Periodontal Disease

Dr Angus Misan.

Dental or periodontal disease is one of the most common issues we see in cats and dogs, with around 80% of dogs and 30% of cats over the age of 3 years old having some evidence of periodontal disease. There are a number of signs that should alert you to the possibility of your pet having dental disease or other mouth problems. These include smelly breath, red or inflamed gums, tartar and behaviour changes (as dental disease is painful). Pain can also lead to drooling and changes in eating habits. However, some pets will continue to eat and show little signs of pain even with severe dental disease and that is why it is important to check your dog’s teeth regularly by lifting their lips,‘flip the lip’ and looking at all of their teeth.

A few months ago, Milo came in to see the vet for a vaccination and annual check up. After an examination and a chat with his owner about how Milo had been going at home, it was recommended that Milo have dental surgery because his teeth were causing him pain and making it difficult for him to eat. Dental disease wasn’t just affecting Milo’s mouth, bacteria from the mouth can enter the blood stream when the gums become inflamed and this can put your pet’s health at risk and impact their quality of life.

As you can see, Milo’s gums look red, inflamed and swollen, with some noticeable gum recession. There is moderate to severe tartar (calculus) covering many of his teeth. His breath smells and there is infection that has caused damage to the teeth, gums and bone (as can be seen in the dental x rays below). On x-rays there is between 25% to 50% bone loss below the gum line in some areas and it is likely multiple teeth will need extraction. This is Grade 4 out of 4 dental disease.

What was included in Milo’s dental procedure?
A full general anaesthetic: to assess your pet’s teeth properly a full general anaesthetic is needed. This allows the vet time to look at all teeth thoroughly while causing the least stress to your pet. The procedure is usually a day procedure with your pet dropped off between 8-9am and home with you in the afternoon once they have fully recovered. We take the management of your pet’s anaesthetic very seriously and have highly trained staff and protocols to ensure each pet is given the best standard of care including the following:

IV fluids during surgery: which helps to maintain blood pressure, assists in the metabolism of the anaesthetic drugs and aids in a quicker recovery.

Monitoring: before, during and after the anaesthesia your pet will be monitored very closely with similar equipment to that found in human hospitals. This allows continuous monitoring of parameters like heart rate, breathing, oxygen saturation and blood pressure so we can react to any changes quickly and make their anaesthetic and recovery as smooth as possible.

Dental charting and x-rays: once asleep and stable the vet will check every tooth for stability, tartar and any cracks or lesions and chart this on a dental form. X-rays are performed for all patients in categories of Grade 2 to 4 out of 4, as there may be issues below the gum line that are not apparent visually or with probing. (Some of Milo’s x-rays can be seen below).

Removal of damaged teeth: Removal of teeth can sometimes require cutting the teeth (as some teeth have multiple roots) or removing some bone to ensure the tooth is removed fully while causing minimal damage to other teeth or gums. Gums heal very quickly but depending on the size of the wound the vet may also suture the gums to help with quick healing.

Scale and polish of all remaining teeth: an ultrasonic scaler is used to remove the hard calculus and film of bacteria that have built up on the teeth and then each tooth is polished with a tooth paste and rotating polishing head.

Pain management: A scale and polish procedure alone is not usually very painful, but should your pet require extractions these can cause some pain. We take the management of your pet’s pain very seriously and use a multi-stage approach to ensure they are as comfortable as possible at all times. This includes pain medication given prior to the start of anaesthesia, local anaesthesia in the gums during the procedure and pain medication on recovery. If needed tablets or oral liquid may also be given to take at home to give in the days after the procedure.

Pre-anaesthetic blood test: We always offer this blood test to all patients, although it is especially advisable in senior dogs and cats over 7 years of age. This testing helps to assess the overall health of your pet, particularly their kidney function, liver function and hydration status. The information allows an assessment of their health status and guides in developing the safest individual anaesthetic approach for each patient.  Owners are often concerned that the risk of giving their senior pet an anaesthetic may outweigh the need to treat their dental disease. Anaesthetic risk is always a consideration in older patients who may be more likely to have concurrent issues affecting their health but should not necessarily override the need to treat the dental disease. Age itself is not a disease!

It is useful to discuss with your vet the specific issues affecting your pet and how they relate to anaesthetic risk. Your vet can work with you to ensure where possible any conditions are well managed and stable prior to the surgery and make sure we have a plan to deal with any expected risks. Sometimes this may include a prolonged time on IV fluids or medications started prior to surgery.

Dental disease can have a large impact on quality of life and many owners of older pets find that after a dental procedure the behaviour and mood of their old dog significantly improves, as was the case with Milo (see his nice clean teeth)!! It is important to consider their dental disease in perspective of their overall health and how each issue contributes to their quality of life. It is also important to note that dental disease is preventable, not just treatable, which means a combination of proactive cleaning, dental diets and chews, and routine scale and polishing can prevent teeth needing to be extracted in the first place!