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Dental Disease in
Charlie
Charlie is an 11-year-old male Cavalier King Charles Spaniel. His owner had noticed persistent bad breath but had delayed dental treatment due to concern over his known heart murmur. On examination, Charlie was found to have severe, painful periodontal disease, requiring multiple tooth extractions. Additionally, a grade 5/6 heart murmur was detected, necessitating further investigation before proceeding with anaesthesia.
Given Charlie’s heart condition, a thorough cardiac assessment was performed before his dental procedure to ensure the safest possible approach.
Diagnostic assessment
Chest X-rays revealed an enlarged heart but fortunately showed no signs of fluid accumulation in the lungs, ruling out congestive heart failure.
An In-house echocardiogram performed by a mobile veterinary cardiologist confirmed Grade B2 myxomatous mitral valve disease (MMVD), a degenerative condition affecting the mitral valve and leading to blood backflow and heart enlargement.
Charlie was started on pimobendan, a medication known to improve heart function and delay the progression of MMVD.
Charlie's treatment
With a carefully tailored anaesthetic plan, Charlie was admitted the following week for a COHAT (Complete Oral Health Assessment and Treatment) under general anaesthesia:
Sedative and anaesthetic drugs were carefully selected to minimise the impact on Charlie’s heart function. His intravenous fluid rate was kept low to prevent left-sided congestive heart failure, a known risk in MMVD patients.
In case of intraoperative hypotension, a dobutamine infusion (a drug used to support blood pressure in patients with heart disease) was prepared.
Probing and imaging revealed eight teeth required extraction due to advanced periodontal disease. Local anaesthetic nerve blocks were administered to numb Charlie’s jaw, reducing the need for general anaesthetic agents and improving safety.
The remaining teeth were cleaned and polished to restore oral health.
Charlie’s anaesthesia and procedure were uneventful, and he recovered well.
Successful outcome
At his 7-day check up, Charlie’s owner reported that he was already eating well, much happier, and enjoying a pain-free, odour-free mouth. His heart condition remained stable with his new medication.
Charlie’s case highlights that patients with significant heart disease can safely undergo essential dental procedures with proper assessment and tailored precautions. Addressing his periodontal disease not only improved his comfort and quality of life but also reduced systemic health risks associated with chronic oral infections.