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?
Dr. Daniel T. Carmichael
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.
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 dvm360.com/HomeDentalCare .)
OTHER FACTORS TO CONSIDER
When deciding when to recommend a professional dental cleaning, many factors need to be considered. Certain dog breeds, especially small breeds (< 33 lb), are more prone to developing periodontitis, Dogs that have been treated for periodontitis in the past usually need more frequent professional cleaning. Anesthesia risk is another consideration, but the percentage of dogs that have significant risk for developing anesthesia complications is quite low, in my experience. Dental care should not be denied to a geriatric patient based solely on age. My No. 1 criterion for recommending professional dental cleaning is the presence of oral inflammation, especially gingivitis.
ANESTHETIZE AND TAKE ACTION WHEN...
Here are some common indications in young animals for recommending a dental procedure under anesthesia:
- Gingivitis—Regardless of the severity of plaque or calculus accumulation, inflammation of the gingival tissues should be treated with a professional dental cleaning.
- Calculus accumulation—Calculus (tartar) tightly adheres to the tooth surface and cannot be removed with brushing. Most important is the subgingival calculus that is not evident on examination of an awake patient.
- Periodontitis—Gingival recession, bone loss, furcation exposure, and loose teeth are all signs of advanced disease. In these cases, there will most likely be more to do than just a professional dental cleaning.
- Halitosis—Bad breath is often a sign of advanced periodontal disease that may not be appreciated on an awake-patient examination.
- Missing teeth—Any missing tooth noted on oral examination should be examined with intraoral dental radiography (performed under anesthesia) to check for the presence of an impacted tooth. This is especially important when the first mandibular premolar tooth is missing in brachycephalic breeds, as impacted teeth in these breeds are commonly associated with the formation of dentigerous cysts.
- Retained deciduous teeth—The rule of thumb is no two teeth of the same kind in the same location. The retained deciduous tooth should be extracted.
- Fractured teeth—Complicated (pulp exposure) and uncomplicated (no pulp exposure) dental fractures should be radiographed and treated accordingly.
- Tooth resorption—This painful dental disease, which is especially common in cats, requires immediate attention. Dental radiography is essential for diagnosis.
- Oral enlargements or tumors—If on an awake examination you identify any areas of oral swelling or enlargement, anesthesia is indicated for closer examination, dental radiography, and biopsy.
Daniel T. Carmichael, DVM, DAVDC
Veterinary Medical Center
75 Sunrise Highway
West Islip, NY 11795