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.
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
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
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teeth cleaning for dogs and cats
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.
This radiograph shows significant periodontal bone loss around the lower premolar and molar teeth. Some of these are best extracted, while some can be saved.
These teeth have several signs of periodontal disease. Notice the gum tissue inflammation (gingivitis), root exposure, and likely bone loss. These teeth need to be evaluated with dental x-rays to see if they can be saved.
An abnormal periodontal probing depth was found around the roots of these lower premolar teeth.
A dental radiograph reveals the full extent of bone loss around the roots of the affected premolar teeth. Dental radiographs are essential for periodontal evaluation and treatment planning.
This patient has a long history of sneezing. The gum tissue covering the upper left canine tooth appears fairly healthy.
The periodontal probe is used to find a deep pocket of disease on the palate side of this tooth. This deep pocket can communicate with the nasal cavity and is likely the cause of the chronic sneezing in this dog. This is called an oro-nasal fistula, a common finding in dashchunds. Treatment involves removing the diseased tooth and closing the defect so food, saliva and bacteria are prevented from entering the nasal cavity.
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