Calculus is a Poor Predictor
If you are a veterinarian in small animal practice, how are you assessing the oral health of your patients during their annual wellness examination? Chances are, you ‘flip the lip’ and have a look in the mouth to see what you can see.
One of the common criteria to be assessed is how much calculus/tartar is visible on the crowns of the teeth. While that is certainly something to be noted, you also need to keep in mind that the amount of calculus on the crowns of the teeth is actually a very poor predictor of periodontal health. In fact, there is almost no relationship between the amount of calculus on the crowns of the teeth and periodontal status. That is because periodontal disease is what is going on below the gum line, not on the crowns.
For more on the hidden nature of periodontal disease, their is this paper – Periodontal Disease is Hidden. I also have a video on this post that describes periodontal anatomy and the progression of disease – Periodontal Anatomy Video
Here are some examples to illustrate what I am getting at. They are by no means rare findings. I see this sort of thing all the time.
First we have a case with lots of coronal calculus but no significant periodontal disease.
One the other hand…
What are the take-aways from this? There are a few that come to mind.
- If you are relying on the amount of coronal calculus visible on conscious examination to determine when a pet is in need of a detailed dental assessment and treatment, you will be missing a lot of cases in need of care. Not only is periodontal disease a hidden problem, the amount of calculus on the crowns has no predictive value for endodontic disease, tooth resorption, cyst formation or a number of other dental/oral pathologies.
- There are lots of products in the market that claim to help control ‘tartar’ (the lay-term for calculus) but since calculus on the crowns of the teeth is not really the problem, how much value would these products have, even if they did what they claim (and most have no research to back their claims, so…)? To look for products that have at least some research to warrant their use, visit www.vohc.org and favour products with a claim from plaque control over ones that just have a claim for tartar control.
- Anesthesia-Free Dentistry, which targets coronal calculus, is going to be worse than useless. It is like putting a fresh coat of paint on rotting window frames. It might look better on the surface but the rot is continuing out of view. For more on AFD, have a look at my page devoted to that subject.