, periodontal disease does not develop. When oral hygiene is less than optimal, plaque can mineralize within 2-3 days to form calculus that resists being readily wiped off. Therefore, tooth brushing should be performed once daily to remove plaque from our pets’ teeth. All you need is a soft-bristled and appropriately-sized toothbrush, some patience, and 1-minute of your daily time. Do not use human toothpaste, as it contains foaming agents that can upset your pet’s stomach and fluorides which, when swallowed in sufficient concentrations, may pose a health hazard. You may find the following brushing instructions to be very helpful.
Diets with Benefit to Oral Health
Certain veterinary diets may be advantageous for maintenance of oral health. Many manufacturers have considered the relationship of diets to oral health of pets. So-called 'dental diets' were designed to either mechanically or chemically reduce plaque and/or calculus (tartar) accumulation. Some products provide a combination of both actions. The mechanical action is derived from a larger than usual, hard kibble that fractures into few large pieces as it is penetrated by the tooth, rather than crumbling into many tiny pieces. The large pieces are penetrated again, and thus the more crunching that is performed, the more abrasive action results and the bacteria-laden plaque is being disturbed. Some kibble also has layers of different textures that contribute to plaque disruption. Diets that help to clean teeth by chemical action are coated with various chemicals that have been shown to reduce the accumulation of plaque or calculus. Polyphosphates are used in some of these diets. The Veterinary Oral Health Council provides a list of products that have successfully met pre-set criteria for effectiveness in controlling plaque and tartar deposition in dogs and cats.
Chew Toys and Dental Treats?
Chew toys and dental treats can be an important part of any pet dental health program. However, they represent only part of the overall maintenance of oral health. Toys and treats are used in combination with daily tooth brushing, oral health care products, appropriate diets, yearly dental check-ups, and professional dental cleaning and periodontal therapy as necessary. There are many different chew toys and dental treats commercially available for our pets. They should not be too hard, as very hard materials can fracture teeth. Inappropriate toys and treats include plastic bones made of hard nylon, meat bones (cooked and uncooked), and cow hooves. Rocks and large ice cubes can also fracture teeth and should be avoided. Tennis balls are a popular toy for many dogs; however, they are very abrasive to teeth because they collect tiny particles of dirt and sand and will wear down the teeth and occasionally cause pulp exposure. Acceptable toys include soft stuffed animals, flexible rubber bones, soft plastic balls, and ropes. Please note that the toy should be appropriate for the size of the animal, and caution should be exerted when pets are left unobserved when playing with toys. A good idea is to choose products that have the VOHC seal of acceptance, ensuring that the product has successfully met pre-set criteria for effectiveness in controlling plaque and tartar deposition in dogs and cats.
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Need for Anesthesia and Frequency of Professional Dental Cleanings
Need for Anesthesia
In order to perform a thorough periodontal examination, dental radiography, scaling and polishing, gingival curettage and root planing, the pet must be under general anesthesia. Anesthetic gas and oxygen are delivered through an endotracheal tube, thus ensuring pain-free procedures and also protecting the airways from aspirating fluids or debris. Owners of pets naturally are concerned when anesthesia is required for their pet. However, anesthesia-free dentistry performed by untrained individuals is inappropriate for several reasons, including:
- Significant safety concerns for the patient and operator.
- Insufficient cleaning of inaccessible tooth surfaces.
- No debridement of periodontal pockets.
- Oral discomfort and serious pain.
- Accidental aspiration of debris that can result in pneumonia and death.
Furthermore, it is illegal for anybody but licensed veterinarians or supervised and trained veterinary technicians to practice veterinary medicine. Although anesthesia will never be 100% risk-free, modern anesthetic and patient evaluation techniques used in veterinary hospitals minimize the risks, and millions of dentistry and oral surgery procedures are safely performed each year. The American Veterinary Dental College adopted a position statement on companion animal dental scaling without anesthesia.
Frequency of Professional Dental Cleaning
The frequency of the need for professional dental cleanings is dependent upon several factors. If thorough home oral hygiene is being provided on a daily basis, the bacterial accumulations should be minimal, and scaling and polishing procedures can be performed less frequently. Specific breeds, such as Yorkshire terriers and miniature schnauzers are more prone to developing periodontal disease; therefore, a professional dental cleaning should be performed more frequently. Your pet should have an annual oral examination performed by a professional to document the presence of abnormal conditions such as periodontal disease, fractured or decayed teeth, tumors, ulcers, etc. Professional dental cleanings require your pet to be anesthetized in order for the skilled and trained operator to remove debris from below the margins of the gums (subgingivally). Since periodontal disease causes the destruction of the supporting structures of the teeth (gingiva, periodontal ligament, and bone), cleaning the crowns of an awake dog without addressing what lies beneath only provides a cosmetic benefit. This superficial procedure does not address the disease in deeper tissues or less accessible sites. In general, the condition (color, texture, shape) of the gingival tissues will dictate the need for placing your pet under general anesthesia to have professional dental scaling, polishing and intra-oral radiographs.
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Periodontal Disease, Fractured and Worn Teeth, Luxated and Avulsed Teeth, and Oral Tumors
Periodontal Disease
This is an inflammatory response to infection of the periodontal tissues by plaque bacteria. Gingivitis is the reversible form of periodontal disease, affecting gingiva only. As inflammation continues, the gingiva detaches from the tooth, creating a periodontal pocket. Bacterial toxins and enzymes from inflammatory cells cause further destruction of periodontal tissues. Periodontitis is the more severe form of periodontal disease, resulting in attachment loss, gingival recession, and loss of alveolar bone. In multi-rooted teeth, the furcation between two roots becomes exposed. The loss of alveolar bone is usually irreversible, and with increasing bone loss the tooth becomes mobile and ultimately falls out. Halitosis (bad breath) often accompanies periodontal disease. The systemic effects of periodontal disease are well documented in humans and include heart disease and stroke, diabetes, respiratory disease, and increased risk of premature delivery and low birth weight infants. Studies about the impact of periodontal disease on systemic health in dogs and cats are currently conducted by Penn faculty. A thorough oral examination includes probing of the gingival sulcus with a periodontal probe and radiography of the teeth with dental radiographic film and a dental x-ray unit. The goal of periodontal therapy is elimination of plaque and surgical reduction of periodontal pockets. Systemic antibiotic therapy should never be used as the sole treatment regimen. Professional dental cleaning (often called a dental prophylaxis or prophy) refers to scaling, smoothing the root surfaces (root planing), and polishing of all crown and subgingival tooth surfaces. Professional periodontal therapy refers to elimination of diseased periodontal tissues by means of periodontal surgery. If a tooth has lost 50% or more of its attachment to the jaw bone, then extraction of this tooth is to be considered. Some severely affected teeth can be successfully retained in the mouth by a combination of scaling, root planing, periodontal surgery, and conscientiously applied home oral hygiene.
Fractured and Worn Teeth
If dental trauma has exposed the pulp cavity, bacteria can enter the pulp through the fractured or worn crown. If left untreated, the pulp becomes inflamed and necrotic, and a periapical abscess may develop. Endodontic therapy is then needed to prevent the possibility of tooth loss. Alternatively, the tooth can also be extracted. Dental radiography, special instruments and materials, knowledge of various techniques, and sufficient operator skills are required for performing endodontic and restorative procedures. Fractures that extend under gums deep into the root must be treated with periodontal surgery prior to endodontic therapy. The two basic endodontic treatment options are (1) vital pulp therapy and (2) standard root canal therapy. Teeth of young animals have a fairly wide pulp cavity, while in old animals the pulp cavity is usually very narrow. The narrower the pulp cavity, the thicker are the dentinal walls, and thus the stronger is the tooth. Vital pulp therapy is primarily utilized for very recent tooth fractures (less than 2 days of duration) in young animals (less than 2 years of age). Sterile instruments must be used, and systemic antibiotics are recommended perioperatively. The infected portion of the pulp in the crown is removed, a pulp dressing is placed, and the tooth is restored. Dental radiographs are obtained in 4-6 months to confirm pulp vitality. If the animal is older or the pulp is exposed for longer periods of time, standard root canal therapy is performed. It consists of accessing the pulp cavity and debriding, shaping, disinfecting and filling the root canal with an inert material, followed by access restoration. Dental radiography is of utmost importance during all steps. The goal of treatment is the removal of diseased or necrotic pulp tissue and providing a hermetic seal around the root(s). Antibiotic therapy is generally not required.
Luxated and Avulsed Teeth
Tooth displacement injuries frequently occur after automobile accidents, falls from great heights, fighting with other animals, or when a tooth gets caught in a fence. A tooth can be luxated to the side, into the alveolus (nasal cavity in the case of a maxillary canine tooth), or to the outside. When a tooth is completely out of its alveolar socket, then we call it an avulsed tooth. The teeth most commonly avulsed in dogs are the incisor and canine teeth. Luxated and avulsed teeth are dental emergencies and require immediate repositioning, stabilization, and endodontic therapy due to the likely loss of blood supply to the pulp. Success of replantation is influenced by the speed with which the tooth is replanted. The avulsed tooth should be placed in a transport medium (such as fresh milk which keeps periodontal ligament cells vital for up to 6 hours) until arrival of the patient and tooth at our hospital. Antibiotic therapy (amoxicillin/clavulanic acid, clindamycin or doxycycline) must be started as soon as possible. The tooth is then replanted, and a splint is applied. In 1-2 weeks, the splint is removed, and endodontic therapy is performed with a calcium hydroxide paste fill. In another 2 weeks, standard root canal therapy is performed. Resorption of the replanted tooth is a common complication, particularly if the avulsed tooth has been allowed to dry on air for longer than 20 minutes.
Oral Tumors
Oral tumors may be benign or malignant (having the potential to spread to distant sites). Even those that are benign may be locally invasive and may result in oral pain, bleeding, drooling, or difficulty eating. Unfortunately, dogs and cats often show no obvious clinical signs until the oral tumor is already very large. It is important to have a thorough oral examination done regularly in an attempt to diagnose these tumors in the early stages. An incisional biopsy of the tumor may be done prior to treatment to determine tumor type and treatment options. Treatment may include one or more of the following:
- Surgery: Removal of a portion of the lower (mandibulectomy) or upper jaw (maxillectomy) are generally very well tolerated, and in many cases result in pets with good function and cosmetic appearance.
- Radiotherapy: Alone or in combination with surgery, depending on the tumor type, location, and the ability to remove the tumor surgically.
- Chemotherapy: Few oral tumors respond to chemotherapy alone, but chemotherapy may be prescribed to minimize spread to distant sites.
- Immunotherapy: Recent advances in vaccine technology offer a completely new treatment approach for certain tumor types.
Although our service usually has a 6-8 week waiting period for the next available appointment, we believe patients with rapidly growing oral tumors should receive immediate veterinary medical attention. Oral tumors are best treated before they have a chance to enlarge to the point where they are no longer surgically removable.