How Do You Treat Stage 4 Periodontal Disease In Dogs?

What is Stage 4 Periodontal Disease?

Stage 4 periodontal disease is the most severe and advanced stage of gum disease in dogs, characterized by extensive damage to the gums, bones, and connective tissue that support the teeth (Source). By stage 4, there is pronounced infection and inflammation of the gums, receding gumlines, gingival pockets deeper than 5mm, and severe bone loss with 50% or more loss of the bone around the teeth (Source).

The main symptoms and signs of stage 4 periodontal disease include:

  • Visibly inflamed and infected gums
  • Excessive drooling
  • Bad breath
  • Loose and moving teeth
  • Missing teeth
  • Pus around the teeth
  • Difficulty eating or chewing
  • Bone loss visible on dental x-rays

Stage 4 periodontal disease progresses from the earlier stages (stage 1, 2, and 3) of gum disease. In the earlier stages, the infection affects primarily the gums and soft tissue around the teeth. As periodontal disease worsens over time without treatment, the inflammation and infection spreads deeper below the gumline, destroying the bone and connective tissue that anchor the teeth (Source). This advanced destruction characterizes stage 4 disease.

Risk Factors

Certain factors can increase a dog’s risk of developing stage 4 periodontal disease:

  • Age – Older dogs are more likely to have periodontal disease. Accumulated tartar, progressive recession of the gums, and root exposure occur over time.
  • Breed – Small breeds like poodles, Yorkshire terriers, and Maltese are more prone to periodontal disease. Large breeds like German shepherds and golden retrievers also commonly have periodontal problems.
  • Overall Health – Dogs with conditions like diabetes, kidney disease, or cancer are at higher risk. Certain medications can also reduce saliva flow and increase plaque buildup.

Regular dental care throughout a dog’s life is important to reduce periodontal disease risk, especially for predisposed breeds as they age. Still, even with good home care, periodontal disease can progress over time.

Treatment Goals

The main treatment goals for stage 4 periodontal disease in dogs are to:

– Reverse infection

Antibiotics may be prescribed to control active infections. Cleaning the teeth thoroughly and extracting badly damaged teeth helps eliminate sources of infection.
Specialized antimicrobial gels may be placed into infected gum pockets as well. (

– Reduce inflammation

In many cases, anti-inflammatory medications are given for 1-2 weeks after professional dental cleaning and extractions to allow the gums time to heal. Good home care, including brushing and using oral rinses, helps maintain lower levels of bacteria and inflammation long-term. (

– Restore lost bone

Unfortunately, the severe bone loss in stage 4 periodontal disease is irreversible. However, removing infection sources through extraction and cleaning helps prevent further bone loss. In some cases, bone grafting material may be placed in extraction sites to encourage bone regrowth. (

Professional Cleaning

The first step in treating stage 4 periodontal disease is a deep cleaning procedure performed under anesthesia by a veterinarian. This involves:

  • Scaling – scraping off tartar above and below the gumline
  • Polishing – smoothing and shining the teeth surfaces
  • Flushing – irrigation under the gums to remove bacteria and infected material
  • Medications – antibiotics may be given to control infection

According to The American Veterinary Dental College (AVDC), a thorough dental prophylaxis is considered an essential part of therapy for advanced periodontal disease. Anesthesia allows for complete assessment of oral health, removal of plaque and tartar above and below the gumline, and flushing of periodontal pockets that cannot be accessed in a conscious patient (

Tooth Extractions

For dogs with stage 4 periodontal disease, tooth extractions will likely be recommended in order to remove damaged and loose teeth. Veterinarians typically assess each individual tooth and extract any that are no longer viable and cannot be saved. Extractions serve to eliminate any source of infection and reduce the bacterial burden in the dog’s mouth. Canine teeth, incisors, premolars and molars can all become damaged and loose from periodontal disease and may need extraction.

According to Windmill Vet (Windmill Vet, n.d.), “The damage caused by Stage 4/4 periodontal disease is irreversible, but a thorough dental cleaning, extraction of nonviable and/or loose teeth, and an organized homecare plan can still improve quality of life.” Extractions help reduce pain and discomfort for the dog once infected teeth are removed.

Follow-up Care

After initial treatment for stage 4 periodontal disease, follow-up care is crucial to manage the condition and prevent further progression. Re-evaluation appointments allow the veterinarian to monitor healing, screen for any lingering infection, and develop an ongoing dental care plan.

Ongoing professional dental cleanings are typically recommended every 6-12 months depending on the individual case. More frequent cleanings may be needed to keep plaque and tartar under control in severe situations. Cleanings allow complete plaque and tartar removal above and below the gumline as well as polishing of the teeth. This helps reduce bacteria and inflammation.

Antibiotics and anti-inflammatory medications may be prescribed for a period after initial treatment. Antibiotics target any remaining bacterial infection while anti-inflammatories reduce pain and swelling. Typical medications include clindamycin, doxycycline, carprofen, meloxicam or steroids (1).

With diligent at-home and professional care, dogs can go on to live comfortably despite having stage 4 periodontal disease. However, a certain degree of tooth loss and oral pathology is usually permanent.

Home Care

For dogs with Stage 4 periodontal disease, it is essential to provide at-home care in addition to professional veterinary cleanings and treatment. Home care helps reduce further plaque and tartar buildup and prevents the progression of gum disease. Some key components of at-home care include:

Brushing Teeth: Daily tooth brushing is the most effective way to remove plaque and prevent periodontal disease. Use a soft bristle toothbrush and dog-safe toothpaste. Gently brush outer surfaces as well as inner surfaces where plaque tends to accumulate. Make it a positive experience with praise and rewards. It may take time for a dog to get used to brushing.

Dental Rinses: Rinsing with an antimicrobial dental rinse can reach areas brushing may miss. Use a product approved for dogs and follow instructions. Do not rinse right after eating or drinking. Rinsing can reduce bacteria and freshen breath.

Dental Treats/Food: Look for vet-approved dental treats and foods designed to scrub plaque and tartar as your dog chews. These also freshen breath. Take care not to overfeed as these function as treats. Check with your vet on specific product recommendations.


The prognosis for a dog with Stage 4 periodontal disease is generally good if treated properly, but ongoing dental care will be needed.1 While the damage caused in Stage 4 cannot be reversed, with professional veterinary treatment the infection can be resolved and further deterioration can be prevented. This involves a deep cleaning under anesthesia to enable extraction of severely compromised teeth, followed by antibiotics and anti-inflammatories.2

With aggressive treatment, most dogs show significant improvement. However, the disease is likely to recur unless consistent home dental care is provided. Owners will need to regularly brush their dog’s teeth, provide dental chews and treats, and come in for annual cleanings. Staying on top of home care and routine veterinary dental visits is key to managing stage 4 periodontal disease and keeping the dog comfortable long-term.3


The best way to prevent stage 4 periodontal disease in dogs is through regular at-home dental care and professional cleanings.

At home, it is recommended to brush your dog’s teeth daily using a soft brush and dog-safe toothpaste. This helps remove plaque and tartar before it can harden into calculus. Be patient and make it a positive experience. Over time, most dogs will allow daily tooth brushing. There are also some dental diets and dental treats that may help reduce tartar buildup [1].

Your veterinarian should perform a thorough dental examination and teeth cleaning under anesthesia at least once per year. This allows the vet to scale away any tartar below the gumline and polish the teeth. X-rays may be taken to evaluate bone loss. Any damaged or infected teeth can be extracted as needed [2].

With diligent at-home care and professional dental cleanings, many dogs can live long lives even after being diagnosed with stage 4 periodontal disease. However, once significant bone loss occurs, the damage cannot be reversed. That’s why prevention starting at a young age is so important.

When to See a Vet

If you notice any of the following signs in your dog, it’s important to schedule a veterinary dental examination as soon as possible:

  • Red, inflamed or bleeding gums – According to Windmillvet, inflammation and bleeding of the gums indicates infection and deterioration of gum tissue, which requires urgent veterinary attention.
  • Bad breath – Foul breath is a telltale sign of periodontal disease in dogs, as reported by Small Door Veterinary. Halitosis results from bacteria proliferating in the mouth.
  • Loose or lost teeth – Advanced stages of periodontitis lead to loss of tooth attachments, eventual tooth loss, and associated pain according to WellPets. Your vet can assess the damage and recommend appropriate treatment.

Don’t delay when you notice these red flags. Getting prompt veterinary attention provides the best chance of stopping disease progression and saving affected teeth.

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