Mouth Tumors

Tumors in the Mouth – An Overview

  • “Oral” refers to the mouth; “oral masses” are tumors or growths located in the mouth
  • Oral masses may be benign or malignant (that is, cancer)

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Golden retrievers, German shorthaired pointers, Weimaraners, Saint Bernards, and cocker spaniels are more prone to tumors of the mouth than other breeds; dachshunds and beagles are less prone to tumors of the mouth than other breeds; boxers are more prone to have enlargement of the gums (known as “gingival hyperplasia”) than other breeds
  • Malignant melanoma—the most common cancer of the mouth in the dog; cocker spaniels, German shepherd dogs, chow chows, and dogs with heavily pigmented linings of the mouth (known as “mucous membranes”) are more likely to develop malignant melanoma than other dogs
  • Squamous cell carcinoma—the second most common cancer of the mouth in the dog; large-breed dogs are more likely to develop squamous cell carcinoma than other dogs

Mean Age and Range

  • Older pets are affected most often
  • Fibromatous epulis—the epulides (plural of epulis) are masses located on the gums; they are the most common benign tumor of the mouth; fibromatous epulis age range is 1–17 years; mean age is 7.5 years
  • Papillary squamous cell carcinoma—a rapidly growing cancer of young dogs (less than 1 year of age)
  • Fibrosarcomas—the third most common cancer of the mouth in dogs; seen in large, older male dogsOsteosarcoma—middle-aged medium- to large-breed dogs
  • Plasmacytoma—older dogs
  • Squamous cell carcinoma in the cat—type of cancer in the mouth; age range is 3–21 years; mean age is 12.5 years
  • Fibrosarcoma in the cat—the second most common cancer of the mouth; age range is 1–21 years; mean age is 10.3 years

Predominant Sex

  • Malignant melanoma—the most common cancer of the mouth in the dog; males more frequently affected than females
  • Fibrosarcomas—the third most common cancer of the mouth in dogs; seen in large, older male dogs
  • Osteosarcoma—females more commonly affected than males

Signs/Observed Changes in the Pet

  • May have no signs
  • May include bad breath (known as “halitosis”), tooth displacement, malocclusion (any deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth), bleeding in the mouth, and drooling
  • Weight loss
  • Lack of appetite (known as “anorexia”)
  • Reluctance to chew or can only eat soft food; chews only on one side of the mouth
  • Inability to open or close mouth
  • Abnormal facial appearance
  • Tooth loss

Causes

  • Unknown for most oral masses
  • Papilloma virus—papilloma, a benign tumor

Risk Factors

  • Squamous cell carcinoma of the tonsils occurs ten times more commonly in dogs from urban settings than in rural dogs
  • Squamous cell carcinoma—more common in white dogs in one study
  • Any long-term (chronic) irritation to the tissues of the mouth (such as inflammation/infection of the tissues surrounding and supporting the teeth [known as “periodontal disease”] or second-hand smoke) increases the risk of tumor development in the mouth
  • Feline leukemia virus (FeLV) or feline immunodeficiency virus (FIV) may play a role in squamous cell carcinoma development in cats
  • Some researchers showed that cats that wore flea collars had 5 times the risk of developing squamous cell carcinoma of the mouth than cats that did not wear flea collars
  • Second-hand smoke may be associated with squamous cell carcinoma in cats
  • Dogs and puppies that have an inability to develop a normal immune response (known as “immunosuppression”) are affected more commonly with papillomas (benign tumors) than dogs with normal immune responses

Treatment

Health Care

  • Depends on the tumor type
  • Benign tumors are treatable with long-term success via surgery and sometimes radiation treatment
  • Cancer (malignant tumors) is treated surgically with varying success, depending on tumor type, location, and if the cancer has spread to other tissues of the body (known as “metastasis”) at time of presentation to the pet’s veterinarian
  • In advanced cancer, combined therapy (surgery, chemotherapy, and radiation) may provide the best care
  • Pain control
  • Supportive care

Diet

  • Nutritional support is essential with any treatment
  • Gruel or liquefied diet may be necessary following surgery of the mouth
  • Tube feeding may be necessary

Surgery

  • Fibromatous epulis—surgical removal is the treatment of choice; freezing (known as “cryotherapy”); and radiation treatment also give long-term success
  • Peripheral odontogenic fibromas (ossifying epulis)—treat the same as fibromatous epulis
  • Acanthomatous ameloblastoma—surgical removal is usually curative; radiation also has been used successfully; the combination of surgery and radiation may be most effective (requiring less aggressive surgery), but if radiation is not readily available, surgery may be the only option; multiple injections of bleomycin at the tumor site have been effective in a small number of reported cases
  • Malignant melanoma—if surgery is chosen for therapy, it should be aggressive; typically involving surgical removal of the lower jaw or mandible (known as “mandibulectomy”) or the upper jaw or maxilla (known as “maxillectomy”)
  • Squamous cell carcinoma—may be removed surgically with wide margins or may be treated with radiation therapy in the dog, especially; surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy) with a 2-cm clean surgical margin is the goal; dogs tolerate surgical removal of 40% to 60% of the tongue (known as “partial glossotomy”); surgery, radiation, and chemotherapy (mitoxantrone) may be the best options for tumors larger than 2 cm or those with incomplete surgical removal
  • Fibrosarcoma—usually requires surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy)
  • Radiation therapy should be considered in pets where complete removal of the tumor is not possible or the location of the tumor makes surgical removal impossible

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Chemotherapy may be indicated for some forms of cancer in the mouth; chemotherapeutic drugs may include mitoxantrone, bleomycin, or cisplatin
  • DNA-based vaccine for malignant melanoma may be used in certain cases after surgical treatment of the tumor in the mouth

Follow-Up Care

Patient Monitoring

  • Depends on type of tumor and the presence or absence of spread of cancer (metastasis)

Preventions and Avoidance

  • Remove or treat any source of irritation to the tissues of the mouth (such as inflammation/infection of the tissues surrounding and supporting the teeth [periodontal disease] or second-hand smoke)

Possible Complications

  • Surgical removal of part of the tongue may result in loss of blood supply to the remaining tongue, with death of tongue tissue
  • Postoperative complications of surgical removal of the lower jaw or mandible (mandibulectomy) include splitting open or bursting along the incision line (known as “wound dehiscence”), difficulty grasping food, tongue hanging out of the mouth, and excessive drooling
  • Surgical removal of the lower jaw or mandible (mandibulectomy) can be performed in cats, but mandibulectomy results in greater complications (such as tongue swelling) than in dogs
  • Within the first few weeks of low-dose radiation therapy, diarrhea, nausea, vomiting, and hair loss may occur (regrowth of hair is usually white); high-dose radiation therapy has these complications as well as superficial loss of tissue on the surface of the lining of the mouth, frequently with inflammation (known as “oral ulceration”) and/or death of tissues in the mouth (known as “oral necrosis”), cataracts (opacities in the normally clear lens), and radiation-induced tumors (mainly in young dogs that underwent radiation therapy)
  • Chemotherapy complications vary depending on the drug used

Expected Course and Prognosis

  • Early diagnosis and treatment offers the best chance for a successful outcome
  • Dogs with inadequate tumor-free surgical margins were 2.5 times more likely to die of the tumor than those with complete surgical removal of the tumor (as demonstrated by microscopic evaluation of tumor margins); some surgical patients need feeding tubes to facilitate nutritional supplementation during the treatment period
  • Dogs with tumors located behind the first premolar tooth had three times greater risk of dying from the disease than those with tumors located in front of the first premolar tooth
  • Malignant melanoma—prognosis improves if the tumor is small and located in the front part of the lower jaw or mandible; treatment of malignant melanoma involves surgical removal of the lower jaw or mandible (mandibulectomy) or the upper jaw or maxilla (maxillectomy)—median survival times average 8 months; combination of surgery, radiation, and chemotherapy (low-dose cisplatin) yielded a median survival of 14 months in one study; pigmentation does not affect the prognosis; this cancer of the mouth is relatively resistant to radiation therapy—one study showed a median survival time of 14 months after radiation only; the problem with melanoma is not local disease management, but spread of the cancer to other body tissues (metastasis)
  • Squamous cell carcinoma in dogs—better long-term prognosis than malignant melanoma or fibrosarcoma in the dog; the prognosis is better if the cancer is located toward the front of the mouth than if it is located toward the back of the mouth in dogs; radiation therapy alone delivers a median survival rate of 15–17 months; in dogs, prognosis for survival following treatment for squamous cell carcinoma of the tongue is poor
  • Squamous cell carcinoma in cats—mean survival time of 2 months; chemotherapy and/or radiation therapy can be used to control the cancer, but not to cure it (known as “palliative treatment”)
  • Fibrosarcoma—surgical removal of the cancer, with at least 2-cm margins, usually results in a 12-month median survival rate; surgical excision in combination with radiation therapy and chemotherapy offers the best prognosis; radiation or chemotherapy alone offered a poorer median survival rate than surgery alone; fibrosarcomas involving the roof of the mouth (palate) carry the poorest prognosis because of the inability to remove them adequately with surgery; radiation therapy can be useful following surgical removal of the mass
  • Osteosarcoma—wide surgical removal is ideal; recurrence can occur and the tumor can spread to other locations in the body (metastasis); radiation therapy can be used following surgery or can be used alone to control the cancer, without curing it (palliative treatment)

Key Points

  • Oral masses are tumors or growths located in the mouth
  • Oral masses may be benign or malignant (that is, cancer)
  • Benign tumors are treatable with long-term success via surgery and sometimes radiation treatment
  • Cancer (malignant tumors) is treated surgically with varying success, depending on tumor type, location, and if the cancer has spread to other tissues of the body (metastasis)
  • Nutritional support is essential with any treatment

Jaw Fractures and Malocclusion

Jaw Fractures – An Overview

  • Fractures of the upper jaw (known as the “maxilla”), the lower jaw (known as the “mandible”), and associated structures are classified as to location, severity (that is, tooth involvement, soft tissue tears, and type of bone fracture), and effects of the chewing muscles (known as “muscles of mastication”) on restoring the bones and teeth to their normal anatomic positions (known as “reduction”)
  • “Occlusion” is the relationship or contact between the biting (known as “incising”) and chewing (known as “masticatory”) surfaces of the upper and lower teeth; “malocclusion” is any deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Signs/Observed Changes in the Pet

  • Vary greatly according to the location, type, extent, cause of the fracture and underlying risk factors resulting in the injury
  • Facial deformity; deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth
  • (malocclusion); fractured teeth or teeth in abnormal positions; bleeding from the mouth or nose; and inability to properly close the mouth may be seen

Causes

  • Injury, trauma, and predisposing factors, such as infections of the mouth and cancer

Risk Factors

  • High-risk environment or temperament
  • Oral infections (such as infection of the gums and supporting tissues of the teeth [known as “periodontal disease”] or infection/inflammation of the bone [known as “osteomyelitis”]); tumors or cancer; and certain metabolic diseases—may result in weaker jaws that are more prone to injury
  • Traumatic injury affecting the jaws or teeth
  • Congenital (present at birth) or hereditary factors resulting in weakened or deformed jaw bone

Treatment

Health Care

  • Determined by the type of fracture, available equipment, supplies, and the veterinarian’s knowledge, experience, and comfort level
  • Treatment selection is based on four major points: (1) reduction of the fracture to restore the bones and teeth (if possible) to their normal anatomic positions and reasonable contact of fracture ends; (2) reestablishment of the natural relationship or contact between the biting (incising) and chewing (masticatory) surfaces of the upper and lower teeth (known as “occlusion”), if possible; (3) stabilization sufficient for proper healing; (4) salvage condition (that is, the fracture cannot be repaired or stabilized sufficiently to allow for proper healing; therefore, treatment is designed to allow the pet to be functional, without restoring the bones and teeth to their normal positions)

Home Care

  • Orthodontic wax—soft, pliable wax sent with owner to periodically cover any potentially irritating wires, which are used in repair of the fractured jaw
  • Oral irrigation/hygiene products—use twice daily for oral hygiene and to reduce bacteria; chlorhexidine solutions help reduce bacteria; zinc and ascorbic acid solutions (Maxi/Guard Gel, Addison Biological) help reduce bacteria and stimulate soft tissue healing

Activity

  • Avoid hard chew items during healing process

Diet

  • Soft food or gruel may be required during healing
  • Nutritional and fluid maintenance required

Surgery

  • Treatment may involve a variety of methods to repair and/or stabilize the fractures; examples include use of a tape muzzle; wiring the jaws (maxilla and mandible) together; use of surgical pins to hold the fractured bone together; use of acrylic or composite splint; wiring around or between teeth; use of bone plates and screws
  • Surgical procedures, such as removal of a portion of the jaw (examples are condylectomy and mandibulectomy), may be necessary for cases in which the fracture cannot be repaired or if massive injury is present—these are generally salvage procedures

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

Pain Management

  • Local anesthesia—nerve blocks to specific areas in the mouth (known as “intraoral local blocks”); regional nerve blocks: mental nerve, mandibular nerve, infraorbital nerve, palatine nerve, and maxillary nerve
  • Injectable pain relievers (analgesics)—butorphanol tartrate (Torbugesic, Pfizer Animal Health); buprenorphine; nalbuphine
  • Transdermal patches for pain relief—fentanyl (Duragesic, Janssen)
  • Oral pain relief medication (analgesics)—carprofen (Rimadyl, Pfizer Animal Health); butorphanol tartrate (Torbugesic); hydrocodone

Antibiotics

  • Broad spectrum based on history, health, and chemical profile

Follow-Up Care

Patient Monitoring

  • Physical examination—recheck 2 weeks after surgical repair
  • X-rays (radiographs)—recheck 4–6 weeks after surgical repair, then every 2 weeks until fracture is healed and/or stabilizing appliance is removed
  • Fracture site may temporarily (1–2 weeks) be more at risk to refracture after the support of the appliance is removed
  • Once the fracture line is stable, compromised teeth may need additional treatment (such as a root canal) or careful extraction
  • If the fracture healing process results in a deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth (malocclusion)—orthodontics, root canal or pulp capping, and/or selective extraction may be required
  • Other considerations—stability of fracture and appliance; oral hygiene; oral intake of food and water; maintenance of weight; appropriate urination and defecation; indications of pain or swelling

Preventions and Avoidance

  • Keep pet in an environment (such as a fenced yard, indoors) to minimize likelihood of trauma (such as being hit by a car)

Possible Complications

  • Deviation in the relationship or contact between the biting and chewing surfaces of the upper and lower teeth (malocclusion)
  • Disease involving the pulp, the tissue inside the hard portion of the tooth (known as “endodontic disease”)
  • Inflammation/infection of the bone (osteomyelitis)
  • Fractured bone does not heal (known as “nonunion” of the bone)
  • A piece of bone that has separated from healthy tissue or does not have blood supply and dies (known as a “sequestrum”)
  • Suture line splits open (known as a “dehiscence”)
  • Nerve defects
  • Facial pain
  • Impaired chewing (mastication)
  • Temporary weight loss
  • Trauma to the soft tissues of the mouth (such as gums, tongue), due to appliance or wires

Expected Course and Prognosis

  • Generally good; however, predisposing factors, initiating force, location, type of fracture, quality of home care, and selection of treatment affect the healing outcome
  • Usually takes 4–12 weeks to achieve bony union (that is, healing of the fracture)

Key Points

  • Fractures of the upper jaw (maxilla), the lower jaw (mandible), and associated structures are classified as to location, severity (that is, tooth involvement, soft tissue tears, and type of bone fracture), and effects of the chewing muscles (muscles of mastication) on restoring the bones and teeth to their normal anatomic positions (reduction)
  • Signs vary greatly according to the location, type, extent, cause of the fracture, and underlying risk factors resulting in the injury
  • Soft food or gruel may be required during healing
  • Avoid hard chew items during healing process

Halitosis or Bad Breath

Bad Breath (Brushing Your Pet’s Teeth) – An Overview

  • Offensive odor coming from the mouth; bad breath (Brushing Your Pet’s Teeth).
  • Both dogs and cats can have bad breath
  • Small breeds and short-nosed, flat-faced breeds (known as “brachycephalic breeds”) are more prone to disease involving the mouth, because their teeth are closer together, and their owners tend to feed softer foods.
  • Older pets are more likely to have bad breath (Brushing Your Pet’s Teeth) than are young pets.

Signs/Observed Changes in the Pet

  • Bad breath or Brushing Your Pet’s Teeth is a sign itself.
  • If due to oral disease, excessive salivation (known as “ptyalism”), with or without blood, may be seen; the pet may paw at the mouth; and lack of appetite (anorexia) may occur.
  • In most cases, no clinical signs other than actual odor are observed.

Causes

  • Disease of the mouth—infection of the gums and supporting tissues of the teeth (known as “periodontal disease”) and/or ulceration of the tissues of the mouth; inflammation of the throat or pharynx (known as “pharyngitis”); inflammation of the tonsils (known as “tonsillitis”); cancer; foreign bodies.
  • Metabolic—diabetes mellitus (“sugar diabetes”), uremia (excess levels of urea and other nitrogenous waste products in the blood).
  • Respiratory—inflammation of the nose or nasal passages (known as “rhinitis”); inflammation of the sinuses (known as “sinusitis”); cancer.
  • Gastrointestinal—enlargement of the esophagus (the tube going from the throat to the stomach; condition known as “megaesophagus”); cancer; foreign body.
  • Dermatologic—infection of the skin folds of the lips (known as “lip-fold pyoderma”)
  • Dietary—eating malodorous or offensive-smelling foodstuffs; eating feces or bowel movement (known as “coprophagy”).
  • Trauma—electric-cord injury, open fractures, caustic agents.
  • Infectious—bacterial, fungal, viral.
  • Autoimmune diseases.
  • Diseases characterized by one or more masses or nodular lesions in the mouth containing a type of white-blood cell, called an eosinophil (known as “eosinophilic granuloma complex”).

Treatment

Dental Care

  • Usually outpatient treatment.
  • Once the specific cause of the bad breath (Brushing Your Pet’s Teeth) is known, direct therapy at correcting the cause; it is possible that multiple causes may be involved (for example, the pet may have infection of the gums and supporting tissues of the teeth [periodontal disease] and have a foreign body or cancer present in the mouth).
  • Dental disease—assessment of the mouth, performed under general anesthesia, with x-rays of the mouth (known as “intraoral radiographs”) and treatment, including cleaning and polishing the teeth and extraction of teeth with greater than 50% loss of supporting tissues (gum and bone) around the teeth (often multiple teeth are extracted when advanced periodontal disease is the cause of the bad breath (Brushing Your Pet’s Teeth).
  • Cancer of the mouth—surgical debulking (removing as much of the tumor as possible) or removal; radiation therapy; other cancer therapies, based on type of cancer.
  • Foreign body—removal of foreign body (may require anesthesia).
  • Dermatologic causes—treatment for infection of the folds of the lips may include antibiotics, antibacterial shampoos, and possible surgery to remove some of the folded tissue.
  • Dietary causes—prevent pet from eating malodorous foodstuffs (for example, keep pet away from garbage); prevent pet from eating bowel movement (for example, block off litter box so dog cannot get to cat feces; clean yard frequently).

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive:

  • Medication is determined by the underlying cause of the bad breath (Brushing Your Pet’s Teeth).
  • Topical treatment with zinc-ascorbate cysteine gel usually reduces bad breath within 30 minutes of application, because of the effect of cysteine on sulfur compounds in the mouth.
  • Antibiotics are not indicated to treat bad breath (Brushing Your Pet’s Teeth); antibiotics are indicated in the treatment of infection of the lip folds and for cases of rhinitis and/or sinusitis, if bacterial infection is involved.
  • Controlling the bacteria that cause infection of the gums and supporting tissues of the teeth (periodontal disease) helps control dental infections and accompanying bad breath; Doxirobe Gel (Pfizer) may be used in dogs with periodontal disease.
  • Weekly application of OraVet (Merial), a plaque prevention gel has been shown to decrease plaque (the thin, “sticky” film that builds up on the teeth; composed of bacteria, white-blood cells, food particles, and components of saliva).
  • The use of oral home-care products that contain metal ions, especially zinc, inhibits odor formation due to the affinity of the metal (zinc) ion to sulfur; zinc complexes with hydrogen sulfide to form insoluble zinc sulfide, decreasing the odor.
  • Zinc ascorbate plus amino acid (Maxi/Guard Oral Cleansing Gel, Addison Biological Laboratory).
  • Chlorhexidine used as a rinse or paste also helps control plaque (the thin, “sticky” film that builds up on the teeth), decreasing eventual odor; many dental home-care products containing chlorhexidine are available commercially.

Follow-Up Care

Patient Monitoring

  • Periodic examinations to monitor results of dental professional and home care

Preventions and Avoidance

  • Varies with underlying cause
  • Daily brushing or friction wipes to remove plaque (the thin, “sticky” film that builds up on the teeth) and control dental disease and odor
  • Prevent pet from eating malodorous foodstuffs (for example, keep pet away from garbage); prevent pet from eating bowel movement (for example, block off litter box so dog cannot get to cat feces; clean yard frequently)

Possible Complications

  • Varies with underlying cause
  • Immature teeth stop developing.

Expected Course and Prognosis

  • Varies with underlying cause

Key Points

  • Bad breath or Brushing Your Pet’s Teeth is a sign; it is an offensive odor coming from the mouth.
  • Bad breath (Brushing Your Pet’s Teeth) generally indicates an unhealthy mouth.
  • Once the specific cause of the bad breath (Brushing Your Pet’s Teeth) is known, direct therapy at correcting the underlying cause.
  • Ensure good oral health by professional and home dental care (such as brushing teeth) to decrease bad breath (Brushing Your Pet’s Teeth).

Brush Your Pet’s Teeth

Brushing Your Pet’s Teeth

Dental care is an important part of your dog and cat’s health care. Pet dental issues are some of the most common problems seen at Tri-County Animal Hospital. Both dogs and cats need routine dental care, and a good dental program will provide comfort and longevity to your pet’s life as well as make them more pleasant to be around.

Dental disease is not just a cause of bad breath, but can lead to heart disease, kidney disease, liver disease and other problems.

We suggest that you start caring for your pets teeth while he or she is a puppy or kitten so that your pet will become accustomed to regular, at home brushing. During your pet’s physical exams, we will give your pet a dental exam and will recommend professional dental cleanings or other dental treatments as needed. We will also offer advice on home dental care and give you options on how to achieve the best results.

At-Home Pet Dental Care

Brushing your pet’s teeth every day will help to reduce or eliminate plaque buildup. Plaque, which is an accumulation of bacteria, will eventually loosen and destroy the tooth and possibly lead to bone loss if left untreated. The infection under the gum line can also spread to the liver, kidneys and heart.

Proper At-Home Pet Dental Care Supplies

    1. Proper Toothbrush

It’s important to spend some time finding the right toothbrush for your dog or cat. You can use a child’s toothbrush, but it is recommended that you buy a special toothbrush for your pet. It will make brushing easier and will be worth the money.

There are some rules for choosing the best brush for your dog or cat:

      • Be sure that the bristles are soft so they don’t damage the pet’s gums.
      • Please choose the right sized brush (just make sure it’s’ not too big or too small for your pet’s mouth).
      • Check that the handle is big enough for you to comfortably get a grip on the toothbrush.
      • Also available, is the “Finger Toothbrush”. This is an Ideal beginner toothbrush to help you and your pet become comfortable with the tooth brushing experience.
      • The staff at Tri-County Animal Hospital will be glad to help you select the best toothbrush for your pet.
    1. Proper Toothpaste

You cannot use human toothpaste on your dog. Rather, use a special high quality toothpaste with ingredients specially formulated for dogs. You need to spend some time choosing your toothpaste too. Cheaper brands might use ingredients that are harmful to your pet, and there are some common ingredients can make your pet sick. Read the labels carefully and check that the toothpaste does not contain salt, detergents or enzymes as these are dangerous for your pet. Feel free to stop by our office and we will be happy to recommend a pet toothpaste that is safe and effective for your pet’s proper dental hygiene.

How to Brush Your Pet’s Teeth

Brushing your pet’ teeth for the first time can be difficult; especially if they are not used to it. This can be avoided by starting when they are puppies or kittens – but if it’s too late for that don’t worry. The key is to be gentle, speak in a soft voice and do not force the pet. The key is to make it an enjoyable experience. Start from the back of the mouth and work your way forward in small circular motions.

If your pet really does not want to allow you to brush his teeth without a fight, you may want to try the finger brush with a beef or chicken flavored toothpaste. Try rubbing his teeth so he gets used to the sensation as well as your fingers in his mouth. Speak encouragingly and softly. After a few patient weeks the pet should allow you to brush his teeth without any hassles.

Start a Dental Routine

You should be brushing your pet’s teeth daily; but if you can’t manage that – once every second day should be fine. It’s important to stay consistent in order to avoid problems.

Please call us to schedule a dental exam with one of our veterinarians for your dog or cat, especially before starting a new dental care regime.

Nail & Nailbed Disorders

Nail & Nailbed Disorders – An Overview

  • Nail and nailbed disorders are a group of abnormalities or diseases that affect the nail or claw and/or the tissues surrounding the nail or claw (that is, the nailbed)
  • “Onycho-” or “onych-” refers to the nail or claw
  • Inflammation of soft tissue around the nail or claw (known as “paronychia”)
  • Fungal infection of the nail or claw (known as “onychomycosis”)
  • Brittle nails or claws that tend to split or break (known as “onychorrhexis”)
  • Sloughing of the nail or claw (known as “onychomadesis”)
  • Deformity of the nail or claw caused by abnormal growth (known as “nail dystrophy” or “onychodystrophy”) that is often the result of a nail or nailbed disorder
  • Softening of the nails (known as “onychomalacia”)

Genetics

  • Certain breeds appear to be more susceptible to nail and nailbed disorders than other breeds, suggesting a possible genetic basis

Signalment/Description of Pet

Species

  • Dogs
  • Cats

Breed Predilections

  • Brittle nails that tend to split or break (onychorrhexis)—dachshund
  • Symmetrical deformity of the nails or claws caused by abnormal growth (nail dystrophy or onychodystrophy) that is related to the autoimmune disease, lupus, or a lupus-like disease (condition known as “symmetrical lupoid onychodystrophy”)—German shepherd dog, rottweiler, possibly giant schnauzer and Doberman pinscher
  • Deformity of the nail or claw caused by abnormal growth (nail dystrophy or onychodystrophy) of unknown cause (condition known as “idiopathic onychodystrophy” [“idiopathic” means unknown])—Siberian husky, dachshund, Rhodesian ridgeback, rottweiler, cocker spaniel
  • Sloughing of the nail or claw of unknown cause (condition known as “idiopathic onychomadesis”)—German shepherd dog, whippet, English springer spaniel

Mean Age and Range

  • Symmetrical deformity of the nails or claws caused by abnormal growth (nail dystrophy or onychodystrophy) that is related to the autoimmune disease, lupus, or a lupus-like disease (symmetrical lupoid onychodystrophy)—3–8 years of age

Signs/Observed Changes in the Pet

  • Licking at the feet and/or nails
  • Lameness
  • Pain
  • Swelling, redness of the skin and tissues (known as “erythema”), and discharge from the nail or the area where the skin and nail or claw come together at the top of the toe (known as the “ungual fold” or “nail fold” or “claw fold”)
  • Deformity or sloughing of one or more nails or claws
  • Discoloration of the nail
  • Bleeding from the nail
  • Loss of one or more nails
  • Being “tender-footed”

Causes

  • Inflammation of soft tissue around the nail or claw (paronychia)
  • Infection or infectious disease—bacteria, fungus (known as “dermatophytosis”), yeast (Candida, Malassezia), demodectic mange mites (condition known as “demodicosis”), leishmaniasis
  • Immune-mediated disease—types include the following: pemphigus, bullous pemphigoid, systemic lupus erythematosus, drug eruption, symmetrical lupoid onychodystrophy
  • Tumor or cancer—types include the following: squamous cell carcinoma, melanoma, eccrine carcinoma, osteosarcoma, subungual keratoacanthoma, inverted squamous papilloma
  • Abnormal communication between an artery and a vein (known as an “arteriovenous fistula”)
  • Fungal infection of the nail or claw (onychomycosis)
  • Dogs—Trichophyton mentagrophytes (usually generalized fungal infection of the skin, involving the nails)
  • Cats—Microsporum canis
  • Brittle nails or claws that tend to split or break (onychorrhexis)
  • Unknown cause (so-called “idiopathic disease”)—especially in dachshunds; involves multiple nails
  • Trauma
  • Infection—fungal infection (dermatophytosis), leishmaniasis
  • Sloughing of the nail or claw (onychomadesis)
  • Infection
  • Immune-mediated disease—types include the following: pemphigus, bullous pemphigoid, systemic lupus erythematosus, drug eruption, symmetrical lupoid onychodystrophy
  • Decreased or inadequate blood flow (known as “vascular insufficiency”)—inflammation of the blood vessels (known as “vasculitis”); clumping together or agglutination of red-blood cells when the temperature of the cells drops below normal body temperature (known as “cold agglutinin disease”), such as exposure of the legs to cold weather
  • Tumor or cancer—types include the following: squamous cell carcinoma, melanoma, eccrine carcinoma, osteosarcoma, subungual keratoacanthoma, inverted squamous papilloma
  • Unknown cause (so-called “idiopathic disease”)
  • Deformity of the nail or claw caused by abnormal growth (nail dystrophy)
  • Condition caused by excessive levels of growth hormone, leading to enlargement of bone and soft-tissues in the body (known as “acromegaly”)
  • Increased levels of thyroid hormone in the cat (known as “feline hyperthyroidism”)
  • Zinc-responsive skin disorder (known as “zinc-responsive dermatosis”)
  • Congenital (present at birth) malformations of the nail or claw

Risk Factors

  • Inflammation of soft tissue around the nail or claw (paronychia) due to infectious causes—decreased ability to develop a normal immune response (known as “immunosuppression”), which may be related to immune-system problem of the body or to the use of medications to decrease the immune response; feline leukemia virus (FeLV) infection; trauma; and diabetes mellitus (sugar diabetes)
  • Sloughing of the nail or claw due to bacterial infection (bacterial onychomadesis)—excessively short nail trimming (into the quick) postulated to increase likelihood of bacterial infection and subsequent sloughing of the nail or claw

Treatment

Health Care

  • Inflammation of soft tissue around the nail or claw (paronychia)
  • Surgical removal of the hard part of the nail (known as the “nail plate” or “shell”)
  • Antimicrobial soaks
  • Identify underlying condition and treat specifically
  • Fungal infection of the nail or claw (onychomycosis)
  • Antifungal soaks—chlorhexidine, povidone iodine, lime sulfur
  • Surgical removal of the hard part of the nail (nail plate or shell)—may improve response to medication administered by mouth or injection (known as “systemic medication”)
  • Amputation of the third bone of the toe (known as the “third phalanx”), which is continued by the nail or claw
  • Brittle nails or claws that tend to split or break (onychorrhexis
  • Repair with fingernail glue (type used to attach false nails in humans), as performed or directed by your pet’s veterinarian
  • Remove splintered pieces
  • Amputation of the third bone of the toe (third phalanx), which is continued by the nail or claw
  • Treat underlying cause
  • Sloughing of the nail or claw (onychomadesis)
  • Antimicrobial soaks
  • Treat underlying cause
  • Deformity of the nail or claw caused by abnormal growth (nail dystrophy or onychodystrophy)
  • Treat underlying cause
  • Tumor or cancer
  • Determined by biologic behavior of specific tumor
  • Surgical removal of the tumor
  • Amputation of toe
  • Amputation of leg
  • Chemotherapy
  • Radiation therapy

Medications

Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive

  • Bacterial infection/inflammation of soft tissue around the nail or claw (paronychia)—antibiotics based on bacterial culture and sensitivity, administered by mouth or injection (systemic antibiotics)
  • Yeast (Candida or Malassezia) infection/inflammation of soft tissue around the nail or claw (yeast paronychia)—ketoconazole administered by mouth (systemic treatment); nystatin or miconazole applied to the affected area directly (topical treatment)
  • Fungal infection of the nail or claw (onychomycosis)—griseofulvin or ketoconazole administered by mouth (systemic treatment) for 6–12 months until negative fungal cultures; itraconazole administered by mouth for 3 weeks and then as directed by your pet’s veterinarian
  • Sloughing of the nail or claw (onychomadesis)—depends on cause; medication to decrease the immune response (known as “immunosuppressive therapy”) for immune-mediated diseases
  • Other medications include cyclosporine, tetracycline with niacinamide, pentoxifylline, vitamin E, essential fatty acid supplementations, and chemotherapeutic agents (such as azathioprine, chlorambucil)

Follow-Up Care

Patient Monitoring

  • Determined by underlying cause

Preventions and Avoidance

  • Determined by underlying cause

Possible Complications

  • Determined by underlying cause

Expected Course and Prognosis

  • Bacterial infection/inflammation of soft tissue around the nail or claw (paronychia) or fungal and yeast infection of the nail or claw (onychomycosis)—treatment may be prolonged and response may be influenced by underlying factors Fungal infection of the nail or claw (onychomycosis) and brittle nails or claws that tend to split or break (onychorrhexis)—may require amputation of the third bone of the toe (third phalanx), which is continued by the nail or claw, in order to get resolution
  • Deformity of the nail or claw caused by abnormal growth (nail dystrophy or onychodystrophy)—prognosis is good when underlying cause can be effectively treated
  • Sloughing of the nail or claw (onychomadesis)—prognosis determined by underlying cause; immune-mediated diseases and blood vessel/blood flow (vascular) problems carry a more guarded prognosis than do trauma or infectious causes
  • Tumor or cancer—removed surgically by amputation of the toe; some are highly malignant and may have already spread (known as “metastasis”) by the time of diagnosis

Key Points

  • Nail and nailbed disorders are a group of abnormalities or diseases that affect the nail or claw and/or the tissues surrounding the nail or claw (that is, the nailbed)