This article is a good overview of all of the decision-making issues for the referring veterinarian as well as the dental specialist and client faced with periodontal disease in a pet. The author points out that periodontal disease is a multifactorial, mixed infectious disease with a broad range of clinical signs and treatment options. Treatment planning needs to consider the big picture, the owner-animal-environment triad, and to assess how these 3 elements will affect the outcome. It is the owners who must pay for treatment, bring the animal to the clinic, and provide home care. Their relationship to the pet, attitude toward dental care, the perceived problem (e.g., halitosis versus periodontal disease), financial situation, follow-through capabilities, and expectations must be considered when making decisions about treatment.

The patient needs to be considered too-is it likely to be cooperative, will one form of treatment be more suitable than another (e.g., police dogs and show dogs must preserve teeth at all costs), does the patient have any anatomical or medical (e.g., diabetes) conditions that will make one form of treatment preferable to another? The environment includes diet, how many other pets are in the household, and the knowledge and attitude toward dental care of the referring veterinarian.

Accurate diagnosis and evaluation of periodontal disease require intraoral dental radiography, which is often the best method for monitoring success of treatment. A good outcome requires a logical approach based on accurate diagnosis. Cost is a legitimate concern, and the veterinarian and the client must work together to determine the goals, both short and long term-extraction may be preferable to preservation in some circumstances. It must be determined whether a tooth is salvageable, borderline, or cannot be saved. Multiple procedures take longer than extraction and have increased cost; appropriate treatment can be more technically challenging than extraction; the patient may or may not be an appropriate anesthetic risk for prolonged procedures-there are many considerations. The overall treatment goal of eliminating and preventing oral infection and pain should be paramount to any treatment plan for periodontal disease.

The owner-animal-environment triad in the treatment of canine periodontal disease. Hale FA. J VET DENT 20:118-122, 2003.