The 2019 AAHA Dental Care Guidelines for Dogs and Cats provide a comprehensive supplement to this section of the Senior Care Guidelines.¹⁷ Senior pets may have an increased risk for oral cavity issues, such as periodontal disease and oral neoplasia. They should be assessed with a good oral examination, especially if the patient has trouble prehending or chewing or swallowing food or shows discomfort during the process. The oral cavity and pharynx should be thoroughly examined for the presence of periodontal disease, oral tumors, or dental disease (including broken or resorbing teeth). Examination of the oral cavity should be done at every veterinary visit. Videos taken by the client of unusual eating practices by the pet can help assess the problem.

The incidence of periodontal disease is increased in smaller and older dogs.¹⁸ Tiny and small senior dogs may have significant periodontal bone loss, which may result in pathologic fractures. Small senior pets may have a higher incidence of pathologic fracture in the mandibles, due to increased bone loss and less dense bone. The general systemic health of a senior may also be affected by the presence of a chronic inflammatory process such as periodontitis.¹⁹

Anesthesia is necessary to provide adequate oral and dental care for any canine or feline patient. Because of their advanced age and possible physiologic deficits, senior pets undergoing anesthesia should receive special attention as discussed in the preceding section on anesthesia.

Dental radiographs are recommended to assess the extent and pattern of bone loss and confirm appropriate extractions. Radiographs may uncover unanticipated dental or periodontal disease requiring additional treatment,^20,21 but these procedures may need to be staged to avoid excessive length of procedures and time under anesthesia.

Periodontal disease incidence is lower in cats than in dogs. Senior cats are less likely to develop conditions such as feline chronic gingivostomatitis, more often seen in younger pets, but the presence of tooth resorption can cause discomfort and may require intervention.²²

Oral tumors are more common in older dogs and cats and may be large at the time of diagnosis because of the occult nature of cancer. Early detection is key to better outcomes. Diagnosis of the tumor type will help formulate a treatment plan, which may include, but is not limited to, en bloc excision, aggressive resection, radiation therapy, and adjuvant cytotoxic or immunotherapy. Cats tend to develop oral squamous cell carcinomas that may be located in the gingiva, tongue, or tonsils. Although locally very aggressive, these tumors tend to be slow to metastasize to the lymph nodes or other locations. ²³ Dogs more commonly develop oral melanocytic tumors that behave aggressively locally and show higher rates of distant metastasis.²³

For more advanced or complex oral disease, consider a referral to a board-certified veterinary dentist. If referring a patient with complex disease is not possible, consider staging procedures to minimize anesthetic risk. Often, resolution of oral and dental issues in our senior dogs and cats can greatly improve their QOL, making the risks worth the benefits.