Better medicine, better business: Periodontal disease

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Periodontal disease is easy to treat and prevent, but it is among the most common infectious conditions we see in our clinic. While many of our clients equate periodontal disease with dirty teeth or bad breath, we know that this infectious and inflammatory condition can contribute to serious problems including heart disease, diabetes, and immune disorders. There are multiple options for managing periodontal disease, but I will focus on 2 approaches: standard and platinum treatment.

Basic, typical approach

Platinum approach

*The progress examination is up to the veterinarian and can be done by a technician or doctor to review home treatment and evaluate the pet’s dental health if needed.

Basic vs platinum standard of care

The basic approach is straightforward—clean the teeth and hope for the best. In my opinion, unless it is not economically feasible for your clients, preanesthetic evaluations such as examinations, labs, and ECGs are not optional. (When did good health and common sense become optional?) If your patient expires under anesthesia, even with the owner opting out of preanesthesia evaluation, you are still liable for what happens to that patient. Unfortunately, defending your position legally in this scenario is rather challenging.

The basic approach addresses what is seen in the mouth but ignores deeper issues such as pain relief following a dental scaling. Although the teeth are technically cleaned, the disease remains present and has not been adequately treated.

The platinum approach involves much more than cleaning teeth. Following a supra- and subgingival scaling, teeth are polished to smooth microscopic indentations in the enamel to help reduce immediate tartar accumulation. Because a dental procedure is at the very least uncomfortable, when the pet awakens, topical lidocaine gel applied to the gingiva provides relief. OraVet and Clindoral are products that aid in periodontal healing by slowing tartar buildup. If a disease is severe enough to cause more pain, or if extractions are performed, additional analgesia such as nonsteroidal anti-inflammatory drugs, opioids, and local nerve blocks should be administered for patient comfort and safety. Additionally, dental radiographs can reveal deeper pathology that is not obvious during a visual examination of the oral cavity. Choosing the platinum approach or something similar allows proper systemic treatment of the disease.

More practices should treat periodontal disease better than they currently do with the basic approach. If a patient had a serious source of infection or inflammation anywhere else in the body, we would be extremely aggressive in explaining to clients why certain tests and treatments were necessary. I think we hesitate with proactively managing periodontal disease because we underestimate its impact on our patients’ health. I fell into this trap many years ago, wondering why I could not convince pet owners to clean their pets’ teeth. If I believe I am simply cleaning their teeth rather than treating disease, I cannot convince an owner to spend a lot of money just so their cat or dog can have a pretty smile. When I attended a cardiology seminar and heard the speaker say that the most important thing to do for a pet with heart disease is to treat that pet’s periodontal infection, it finally clicked for me.

Once I gained this understanding, I was able to adjust my approach to managing periodontal disease. If you opt for the platinum approach, you must get your team to agree that cleaning teeth helps to end pain and save lives. Market your platinum approach to your clients with handouts, videos, and email newsletters. Replace terms like “teeth cleaning” or “dental” with “periodontal treatment" or "therapy,” thus improving client acceptance. Additionally, start discussing dental health at the first veterinary visit, even for puppies and kittens. Make sure you educate your clients about the seriousness of periodontal disease.

The platinum approach shows that there is more to assisting a sick pet than just hospitalization and fluids. To determine the best treatment approach for your patient, consider the potential nature of the illness, severity/chronicity, age of the pet, and the ability of the owner to afford the treatment.

Finally, the platinum approach includes items that are also incorporated in human hospitalizations. For example, technicians are provided to patients and clients are charged for their services. Pet owners are also charged for medical waste removal. For critical cases, sick pets may require ongoing monitoring (ECG, SpO2, etc).

In addition to fluid therapy, I have found it extremely beneficial to include vitamins, injectable herbs, and other homeopathic remedies to support the immune system, detoxify the pet, and hasten healing and well-being.

As a holistic veterinarian, I rarely use conventional medications indiscriminately. However, there are certain circumstances when antibiotics are needed. Additionally, believing that no pet should die without the benefit of steroids, I often use injectable dexamethasone to enhance recovery and support pets with undiagnosed Addison disease. A daily fee for the doctor exam is included, and a pet’s condition should be assessed daily during hospitalization.

Shawn P. Messonnier, DVM, owns Paws & Claws Animal Hospital and Holistic Pet Center in Plano, Texas, and serves on the dvm360® Editorial Advisory Board. He has written multiple books on marketing as well as holistic veterinary medicine.