The Perils Of Not Looking Into Your Dog’s Mouth

An earlier version of this article was published in Spring 2016 issue of Norwich News.  

beanie's teethWhat Are the Chances Your Dog Has A Dental Problem?

If you were to guess what percentage of dogs show signs of a periodontal disease at the age of 3, would you say 50%? Wouldn’t that be a scary number? What if I told you it was 80%? Would you rush to look at your dog’s gums and teeth? Well, you should!
80% of dogs show signs of periodontal disease by the age of 3. And that is a number for a
general population of dogs. Small breed dogs are more prone to dental diseases than large dogs, so chances are that unless you brush your terrier’s teeth daily, you have a problem. Without brushing, by the age of 3 your dog’s teeth had 1095 days to form layer after layer of hardened tartar, over thousand layers in total. Dogs are five times more prone to periodontal disease than people, so we tend to overlook this problem.

It works like this. A dog eats, chews, puts various things in his mouth and a large spectrum of bacteria take up permanent residence. When the bacteria adhere to the teeth they form a thin film of plaque. That plaque is then mineralized into a hard tartar. It takes only 24 to 36 hours for soft plaque to become mineralized. That short time frame is why only daily brushing can prevent tartar buildup. Doing it less frequently is better than not doing it at all but you would be allowing layers of tartar to form on the days you don’t brush, and when you did brush, you would be only removing plaque that had most recently formed.

The plaque and tartar cause an inflammatory response (gingivitis) as the bacteria are foreign invaders, after all. That inflammatory response causes the gums to separate from the teeth, away from the bacterial attackers. Unfortunately, the process is a downward spiral. The receding gums allow the bacteria to bury under the gum line, enter the bloodstream, and eventually course through the dog’s body gradually seeding the internal organs with infection. A dog with a periodontal disease may have micro-infections in many of his organs. It’s not about the superficiality of the pearly whites: periodontal disease shortens your dog’s life and affects its quality.

Symptoms of Dental Problems

tartarWhen the periodontal disease is in its early stages, you might not even notice any symptoms. The dog might have occasional “bad breath”, an early sign of a periodontal disease, or not be as enthusiastic about his chew toys. Terriers are especially stoic and can live with considerable pain without giving you clues representative of the degree of their discomfort.

This is why you have to check the inside of your dog’s mouth. The visual symptom of periodontal disease is dark tartar buildup on canines and adjacent teeth, accompanied by reddened gums.

Another telltale sign of your dog living with dental discomfort is reluctance to eat hard food, or learning to swallow kibble without any chewing.

CUPS Disease

In some dogs, periodontal disease might take a form of Chronic Ulcerative Paradental Stomatitis (CUPS), also referred to as idiopathic stomatitis, a condition with its own set of pronounced symptoms.

I believe the condition is more common in my breed, Norwich Terriers, than reported. CUPS in its most typical presentation in dogs involves painful ulcers, therefore there is “ulcerative” word in its name. In Norwich terriers CUPS sometimes does not express itself with ulcers and so semantically a more befitting name for the condition as expressed in our breed is its secondary name: idiopathic stomatitis. However, most veterinary literature and official diagnosis uses the nomenclature CUPS, and so I will follow this canon, even as we understand that some dogs might not necessarily form ulcers. The absence of ulcers probably explains why often Norwich are not diagnosed with CUPS until specifically tested for it, and that they respond to treatment for CUPS even as they have no ulcers.

CUPS is a serious inflammatory response to bacteria in the plaque and tartar. Think severe allergic reaction to plaque. Just like a “regular” periodontal disease, but much, much more serious. The inflammatory response in CUPS puts the entire dog’s mouth on fire. It’s no longer a battle with plaque bacteria. It’s a war! Inflammation is so unrelenting and harsh that it results in ulcers in most dogs, and in painfully inflamed tissue overall in Norwich terriers. The affected dogs experience considerable pain. In serious cases, your dog’s breath might become extremely unpleasant and he might be reluctant to have his mouth examined. He will form tartar very fast, often requiring full dental cleanings every few months.

As the inflammatory condition continues, the pockets between teeth and gums become deeper and there is bone loss under the gum line, but even as the disease rages, most of the damage is not visible to you.

When I hear an owner of a Norwich Terrier tell me that their dog is not an enthusiastic eater of his kibble I always suspect discomfort while eating hard foods. If the dog is 3 years old or older I urge the owners to bring the dog to the vet to get dental x-rays. On numerous occasions, the radiographs revealed bone loss and cracked teeth under the gums. Imagine the pain!

Research of the condition recorded a change from predominantly gram-positive to predominantly gram-negative bacterial flora in the dog’s mouth, which seems to trigger an even stronger inflammatory response in affected dogs. Without intervention, the disease is a constant and deepening misery for your dog.

Diagnosis and treatment of CUPS should be ideally conducted by a board certified veterinary dental specialist. Unfortunately, there are very few of them. In my very populous state of New Jersey at this time there are only two such specialists. To find a specialist in your area visit American Veterinary Dental College at

I learned about CUPS when my own dog was diagnosed a few years ago. She cracked incisors when hunting. Taking dental radiographs was a critical first step in diagnosing her condition. dental xrayThey revealed a splintered tooth and bone loss under the gum line.  Kate is now 13 years old and doing great on the combination of a low dose of antibiotics every other day and probiotics on the days without an antibiotic. The treatment seems to be keeping the gram-negative bacteria in check. Kate had all her incisors removed but her remaining teeth have never looked better. She is free of discomfort and still able to catch rodents!

Prevention of Tartar Buildup

I know you will hear about additives to water, gum sprays, miracle dental chews that are supposed to stave off dental disease. By all means, try them all, but please do not consider them to be a substitute to daily brushing.


Good news is that a vaccine preventing the colonization of bacteria implicated in periodontal disease is on the horizon. The Norwich Terrier Club of America has been one of the sponsors of research conducted at University of Glasgow by Dr. Marcello Pasquale Riggio, PhD: Defining the Specific Species of Bacteria That Contribute To Canine Periodontal Disease. We are awaiting the publishing of the results. The study was a first step towards developing a vaccine immunizing dogs against organism implicated in periodontitis.

A Word About Scaling Teeth And Ultrasound Toothbrushes

Many dog owners scale their dog’s teeth. Unfortunately, you may be doing more harm than good. Even as you remove the hardened tartar, and the teeth look better, you are not preventing periodontal disease and you may be even making the problem worse. How? Scaling teeth leaves microscopic scratches. Without polishing after scaling, those scratches become a perfect spot for the food and debris to build up. According to American Veterinary Dental College only cleaning under the general anesthesia allows both for the tartar to be removed, even under the gums, and teeth polished.

Last summer I found out about an ultrasound tooth brushing system that supposedly can also safely detach plaque. It is popular in Europe. On a recommendation of a breeder friend from Europe and another breeder who happens to also be a veterinarian, I gave it a try. The system I purchased is made by Emmi-pet. I have only been using it for a few months but I do see results. A tiny pocket of plaque that was forming on one of my dog’s teeth is gone. An ultrasound toothbrush’s head does not move at all . Unlike a traditional toothbrush, or sonic toothbrushes that work by creating mechanical abrasion, an ultrasound toothbrush creates nano bubbles within a specially formulated toothpaste. The manufacturer claims that “it cleans even deep inside fissures and gum pockets”. The system is pricey, but if it continues to work well long term, it will be well worth the investment.


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2 Responses to The Perils Of Not Looking Into Your Dog’s Mouth

  1. Elaine says:

    Hi Magda–This is such a good discussion of Norwich oral health! What did you finally conclude about the Emi-pet ultrasonic toothbrush? Did your dogs accept it and did you think that it made a difference? Thank you for all your words of wisdom on the care and nurturing of our wonderful breed over the years. Elaine


    • dignpop says:

      Mixed success. I found a huge improvement in some of my dogs and not that much of an improvement in others. I still use mechanical toothbrush alongside ultrasonic one.


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