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 http://dvm360.com/HomeDentalCare.)