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What you Need to Know About Periodontal Disease
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It is commonly accepted that roughly 80% of all dogs and cats over the age of 3 have some form of dental disease. Much of this can be categorized as periodontal disease.

One of the most common questions veterinarians get is “At what point do my pet’s teeth need professional cleaning?” In order to answer that one needs to have a basic understanding of the anatomy of the periodontal tissues.

Periodontal disease involves the gingiva (gums) and supporting structures of the teeth. The word “periodontics” literally means “around the tooth.” Periodontal diseases are bacterial infections that destroy the attachment fibers and supporting bone that holds the teeth in the mouth.
drawing of tooth Once the JE has been compromised by bacteria, the very thin zone of fibrous gingival attachment is all that remains to protect the deeper periodontal tissues—bone and the periodontal ligament.
drawing 2 This drawing shows that the junctional epithelium has been destroyed and the gingival attachment layer is becoming compromised. The red shows the infection invading the gingiva adjacent to the sulcus. A periodontal pocket is developing.
drawing3 Eventually, infection destroys the gingival attachment to the tooth and infection attacks more of the soft tissue and bone. Once greater than 50% of the bone is lost, the tooth generally cannot be saved.
A summary of how periodontal disease develops...

1. Invasion of plaque associated bacteria
2. Plaque becomes mineralized to form calculus (tartar)
3. Junctional epithelium is destroyed
4. Attached gingiva becomes infected and “attachment loss” occurs
5. Osteomyelitis (bone infection) occurs
6. Bone is destroyed and the foundation of the tooth is lost
7. After 50% of the bone is lost, the tooth becomes “end-stage” and typically must be extracted.

To accurately describe the severity of periodontal disease we stage it, Stage I through Stage IV, based on the degree of inflammation, damage to the gingiva (gum) and amount of bone and attachment loss.

Stages of periodontal disease:
Normal Stage
< Normal
Home dental care is needed to maintain these healthy teeth and gums.  Brushing your pet’s teeth regularly is ideal.  There are also products available to help make home dental care easier. 
Stage 2 < Stage I - Gingivitis
The margin of attached gum is inflamed and swollen.  No radiographic changes. Plaque covers teeth. Professional dental cleaning is needed to prevent progression of the disease and homecare must be started.  Is reversible with treatment.
Stage II < Stage II - Early Periodontal Disease
Increased inflammation with subgingival plaque and calculus. No root exposure. Little to no radiographic changes visible. Professional cleaning and assessment of damage is needed. Homecare must be started. Is reversible with treatment.
Stage III < Stage III - Established Periodontal Disease
The gums are red and bleed easily...they have been permanently damaged by the calculus and infection.  The mouth may appear sore and bad breath is evident. The teeth must be cleaned and a thorough assessment of the periodontal disease is needed immediately.  A calculus control diet and home care are needed afterward to prevent recurrence.
Stage V < Stage IV - Advanced Periodontal Disease
Chronic infection is destroying the gums, teeth, and supporting bone. Bacteria is spreading through the body via the bloodstream and may damage vital organ systems.  Dental cleaning and assessment of periodontal disease is needed immediately.  Some teeth may need extraction.  Home dental care will be needed afterwards to stop progression of this disease.
Pet owners should watch for any of the following signs of periodontal disease….
  • Plaque and calculus buildup
  • Gum recession
  • Loose teeth
  • Excessive drooling (salivation)
  • Difficulty chewing
  • Halitosis
Anytime you can see gingivitis occurring there is disease causing damage to the junctional epithelium along with possible damage to the connective tissue bundles and alveolar bone. It is impossible to tell the true extent of the damage that is occurring without an examination and charting while under a general anesthetic.

So, the answer to the question is that “Whenever one sees ANY gingivitis, especially when accompanied by calculus buildup, one must be thinking about treatment and a more effective homecare program.”
 
Anytime your pet is being examined by your veterinarian, be sure and ask about it’s oral health status and get a diagnosis of what state exists.
 

What do we do if all preventative efforts have failed and your pet has actually developed periodontal disease?

In order to formulate a logical treatment plan one needs to make an accurate diagnosis. That requires anesthesia, dental radiographs, and charting…integral parts of our Oral ATP protocol. A treatment plan may include anything from localized periodontal debridement and pocket therapy to extraction.

It is important that a pet owner, before initiating any periodontal therapy, other than extraction, consider the following questions…

  • • Are you committed to regular home care?
  • • Does the pet’s personality allow the recommended home care that will be necessary?
  • • Is a given tooth’s condition beyond a point at which we can recommend advanced treatment?
  • • Are there any other concurrent conditions, e.g., malocclusions or severe crowding, which must be addressed, in addition to the primary question of periodontal disease?

It does not make a lot of sense to proceed with advanced dental procedures unless one is prepared for and committed to the necessary home care that will be required. On the other hand, advanced dentistry offers us an alternative to extraction. It can also, potentially, cure a pet’s painful dental disease as well as enhancing its quality of life and longevity

Assuming that the questions listed above have been answered favorably, the following treatment options may be considered:

Stage 1: Gingivitis
Remove plaque and calculus from the teeth. Initiate a comprehensive home care program including daily brushing, applying a dental sealant weekly (Oravet®),  using a “dental diet”, and approved chews.

Stage 2: Early Periodontal Disease  (<25% of the tooth support is lost)
Remove plaque and calculus, localized gingival treatment including gingivectomy (trimming of the gum), and local pocket treatment with an antibiotic gel (Doxyrobe®). If there is gum recession, regular home care is sufficient.

Stage 3: Established Periodontal Disease (25% - 50% tooth support has been lost)
Treatment involves decreasing or eliminating periodontal pockets, if present

Stage 4: Advanced Periodontal Disease (>50% tooth support has been lost)
These teeth generally have insufficient bone to support the tooth and extraction is the only option.  Preventing the disease from affecting adjacent teeth is important.

 
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Berkeley Dog & Cat Hospital • 2126 Haste Street • Berkeley, CA 94704 • phone (510) 848-5041 • fax (510)548-4071