NSAH Dental Care Guidelines

Dental care is a necessary part of providing superior health care and a better quality of life to our patients. Disease of the oral cavity can be painful and contribute to or cause disease in other organ systems. In our senior patients who might have underlying disease, good oral care is even more important to avoid exacerbating disease already present. The purpose of these guidelines, adopted from the American Animal Hospital Association (AAHA) and the American Veterinary Dental College (AVDC) is to insure that our patients receive excellent care that will enhance their quality of life. Early recognition, intervention, diagnosis and treatment are key.

1. Patients less than 8 years of age should have an oral exam annually as part of their wellness examinations. Patients who have a history of periodontal disease or a toy breed dog (e.g. Chihuahua, poodle, shih tzu, yorkie, etc.) should have oral exams twice per year.
2. Patient’s older than 8 years of age should have oral exams twice yearly during their semi-annual exams.
3. During the examination Dr. Sosnow will discuss his observations and determine an appropriate treatment plan to meet your patients’ needs. A variety of home care options are available to minimize the severity or slow the progression of periodontal disease. In-hospital dental prophylaxis and referral to a veterinary dental specialist are also readily available to treat patients with more advanced periodontal disease.

Definitions pertaining to Dental Guidelines

(Adopted from the AAHA Dental Care Guidelines for Dogs and Cats, JAAHA 2005;4:277-283)
Dental prophylaxis: A procedure that includes oral hygiene care, as well as techniques to prevent disease and to remove plaque and calculus from the teeth above and beneath the gumline before periodontitis has occurred.

Gingivitis: Inflammation of the gingiva without loss of the supporting structure(s) that may or may not be visible to the eye.

Periodontal disease: The disease process that begins with gingivitis and progresses to periodontitis when left untreated.

Periodontitis: A destructive process involving the loss of supportive structures of the teeth, including the periodontium, gingival, periodontal ligament, cementum, and/or alveolus.

Periodontal therapy: The treatment of the tooth-supporting structures where periodontal disease exists; the nonsurgical removal of plaque, calculus, and debris in pockets, and the local application of antimicrobials.

Pocket: A pathological space between supporting structures and the tooth, extending apically from the normal site of the gingival epithelial attachment.

Classification of Periodontal Disease

Periodontal (PD) disease is classified using a scoring system from 0 to 4. A patient’s score along with the presence of halitosis and/or underlying systemic disease is used to determine the most appropriate treatment plan.

PD 0/4: Healthy gingiva, no significant deposit of plaque or tartar.

PD 1/4: Gingivitis -Redness of the gingival is present with no loss of attachment between the gumline and tooth; mild tartar or discoloration of enamel may be present.

PD 2/4: Early Periodontitis - Inflammation and edema of the gumline, ≤ 25% loss of bone and gingival support (determined with radiography and probing of the gingiva), moderate tarter, +/- plaque deposits present.

PD 3/4: Moderate Periodontitis -Moderate loss of attachment and/or moderate pocket formation with between 25-50% loss of the support structures. Furcation exposure and movement of the tooth may be possible. Gingiva will bleed with dental probing. Moderate to severe plaque and tartar deposits present.

PD 4/4: Advanced Periodontitis -Breakdown of support structures of teeth, with ≥50% loss of support, deep pockets and recession of gingival. Severe plaque and tartar, severe halitosis also present.

Essential Steps for Dental Cleaning

(Adopted from the AAHA Dental Care Guidelines for Dogs and Cats, JAAHA 2005;4:277-283)
The essential steps for a dental cleaning and treatment of periodontal disease are as follows:

1. Perform an oral evaluation.
2. Radiograph the entire mouth using intraoral or digital radiographic systems. Take oral survey films at the initial examination and periodically thereafter. Take specific or localized radiographs when oral pathology is discovered. Radiographs are necessary for accurate evaluation and diagnosis. In one published report, intraoral radiographs revealed clinically important pathology in 27.8% of dogs and 41.7% of cats when no abnormal findings were noted on the initial examination. In patients with abnormal findings, radiography revealed additional pathology in 50% of dogs and 53.9% of cats.
3. Scale the teeth using a hand scaler or powered device.
4. Polish the teeth using a low-speed hand piece with prophy paste that is measured and loaded on a prophy cup for each patient, to avoid cross contamination.
5. Perform subgingival irrigation to remove debris and polishing paste and to inspect the crown and subgingival areas.
6. Apply anti-plaque substances, such as fluoride and/or sealants.

Additional Steps for Periodontal Disease and Other Conditions

1. Evaluate for abnormal periodontal pocket depths using a periodontal probe. The depth that is considered abnormal varies among teeth and with the size of the dog or cat.
2. Perform periodontal therapy as determined by radiographs and probing.
3. Administer perioperative antibiotics when indicated, either parenterally or locally.
4. Perform periodontal surgery to remove deep debris, eliminate pockets, and/or extract teeth.
5. Biopsy all abnormal masses (visualized grossly or on radiographs) and submit samples for histopathology.
6. Take postoperative radiographs to evaluate the treatment applied.
7. Recommend to the client that the pet be referred to a specialist when the practitioner does not have the skills, knowledge, equipment, or facilities to perform a given procedure or treatment.

Recommended Dental Products for Patients with Periodontal Disease