Brook A. Niemiec
DVM, DAVDC, DEVDC, FAVD
Dr. Niemiec is chief of staff of Veterinary Dental Specialties & Oral Surgery, with 14 offices throughout the United States. He is a regular speaker on local, national, and international levels and was elected Clinical Instructor of the Year for the 2016 Western Veterinary Conference. He has authored many articles, chapters, and books and founded the veterinary dental telemedicine website vetdentalrad.com. Finally, he coordinates the San Diego Vet Dental Training Center, with 3 to 4 meetings per year covering basic and intermediate veterinary dentistry.Read Articles Written by Brook A. Niemiec
In honor of National Pet Dental Health Month (February 2013), Dr. Niemiec discusses the top 8 myths that practitioners and pet owners may believe about pet dental disease.
Myth 1: 80% of dogs and 70% of cats have some form of periodontal disease.
As shocking as these numbers are, they underestimate the true incidence of disease. This is because the study that determined these percentages was based on diagnosis of gingivitis via color change of the gingiva. While erythema of the gingiva is a reliable sign, progressive periodontal disease can occur in the absence of any visual cues, including inflammation. It is now known that increased gingival bleeding on probing occurs prior to visual inflammation (Figure 1).1,2 A current and ongoing study places the incidence at close to 90% at 1 year of age.
Myth 2: Level of calculus is an accurate indicator of level of infection.
Although periodontal disease is typically associated with calculus, it is primarily elicited by plaque and is often seen in the absence of calculus.3,4 Conversely, widespread supragingival calculus may be present with little to no periodontal disease (Figure 2). It is critical to remember that calculus acts as an irritant, but is essentially nonpathogenic. Therefore, the degree of gingival inflammation should be used to judge the need for professional therapy. However, even the degree of gingival inflammation is inadequate for diagnosis, as it often underestimates the severity of periodontal disease (Figure 3).
Myth 3: Dry dog food is good for a dog’s teeth.
Dry dog foods may decrease the amount of calculus on the teeth, but are minimally effective against periodontal disease.5 In addition, there are a plethora of products available which tout efficacy for treating periodontal disease, but the vast majority have NO research to back up their claims.6 The best way to confirm efficacy of a product is to look for the Veterinary Oral Health Council seal of approval. Products with this seal have been evaluated by qualified veterinary dentists and found to be effective. For a list of VOHC-approved products, visit VOHC.org.
Myth 4: Bad breath is normal in dogs.
This is such a common misconception that 1/3 of pet parents (28 million owners) believe it to be true.7 Bad breath is a sure sign of significant oral infection and, while there are other causes, periodontal disease is by far the number 1 cause of halitosis.8-10 Halitosis is caused by anaerobic bacteria digesting certain amino acids. While gingivitis alone can create some halitosis, significant periodontal infection is almost always present in patients with halitosis.11
Myth 5: Only loose teeth need to be extracted.
Actually, any teeth with pockets greater than 6 mm, furcation levels of 2 or 3, or are otherwise diseased CANNOT be effectively treated with closed root planing.12-16 For the infection to be fully removed, these teeth need to be treated with periodontal flap surgery and open root planing or extraction.17
Myth 6: A conscious oral examination is sufficient to diagnose periodontal disease.
While severe oral disease may be diagnosed during an awake examination, the vast majority of patients have hidden periodontal disease. This is due to several factors including:
- The back of the mouth (molars) cannot be examined in most patients.
- The lingual/palatal surfaces cannot be evaluated (Figure 4).
- Dark pigmentation can interfere with the diagnosis of gingival inflammation.
- Small breed dogs are very resistant to conscious oral examinations.
The best way to diagnose periodontal disease is by periodontal probing under general anesthesia. The normal sulcal depth in dogs is 0 to 3 mm, and in cats, 0 to 0.5 mm.18
- A color-coded probe (Niemiec Periodontal Probe, dentalaireproducts.com) has been developed with various depths marked in different colors.
- An additional diagnostic tool (Orastrip QuickCheck Canine, periodx.com) measures the production of thiols, which are produced by periodontal pathogens. A quick swipe of the maxillary gingival margin will reveal visual evidence of periodontal infection beneath the gingiva, improving pet owner compliance with dental recommendations.
Myth 7: Nonanesthetic “cleanings” are safer and cheaper than traditional dental cleanings.
Nothing could be further from the truth. Nonanesthetic dental (NAD) cleaning carries a high risk for iatrogenic damage. The sharp instruments required for a proper cleaning can lacerate delicate gingival tissues if the patient moves, which is repeatedly seen and reported. Jaw fractures and neck injuries have been seen following restraint for NAD cleanings, and the risk for aspiration pneumonia from the lack of intubation is of high concern.
In contrast, well-performed general anesthesia is very safe. When current standards of multimodal anesthesia are performed with appropriate monitoring, rarely are there complications. One study suggested that mortality risk in healthy dogs was 0.05%.19 Since these practices had widely varying anesthetic protocols and monitoring, ideal anesthesia protocols and monitoring should improve this number even further.20
The issue of cost is also a proposed benefit of NAD cleanings over traditional anesthetized cleanings. However, under closer examination, it is generally more expensive than traditional cleaning. In southern California, the initial NAD procedure can run from $75 to $125, with monthly maintenance of $35 to $65. This means that the first year of care can amount to $460 to $840. In contrast, an annual cleaning in a general practice is typically $400 to $600 and, in my specialty practice, averages $700 before radiographs.
Myth 8: My clients will not pay for a dental procedure.
While every clinic has clients who simply will not pursue quality dental care for their pets due to financial constraints, the vast majority of clients want to take optimal care of their pets. Therefore, if they understand the value of dental procedures, they will be much more likely to comply with treatment recommendations. The best way to convince pet parents of the importance of proper dental care is to educate them about its benefits.18
There are numerous sources of client educational tools for the practitioner. There are YouTube videos about periodontal disease that can be viewed by clients at home, in the clinic, or uploaded to a practices’ website. I offer client educational videos at dogbeachvet.com. In addition, for National Pet Dental Health Month, Greenies (greenies.com) is sending out a free Dental Checkup Day kit to help practitioners promote oral health. The kit contains not only a tremendous amount of educational material but also a free box of OraStrip QuickCheck Canine tests. Kits are available at vetresources.greenies.com/order-resources.aspx.
Read Dr. Niemiec’s new book, Veterinary Periodontology (Wiley Blackwell, 2013), now available through several online sources.
- Fiorellini JP, Ishikawa SO, Kim DM. Clinical features of gingivitis. Carranza’s Clinical Periodontology. St. Louis: WB Saunders, 2006, pp 362-372.
- Meitner SW, Zander H, Iker HP, et al. Identification of inflamed gingival surfaces. J Clin Periodontol 1979; 6:93.
- Hinrichs JE. The role of dental calculus and other predisposing factors. Carranza’s Clinical Periodontology. St. Louis: WB Saunders, 2006, pp 170-192.
- Niemiec BA. Periodontal disease. Top Companion Anim Med 2008; 23(2):72-80.
- Harvey CE, Shofer FS, Laster L. Correlation of diet, other chewing activities, and periodontal disease in North American client-owned dogs. J Vet Dent 1996; 13:101-105.
- Niemiec BA. Home plaque control. In Niemiec BA (ed): Veterinary Periodontology. Ames, IA: Wiley Blackwell, 2013, 175-185.
- Information from Greenies website, greenies.com, assessed January 29, 2012.
- Persson S, Claesson R, Carlsson J. The capacity of subgingival microbiotas to produce volatile sulfur compounds in human serum. Oral Microbiol Immunol 1989; 4(3):169-172.
- Yaegaki K, Sanada K. Biochemical and clinical factors influencing oral malodor in periodontal patients. J Periodontol 1992; 63(9):783-789.
- Lee CH, Kho HS, Chung SC, et al. The relationship between volatile sulfur compounds and major halitosis-inducing factors. J Periodontol 2003; 74(1):32-37.
- Niemiec BA. Periodontitis. In Niemiec BA (ed): Veterinary Periodontology. Ames, IA: Wiley Blackwell, 2013, pp 51-68.
- Carranza FA, Takei HH. Phase II periodontal therapy. Carranza’s Clinical Periodontology. St. Louis: WB Saunders, 2006, pp 881-886.
- Perry DA, Schmid MO, Takei HH. Phase I periodontal therapy. Carranza’s Clinical Periodontology. St. Louis: WB Saunders, pp 722-727, 2006
- Caffesse RG, Sweeney PL, Smith BA. Scaling and root planing with and without periodontal flap surgery. J Clin Periodontol 1986; 13(3):205-210.
- Wiggs RB, Lobprise HB. Periodontology. Veterinary Dentistry, Principals and Practice. Philadelphia: Lippincott Raven, 1997, pp 186-231.
- Holmstrom SE, Frost P, Eisner ER. Periodontal therapy and surgery. Veterinary Dental Techniques, 2nd ed. Philadelphia: Saunders, 1998, pp 167-213.
- Niemiec BA. Advacned non-surgical therapy. In Niemiec BA (ed): Veterinary Periodontology. Ames, IA: Wiley Blackwell, 2013, pp 154-169.
- Niemiec BA. The complete dental propylaxis. In Niemiec BA (ed): Veterinary Periodontology. Ames, IA: Wiley Blackwell, 2013, pp 129-153.
- Brodbelt DC, Blissitt KJ, Hammond RA, et al. The risk of death: The confidential enquiry into perioperative small animal fatalities. Vet Anaesth Analg 2008; 35(5):365-373.
- Dyson DH, Maxie MG, Schnurr D. Morbidity and mortality associated with anesthetic management in small animal veterinary practice in Ontario. JAAHA 1998; 34(4):325-335.