Is Stage 4 Periodontal Disease In Dogs Painful?

What is Periodontal Disease in Dogs?

Periodontal disease is a progressive disease of the gums and supporting structures of the teeth caused by the buildup of plaque bacteria. Plaque is a sticky film containing bacteria that forms on the teeth. As plaque accumulates, it hardens into tartar (calculus).

Tartar buildup at the gumline leads to inflammation of the gums, also known as gingivitis. Gingivitis is the earliest stage of periodontal disease. Without treatment, gingivitis can advance to periodontitis, where the infection spreads past the gums and affects the supportive structures of the tooth like the periodontal ligament and alveolar bone. This can eventually lead to tooth loss.

There are 5 stages of periodontal disease progression in dogs:[1]

Stage 1 – Gingivitis: Mild inflammation of the gums with no attachment loss

Stage 2 – Early Periodontitis: Up to 25% attachment loss

Stage 3 – Moderate Periodontitis: 25-50% attachment loss

Stage 4 – Severe Periodontitis: >50% attachment loss

Stage 5 – Advanced Periodontitis: Tooth is loose or missing

Early symptoms of periodontal disease include bad breath (halitosis), red and swollen gums, sensitivity around the teeth, and bleeding when brushing or eating.

Is Periodontal Disease Painful for Dogs?

Periodontal disease can be quite painful for dogs, especially in the advanced stages (3 and 4). However, the pain and discomfort are often not noticeable in the early stages of the disease.

According to veterinarians, dogs have a high pain tolerance and instinctively tend to hide signs of pain and discomfort. This makes early gum disease harder to detect. Even when the gums are inflamed and teeth are loose in stage 2-3 periodontal disease, many dogs show minimal outward signs of pain.

However, as periodontal disease progresses to stage 4 and there is significant bone and tooth loss, the pain becomes much more apparent. According to the Cornell College of Veterinary Medicine, periodontal disease at this stage is quite painful for dogs, even if they do not show obvious outward signs. Advanced periodontal disease can lead to tooth loss, abscesses, infection, and damage to surrounding bone – all of which are very painful conditions for dogs.

While the early stages may not have noticeable discomfort, stage 4 periodontal disease requires professional veterinary treatment and pain management. Catching and treating gum disease early is critical to minimize pain and maintain your dog’s quality of life.

Stage 4 Periodontal Disease

Stage 4 periodontal disease in dogs is characterized by severe bone loss, tooth mobility, and significant oral pain and discomfort. According to Small Door Veterinary, in stage 4, there is pronounced infection and advanced damage in the mouth.

At this stage, more than 50% of the tooth’s attachment has been lost due to destruction of the periodontal ligament. There is severe gingivitis and inflammation, leading to constant discomfort and pain (Source). The teeth become very loose, sometimes just falling out on their own. There can also be pus around the teeth and bad breath.

The bacteria have deeply invaded the tooth sockets and jaw bone, causing irreversible damage. The supporting structures keeping teeth rooted are almost completely destroyed. Dogs with stage 4 disease usually show clear signs of oral pain like reluctance to eat or chew, drooling, and aggression when the mouth is touched (Source).

Without treatment, stage 4 periodontal disease continues worsening. The bacteria spreads to other parts of the body through the bloodstream, potentially causing further health complications. At this advanced stage, treatment requires deep cleaning below the gumline and likely tooth extractions to remove sources of infection and pain.

Signs of Pain in Stage 4

Dogs with stage 4 periodontal disease often show clear signs of pain and discomfort. Some of the most common signs of pain seen in dogs with severe periodontal disease include:

  • Excessive drooling and whining, especially when eating or chewing
  • Difficulty eating hard food or treats
  • Aggression or grumpiness, which may indicate the dog is in chronic pain
  • Lethargy and depression, potentially from the pain and discomfort
  • Avoiding chewing bones, toys, or other objects that would put pressure on the painful teeth and gums

Dogs rely heavily on their mouths to interact with their world, so chronic dental pain can significantly impact their quality of life. Stage 4 periodontal disease causes inflammation, receding gums, and exposure of the tooth roots. This damage stimulates intense pain sensation from the many nerves in the teeth and gums.

Owners may also notice bad breath, red and swollen gums, and even loose or missing teeth in dogs with advanced periodontal disease. All of these symptoms combined can make eating very difficult and painful. Prompt veterinary treatment is imperative to relieve pain and prevent progression to irreversible bone loss around the tooth roots.

Consequences of Severe Periodontal Disease

If stage 4 periodontal disease goes untreated in dogs, it can lead to serious consequences. The most common result is tooth loss, as the infection destroys the tissues supporting the teeth, causing them to loosen and fall out (Hamilton Animal Hospital). Dogs may lose many teeth, which affects their ability to eat and causes them discomfort.

The bacterial infection in the mouth can also spread through the bloodstream, potentially leading to issues in other organs like the kidneys, liver, and heart (VCA Hospitals). Bacteria seed secondary infections as they travel through the body. A study showed 16% of dogs with severe periodontal disease also had kidney disease, while another found endocarditis in 13% of dogs with severe infections (McFadden et al.). So careful monitoring and treatment is essential.

Treatment Options

Treatment for stage 4 periodontal disease in dogs focuses on removing infection and stopping disease progression. The main treatments include:

Professional dental cleaning is crucial for removing plaque and tartar on teeth and below the gumline that harbor harmful bacteria. A veterinarian will scale the teeth under anesthesia to thoroughly clean areas that cannot be reached at home. According to Small Door Veterinary, a full dental cleaning helps remove infection and provides a smooth clean surface on teeth for easier ongoing home care.

Extraction of severely compromised teeth is usually necessary in stage 4 disease. As PetMD explains, the extensive bone loss and infection in stage 4 makes saving affected teeth impossible. Removing infected teeth eliminates sources of bacteria and inflammation and allows healing of surrounding gum tissues.

Medications are often prescribed, including antibiotics to control infection and anti-inflammatory drugs to manage pain. Antibiotics may be given for several weeks following dental extraction and cleaning procedures in stage 4 disease, according to Small Door Veterinary.

Recovery and Outlook

With proper treatment, dogs with stage 4 periodontal disease can recover well. However, the damage caused is irreversible. Dogs that undergo dental extractions will need to adjust to missing teeth. Soft food may be recommended for easier eating. Any remaining teeth will require diligent at-home brushing to prevent further disease progression.

With thorough professional dental cleanings, extractions, and antibiotics, the infection and inflammation can be eliminated ( The gums will heal and become healthier. However, bone loss cannot be reversed. The prognosis is good if proper homecare is maintained to prevent recurrence of infection.

Dogs with multiple extractions can regain excellent quality of life. However, their dental health will require vigilant homecare and regular professional cleanings ( BRUSH TEETH DAILY AND SCHEDULE REGULAR PROFESSIONAL CLEANINGS.

While stage 4 periodontal disease causes irreparable damage, dogs can live comfortably if the disease is brought under control. With treatment and lifestyle adjustments, dogs can regain their normal pep and enjoy chewing their favorite toys and treats.


Preventing periodontal disease in dogs requires diligent oral hygiene and dental care at home as well as regular professional cleanings. Here are some tips for prevention:

Oral Hygiene and Dental Care:

  • Brush your dog’s teeth daily using a toothbrush and dog-safe toothpaste. This helps remove plaque and prevent tartar buildup.
  • Offer dental chews and treats to help scrape away plaque and tartar.
  • Use an antiseptic rinse or gel after brushing to kill bacteria.
  • Schedule annual or biannual professional dental cleanings and exams.

Professional Cleanings:

  • Veterinarians use scalers and polishers to thoroughly clean beneath the gumline and remove tartar from the teeth.
  • X-rays allow vets to evaluate tooth roots for any infections.
  • Regular professional cleanings are key for detecting and treating early stage periodontal disease.

Dental Diet:

  • Feed kibble or treats designed to reduce plaque and tartar buildup.
  • Avoid feeding wet food exclusively, as the starches can stick to teeth.
  • Choose larger kibbles, which scrape teeth better than smaller pieces.

With vigilant at-home care and professional cleanings, periodontal disease can be effectively prevented in most dogs.

When to See a Veterinarian

If your dog is exhibiting signs of dental problems, it’s important to schedule an appointment with your veterinarian right away. Some common signs that indicate your dog may have periodontal disease or other dental issues include: foul breath, bleeding gums, broken teeth, pain or difficulty eating, swelling around the mouth, and discolored teeth.

Your vet will perform a thorough oral exam to check for dental disease. They will look for built-up tartar, gum inflammation, loose or infected teeth, and other issues. The veterinarian may take dental x-rays to evaluate the health of the teeth below the gumline. Based on the exam findings, your vet will recommend appropriate treatment, which may include a professional dental cleaning, tooth extractions, antibiotics, or other care.

Since pets often don’t show obvious signs of dental disease until it has progressed, it’s important to have your dog’s teeth examined by a vet regularly. The American Veterinary Dental College recommends all pets receive annual oral health exams and dental cleanings as needed. Catching dental problems early allows for less invasive treatment and improves your dog’s overall health and quality of life. Don’t wait until you notice bad breath or other issues – be proactive about your dog’s dental care by scheduling regular vet checks.


Here are some frequently asked questions about whether stage 4 periodontal disease is painful for dogs:

Is my dog in pain if they have stage 4 periodontal disease?

Yes, dogs with stage 4 periodontal disease are likely experiencing significant pain. At this advanced stage, there is deep pocketing around the teeth, bone loss, and potential tooth loss. This can expose nerve endings and allow bacteria to penetrate deeper, causing inflammation, infections, and discomfort [1].

What are some signs my dog is in pain from periodontal disease?

Signs of pain from periodontal disease may include irritability, reduced appetite, reluctance to have the mouth handled, loose teeth, bleeding gums, pawing at the mouth, and facial swelling. Bad breath is also common. Dogs may even avoid chewing on one side of their mouth if they have a painful tooth [2].

Will treatment help relieve my dog’s pain?

Yes, treating periodontal disease can significantly relieve pain for dogs. A deep dental cleaning to remove plaque and tartar provides immediate relief. Extracting badly damaged teeth also reduces pain. Ongoing home care and professional dentals can prevent the disease from causing further discomfort.

What is the prognosis for a dog with stage 4 periodontal disease?

With prompt treatment, dogs with stage 4 periodontal disease can make a full recovery and lead comfortable lives. However, the disease can shorten lifespan if left untreated. Catching it early and maintaining dental health are important to prevent pain and other complications.

Scroll to Top