What's Behind Doggie Breath?
Most of our veterinary dental patients present for bad breath. We clean, polish, x-ray, and treat abnormalities of the teeth and oral cavity. The breath returns to normal, but for how long and why does the malodor return?
Malodor also referred as halitosis, fetor ex or, fetor oris means an offensive odor emanating from the oral cavity. Mouth odors may be of diagnostic significance, in that their origin may be either local or extraoral. Local sources of mouth odor include retention of odoriferous decaying food particles on and between the teeth, chronic periodontal disease with putrefied sulcular bacteria, oral tumors andimmune mediated oral disease. Extraoral causes of "bad breath" have also been attributed to upper respitratory infections, sinusitis, tonsilities, lipfold infections, chirrosis of the liver, end stage kidney disease, diabetes, and generalized bleeding disorders which cause decomposition of blood oozing from the hemorrahgic gingiva.
A normal healthy mouth has 750 million bacteria per cc of saliva: Bacteria initiate plaque growth by means of their ability to the search surface (pellicle). In dogs as in people, most oral odors come from the by-products of oral bacteria located above and below the gumline. There are different odors from grade one gingival disease compared to grade four periondontitis. In gingivitgis plaque laden bacteria are aerobic gram negative cocci. The odor is minimally disagreeable. As the plaque accumulates and thickens, the bacterial population changes to anaerobic rods. If untreated, supragingival plaque soon causes inflammation and edema below the gumline and begins to populate the gingival sulcus.
Grade one and two gingival disease usually presents with minimal disagreeable odor. Most cases of in gingivitis are typified by gram positive non-motile cocci located in the subgingival and supragingival plaque. As gingivitis progresses the bacteria population changes to gram negative motile rods including Bacteroides, Fusobacterium, and Actinomyces species. Malodor comes from a combination of the bacteria, their breakdown products or decaying food and resorbing bone located in deep periondontal pockests. The biggest cause of the malodor is the bacterial breakdown products of sugar. Odoriferous products such as hydrogen sulfide, ammonia, acetate, butyrate, isobutyrate, and other organic acids are produced.
So what can be done about all this doggie breathe? The key is diagnosing and treating gingivitis early. Most children's dentists recommend the first cleaning at four to five years old. As soon as a dog or cat is one year old the patient should be scheduled for an oral examination. If there are any signs of gingivitis (inflammation, edema) and /or if calculus on the upper fourth premolar or maxillary canines are touching the free ginigva, then it's time for the pet's first prophy including removal of plaque and calculus above and below the gumline, irrigation, polishing, charting, home care instructions.
If the patient affected with perodontal disease leaves the office with out its's owner scheduling a teeth cleaning, the plaque and calculus will progress. It is up to the veterinarian to be the animal's advocate and urge the client to agree to the cleaning. Most important the veterinarian needs to believe that they are providing the best care for their patients by starting active oral health care early.
Home care cannot be over emphasized. No amount of hard food or chew will prevent gingival disease as well as daily brushing. The use of oral rinses may help to reduce halitosis for as long as three hours. The antiodor properties are due to their antimicrobial activity. One mouthrinse with the active agent of sanguinarine decreases volatile sulfur compounds responsible of malodor. Once periodontal disease is established the control of malodor is harder. In addition to daily brushing the client should decrease plaque formation and aid odorigentic bacteria control through supplementation of fluoride or chlorhexidine.
Our goal as animal health care providers and handlers is to prevent gingival disease when the patient is young and educate the client on home care to continue the prevention process through life. When a dog presents with moderate to severe malodor the process usually not curable but controllable. A challenge at best--the payoff will reward you with a happier healthier partner.