Q&A: Manage dental disease to improve overall health

In this dvm360 interview, Heidi Lobprise, DVM, DAVDC, covers decision making for extractions, how to talk to clients about the oral systemic link, feline stomatitis and tooth resorption, and more.

RELATED: How to decide when dental extraction improves senior pet health

Editor’s note: This dvm360 Q&A has been lightly edited and consolidated from a verbal interview to better fit a written format while retaining the substance of the original conversation.

When you see mixed periodontal disease, what tips you toward extraction instead of saving the tooth?

Lobprise: For mid-range periodontal disease with 25% to 50% attachment loss, we decide based on the tooth and the patient. We are less likely to spend time saving a small incisor than a canine or carnassial. If the patient has systemic disease such as heart or kidney problems, the additional anesthetic time to preserve a tooth may not be in the pet’s best interest. Chronic inflammation from a problematic tooth can worsen other conditions, so extraction may make the patient healthier. Client preference and cost also influence the decision.

How often are you combating Dr Google and similar sources in dentistry cases?

Lobprise: Owners often research and bring ideas to the clinic. By the time they reach a specialist, they usually already know there is a problem because their general practitioner has identified it. Education is key. Explain that dental disease is ongoing, often below the gum line, and requires professional care under general anesthesia. Quick cosmetic fixes and nonanesthetic cleanings do not address the true disease.

What can general practitioners do before referring a dental case to a specialist?

Lobprise: Continue client education about the progressive nature of dental disease and why professional care is necessary. Perform appropriate diagnostics when possible and stabilize systemic issues so patients are in the best possible shape for referral. Explain risks and benefits clearly so owners understand the reasons for treatment.

How do you frame the oral-systemic connection for clients?

Lobprise: Emphasize that chronic oral inflammation is likely driving much of the systemic impact we see. Historically we talked about bacteria entering the bloodstream. Now we focus more on how chronic sterile inflammation from dental disease can accelerate aging and affect multiple organs. Explain that treating oral inflammation can reduce that systemic inflammatory burden and improve overall health.

What practical advice do you give for feline stomatitis and tooth resorption?

Lobprise: For severe stomatitis we often recommend full mouth extractions because the inflammation and ulceration severely affect quality of life. Tooth resorption is common and may be painful when the lesion reaches the crown. Management is case dependent and extractions are performed selectively when resorption is causing discomfort.

How do you approach anesthesia and analgesia for senior dental patients?

Lobprise: Senior patients need careful work up and stabilization of comorbidities so they can tolerate general anesthesia. Often dental surgery in seniors addresses chronic inflammation that is harming other organ systems. We balance risk and benefit, and when possible, removing oral inflammation can substantially improve how the patient feels in 2 weeks.

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