Dr. Carmichael welcomes dentistry questions from veterinarians and veterinary technicians.
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Q. I have always promoted dental care for my patients from the time they are puppies and kittens. I explain that even with the best care, dental cleaning with sedation will be necessary later in life. If I see tartar build-up on canines or caudal molars only, I still recommend full dental scaling and polishing. The other doctor I work with thinks this is overkill and puts a younger animal at unnecessary anesthetic risk. I hate to think I have been spending clients' money needlessly but would like clarification. I always thought that where there is tartar, there are plaque and bacteria that need to be addressed.
A. Let's start with a few basic assumptions—first, that properly administered general anesthesia carries minimal risks in healthy animals; second, that clients want the best for their pets and will spend money on preventive care to promote a better quality of life; and third, that your practice is equipped with dental radiography. The question then becomes: When is it time to recommend professional dental cleaning for my patients?
Professional dental cleaning is newly recommended terminology that should now be used to describe the scaling (supragingival and subgingival plaque and calculus removal) and polishing of teeth by a trained veterinary healthcare provider with power or hand instrumentation while a patient is anesthetized.
Dr. Daniel T. Carmichael
Dental care for our patients involves assessing for and treating a variety of problems. The most common problem in dogs is periodontal disease, which can be staged for the purpose of diagnosis and treatment. A critical point is when the disease progresses from stage 1 periodontal disease (gingivitis) to stage 2 periodontal disease (periodontitis) because this is when the disease progresses from reversible to irreversible (Figure 1). Our treatment goal is to intervene with prophylactic treatment (administered under general anesthesia) and halt disease progression to the more advanced and irreversible stages of periodontitis.
1. This dog’s maxillary canine tooth shows mild plaque and calculus accumulation near the gingival margin. Erythema and edema of the gingival tissue are also seen in that immediate area. This is stage 1 periodontal disease, and a professional dental cleaning should be recommended to reverse this disease process and prevent progression of gingivitis to more advanced stages of periodontal disease.
You are correct in your assessment that where there is tartar, there are plaque and bacteria. Tartar (or, more properly, dental calculus) is essentially mineralized plaque, and plaque is composed of 70% bacteria. If you are finding dental calculus on oral examination, it is time to recommend professional dental cleaning.
I applaud your promotion of dental care for puppies and kittens—early institution of home care is paramount. (For more information on providing home care for your dental patients, see "Educate your clients about dental home care for their pets" in the May 2007 issue of Veterinary Medicine, available at http://dvm360.com/HomeDentalCare.)