THE PROBLEM
Periodontal disease (PD) is the disease of the supporting structures of the teeth, including the gingiva, the periodontal ligament that holds the tooth in place, and the bone of the tooth socket. Periodontal disease is degenerative and progressive; once it starts it continues to get worse, often despite treatment.

Little dogs are predisposed to PD, most likely because of their anatomy - their teeth are too big for their heads. As a result, their teeth are crowded together and there is proportionally a large amount of tooth surface area in their small mouths; both of these conditions create the perfect situation for plaque and tartar to build up and PD to occur.

As periodontal disease progresses the teeth become loose, the mouth becomes painful and infected, and the inflammation and infection can have negative effects throughout the dog's body, including contributing to heart disease, kidney disease, and even arthritis.

DIAGNOSIS
Bad breath, pain with handling the mouth, and visualizing the tartar, gingivitis and other changes allow us to diagnose periodontal disease in most little dogs on their awake physical exam. We can never diagnose the extent of the periodontal disease without an anesthetized exam, however. Even with anesthesia, we often have to first clean the teeth and take dental x-rays in order to create a treatment plan.

(Because of the necessity of anesthesia, and sometimes cleaning and x-rays, the estimates we provide before a pet's dental procedure are often inaccurate, and need to be revised following the anesthetized exam.)

THE GOAL OF TREATMENT
When the tooth/teeth in a part of the mouth that is affected by PD are removed, the inflamed, infected gums and other tissues in the area heal and become normal. It is far better for our little patients to have few or no teeth and healthy gums and other oral tissues, than to have teeth in a mouth with severe PD. Our goal with treating periodontal disease is to provide the patient with a healthy mouth, and not to save as many teeth as we can.

THE TREATMENT
A typical dental procedure for a little dog with PD involves general anesthesia, anesthetized exam, extraction of teeth in severely affected areas, and cleaning and polishing. Occasionally oral surgery other than extractions is needed.

Sometimes owners will ask why we don't just "remove all the teeth and get it over with". We do not remove teeth that are only mildly affected because these extractions are much more traumatic than removing teeth in badly diseased areas. Also, removal of the more severely affected surrounding teeth often allows the gums around the mildly affected teeth to heal. In other words, we attempt to balance minimizing the number of procedures a patient has with avoiding seriously traumatic oral surgery.

We repeat this procedure on a schedule individualized for each patient. A typical schedule is once every three to six months until the patient's PD is relatively minimal and stable, or until all the teeth are removed.

For patients in the former condition, a dental cleaning and re-evaluation once yearly is usually indicated.