COHAT in a Maltipoo: why it's not just a teeth cleaning

Reason for the visit

The owner came in with a 3-year-old Maltipoo because of bad breath and dark spots on the teeth.

The initial exam showed significant tartar buildup and localized gum inflammation.

At first glance, it could have seemed that the dog simply needed a professional teeth cleaning.

However, visible tartar does not show the condition of the roots, periodontal attachment, or alveolar bone.

That is why a comprehensive dental workup and treatment under the COHAT protocol was recommended, rather than an isolated scaling.

The owner came in because of visible tartar and odor, but it was the comprehensive diagnostics that revealed a pathology that could not be fully assessed during a routine exam.

What the dark spots on the teeth meant

Dark spots on the tooth surface can have different origins.

They may be related to:

• Pigmented tartar deposits
• Discoloration of the tooth surface
• Wear
• Structural defects
• Other dental changes

Appearance alone cannot automatically determine the exact diagnosis.

Dark spots on teeth can have different origins. In this patient, significant tartar buildup was noted on exam, but each tooth's condition was assessed individually during the full procedure.

Why an exam without anesthesia was not enough

A routine exam can assess:

• The visible portion of the tooth crowns
• The condition of accessible gum areas
• Significant tartar deposits
• Obvious fractures
• Pronounced mobility of individual teeth, if the patient allows such an assessment

However, without controlled general anesthesia, it is not possible to fully examine every surface of every tooth, assess the tissue beneath the gumline, perform systematic periodontal probing, obtain quality full-mouth dental radiographs, carry out supra- and subgingival cleaning, or form a final treatment plan.

The initial exam therefore sets the direction for diagnostics, but does not replace a full dental procedure.

What COHAT is

COHAT stands for Comprehensive Oral Health Assessment and Treatment.

It is not a single procedure and not just tartar removal.

In this case, the procedure included:

• An oral examination under controlled general anesthesia
• A per-tooth assessment
• Full-mouth dental radiography
• Periodontal probing
• A tooth mobility assessment
• Professional supra- and subgingival cleaning
• Development of an individualized treatment plan
• Performance of the agreed-upon procedures
• Recording of findings in the dental chart
• Recommendations for further home care

COHAT is a comprehensive assessment and treatment of oral health, not just removal of visible tartar.

Professional cleaning

Hard tartar deposits were removed using an ultrasonic scaler.

Tooth surfaces were cleaned not only above the gumline but also in accessible subgingival areas, where periodontal disease develops.

Any remaining soft plaque was then removed using AirPolishing.

The final step of professional cleaning was polishing the tooth surfaces.

Professional cleaning removed tartar deposits, but on its own could not determine the prognosis of the mobile tooth or restore periodontal tissue already lost.

Why radiographs of all teeth are needed

A significant part of each tooth lies beneath the gumline and inside the alveolar bone.

Full-mouth dental radiography helps assess:

• Tooth roots
• The level of alveolar bone support
• Tissue around the root apices
• Hidden fractures
• Retained roots
• Unerupted teeth
• Resorptive lesions
• Other pathology not visible on routine exam

In this dog, dental radiographs were part of assessing the mobile tooth and its periodontal prognosis.

The periodontitis stage is determined from the combined clinical and radiographic findings, not from radiographs alone.

What periodontal probing is

Periodontal probing is a systematic assessment of the space between the tooth and the gum using a specialized instrument.

During probing, the following are assessed:

• Periodontal pocket depth
• Level of clinical attachment
• Bleeding on probing
• Gingival recession
• The condition of tissue around each tooth
• Furcation involvement in multi-rooted teeth, if present

Probing results are compared with dental radiographs and the mobility assessment.

It is the combination of this data that allows the periodontitis stage to be determined for a specific tooth.

What hidden pathology was found

During the comprehensive assessment, one mobile tooth with stage IV periodontitis was found.

Visible tartar was only the surface-level part of the problem.

Around the affected tooth, a significant amount of the tissue that had held it in the jaw was already lost.

Tooth mobility confirmed that its support was significantly compromised.

This pathology could not be fully assessed based on the amount of tartar alone.

What stage IV periodontitis means

Periodontitis is a disease that destroys the tissues supporting the tooth:

• Periodontal attachment
• Periodontal ligament
• Root cementum
• Alveolar bone

PD4 indicates severe periodontitis with more than 50% loss of periodontal attachment for that specific tooth, or corresponding severe changes in the furcation area of a multi-rooted tooth.

The tooth had lost a significant portion of the tissue that held it in the jaw.

Importantly, the stage is determined separately for each tooth.

In a single patient, different teeth may have healthy periodontium, gingivitis only, or early, moderate, or severe periodontitis.

A single overall assessment of the whole mouth therefore does not replace a dental chart for each individual tooth.

Why the affected tooth was extracted

This tooth had a combination of:

• Stage IV periodontitis
• Significant loss of supporting tissue
• Pathologic mobility
• An unfavorable prognosis for predictable retention

In this situation, keeping the tooth would not have restored the lost attachment and could have continued to cause pain and inflammation.

Based on the combined clinical and radiographic findings, the decision was made to extract the affected tooth.

Why simply removing the tartar and keeping the tooth was not an option

After tartar removal, the tooth crown could have looked cleaner.

But professional cleaning alone could not:

• Restore already-lost bone support
• Rebuild destroyed periodontal attachment
• Eliminate pathologic mobility
• Make the tooth's prognosis favorable
• Remove a source of chronic pain by cleaning only the visible surfaces

This is why COHAT involves not only cleaning but also diagnosis and treatment of pathology found during the procedure.

Dental chart

After assessing each tooth, the findings were recorded in the dental chart.

The chart documents:

• Present teeth
• Missing teeth
• Mobility
• Gum condition
• Periodontal measurements
• Radiographic findings
• Diagnoses
• Treatment performed
• Teeth that require further monitoring

The dental chart helps document the baseline condition, explain the findings to the owner, retain information about individual teeth, compare the condition at future procedures, and plan home and professional care.

Completion of the procedure

After professional cleaning, full diagnostics, and extraction of the tooth with an unfavorable prognosis, the dog recovered from anesthesia.

The owner was informed about:

• What was found
• Why the procedure could not be limited to tartar removal
• Why the mobile tooth needed to be extracted
• Which findings were recorded in the dental chart
• How to maintain oral health after treatment

Home care

After the initial postoperative period was over, the owner was advised to maintain regular home dental care for the dog.

The main goal of home oral hygiene is mechanical control of soft bacterial plaque before it mineralizes and builds up again.

The care plan is chosen individually based on:

• The condition of the gums
• The treatment performed
• The dog's behavior
• How well the dog tolerates having its muzzle and teeth touched
• The rate of plaque accumulation

The specific home oral hygiene method should match the individual recommendations for this patient.

Why small dogs need regular monitoring in particular

In small and medium-sized dogs, teeth can be more closely spaced, so plaque may accumulate faster in some patients, and periodontal problems can appear at a younger age.

This does not mean that every Maltipoo will necessarily develop severe periodontitis.

However, an age of 3 years does not rule out significant dental pathology.

This is why relying only on age or a preserved appetite is not sufficient.