Periodontal disease is considered by many veterinarians to be the most common disease that affects pets. Most cats and dogs develop significant plaque, calculus, and gingivitis by the time they are 4 years of age. There are many factors that influence the development of periodontal disease: age, diet, shape of teeth, occlusion, bacterial flora, immune status, general health, genetic predisposition, lack of oral hygiene, size and shape of dental arches, breed and chewing habits or motion. Of these, lack of oral hygiene is probably the most significant reason for the development of periodontal disease in companion animals. Periodontal disease can be defined as inflammation of one or more of the periodontal tissues, their active recessive alteration, or their altered state with or without active disease. The periodontal tissues include: gingiva, periodontal ligament, cementum, and alveolar bone. Gingivitis is an inflammation of the gingiva and can be caused by chemical, mechanical, neoplastic, and infectious etiologies. Periodontitis is the active destruction of tissue attachment between tooth and peridontium and is diagnosed when there is visible inflammation and the loss of bone. The loss gum tissue attachment and bone results in “pockets” of disease or a more generalized horizontal loss of attachment. This loss of attachment allows for constant sources of infection, weakened areas of bone, mobile teeth, and eventually tooth loss if the process is not recognized and treated.
Plaque, a biofilm of glycoproteins and bacteria, has been shown to be directly associated with periodontal disease. Therefore, if plaque can be controlled, periodontal disease should not develop. Due to the inherent nature of biofilms, mechanical removal i.e. brushing, has proven to be the best method of control. A precursor to plaque forms within 30 minutes after the teeth are cleaned, and plaque bacteria start to inhabit the tooth surface within 8-24 hours. For this reason, most pets should have their teeth brushed daily, or at least every other day, to help retard the accumulation of plaque.
There are many clinical signs associated with periodontal disease which are determined by the extent and severity of involvement. Some of the signs of periodontal disease include: swelling and inflammation of the gums, halitosis (bad breath), plaque and calculus deposition, gum tissue that bleeds with gentle probing, gum tissue recession (exposed tooth roots), mouth ulcers, bone loss, mobile teeth, or missing teeth.
KEY POINTS TO REMEMBER for Periodontal Disease:
- Periodontal disease is the inflammation and destruction of the tissues which surround and support the tooth.
- Plaque appears to be intimately involved with the disease process.
- Attachment loss of peridontium can lead to tooth loss if left untreated.
Periodontal disease is not always obvious upon initial oral exam. A thorough and complete exam involves sedation or anesthesia to evaluate each individual tooth and the tissues which surround it. The clinical signs noted previously i.e. gingivitis, halitosis, mobile teeth, etc. may give the initial indication periodontal disease is present, but the standard for accurate diagnosis and follow-up monitoring, is periodontal probe depth measurement and oral radiography (dental x-rays). The periodontal probe is a blunt ended instrument which is marked in millimeters at its working end allowing for examination of the depth and topography of an area. The tip of the probe is gently inserted between the tooth and gingiva into the sulcus until the bottom of the sulcus is engaged. The depth is noted and the instrument is raised about 1mm, advanced along the side of the tooth, and replaced to the bottom of the sulcus. This is repeated around the tooth at 6-8 points to completely evaluate where the peridontium attaches to the tooth. Normal probe depths are 1-2mm in the dog and less than 1mm in the cat. Any depths greater than this would warrant radiographic evaluation. Dental radiographs are an important tool along with clinical signs, exam, and probe depths for accurate evaluation of periodontal disease. Although radiographs do not give representation of the attachment of the gum tissue, they do reveal changes in the bone and root architecture. The percentage of bone loss along a tooth root helps stage the periodontal disease and choose the appropriate treatment. Dental radiographs are also an effective tool for monitoring treatment success or progression of disease. Radiographs can be useful for client education of a disease that is difficult to see by simply looking in the mouth. Tampa Bay Veterinary Dentistry utilizes a combination of digital dental radiographs and conventional dental film radiographs to give the best representation of the periodontal status of each tooth. See our web page regarding dental radiology for more information.
KEY POINTS TO REMEMBER:
- Periodontal probing allows for evaluation of the level of attachment of peridontium to the tooth.
- Oral radiographs are important to evaluate bone loss, help plan treatment provide a permanent record, and help with client education.
- Use other signs such as tooth mobility, gum recession, root exposure, etc. to fully evaluate.
The goal of periodontal therapy is to restore physiologic anatomy of the peridontium and retard plaque on all tooth surfaces, thus preventing tissue inflammation, tissue attachment loss, and tooth loss. The extent of periodontal disease will vary from patient to patient and from tooth to tooth within the same patient, so each tooth must be individually evaluated and treated according to the disease present. The periodontal treatments offered at Tampa Bay Veterinary Dentistry include: cleaning and polishing of teeth, closed root planing, open root planing, subgingival curettage, gingival surgery, perioceutic therapy, and guided tissue regeneration (GTR).
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Treatment options change as the severity of disease progresses.
The severity and extent of periodontal disease as determined by probing, charting, and radiography will dictate treatment. Therapy options range from simple cleaning and polishing in early stages to closed root planing, subgingival curettage, and perioceutic therapy in moderate cases and can extend to gingival flap surgery, open root planing, and guided tissue regeneration (GTR) in advanced stages. In the most severe instances, extraction with or without alveolar ridge maintenance (bone grafting) may be the most appropriate treatment especially when smaller, less functional teeth with severe periodontal disease jeopardize larger functionally or aesthetically important teeth. Treatment options, prognosis for success, and need for further homecare or follow-up examinations will always be discussed prior to therapy to allow our clients to make the best, informed decision for their pet. Innovations in periodontal therapy are constantly being developed, and Tampa Bay Veterinary Dentistry will continue to offer the latest in periodontal therapy.
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