You are nearing the end of the ops list, and there is just one procedure to go before lunch – a 10-year-old greyhound with a malodorous mouth and a tooth root abscess. Do you relish the challenge or secretly wish it was your consult day instead?
Dental cases are some of the most common in first opinion practice, yet they can also be among the most challenging. Understanding how to manage these cases effectively can transform them from stressful hurdles into opportunities to make a significant impact on patient welfare.
Periodontal disease: an overlooked epidemic
Periodontal disease is the most commonly diagnosed condition in dogs in primary care, with an overall prevalence of 12.5 percent and a median age of presentation of just over seven years.1 And the prevalence increases significantly with age, with dogs over eight years being three times more likely to be affected than younger dogs.
Despite this, the condition often goes unnoticed by owners. Subtle signs such as dropping food, eating on one side, or reluctance to play are easily dismissed. However, the condition has a significant welfare impact, causing pain and systemic effects that can have a knock-on effect on general health, increasing the risk of conditions including kidney, liver, and heart disease.
What causes periodontal disease?
Periodontal disease arises from a complex interplay between bacterial plaque, an invisible biofilm, and the host’s immune-inflammatory response. Without regular oral care, plaque builds up, triggering inflammation that leads to tissue destruction and attachment loss. As the disease progresses, periodontal pockets form, creating an ideal environment for bacteria to evade the immune system, perpetuating a cycle of inflammation and tissue loss.
Periodontal disease encompasses two conditions:
- Gingivitis: Inflammation of the gingiva caused by plaque and bacterial activity. This is reversible with appropriate care.
- Periodontitis: Destruction of the periodontal ligament and alveolar bone due to the inflammatory response to plaque. Loss of these supporting structures leads to tooth loss. Periodontitis is irreversible but can be managed to slow progression.
Plaque can mineralise to form tartar in as little as 24-48 hours, making early intervention and regular dental care essential.
Top tips for success
- Schedule adequate time and prepare well
- Take dental radiographs
- Use sharp, well-maintained instruments
- Section multi-rooted teeth
- Do surgical extractions when appropriate
- Consider staged procedures
- Prioritise client communication
- Take pre and post op photos
Be prepared
Patients with periodontal disease can be some of the most satisfying to manage… the older pet that has a new lease of life after a dental, or the patient with severe periodontal disease that leaves with a pain-free mouth. But that does not detract from the fact that these cases often come with significant challenges.
Many patients with dental disease will be older, with co-morbidities that may make anaesthesia more challenging. Other patients may have advanced disease and need multiple extractions of multi-rooted teeth. So set yourself up for success…
Successfully managing challenging dental cases requires careful planning, the right equipment, and effective communication. Start by allowing sufficient time for the procedure – dentals are often scheduled as the last task before lunch or at the end of a busy day. While it makes sense to perform clean procedures first, this means that dentals are often squeezed into the end of a busy ops morning. Make sure the whole practice team is on-board – it may not be immediately obvious to non-clinical staff why a ‘routine’ dental may need a longer op slot than a bitch spay, for example. Communication and teamwork are key.
A thorough pre-anaesthetic assessment, including bloodwork where appropriate, will help identify any potential anaesthetic or surgical risks and ensure the patient is prepared. Being equipped with high-quality tools is equally important. A reliable dental unit with both high- and low-speed handpieces, along with sharp, well-maintained instruments, will make the work smoother and more efficient. Incorporating an examination under general anaesthesia with full mouth dental radiography into your practice protocols is also important, as it can reveal up to 18 percent more dental pathology than visual examination alone.2
Technique plays a crucial role in ensuring the procedure is efficient and minimally traumatic. Familiarity with dental anatomy is essential for planning extractions, particularly for multi-rooted teeth that may need sectioning. In many cases, surgical extractions are more time-effective and reduce trauma compared to closed techniques. To manage bleeding effectively, consider using haemostatic agents such as Vetigel.
Finally, clear communication with the client is essential to achieving the best outcomes. Taking photographs during the procedure allows you to visually demonstrate the severity of dental disease and the work undertaken, helping clients understand the value of the treatment. And in cases with extensive disease, staging procedures over more than one session can ensure the best results. When the rationale and benefits for their pet are clearly explained, most owners are not only understanding but also appreciate the care that has been taken in tailoring the treatment to their pet’s needs.
Cornerstone of dental care
Of course, dental care does not stop when the patient leaves the practice. Preventive care is the cornerstone of reducing the incidence of periodontal disease and the need for lengthy dental procedures. Plaque can mineralise into tartar in as little as 24 hours, so regular home dental care is vital.
- Tooth brushing: The gold standard in home oral care, using a pet-safe toothpaste and a soft-bristled brush.
- Dental wipes and oral rinses: Chlorhexidine-based products can help reduce bacterial load and plaque formation.
- Dental chews and toys: These can supplement brushing by mechanically disrupting plaque, though they should be appropriately sized to avoid choking hazards.
- Dental diets: Specially formulated diets, such as Calibra Expert Nutrition Oral Care can help reduce plaque accumulation through texture and active ingredients.
Encourage owners to make dental care part of their daily routine and emphasise the long-term benefits of good oral hygiene. With consistent preventive care, many cases of advanced periodontal disease – and the associated challenges of difficult dentals – can be avoided.
References
- O’Neill, D.G. et al. (2021) Prevalence of commonly diagnosed disorders in UK dogs under primary veterinary care: results and applications. BMC Vet Res 17, 69
- Queck, K.E. et al. (2018) Oral-Fluid Thiol-Detection Test Identifies Underlying Active Periodontal Disease Not Detected by the Visual Awake Examination. J Am Anim Hosp Assoc; 54 (3): 132–137. doi: https://doi.org/10.5326/JAAHA-MS-6607