How to decide when dental extraction improves senior pet health

Deciding whether to extract or preserve a diseased tooth is a frequent and consequential clinical decision, especially in senior patients. In this dvm360 interview, Heidi Lobprise, DVM, DAVDC, discusses the need to assess tooth strategic value, stage of attachment loss, comorbidities, anesthetic risk, and client goals to help choose the best path for each patient.

Transcript

Heidi Lobprise, DVM, DAVDC: Hi, I'm Heidi Lobprise. I am a veterinarian. I graduated from Texas A&M back in the previous century, and I've been doing dentistry for over 30 years now. As a dental specialist, I've been in practice with Veterinary Dental Specialists, but I've also worked in industry, teaching others about dentistry. I'm back in practice, but semi-retired—a couple days a week. So of course, I really love dental things, but I also love senior care and senior pets, so that's been a big focus of mine as well.

So, in periodontal disease, we do have to make decisions about should we extract it, or is it worth trying to save the tooth? Usually, these are teeth that have mid-range periodontal disease: stage 3, 25% to 50% attachment loss, mainly bone loss too. When we look at that patient, first off, we look at the tooth. We're not going to do a lot to save a less strategic tooth, a small incisor, as compared to a canine tooth or a carnassial tooth. And I also look at the patient. If we have a patient that has any systemic disease—heart disease, kidney issues—where the additional anesthetic time to help preserve that tooth may be risky, sometimes it's better to extract the tooth with chronic inflammation to make that pet healthier with their other conditions. And sometimes it depends on the client. Sometimes they really want to save teeth, but that usually takes more time and more money, and sometimes they elect to do the extractions anyway.

So, in general practice there [are] always concerns. Owners will talk about, “Oh, I've heard about this pet dying under anesthesia,” or “I've heard about the cost,” and they try to think, “Well, I saw this product that can make the teeth miraculously clean.” So, it takes some education that this is an ongoing process with the disease. It might be underneath the gum line. It really takes professional care to make a difference. We can't just clean the teeth without anesthesia, and just giving them a certain chew once a day isn't going to cure all the problems. So, it's an ongoing educational effort.

Especially when there [are] concerns about having care done under general anesthesia, we definitely like to educate [clients] about the impact that dental disease can have on systemic health. We used to talk a lot about when you have dental disease, you have bacteria and that can get into the bloodstream and cause issues with the heart, with the lungs, liver, kidneys, you name it. Now, we think more about how the presence of that chronic inflammation due to the dental disease is actually what's probably driving a lot of the issues we see, because chronic inflammation, when untreated, can actually increase aging and impact almost every body condition. In fact, for chronic inflammation, there's a term called “inflammaging.” This is a chronic, sterile inflammation that impacts both morbidity and mortality of patients and is present in every aging organ system.

I think cats have a way of inventing means to get rid of their teeth. Stomatitis is certainly one of them. It may not be as prevalent as tooth resorption in cats, but it's definitely more severe. When we get these cats that have so much inflammation and ulceration that [it] impacts their quality of life, we usually talk about full-mouth extractions, and that's pretty significant. On the other side, tooth resorptions may be uncomfortable and cause some pain. It may not be to the extent of stomatitis, but we certainly see it in a large segment of the population. In fact, some estimates suggest up to 60% of cats at some point in time will have tooth resorption. If that resorption is just down in the roots, they may not have a lot of problems, but when it gets up into the crown of the tooth, that's when we see the potential discomfort. And that's when we talk about extraction on those, but usually on a select basis.

With the senior dentistry discussion—and even with the group that we had in the room—other than general surgeries when they're younger, when we're doing surgery on a senior patient, it's usually for dental or oral reasons. The thing [about] it is, yes, now we're looking at this individual that might have other diseases, comorbidities, and we're talking general anesthesia. That's where we can have a lot of concern from the owners, so we have to really work these cases up. Look for the issues, stabilize them, get them to where they're steady enough to be able to handle the general anesthesia so we can take care of that dental disease, that oral disease that's causing inflammation, remove that inflammation—potentially help the other areas as well. If we can get rid of inflammation, we want to do it, and we can do that in the oral cavity. So, that's a big plus.

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