I see it everyday: patients with severe periodontal disease who have reached an age where anesthesia becomes an increased concern. These are patients who have either been having routine cleanings at least yearly to ward off the negative effects of periodontal disease or they are patients who should have had yearly cleanings and didn't. As these pets age they become increasingly susceptible to the effects of periodontal disease and will likely either require multiple cleanings per year or multiple extractions per cleaning. This means that we are looking at either an increase in the number of anesthesia events or the duration of anesthesia events when they occur. While this can be done safely and effectively it is not right for every patient and I would say it's not right for most. The other option is of course to do nothing. Most likely the pet is still eating, playing and acting normally. Sure, they have some bad breath and it's not pretty to look at but what's the real problem?
I see two problems with it.
It hurts and I've adressed the pain topic before: Pain Article
It is an active infection. I've also touched on periodontal disease: Periodontal Disease
So what do we do? Is it better to have your pet endure multiple anesthesia episodes or to allow them to live with active periodontal disease? I'd say we've reached a different point. We've reached the point where it is no longer possible to keep this mouth- and the teeth within it- healthy. We can make the mouth healthy by removing all of the teeth.
I know, your jaw just dropped. ALL of the teeth? All of the teeth. Your pet cat or dog does not need teeth- they do not really guard your house. Guard dog breeds also tend to be breeds that are much more resistant to periodontal disease. Your pet dog or cat does not need to catch and kill its food nor does it need to defend itself from predators. What your pet does need is a mouth that is pain free and not actively infected.
How is my pet going to eat? Better.
I'm not talking about pets that don't have obvious active periodontal disease on physical exam. I am talking about the cat or dog who has had (or should have had) yearly cleanings and still is requiring extractions or is entering an age where anesthesia events are becoming increasingly less attractive options. These pets have infected teeth; eating with infected teeth hurts. Eating with infected teeth also mobilizes bacteria into the blood stream and can lead to systemic infection. Periodontal infections cause metastatic inflammation that exacerbates arthritis, auto-immune diseases and allergic dermatitis. There is no reason to allow this process to continue.
I have four situations in which I would consider full mouth extraction the best possible solution for a pet cat or dog's periodontal disease:
1. Feline stomatitis is an inflammatory condition within the mouth that is really only properly treated by removing all of the tooth material.
2. Patients who have had yearly cleanings but are still requiring extractions at each cleaning and are either entering their golden years or have been left with teeth in a non functional pattern.
3. Patients who are prone to periodontal disease but have recently aquired a condition that puts them at increased risk for anesthesia. Better to have one last big anesthesia even in that case.
4. Patients where I have tried for several years to address the periodontal disease and have been given the chance to make a different in that pet's life. In those cases I am going to push to maximize the good I can do for that pet by removing any chances of it developing periodontal disease ever again.
Here is a case I had just this morning. It was an older dog who has been very prone to periodontal disease. We had removed several teeth at the last visit. She is incredibly stubborn and won't allow brushing at home and at this visit we were going to be left with only 2 viable teeth. The owner and I instead elected complete removal.
Here are the befores:
And the afters.
This dog will never again require another dental treatment nor will she ever again experience the pain associated with periodontal disease.