Dental and Gum Disorders (Periodontal Disease) of the Cavalier King Charles Spaniel

• Tooth Anatomy
• What Is Peridontal Disease
• Cavalier's Unique Form of PD
• Symptoms
• Diagnosis
• Related Disorders
• Treatment
• Genetics
• Breeders' Responsibilities
• What You Can Do
• Research News
• Related Links
• Veterinary Resources

Cavalier King Charles spaniels are more susceptible to a dental and gum disorder called periodontal disease (PD) than most any other dog breeds. PD is Periodontal disease. While PD is the most commonly diagnosed disease in dogs, the CKCS suffers from an earlier-onset version in which the the gums recede and the tooth roots become exposed as early as two years of age. 

In an April 2015 article, a team of UK veterinary researchers reviewed the primary-care medical records of 1,875 cavalier King Charles spaniels from July 2007 to July 2013. They categorized the most common specific disorders recorded by the examining veterinary clinicans, as follows: First were heart murmurs, followed by dental disease, including periodontal disorders. Dental disorders were included only when severe enough to result in a veterinary recommendation for medical or surgical intervention.

In an August 2021 review of the prevalence of PD in dogs treated at UK veterinary clinics, cavaliers ranked fourth (behind greyhounds, King Charles spaniels, and toy poodles), and in a July 2021 article, CKCSs were found to have the highest probability of PD in the medium-small size category treated at a nationwide chain of USA clinics.

In a poster presented at the March 2024 BSAVA 2024 conference, UK researchers found that among 177 cavaliers surrendered to a cavalier rescue group,  the second most common health condition (after painful Chiari-like malformation) was dental disease requiring extractions, numbering 121 cavaliers (68.45%). The data was collected from a combination of questionnaires, health checklists, veterinary medical histories, and veterinary examinations following surrender.

Read our section below -- Cavalier's Unique Form of PD -- to find out why CKCSs may be so susceptible to an early-onset version of periodontal disease.

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Tooth Anatomy

Puppies are born toothless, and then they develop 28 puppy teeth, also called "milk teeth" or "deciduous teeth", after they reach about three weeks of age. At about the age of four months, their 42 permanent teeth begin to appear, replacing the puppy teeth. This process usually is complete by the seventh month. From the front to the rear, the permanent teeth consist of 12 incisors, 4 canines, 16 premolars, and 10 molars. (See diagram below.)

As this diagram (right, from ColoSate Univ.) shows, a typical tooth consists of the visible portion above the gumline, called the "crown", and the portion beneath the gumline, called the "root". The crown consists of the enamel exterior, within which is dentin and pulp.

The root is surrounded by the "periodontal ligament" and a thin coating called "cementum" and then the jaw bone, called "alveolar bone". The root includes nerves and blood vessels which are connected at the bottom, called the "root end opening".

The gums are called the "gingiva". They surround the teeth and cover the alveolar bone. Healthy gums normally are pink, unless the breed has pigmented gums.

The gums (gingiva), periodontal ligament, cementum, and alveolar bone make up the periodontium.

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What is Periodontal Disease

While periodontal disease (PD) affects the teeth, it actually is an inflammatory disease of the periodontium -- the gums, periodontal ligament, cementum, and/or alveolar bone. (See diagram above.) It is defined as periodontal pockets greater than 3 mm in depth. A pocket is a gap in the gums surrounding the tooth. The presence of plaque, and even gingivitis, technically are not PD.

• Plaque
• Gingivitis
• Periodontal Pocket
• Periodontitis
• Furcation

Plaque

PD usually is a late stage of a series of infectious disorders which begin when bacteria which enters the dog's mouth adheres to its teeth, both above and below the gumline, and to the gums themselves in the form of a biofilm called plaque. Plaque consists of saliva, food particles, and hundreds of bacterial microbes. Extracellular polysaccharides (EPS) are sugars from some foods which become the backbone of the biofilm and ensure that bacteria are able to attach to the plaque.

Plaque can attach to the teeth and gums within twenty-four hours if not subject to daily cleaning. Plaque on the tooth surface above the gumline is called supragingival plaque. Supragingival plaque can be treated and then reversed in most cases by daily dental care.   Within three days, undisturbed plaque becomes calcified by minerals in the dog's saliva, becoming calculus or tartar (See photo of brownish calculus on a dog's tooth, at right.) Calculus forms from plaque when calcium salts in the saliva mineralize the plaque. The calculus (or tartar) encases the bacteria and permits it to spread unimpeded.

Gingivitis

If the biofilm is not removed by daily cleaning, the bacteria adheres to the gums (the gingiva) and causes inflammation which is called gingivitis. (See photo at right.) This process can occur in as early as two weeks.

If left untreated, the plaque will advance by extending under the gums between the teeth and underlying alveolar bone, a stage called subgingival plaque. The presence of the darkened tartar on the visible crowns serve as an early warning that the dog has a potential PD problem which needs professional veterinary attention. Therefore, the plaque must be removed from both above and below the gumline to defeat the progression of the gingivitis to becoming PD.

While the hardened tartar is visible on the crown of the teeth as a stained coating, that does not cause PD. It is the plaque beneath the gumline -- the subgingival plaque -- which causes gingivitis, the precursor of PD.

Periodontal Pocket

The inflammed gums  will start to recede from the tooth, creating a gap called a periodontal pocket. These pockets create  hiding places for the plaque and tartar, and eventually the pockets deepen down along the roots of the teeth. As long as those pockets are no deeper than 3 mm, gingivitis can be reversed by a thorough professional cleaning -- scaling of each tooth -- and PD can be avoided.

Periodontitis

Periodontitis is an inflammation of the periodontal ligaments benealth the gums and of the alveolar bone, resulting in their destruction and leading to more recession of the gums and the formation of periodontal pockets deeper than 6 mm, and then bone loss. this process usually takes two to five years to develop in most large breeds. (See photo at right.)

Furcation

The final stage of PD, also called furcation disease, is recession of the gums and bone to the point that the area between the roots become exposed, leading to tooth loss and potentially a host of related systemic disorders, due to the bacteria's access to the blood stream.

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Cavalier's Unique Form of PD

Periodontal disease is the most commonly diagnosed disease in all dogs, and it is known to develop earlier in small and toy breeds than in larger ones. In the cavalier, PD is second only to mitral valve disease, and yet, PD is more prevalent in the CKCS than in any other breed.

As noted above, the usual progression of PD starts with the biofilm of plaque, then the hardening of the plaque into tartar above the gums and into subgingival plaque beneath, and then gingivitis, and then periodontitis. Each phase typically takes time in the mouth of the average dog. Plaque attaches to the teeth in 24 hours. Plaque turns to tartar (calculus) in three days. Gingivitis can develop below the gums in two weeks. Periodontitis may take two to five years. However, the cavalier King Charles spaniel breed has been found to suffer from an earlier-onset version in which PD develops much more rapidly and by-passes the usual time-line of progression. Cavaliers reportedly can develop severe periodontitis with minimal tartar build-up or visible gum infection -- the usual early-warning signs of PD. (See Figure 1.18, below.)

The reasons for the cavaliers' early-onset version of PD have not been proven, but the breed's evolutionary history is suspected. All  dogs, regardless of how big or small they are or how long or short their muzzles are, have the same number of adult teeth -- 42. Most brachycephalic breeds, with their shorter muzzles, tend to have their rows of teeth somewhat jumbled, with teeth overlapping each other as all 42 of them try to fit into a much shorter mouth than those of their earlier ancestors with much longer snouts. The cavalier is an even more convoluted example of this evolution, because in the late 1920s the breed developed from the even-shorter muzzled King Charles spaniel (English toy spaniel).

Most of the earlier versions of the King Charles spaniel (KCS), up to the late 1800s, had relatively long muzzle lengths. (See the 1850 version, above.) Then, beginning in the 1890s through the 1920s, the breed standard called for their snouts to be bred much shorter. By 1910, champion King Charles spaniels had snouts no longer than those of today's pugs and French bulldogs. (See the 1910 champion KCS, above.) Breeders still produced longer-muzzled KCS puppies, but they did not intentionally breed them. In 1926, an American dog fancier campaigned to bring back the longer-muzzled "old type" King Charles spaniel, and by the early 1930s, the new breed, the "cavalier" King Charles spaniel, came into being after breeders started selecting their longer-snouted offspring for breeding and then competing with them at Crufts and other UK conformation shows as a breed different from the KCS. (See the series of photos above to follow the transition to the first of the cavaliers in the 1930 photo, followed by more recent examples.)

A consequence of this evolution was first to create very short-muzzled dogs with necessarily extremely jumbled sets of teeth, and then produce from those dogs a longer-muzzled version which became the cavalier. The compressed set of teeth in the KCS did not conveniently re-arrange themselves into an orderly, straightened line up in the longer mouths of the CKCS. So, the typical cavalier's mouth has been the result of an accordion-like compression and then enlongation of teeth, resulting in mass confusion. (See the photo at right of a CKCS mouth.)

In a December 2022 article, veterinary dental specialists found that cavaliers are among the most commonly affected breeds of abnormal alignment and positioning of their upper and lower sets of teeth. In that case, the researchers examined the records of 198 dogs presented to a California veterinary dental clinic with misalignment (malocclusion) of either their baby teeth (deciduous) or permanent teeth. There are two types of malocclusions: (1) skeletal, which means that an abnormal jaw length results in a misalignment of the teeth, and (2) dental, which occurs when one ore more teeth are out of normal alignment, also called malpositioned teeth. In this California study, which spanned from 2015 to 2018, the cavalier, along with the poodle and Labrador retriever, comprised 50% of the dogs with deciduous (baby teeth) malocclusions. The five most commonly affected breeds with permanent malocclusions were the cavalier, along with poodles, Labrador retrievers, chihuahuas, and pit bull terriers. See also this December 2022 article.

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Symptoms

Normal features of the dog's mouth are clean-looking teeth and pink gums (gingival tissues), without any staining of the teeth or redness or signs of inflammation in the gums. (See Figure 1 below.) In the early stage of gingivitis, the teeth will look stained by being partially coated with a somewhat dirty-looking calculus (tartar), and areas of the gums, particularly where directly attached to the teeth, will be puffy, redish, and appear inflammed. (See Figure 2 below.)

As the PD progresses, the inflammation will have spread and intensified.  The discolored tartar will be more extensive. The gums will bleed or develop ulcers, and they will appear to bulge and to have receded. Eventually the teeth roots will become exposed. The dog's breath will be consistently bad (halitosis). Some of the teeth may become loose. White pus may discharge from the periodontal pockets.

The level of inflammation is the surest sign that professional care is needed.

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Diagnosis

Diagnosis is primarily a visual inspection of the teeth and gums. If the dog is under anesthesia, the veterinarian will use a stainless steel periodontal probe to poke into the pockets to determine their depth and condition. X-rays of the teeth and roots and bone will be necessary for a thorough analysis of the extent of the condition of the PD.

Diagnosis beneath the gumline customarily is performed along with a thorough cleaning, while the dog is under anesthesia. See the Periodic Cleaning Procedures described below.

While periodic teeth scaling and polishing procedures (limited to above the gum-line) are not advised for the treatment of PD, a July 2021 study found that the longer time period since a scale-and-polish treatment increased the odds of PD being diagnosed and also more severe PD being found.

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Related Disorders

• Localized Disorders
• Systemic Disorders

Inflammation and redness in the gums, due to gingivitis, are indications that blood capillaries are leaking, allowing the plaque bacteria access to the bloodstream. Once in the bloodstream, the bacteria travel to the vital organs -- the heart, lungs, kidneys, liver, and brain.

Localized Disorders

See Dr. Brook Niemiec's YouTube video, begining at 5:32 minutes, for a full review of these localized related disorders:

• Oronasal fistula: As the PD progresses and the gums, roots, and bone erode, a fistula (vacant gap) may develop into the nasal cavity between the the upper jaw and the nasal passage. This is called an oronasal fistula (ONF). Infected ONFs must be surgically repaired, usually by extracting the adjoining tooth and suturing a flap of tissue in the mouth.

• Fracture of the mandible: As the bone in affected areas of the lower jaw become weakened, the jaw may become so fragile that a slight trauma or even a tooth extraction could cause a fracture. Pre-surgical x-rays must be taken to locate the eroded bone and its remaining dimensions. Surgical options include inserting pins or wires or plates. Healing of this procedure can be quite difficult, and the usual prognosis is "guarded".

• Chronic ulcerative paradental stomatitis (CUPS): CUPS are extremely painful, inflammed sores and ulcers on the soft tissues which come in contact with the teeth (paradental areas).   The are believed to be an allergic response to bacterial plaque on the teeth. See our webpage, Chronic Ulcerative Paradental Stomatitis (CUPS) and the Cavalier King Charles Spaniel.

• Eosinophilic stomatitis (eosinophilic granuloma): Cavaliers are predisposed to some eosinophilic syndromes, especially eosinophilic stomatitis, an autoimmune disorder which is an inflammation of the mucous lining of any parts of the mouth, such as the tongue, palate, and gums. It usually appears as ulcers and lesions on the surfaces within the mouth. See our webpage, Eosinophilic Stomatitis and the Cavalier King Charles Spaniel.

• Blindness: PD inflammation and infection close to an eye cavity (orbit) may jeapardize the optic tissues and lead to blindness.

• Osteomyelitis: Inflammation due to PD of  bone or bone marrow may lead to infected, and even dead, bone tissue. This is called osteomyelitis, and the affected bone must be removed surgically.

• Oral cancer: Chronic inflammation due to PD may result in cancer in the mouth. See our webpage, Cancer and the Cavalier King Charles Spaniel.

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Possible Systemic Disorders

• Endocarditis: While endocarditis is a different disease from the mitral valve disease (MVD) affecting cavaliers (also called endocardiosis), this infectious disorder damages the heart valves and may extend to blood clots in the blood vessels.

• Cerebellar Infarcts (Strokes): Oral bacterias have been linked to cerebral infarctions.

• Meningoencephalomyelitis: In a June 2018 article, a team of PennVet clinicians diagnosed meningoencephalomyelitis caused by the bacteria Pasteurella multocida in a 5-year-old female cavalier with severe periodontal disease, with contact ulceration and possible necrotizing stomatitis. Meningoencephalomyelitis (MEM) is inflammation of the brain, including its protective membranes, and of the spinal cord, caused by a bacteria.  Her symptoms included fever, lethargy, inappetence, and multifocal neurologic signs, mainly dull mentation. Based upon examination of her cerebrospinal fluid (CSF) and blood culture, and her response to therapy (anti-emetics and gastroprotectants, an opioid for analgesia, and dexamethasone sodium phosphate as an antiinflammatory), P. multocida meningoencephalomyelitis was diagnosed. They opined that the severe periodontal disease led to a bacteremia causing hematogenous seeding of a bacterial meningitis originating at the disrupted blood–spinal cord barrier.They concluded::

"In the future, be aware that a fever with multifocal neurologic signs and severe periodontal disease in a canine patient may suggest a P. multocida infection and both CSF and blood cultures can be submitted for confirmation."

• Diabetes Mellitus: There is a possible connection between orally-sourced inflammation and poor control of diabetes mellitus. See, for example, this January 2024 article.

• Kidney Disease: A kidney disease -- glomeruloneohriis -- is considered a potential consequence of chroiric bacteria associated with periodontal disease.

• Liver Disease: Bacteria from PD is a suspected cause of some hepatic disorders in dogs, including hepatitis and hepatic parenchyrnal inflammation.

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Treatment

• Coenzyme Q10 (CoQ10)
• Periodic Cleaning Procedures
• Closed Root Planing
• Periodontal Flap Surgery
• Extraction
• Anesthesia-Free Dentistry
• Bone Chewing

The key to periodontal therapy is plaque control. Periodontal disease can be prevented by daily home care. See "What You Can Do" below. If the plaque already has taken hold of the dog's teeth and gums, causing gingivitis, then if the plaque is removed, it will in turn remove the gingivitis, allowing the return to a healthy tooth.

Watch this video about how to train your dog (and yourself) to brush its teeth.

Veterinary dental specialists recommend that small and other at-risk breeds, particularly the cavalier King Charles spaniel, have their first professional dental cleaning at nine to twelve months of age, followed by periodic professional cleanings every six to nine month s thereafter. These are intended to be preventative procedures as well as treatments if affected teeth need to be surgically cared for or removed. Oral procedures under full anesthesia (anaesthesia) are required for all levels of veterinary care beyond daily home care.

An Internet search engine for finding board certified veterinary dentists is linked here.

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Coenzyme Q10 (CoQ10)

Daily supplementation of Coenzyme Q10 (CoQ10) has been reported to be beneficial both as boosting resistance to, and treatment for, periodontal disease. Dosages from 30 mg. to of 100 mg. of CoQ10 twice daily has been found to be well tolerated. See this January 1983 article and this October 2021 article.

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Periodic Cleaning Procedures

Periodic, thorough veterinary teeth and gum cleaning procedures under anesthesia are recommended, both as a preventative when the early stages of PD are detected, and especially after the onset of periodontitis.

Preparation of the dog at home is essential before the dental procedure. Since the dog will be under anesethesia, no food should be offered after the evening before the treatment date. A sterile environment also is essential, since bacteria getting into the gums and the blood stream will lead straight to the heart. Therefore, many veterinarians advise dog owners to bathe their dogs at least once or twice in the days leading up to the date of the procedure, using an antiseptic shampoo such as VetraSeb CeraDerm.

The veterinarian probably will prescribe an oral antibiotic medication to be given to the dog periodically, beginning the day before the cleaning procedure. These pills will continue to be given for a period of time after the dog returns home. The concern is that bacteria in the dog's mouth, prior to and during the cleaning, may enter the bloodsteam and cause systemic damage. However, in a November 2023 article in which 13 healthy dogs had teeth removed during a dental procedure, and did not receive any antibiotics, begiining two weeks prior to the cleaning or afterwards, the researchers found that any bacteria which appeared in their bloodstreams during and following the cleaning had cleared from their blood without antibiotic therapy. They concluded "that systemic antibiotic usage is not warranted for severe periodontal disease where an episode of transient bacteremia is produced from SRP and dental extractions in an otherwise healthy patient."

Before the cleaning, but after the dog is placed under anesthesia, a full-mouth set of x-rays should be obtained. Only x-rays below the gum lines will show the extent of damage to the roots of the teeth and any bone loss. For example, the black areas around the roots of the teeth in this x-ray (right) are hollow from bone loss due to periodontal disease.

The veterinarians' cleaning process includes:

• Pre-anesthesia examination and work-up
• Proper anesthesia and monitoring by a trained veterinary professional
• Antiseptic (chlorhexidine) rinse (to decrease bacterial load)
• Supra-gingival scaling (cleaning the visible crown)
• Subgingival scaling (under the gumline cleaning - the most important step)
• Thorough polishing
• Sulcal lavage
• Oral exam and charting
• Dental radiographs
• Treatment planning and any additional therapy
• Application of a barrier sealant where appropriate

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Closed Root Planing

Periodontal disease (PD) is an inflammatory disease of the gums. It is defined as periodontal pockets greater than 3 mm in depth. Pockets between 3 and 6 mm can be treated by "closed root planing" and placement of a long-acting antibiotic, if the tooth has not become loose (mobile). Root planing means using dental instruments to scrape the tooth's roots, which are below the normal gum line but which have become bare and visible due to recession of the gums. By "closed", it means that the scraping is performed without having to surgically cut the gum away to access the roots. 

If the pockets are too deep -- deeper than 6 mm -- or if furcation has occurred, closed root planing alone will be insufficient to avoid contnued infection of the teeth.

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Periodontal Flap Surgery

If the pockets exceed 6 mm or furcation has occurred, then "periodontal flap surgery" is required. This procedure entails cutting into the gum, laying the gum flap back to see the bare tooth and roots and bone, to remove the plaque deep down below the gumline, and perhaps add bone-grafting material before sutchering the gum back in place. (See the flap surgery photo from dvm360, at right.)

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Extraction

If the PD has progressed to the point of the tooth becoming loose, that tooth must be extracted. Tooth extraction is the one true cure of PD.

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Anesthesia-Free Dentistry

"Anesthesia-free" dentistry -- essentially partial cleanings of the crowns of the teeth of conscious patients -- generally are inadequate because that form of treatment cannot do a thorough job of examining and cleaning the periodontal pockets and examining the roots and alveolar bone. While the visible part of the tooth -- the crown -- may be discolored due to plaque turning into tartar, that does not lead to periodontal disease. It is the area of the tooth below the gumline where gingivitis starts and then becomes periodontitis.

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Bone Chewing

Giving the dog a bone is not the answer to either preventing or treating periodontal disease.  In a February 2020 article, a team of Brazilian veterinary dental researchers studied the effects of twelve Beagles chewing either sterile cortical (hard) bovine femur bones or sterile spongy bovine femur bones over a two week period, to evaluate the effect of bone chewing on the dental roots, enamel, and gingiva of the dogs. They report that both types of bones "were highly effective in removing dental calculus" and gingival inflammation reduction, with the spongy bones being more effective than the hard ones. Dental calculus was completely removed from the first and second premolars and molars in less than three days. No lesions or teeth root and enamel fracture, or esophageal or intestinal obstructions were observed. However, the spongy showed some gingival lesions and bone remnants between the dogs' teeth. Gingival lesions were caused by the daily and continuous supply of new pieces of bone for the 13 days. However, the bones failed to cure or even partially treat periodontal disease, which is a below-the-gumline disorder. They stated:

"Although there was an improvement in the visual appearance of the gum, there was no reduction in plaque and calculus under the gumline. The maintenance of subgingival [below the gumline] plaque and calculus is the etiological factor of loss of dental adhesion to its alveolus, characteristic to periodontal disease. Thus, bones are not efficient in removing plaque and calculus under the gumline, they are only able to remove it on the crown."

Dogs also can fracture their teeth by chewing on bones. When veterinary specialist Dr. Jan Bellows was asked, "How can I prevent my dog from fracturing more teeth?", he responded: "Examine your dog’s treats and chew toys. Eliminate any bones, antlers, cow hoofs, nylon chews, and pizzle sticks. Throw out chews or toys that do not readily bend."

Broken teeth cause pain and may lead to infection, especially if the inner pulp is exposed. (See photo at right of exposed pulp in a broken tooth.) Infection in turn may lead to abscesses and jaw bone weakness.

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Genetics

While PD has not been shown to be more common in the cavalier than in other breeds, in an April 2014 study, Portugese veterinarians, searching the genetics of canine periodontal disease, discovered that variants of the interleukin-10 gene, particularly interleukin-10 (IL-10), is "highly polymorphic with genetic variants that may be important in PD susceptibility." Previous studies of IL-10 in the CKCS suggest that it may play a role in determining the cavaliers' susceptibility to diabetes.

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Breeders' Responsibilities

Since cavaliers are more susceptible to this dental and gum disorder called periodontal disease (PD) than any other dog breed, breeders should educate their buyers about the vital importance of daily dental home care and how best to perform it.

At the March 2024 BSAVA 2024 conference, UK researchers found that among 177 cavaliers surrendered to a cavalier rescue group, retired breeding stock cavaliers surrendered by breeders had the worst cases of dental disease, of which 92% required tooth extractions, with 76.3% requiring 21 or more teeth removed. They presented a poster examining the reasons 177 cavalier King Charles spaniels were surrendered by their owners to a UK canine rescue group, Bliss Cavalier Rescue. The data was collected from a combination of questionnaires, health checklists, veterinary medical histories, and veterinary examinations following surrender. At the date of surrender, these cavaliers by age 6 years had an average of 6 physical health conditions (excluding anxiety, obesity, and underweight), referred to in the study as multi-morbidities. The second most common health condition (after painful Chiari-like malformation) was dental disease requiring extractions, numbering 121 cavaliers (68.45%). The researchers highlighted the details regarding dental disease. The cavaliers surrendered by breeders had the average age of 5.5 years, and 94.4% of those breeders were registered with the UK Kennel Club.

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What You Can Do

The key to periodontal therapy is plaque control. Beginning at 6 months, daily cleaning of the dog's teeth and gums is critical to avoiding periodontal disease. Plaque can attach to the teeth within twenty-four hours if not subject to daily cleaning. Therefore, the goal of daily care is to reduce the amount of bacteria on the teeth, thereby decreasing gingival inflammation and avoiding PD. Since cavaliers are an "at-risk" breed for PD, it is critical that homecare be started early.

When properly performed, tooth brushing is the most effective method of controlling plaque. See this May 2015 article. The movement of the brush is a key to controlling the plaque. The owner should begin training the dog to accept the brush and its movement as early as possible, making the process a learned behavior. Alternatively, applying tooth paste or other dental ointments is second best to actual daily brushing. See this April 2016 article. Be sure to brush along the gum lines and not just the crowns of the teeth.

Watch this video about how to train your dog (and yourself) to brush its teeth.

Daily supplementation of Coenzyme Q10 (CoQ10) has been reported to be beneficial both as boosting resistance to, and treatment for, periodontal disease. Dosages from 30 mg. to of 100 mg. of CoQ10 twice daily has been found to be well tolerated. See this January 1983 article and this October 2021 article.

Also, consider the daily application of 1-Tetradecanol complex (1-TDC) on the gums of your dog. 1-TDC is a mixture of monounsaturated fatty acids (MUFAs) which have been found effective in reducing chronic inflammation in the gums of humans, rabbits, and cats. In the cat study, gel capsules containing 525 mg of 1-TDC were squeezed onto the affected gums of cats with moderate-to-severe periodontal disease daily for six weeks. At the end of the study, the researchers reported finding "significant reductions in all parameters of clinical periodontal disease", which included "clinical attachment level", "gingival index", and "beeding on probing". There also was a decrease in tooth mobility in the 1-TDC group cats, but it was not statistically significant. They acknowledged that the "underlying mechanisms of action of 1-TDC is still not elucidated". They concluded that daily 1-TDC treatment of periodontal disease in cats should be considered to manage the disorder. Thus far, we have found no similar studies including dogs. 

Note that bone chewing has not been shown to be effective in either preventing or treating periodontal disease. Chewing on bones also can result in tooth fractures. See the Bone Chewing section above.

Since cavaliers are more susceptible to periodontal disease than are most breeds, owners should consider having their CKCSs examined by dental specialists. An Internet search engine for finding board certified veterinary dentists is linked here.

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Research News

March 2024: UK breeders surrendered retired breeding cavaliers to rescue group with worst cases of dental disease. At the March 2024 BSAVA 2024 conference, UK researchers Rebecca Mosley, Tena Kras, Clare Buxton, Felipe Zabaneh Rodal, Peter Buxton, and Clare Rusbridge presented a poster examining the reasons 177 cavalier King Charles spaniels were surrendered by their owners to a UK canine rescue group, Bliss Cavalier Rescue. The data was collected from a combination of questionnaires, health checklists, veterinary medical histories, and veterinary examinations following surrender. At the date of surrender, these cavaliers by age 6 years had an average of 6 physical health conditions (excluding anxiety, obesity, and underweight), referred to in the study as multi-morbidities. The second most common health condition (after painful Chiari-like malformation) was dental disease requiring extractions, numbering 121 cavaliers (68.45%). The researchers highlighted the details regarding dental disease. They found that retired breeding stock cavaliers surrendered by breeders had the worst cases of dental disease, of which 92% required tooth extractions, with 76.3% requiring 21 or more teeth removed. The cavaliers surrendered by breeders had the average age of 5.5 years, and 94.4% of those breeders were registered with the UK Kennel Club.

February 2024: Cavalier's baby canine tooth root prevented development of its permanent canine tooth. In a February 2024 article, two UK dentistry specialists (Charlie Tewson [right], Simone Kirby) report a case study of a 23-month-old cavalier King Charles spaniel with the root of its left upper baby canine tooth (#204 on the chart above) which had grown into the pulp of its permanent canine tooth, preventing the permanent tooth's full development. At age 6 months, the cavalier's canine teeth had been extracted due to their failure to fall out naturally. Seventeen months later, the permanent left maxillary (upper) canine tooth was found to have stopped developing. X-rays showed that the root of the baby tooth remained and was inside of the pulp of the immature permanent tooth. The permanent tooth had to be removed. The authors conclude by recommending that this unusual complication should be considered with extracting peristent baby teeth.

December 2022: Cavaliers ranked third among breeds with malaligned teeth in a three-year California study. In a December 2022 article, three USA veterinary dental specialists (Marissa Berman [right], Maria Soltero-Rivera, Amy J. Fulton Scanlan) examined the records of 198 dogs presented to a California veterinary dental clinic (VCA Encina Veterinary Medical Center) with abnormal alignment (maloccusion) of either their baby teeth (deciduous) or permanent teeth. There are two types of malocclusions: (1) skeletal, which means that an abnormal jaw length results in a misalignment of the teeth, and (2) dental, which occurs when one ore more teeth are out of normal alignment, also called malpositioned teeth. In this California study, which spanned from 2015 to 2018, the cavalier King Charles spaniel, along with the poodle and Labrador retriever, comprised 50% of the dogs with deciduous (baby teeth) malocclusions. The five most commonly affected breeds with permanent malocclusions were the cavalier, along with poodles, Labrador retrievers, chihuahuas, and pit bull terriers.

August 2021: Cavaliers are found to have a "strong breed predisposition for periodontal disease", in UK study. In an August 2021 article, UK researchers (D. G. O'Neill, C. E. Mitchell, J. Humphrey, D. B. Church, D. C. Brodbelt [right], C. Pegram) reviewed the veterinary records of a random sample of 22,333 dogs among over 900,000 attending 784 clinics during 2016, to determine the breeds with the greatest prevalence of having periodontal disease. They measured the breeds by (a) prevalence of diagnosis, (b) increased odds, and (c) breed predisposition. They report that the cavalier King Charles spaniel ranked 4th (behind the greyhound, King Charles spaniel, and toy poodle) in prevalence of diagnosis. The cavalier also came in 4th (behind the toy poodle, King Charles spaniel, and greyhound) in increased odds compared to crossbred dogs. They found that, overall, periodontal disease is a common diagnosis in UK dogs, with one in eight dogs diagnosed annually. They concluded that cavaliers have "a strong breed predisposition for periodontal disease".

July 2021:  Cavaliers top the list of having periodontal disease among medium-small breeds, 5-year US study shows. In a July 2021 article, investigators (C. Wallis [right], E.K. Saito, C. Salt, L.J. Holcombe, N.G. Desforges) reviewed the medical records of 2,841,038 dogs of 60 pure breeds of dogs at Banfield veterinary clinics between 2010 and 2014 to find the breeds, age, gender, neuter status, weight, and body condition score, and frequency of dental treatment visits of all dogs diagnosed with periodontal disease (PD), which included periodontal pocket, gingival recession, attachment loss percentages, and periodontitis.

The 10 breeds with the highest prevalence of PD (Grades 1-4 combined) were: Greyhound (38.7%), Shetland sheepdog (30.6%), Papillon (29.7%), Toy poodle (28.9%), Miniature poodle (28.2%), Dachshund (28.1%), Bichon frise (27.9%), Cavalier King Charles spaniel (27.3%), American Eskimo dog (27.0%), and Cairn terrier (26.8%). ... Cavaliers had the highest probability of PD within the medium-small size category. The odds of a CKCS having PD was over 8 times that of a French bulldog. Additional risk factors for PD diagnosis included age, being overweight, and the length of time since the dog's last scaling and polishing of its teeth.

May 2021: US study finds a link between dogs with periodontal disease and canine cognitive dysfunction. In an April 2021 article, Drs. Curtis W. Dewey [right] and Mark Rishniw report the results of a study of 21 aging (over 9 years of age) dogs -- 11 diagnosed with canine cognitive dysfunction (CCD) and 10 (including one cavalier King Charles spaniel) control dogs. All 21 dogs were visually examined and photographed for periodontal disease, which was ranked mild, moderate, or severe. Owners of the dogs with CCD completed questionnaires examining six variables: disorientation, interactions-social, sleep/wake cycles, house soiling/ learning/ memory, activity, and anxiety (DISHAA) to produce a score that determined their dogs' degree of cognitive impairment or dysfunction. A team of 12 veterinarians evaluated the dogs' dental photographs and scored the severity of periodontal disease on a scale of 0 to 4. They report that scores of cognitive dysfunction correlated positively, but modestly, with periodontal disease. They concluded that their study has identified an association between visually categorized periodontal disease and CCD, but that further and more detailed investigations are called for.

March 2021: Cavaliers are reported to be most susceptible to periodontal disease of all dog breeds.  In a June 2021 article, in a not-yet published book (Breed Predispositions to Dental and Oral Disease in Dogs), Dr. Brook A. Niemiec (right), a veterinary dental specialist in California, has authored an extensive review of periodontal disease and therapy in small and toy breeds. He states that:

"Cavalier King Charles Spaniels (CKCS) and Greyhounds are well known for significant periodontal disease. CKCS suffer from early onset periodontal disease, especially in the maxillary premolars (as they are similar to other brachycephalic breeds). There is quite often furcation exposure of these teeth as early as two years of age. Interestingly, it is quite common for them to have advance periodontal loss with minimum calculus and gingivitis. ... Both of these breeds are very difficult to manage due to the high genetic potential for the disease. They typically suffer from significant gingivitis and early bone loss with only minimal calculus.

"In general, these [brachycephalic] breeds do not appear to be more susceptible to periodontal disease than others of their size (with the exception of Cavalier King Charles Spaniels)."

February 2020: Bone chewing fails to prevent or treat dogs' periodontal disease, in a Brazilian study. In a February 2020 article, a team of Brazilian veterinary dental researchers (Caroline Fredrich Dourado Pinto, Willian Lehr, Víviam Nunes Pignone, Caio Peixoto Chain, Luciano Trevizan [right]) studied the effects of twelve Beagles chewing either sterile cortical (hard) bovine femur bones or sterile spongy bovine femur bones over a two week period, to evaluate the effect of bone chewing on the dental roots, enamel, and gingiva of the dogs. They report that both types of bones "were highly effective in removing dental calculus" and gingival inflammation reduction, with the spongy bones being more effective than the hard ones. Dental calculus was completely removed from the first and second premolars and molars in less than three days. No lesions or teeth root and enamel fracture, or esophageal or intestinal obstructions were observed. However, the spongy showed some gingival lesions and bone remnants between the dogs' teeth. Gingival lesions were caused by the daily and continuous supply of new pieces of bone for the 13 days. However, the bones failed to cure or even partially treat periodontal disease, which is a below-the-gumline disorder. They stated:

"Although there was an improvement in the visual appearance of the gum, there was no reduction in plaque and calculus under the gumline. The maintenance of subgingival [below the gumline] plaque and calculus is the etiological factor of loss of dental adhesion to its alveolus, characteristic to periodontal disease. Thus, bones are not efficient in removing plaque and calculus under the gumline, they are only able to remove it on the crown."

February 2019: Cat study finds 1-tetradecanol complex (1-TDC) applied to gums significantly reduced periodontal disease. In a February 2019 article by Brazilian dental specialists Fernanda Maria Lopes Kubitza (right) and James Mudie George Anthony, they orally applied the fatty acid combination of 1-tetradecanol complex (1-TDC) to the teeth of nine cats (compared to the olive oil placebo to four other cats) all of which had been diagnosed with moderate-to-severe periodontal disease over a period of six weeks. Gel capsules of the ingredients were squeezed into the cats' mouths once a day. The 1-TDC capsules contained 525 mg each. At the end of the 6-week study, they report finding "significant reductions in all parameters of clinical periodontal disease", which included "clinical attachment level", "gingival index", and "beeding on probing". There also was a decrease in tooth mobility in the 1-TDC group cats, but it was not statistically significant. They acknowledged that the "underlying mechanisms of action of 1-TDC is still not elucidated". They concluded that daily 1-TDC treatment of periodontal disease in cats should be considered to manage the disorder.

EDITOR'S NOTE: We are including this report about cats because, thus far, we have found no similar studies including dogs. In one prior study of fifteen rabbits with experimentally induced periodontitis, 1-TDC had been found effective in reducing inflammation in the gums of the ten rabbits in the treatment groups.

June 2018: Periodontal disease is suspected cause of bacterial meningoencephalomyelitis in a cavalier. In a June 2018 article, a team of PennVet clinicians (Alexander E. Tun [right], Leontine Benedicenti, Evelyn M. Galban) diagnosed meningoencephalomyelitis caused by the bacteria Pasteurella multocida in a 5-year-old cavalier King Charles spaniel. (Meningoencephalomyelitis [MEM] is inflammation of the brain, including its protective membranes, and of the spinal cord, caused by a bacteria.) The dog had severe periodontal disease, with contact ulceration and possible necrotizing stomatitis. Her symptoms included fever, lethargy, inappetence, and multifocal neurologic signs, mainly dull mentation. Based upon examination of her cerebrospinal fluid (CSF) and blood culture, and her response to therapy (anti-emetics and gastroprotectants, an opioid for analgesia, and dexamethasone sodium phosphate as an antiinflammatory), P. multocida meningoencephalomyelitis was diagnosed. They opine that the severe periodontal disease led to a bacteremia causing hematogenous seeding of a bacterial meningitis originating at the disrupted blood–spinal cord barrier.They concluded:

"In the future, be aware that a fever with multifocal neurologic signs and severe periodontal disease in a canine patient may suggest a P. multocida infection and both CSF and blood cultures can be submitted for confirmation."

April 2018: Cavalier with severe periodontal disease develops Pasteurella Multocida meningoencephalomyelitis. In an April 2018 article, a team of University of Pennsylvania neurologists (Alexander E. Tun [right], Leontine Benedicenti, Evelyn M. Galban) report on a 5-year-old spayed female cavalier King Charles spaniel with severe periodontal disease which had developed Pasteurella Multocida meningo-encephalomyelitis causing signs of a neurological disorder. Based on cerebrospinal fluid and blood culture, as well as response to therapy, they opine that the severe periodontal disease led to a bacteremia causing hematogenous seeding of a bacterial meningitis originating at the disrupted blood–spinal cord barrier.

April 2015: Dental disease was second to only heart murmurs in cavaliers in the UK in a 6-year veterinary records review. In an April 2015 article, a team of UK veterinary researchers (Jennifer F. Summers [right], Dan G. O’Neill, David B. Church, Peter C. Thomson, Paul D. McGreevy, David C. Brodbelt) reviewed the primary-care medical records of 1,875 cavalier King Charles spaniels from July 2007 to July 2013. They categorized the most common specific disorders recorded by the examining veterinary clinicans, as follows: First were heart murmurs, followed by dental disease, including periodontal disorders. Dental disorders were included only when severe enough to result in a veterinary recommendation for medical or surgical intervention.

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