The inflammation in gingivitis and periodontitis does not appear overnight. In most dogs and cats, it begins quietly with plaque buildup and gum inflammation (gingivitis). Plaque is generally clear, slimy, but sticky, and forms a thin film that covers the crowns, extends under the gumline (subgingival plaque), and fills spaces between teeth. An analogy for plaque is the slime layer that forms in the bottom of your pet’s water dish. Simply rinsing the dish with water will not remove the slime layer, but scrubbing with a sponge or mild abrasive cleanser will cause the slime layer to break apart.  The slime in the water dish and the plaque that forms on teeth are both a biofilm. A biofilm is composed of microorganisms, their proteins, carbohydrates, and cellular debris. Similar to the slime layer in the water bowl,  plaque film can be disrupted and removed by toothbrushing. However, if plaque is allowed to accumulate, it hardens into a firmly attached crust called calculus or, in common parlance, “tartar”. Calcium, phosphorus, and other minerals present in saliva saturate the plaque, causing it to mineralize and form calculus. Once calculus forms and adheres to the tooth surfaces, below the gumline (subgingival calculus) and between teeth, it can no longer be removed with a toothbrush. Think about your own teeth. Most humans brush their teeth twice a day, but still go to the dental hygienist every six months for professional cleaning, to remove calculus that typically accumulates on the back surfaces of our lower incisor teeth. Dental calculus is similar to lava rock at the bottom of your barbecue grill. Like a lava rock, calculus is hard but very porous, and those porosities provide an enormous surface area for more plaque to adhere. In a repetitive loop, plaque accumulates, turns to calculus, more plaque accumulates, which then mineralizes into more calculus, and the process continues.

Most humans (but not all :-) will sit in the dental chair and allow the dental hygienist to remove calculus from their teeth with sharp, pointy instruments, and they will sit still with an X-ray sensor in their mouth until the hygienist steps out of the doorway to click the button to take the X-ray. Cats and dogs are terribly frightened if such interventions are forced upon them. They may struggle, get injured by sharp instruments, or they can inhale chunks of calculus chipped away from their teeth. And of course, awake animals will absolutely not sit still with an X-ray sensor in their mouth long enough for an X-ray to be taken. X-ray sensors are expensive, and they don’t hold up well after getting chewed to bits! Therefore, in order for us to safely examine all oral surfaces, clean and polish the teeth, including the subgingival surfaces and between teeth, and perform diagnostic imaging, general anesthesia is required.

At Animal Dental Specialists of Upstate New York, we take anesthesia very seriously, and we employ a multitude of strategies and procedures to make it as safe as possible for our patients. The care we provide each patient is individualized according to the special needs of that individual, particularly since many of our patients are elderly and have other health problems (heart disease, kidney or liver disease, endocrine disease) in addition to their oral disease. We generally treat only two patients a day, so that our entire staff is focused on just one pet at a time. We use small amounts of a few different drugs rather than a large volume of a single drug, to minimize the possibility of an adverse reaction. One licensed veterinary technician's sole responsibility is to monitor the patient throughout the entire procedure, including post-operative recovery. Heart rate, respiratory rate, oxygenation, electrocardiogram, blood pressure, end-tidal CO₂, and body temperature are continuously monitored and recorded. All patients get cold under anesthesia, so keeping them warm is crucial. We use thermal blankets under the patient and a Bair Hugger warming device over the patient’s body. IV fluids are also warmed. Room-temperature fluids are 68^º, but the bodies of dogs and cats are 101º. Room-temperature fluids contribute to hypothermia. We place local anesthetics similar to novocaine, even though the patients are under general anesthesia. The purpose is to make the patient numb where surgery is being performed, which enables us to reduce the level of general anesthesia, adding to safety. Patients are kept with us and monitored for a minimum of two hours post-operatively, to make sure that their anesthetic recovery is smooth and uneventful.

Conclusion

The progression from gingivitis to periodontitis is a reminder that dental disease is progressive and never gets better by itself. What begins as mild gum inflammation can eventually become a more painful and complicated problem. As specialists, veterinarians refer their patients to us for advanced procedures that are not typically performed at general veterinary practices. We provide care for fragile patients with oral disease who also have concurrent health issues that make general anesthesia challenging. Early recognition of oral disease can reduce the chances of more advanced disease that requires specialty care. Although most of our patients are referred by other veterinarians, we also accept patients who have not been specifically referred to our practice. Generally, our referral base includes veterinary hospitals located between Rochester in the west to Albany in the east, and from Watertown in the north to Binghamton in the south.