Tia: Stage 4 Periodontal Disease with a Grade III Heart Murmur
Tia is a sweet Jack Russell Terrier, 13 years and 8 months old. Tia was diagnosed with advanced stage 4 periodontal disease.
Upon Tia’s examination in July 2025, Dr. Rensink addressed her dental health. She presented with heavy calculus, gum recession, inflamed gums, and halitosis. Due to a grade III heart murmur, there were concerns about whether she would be a good candidate for a dental procedure, as anesthesia can pose risks when underlying heart conditions are present.
Dr. Rensink recommended a cardiology workup to determine the best course of action for Tia’s care.
Tia returned one month later to see Dr. Moore for her cardiology evaluation. While at Livermore Family Pet Hospital, she underwent chest radiographs, blood pressure assessment, and comprehensive wellness lab work. The radiographs revealed that Tia’s heart was within normal limits and her lungs were clear. There was no indication of heart failure.
At that time, Dr. Moore and Tia’s owner discussed her severe periodontal disease and the likelihood that she was experiencing significant oral pain. This discomfort was believed to be contributing to her decreased appetite, weight loss, and jaw chattering. It was noted that she might require most or all of her teeth to be extracted. They agreed to wait for the pending lab diagnostics to determine the final treatment plan.
Without dental intervention, Tia would likely continue to experience chronic pain, and there would be an ongoing risk of bacteria spreading from her gums into the bloodstream, potentially causing further damage to her heart and other organs.
The day after her visit, Dr. Moore contacted Tia’s owner with the results of her lab work. Despite some mild abnormalities likely associated with her dental disease, Tia was considered a reasonable candidate for anesthesia, even with her heart murmur. After careful consideration, her owner elected to proceed with the dental procedure with Dr. Moore and the team at Livermore Family Pet Hospital.
Dental Day
One month later, Tia returned for the scheduled dental procedure. During the preoperative assessment, Dr. Moore confirmed that the heart murmur had not progressed. The goal of the procedure was to save 3–4 canines, one upper right molar, and 1–2 incisors, if deemed viable upon sedated examination. However, based on the severity of her periodontal disease, it was anticipated that a near full-mouth extraction would be necessary.
As expected, Dr. Moore identified extensive calculus buildup, gum recession, and grade 3 gingivitis throughout the mouth. Multiple teeth showed root exposure, and most were mobile due to periodontal pocketing and bone loss. In cases of advanced periodontal disease, pockets form between the teeth and gums, which become filled with plaque and debris. As bacteria proliferate, these pockets deepen, leading to further bone and tissue destruction.
Tia’s dental procedure was a success. A total of 30 teeth were extracted, and Dr. Moore and her team were able to preserve eight teeth, including all four canines. Due to the high number of extractions and the significant inflammation caused by advanced periodontal disease, cold laser therapy was administered to help manage pain and promote healing of the gingival tissues. Tia recovered smoothly from anesthesia with no complications.
Recovery
As of October 13th, Tia is doing very well at home. Her appetite, weight and activity level has all improved, as has her quality of life.