Dental Disease Stages



How Does Gum Infection Progress To  Dental Disease?

Dental disease progression in pets depends on multiple factors, diet, home care, and overall health, but mostly your veterinarians dental education and prevention awareness, below is a timeline representing the duration involved for the progression of dental disease, which we know ultimately leads to severe health issues and is potentially life-threatening.

Periodontal Disease Here you see 3 examples of a healthy gum line and how the gums should fit tightly along the tooth. The longer this air tight seal is maintained the longer your preventing bacteria from migrating into the bodies system. 



Periodontal Disease

Healthy mouth of a 6 yr. old Min. Pinscher who has had his teeth cleaned non-surgically, every 3-4 months since he was 2 yrs old. This preventive care has kept his teeth & gums in pristine condition.

Gum disease is a progressive infection of the gums. This infection is most recognized  by the accumulation of  oral plaque biofilm. Although bacterial biofilm is a primary cause of inflammatory periodontal diseases, it is also recognized that the health of the pet’s immune system contributes to the rate of advancement.

Gingivitis, is recognized as red, swollen gums that may bleed when touched.

The  pictures below are examples of Stage 2.  Even though both pictures are considered the same level, you can see that they are very different. The body’s immune system is reacting in different ways to the instability presented by the biofilm. The one on the right is advancing faster than the picture on the left.

Examples of  Gingivitis(redness along the gum line, Plaque(soft gooey slime) & Calculus(hard deposits on tooth surface).
Periodontal Disease

Explanation Of Progressive Decline Of Oral Health

Plaque & Calculus are the supragingival & subgingival (above & below the gum line) buildup on the surfaces of the teeth. 

Calculus levels do not determine the stage of periodontal disease, calculus can be present in a mouth with little to no periodontal disease. 

Dental Stage1

Mild gingivitis is present. Plaque may or may not be visible. Mouth odor may be noticeable. This condition is reversible with routine dental cleaning & home care.

At this stage, this pet’s mouth is beginning to display early symptoms of progression towards dental disease. The goal is to not progress beyond this stage. The gums may have a thin red line of gingivitis and there maybe some visible plaque appearing as a sticky creamy slime that could be wiped or brushed off with daily home care- wiping or brushing, should maintain the mouth in good health. If calculus is present, a routine cleaning is needed to get you and your pet ready for home care. This is the time to talk to your vet about schedule a Routine Dental Cleaning.

Periodontal Disease

Stage1: Strategy >Slight appearance of gingivitis can occur as early as12-18 months of age- Reddening along gumline is barely noticeable. The immune system is attempting to protect the area from plaque bacteria.

This is the beginning stage of dental disease. The protective  gumline seal is unaffected at this level and is manageable. First line of prevention > Your veterinarian brings it to your attention and starts your pet on their recommended dental hygiene protocol to halt the progression Advancement is halted. No permanent damage observed



Dental Stage 2

Periodontal Disease

Stage 2: Warning > Moderate gingivitis as early as 18months-30 months of age- Colonies of plaque bacteria are beginning to establish themselves. Bad breath (halitosis) may be present and more gingivitis is apparent.

  • As bacterium multiplies it also becomes more toxic. Your pet’s immune system is alerted and sends defenses to this area, leaving other vital areas less protected.
  • Your veterinarian strongly suggests a nonsurgical, routine dental hygiene appointment as soon as possible. At this stage there is still no permeant damage to structure of the gumline, taking immediate action will halt the progression. Advancement is halted. No permanent damage observed


stage2 of moderate gingivitis w/ inflamed, swollen gums.

Stage 3: Attack > Periodontitis can occur as early as 3-4 years of age– The gumline has lost its protective seal.  The bacteria have overwhelmed the immune systems attempt to secure the area.

  • Periodontal pockets have formed. Bacteria now have breeding grounds to mature and become stronger. At this stage, significant damage has occurred as gingivitis progresses into periodontitis or better known as dental disease.. The protective seal of the gumline has been breached in multiple areas. You may also notice your pet having bad breath. Subtle changes in your pet’s playfulness may become noticeable. The gums will appear red, swollen, and tender. Tartar buildup on some or all the teeth, particularly the rear molars. Remember,oral bacteria can have adverse effects on the kidneys, heart, and liver. You may also notice changes in your pet’s appetite or eating behavior.


Periodontal Disease This stage 3 is very active and unstable. Sticky plaque & hard calculus, inflammation, edema & mild gum recession.  Most stage 3s can be cared for with routine oral care. But, because of how unstable this mouth is it may not be a candidate for a nonsurgical procedure at this time. We would recommend an oral surgical protocol with x-rays to establish a baseline. Follow up 2-3 month with periodontal therapy cleaning to  maintain the health of the mouth with appropriate follow up care.

Image of Grade 3, Widespread inflammation, heavy periodontal.
This level 3 is very advanced, oral surgery protocol maybe necessary. X-rays and follow up Wellness Care in 3-4 months. Followed with a recommended of frequent periodontal maintenance cleanings, to keep the mouth in a healthy condition.

Stage 4-Advanced Periodontitis

Stage 4: Triage >Advanced Periodontitis (3+years of neglect)- Severe destruction of gum tissue, x-rays will show extensive bone loss and several teeth need extraction. Suttle health issues may start to show up in yearly wellness examine.

  • At this critical stage, the only option is oral surgery to restore the mouth
  • The decision to undergo a major surgery procedure is never made easily. But when veterinarians and pet owners are faced with the consequences of years of neglect, it’s now necessary for the risks in order to acquire the benefits.

There is severe inflammation, gum recession & bleeding, deep pockets, tooth mobility. Oral Surgical procedure is necessary, x-rays will show how severe bone loss requiring multiple extractions. Regular follow-up cleanings & diligent home care will be needed in order to maintain oral stability.

The photos below show extreme levels of dental neglect, stage 4. The  pet’s mouth is a train wreck & needs immediate oral surgery in order to relieve the pain & disease. Post-surgical supportive care, including frequent follow-up cleanings & diligent home care will be needed in order to maintain oral stability.
Image of Grade 4 Example-Advanced Periodontitis, Molar, Heavy plaque formation and gum recession.

How does dental disease progress to this level of neglect, critical Stage 4 severe dental disease?

This took several years and this pet  likely had several medical visits during this time. If your vet preforms a “flip the lip” dental examine and doesn’t suggest a routine dental cleaning, then how much did the veterinary clinics dental protocol contribute to this disease? After all, aren’t veterinarians trained to identify visible dental issues? Isn’t this what the wellness examine is all about, to spot and halt progression?

Is the veterinarian’s current dental protocol out dated? After all it hasn’t been changed in over 60 years. Remember, the old dental protocol is never based on wellness care, it is always based on triage/damage control.


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