We all understand the value of regular dental cleanings for ourselves. As a matter of fact, we generally go every six months regardless of our oral health. In addition, annual physical exams and laboratory exams are recommended for both humans and veterinary patients. This is all a function of current best practice which is “preventative medicine”. This type of care is ubiquitous in all forms of health practice, except veterinary dentistry, where we wait for disease to be present and then we treat it.
In general, patients with mild calculus and gingivitis are not treated because “its not bad enough yet”, and this often extends to moderate disease seen on conscious oral exam. Sadly, due to the commonalty of dental disease in our current canine population, more and more severe disease is considered “normal”. Therefore, our patients are not receiving the care that they need in a timely manner. This, combined with the difficulty in performing and oral exam on an awake patient means that even when they are performed, they are often not accurate.
At Veterinary Dental Specialties and Oral Surgery as well as the majority of veterinary dentists have been promoting annual dental cleanings for years, regardless of the results of the conscious oral exam. The reason for this is twofold. First, in this way we are generally truly preventing periodontal (gum) disease, rather than treating established disease. This leads to less infection and pain for the pet and maintains the maximum number of teeth. However, possibly more important is that we often find painful and/or infections on oral exam and dental radiographs under anesthesia. Treating these conditions will greatly benefit the health and comfort of the patient. This is the subject of this case report.
An eight year old American Eskimo was presented to Veterinary Dental Specialties and Oral Surgery for a professional dental cleaning. The clients were very consistent with home care and there were no clinical signs of dental disease because the outside of the mouth was clean. As a matter of fact, a recent visit to their family vet did not result in a recommendation for a cleaning. However, since it had been three years, a dental cleaning with full mouth exam and radiographs was recommended.
The patient was placed under general anesthesia, and a complete dental exam performed. Externally, the mouth looked fairly heathy with minimal calculus and/or gingivitis (Figure 1). However, periodontal evaluation with a periodontal probe, especially on the palatal side revealed advanced periodontal disease (Figures 2-5). Dental radiographs were exposed which confirmed the periodontal loss as well as revealed advanced tooth resorption and periapical infection (indicating endodontic or root canal disease). All of these findings were evidence of the pain and infection that this pet was suffering.
Numerous teeth were extracted based on these findings. The patient was made far more comfortable and infection free with this procedure. Cases like this is why we recommend annual cleanings regardless of how healthy the mouth looks on conscious exam.