AVDS Case of the Month

                                                                                                                                                                                  

Figure 1

History and Question:

The above patient (Figure 1) is presented for a routine physical exam and immunizations.  The patient is a four year old Jack Russell Terrier.   

The owner reports the dog is eating well with no change in behavior.   The crowns of the teeth are minimally covered with calculus and

surrounded by healthy looking gums.  What stage of periodontal disease is present?

Answer to Case of the Month:

If you answered stage I-IV periodontal disease you would be guessing.  The answer cannot be determined with the information provided.        

The point to be made is that periodontal disease absolutely cannot be properly or fully appreciated in a conscious dog or cat because the

problem is located below the gingiva, out of sight. As an example, in the photo of a four-year-old Jack Russell Terrier, there is at

least one tooth with end-stage periodontal disease that required extraction. That is despite the fact that

all the teeth in the photo appear to have minimal calculus accumulation and the gingival tissue in the photo all looks healthy and normal.

In the radiograph below (Figure 2) we see the left maxillary fourth premolar (208). The linear density is a soft, rubber probe

(gutta percha point) placed into the periodontal pocket around the mesio-palatal root of this tooth (208). The probe extends about 85% of the length

of the palatal root and so we have about 85% attachment loss. That is well beyond end-stage periodontal disease (Stage IV) There is also

almost total bone loss around the left maxillary second molar to the far right (210).

Figure 2

The vast majority of periodontal disease is hidden from view, even in the anesthetized patient. The extent of periodontal disease

can only be determined after probing around every tooth and taking intra-oral dental radiographs. Only after making this detailed

assessment can an appropriate treatment plan be developed and carried out. 

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Case of the Month provided by Dr. Fraser Hale  www.toothvet.ca