Scotty is an 11 year old, male, neutered, rat terrier. He was very recently adopted from an elderly lady. Scotty has been generally quiet since adopted. He has seemed to eat normally. He presented for evaluation of his mouth. On examination his mouth seemed generally painful and he had very severe halitosis. Severe tartar, gum recession and loose teeth were noted. He appeared to be in otherwise good body condition and generally healthy. The Dental ATP (Assess, Treatment, Prevention) procedure was scheduled. Pre-anesthetic lab work was normal. He was anesthetized and the mouth was assessed physically and with X-rays. (See the pictures below.)
What is the proper treatment and expected outcome for this mouth?
Answer: Full mouth extraction
The best solution for Scotty's mouth is a full mouth extraction. The teeth are all loose and most have significant gum recession. Teeth like these are very painful. Once periodontal disease reaches this level of severity, it is not possible to save the teeth. Attempting to do so will only result in ongoing pain.
At the start of the procedure most of the teeth were present but severely disease. The majority of teeth were extracted very easily. Even the multi-rooted teeth came out easily, although some were cut with a dental burr to make extraction easier. Several teeth had abscesses at the root tips. It took longer to close the extraction sites than it did to extract the teeth. Closure was actually quite difficult due to the lack of gingival tissue in some places.
Due to the number of teeth extracted and the time it was taking, all but the lower right teeth were extracted during this first procedure. A second procedure was scheduled 2 weeks after the first. The remaining right lower teeth were extracted at that time. (Staged extractions) Scotty was reported to have been a bit quieter for the first 2-3 days after the first procedure but then to have become more active than previously.
At the second procedure the mouth was again carefully evaluated. The extraction sites were healing extremely well. After the second procedure he was again quiet for a couple of days but then became even more active.
Scotty is a good example of how well dogs do after having all their teeth extracted due to severe dental disease. Not only are they more pleasant to be around, they are much more comfortable. This often shows in their level of activity. We feed our pets prepared kibble or canned food. They do not need their teeth to hunt and kill food or to scavenge. They are able to eat just fine without teeth.
Small breed dogs, like Scotty, seem to have a greater risk of dental disease than do larger dogs. We often need to start Dental ATP procedures at a young age to help preserve their teeth and to keep their mouths healthy and comfortable. The loss of a few teeth rarely does more than make them more comfortable. However, the loss of the lower canine teeth can cause the tongue to hang out.