Q&A: Dentistry insights for all veterinary medicine practitioners

Naomi Hoyer, DVM, DAVDC, an associate professor of dentistry and oral surgery at Colorado State University in Fort Collins, presented dentistry-focused continuing education (CE) sessions and provided instruction for workshops on feline and canine extractions at the 2026 Veterinary Meeting & Expo (VMX) in Orlando, Florida. Her CE topics included oral neoplasia and stomatitis in dogs and cats. Hoyer also copresented a CE session, “Mastering Dental Radiographic Interpretation,” with Benita Altier, LVT, VTS (Dentistry), CEO of Pawsitive Dental Education.

In an interview with dvm360 at VMX, Hoyer discussed how to distinguish the neoplasia from other oral diseases, provided recommendations for stomatitis care in companion animals, and explained the importance of taking multiple dental radiographs to determine which tooth is causing a problem.

The interview questions and answers are as follows:

dvm360: Why is it important to view multiple radiographic images in veterinary dentistry?

Naomi Hoyer, DVM, DAVDC: Full mouth radiographs really are the best way to evaluate a patient's dental health because most of our dog and cat patients cannot tell us, “This is where the pain is.” Having a complete set of dental radiographs is really critical when we're evaluating pain. Sometimes you'll hear people advocating…just to take an x-ray of the tooth you're concerned about. The problem is [that] sometimes the tooth looks totally normal on the outside. We can't tell until we look at the tooth on the inside that there was even a problem.

There's so much anatomy that we see on the dental radiograph: mental foramina, for example, the little holes in the mandibles where the blood vessels come out of the sinuses, the nasal cavity, mandibular canal. All of those things are going to show up on your dental radiographs, and it's important to note what those look like so you know not to overinterpret those findings.

dvm360: What is a useful strategy for intraoral radiographic interpretation in a case-based format?

Hoyer: I think that the best strategy for interpreting dentistry cases is just to think of every tooth as your patient. So if you're sitting down with a dog that has facial swelling, for example, and you are looking at x-rays and trying to imagine which tooth it is—let's say it's not an obviously broken tooth—that's causing the problem. Look at every single tooth in the x-rays as if they're your patient, and then try to determine which is the one that's most likely associated with these clinical signs.

dvm360: What diagnostic steps should be taken next when an oral tumor is identified?

Hoyer: The first thing I always ask myself when I see an oral tumor in the oral cavity [is]: Is it more likely benign, or is it more likely malignant? You can get a lot of information just by the way a tumor looks. Is it really red and inflamed? Is it moving teeth around? Does it look like it's destroying bone? Is it the same color as the oral tissue? Once you've determined that, [the] next step is getting a biopsy.

Biopsies—whole tissue sample biopsies, not aspirants—are really better in the oral cavity because they're more likely to get us a diagnosis. Once we know what the oral tumor is, then we can really make some custom recommendations for [the] owner. Do we want to consider surgery? Are there alternative options? Should we be having a quality-of-life discussion? But a biopsy is usually where we're going to start.

dvm360: What are common clinical signs of stomatitis?

Hoyer: Often, dogs and cats will actually show up, telling us that they're [in pain]. When I say that, I mean things like bloody drool, difficulty eating, [or] changes in food behavior. So, “I always used to eat dry food, and now I only want to eat canned food,” shying away from having the face touched, [and] sometimes even changes in behavior like development of aggression can all be signs of oral pain. In those situations, I would want to rule out stomatitis.

In cats, one of the most common [clinical signs] is actually decreased grooming. Cats will stop grooming because it hurts to stick their tongue out because of where the inflammation is.

dvm360: How do you distinguish stomatitis from other oral diseases?

Hoyer: Usually, where the inflammation is, [that’s] the best place to distinguish it. So in cats, it's not just the gingiva, so not just the soft tissues that are next to the teeth. We're actually looking in the very far back of the mouth, the hollow muscle folds. And in dogs, for their variety of stomatitis that they get, we're looking at the mucosa, which is the lining on the insides of the cheeks, where that's contacting the teeth. That's actually one of the best places to locate stomatitis. Most people think of only looking at the teeth, but for stomatitis, we want to look at the rest of the mouth, too.

dvm360: What are some current recommendations for stomatitis care?

Hoyer: Well, for cats, unfortunately, our best recommendation initially is still to take the teeth out. We don't really have a great way to manage this condition without removing teeth, so extractions are a very common first step. We also want to provide a lot of pain support, because these are very painful conditions. Then we have a series of medications that we can use in the postoperative period to help keep cats more comfortable. There are standard things like anti-inflammatory doses of steroids. Then there are some new things on the market. If you have a cat where you have taken out all the teeth and it hasn't quite resolved it, maybe consider stem cell use if it's calicivirus positive, [or] maybe we test for calicivirus and think about whether something like molnupiravir would be appropriate. So lots of good things [are] up and coming, but we always have to start with extractions.

For dogs, it's a little bit different. We can do a lot to help keep the teeth plaque free, and that will help the symptoms of stomatitis in dogs.

dvm360: What else would you like other veterinary professionals to know about dentistry practice?

Hoyer: Dentistry, in general—there are so many people who come to me because they graduated from veterinary school. They just don't feel comfortable doing dentistry. They feel intimidated by it. But there are so many great educational opportunities out there that will make it less intimidating, less scary, and more enjoyable. For you, it's the No. 1 most common disease, so as a [general practitioner], you've got to feel comfortable, and there are so many of us who want to help you get there.

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