• periodontal disease

    Figure 1 Bone and soft tissue loss associated with periodontal disease

    Dental disease is the number one disease in dogs and cats, 80% of dogs and 70% of cats have some level of periodontal disease by 2 years of age. It is a chronic, progressive disease, which gets worse in older pets.
    Small to medium breed dogs, sight hounds (Greyhounds, Whippets, Italian Greyhounds, etc.), and purebred cats are especially predisposed to periodontal disease.

    What is periodontal disease?
    Periodontal disease is inflammation or loss of some or all of a tooth’s support structures.
    Periodontal disease is broken up into two entities, gingivitis and periodontitis. Gingivitis is the initial, reversible stage in which the inflammation is confined to the gingiva (gum tissue). This inflammation may be reversed by a dental cleaning and homecare (brushing, etc.). Gingivitis, if left untreated, may progress to periodontitis. Periodontitis is the active stage of inflammation, and is the irreversible (without surgery) loss of the supporting structures (bone and soft tissue) of the tooth. While it is irreversible, it is possible to arrest its progression with proper professional therapy and home care.

    If left untreated, periodontitis may cause loose, painful teeth as well as internal disease. In addition, the resulting infection can weaken the bone of the jaw, resulting in a pathologic fracture. A pathologic fracture of the jaw is when the jawbone breaks under normal circumstances, such as chewing or minor trauma like jumping off of a couch.

    Pathologic fracture

    Figure 2 Pathologic fracture

    Another potential result of periodontal disease, which is more common than pathologic fracture, is an oral-nasal fistula (also called an oronasal fistula). This results from periodontal disease progressing up the inside surface of the upper canines, incisors, or cheek teeth. The roots of these teeth are next to the nasal cavity, and are separated from it by only a thin sheet of bone. Periodontal disease destroys this bone resulting in a communication between the oral and nasal cavities. The bacteria, food particles, and other oral debris will enter this area and cause an infection in the nasal cavity. Signs are chronic nasal discharge, sneezing, and occasionally loss of appetite and bad breath. Interestingly, this condition can occur even when the remainder of the teeth are relatively healthy. Unfortunately there is little recourse for this problem other than extraction of the affected tooth.

    Oronasal fistula

    Figure 3 Oronasal fistula

    What causes periodontal disease?
    Periodontal disease starts with the formation of plaque, which is a combination of bacteria, salivary glycoproteins, and sloughed skin cells from the mouth. Bacteria are attracted to the tooth surface within hours of the teeth being cleaned. If not removed, plaque will extend under the gum line and the bacteria in this subgingival plaque will secrete toxins and metabolic products. The bacterial toxins elicit an inflammatory response from the pet. These inflammatory events result in either gingival recession where roots are exposed, or the gingiva can remain the same height while the area of attachment moves down, thus creating a periodontal pocket.

    The plaque above the gum line becomes mineralized and forms calculus (tartar). This can happen in as little as 2 weeks time after a dental cleaning. By-products of these bacteria “eat away” at the tooth’s support structures, causing progressive pain and inflammation, and eventually causing the tooth to be lost in some cases.

    The inflammation that allows the body’s defenses to attack the invaders also allows those invaders to gain access to the body. Animal studies suggest that these bacteria can negatively affect the kidney and liver. Bacteremias have also been linked to heart attacks and strokes in people. These bacteria may become attached to heart valves and cause endocarditis which results in an intermittent infection and strokes. While these studies are not definitive, this is an infectious process which can lead to a state of chronic disease.

    gum recession

    Figure 4 Periodontal disease with gum recession

    What are the signs?
    Clinical signs of gingivitis are swelling, a gingival color change from pink to red, bleeding gums, significant tartar, and bad breath. Clinical signs of periodontitis include the above plus gum recession, difficulty chewing, drooling with or without blood, and increased tooth mobility.

    Halitosis or bad breath is the primary sign of periodontal disease that is noticed by pet owners. Dogs’ and cats’ breath should not have a disagreeable odor. If your pet has “doggie breath” then it is likely due to some level of periodontal disease.

    How is periodontal disease diagnosed?

    bone loss

    Figure 5 Radiographic bone loss in periodontal disease

    Bone loss from periodontal disease occurs below the gum line. In order to evaluate the stage of disease as well as the best treatment, your pet must be examined under general anesthesia. In addition to a visual examination, x-rays and instruments to measure bone loss are used.
    Periodontal disease is also staged:
    • Stage 1 gingivitis
    • Stage 2 early periodontitis-less than 25% support loss
    • Stage 3 established periodontitis- between 25-50% support loss
    • Stage 4 advanced periodontitis- greater than 50% support loss

    How is periodontal disease treated?
    Treatment depends on the severity of disease.
    Stage 1 gingivitis (reversible stage) can be treated by teeth cleaning, polishing, application of fluoride, and applying dental sealants such as OraVet plaque prevention gel or Sanos dental sealant.
    Note: Stages greater than stage 1 represent irreversible changes. However, therapy at any point in the disease process will stop or slow this progression.
    Stage 2 disease will require deep scaling and application of a local antimicrobial (Doxirobe) if a pocket exists.
    Stage 3 disease is treated similarly to Stage 2. However, in some cases (pockets around a tooth more than 5mm deep) a surgical procedure such as open root planing or guided tissue regeneration is needed. These surgical procedures can be effective if the owner is able to provide, and the pet is willing to accept, daily home dental care.
    Once Stage 4 disease occurs, the prognosis for the affected teeth is poor. If the teeth are to be saved, aggressive periodontal surgery is necessary. If surgery is performed, the owner must be dedicated to daily tooth brushing and other forms of home dental care in order for the procedure to be successful. In most cases of stage 4 periodontal disease, extraction is the best option for the affected teeth.

    This part is critical, and bears repeating: If surgery to save teeth with Stage 4 (and sometimes Stage 3) periodontal disease is going to be successful, the pet owner needs to be committed to save the animal’s teeth. This commitment includes daily brushing at home to remove plaque, which begins to colonize within 12 hours after a procedure. Frequent veterinary dental progress re-examinations should also be anticipated. Depending upon the stage of periodontal disease that is present, anesthetized dental cleaning and assessment will be needed every 3-12 months. Advanced periodontal disease can also be very expensive to treat effectively, and this must be taken into consideration as well. The patient must be a willing partner. If the dog or cat will not allow home care, the best dental surgeon and most caring owner will not make a difference. Unless there is strong owner commitment and patient compliance, it is much wiser to extract the tooth affected by advanced periodontal disease rather than letting the pet suffer needlessly.

    Anesthesia free “cleanings”
    This common and severe disease process can be prevented or slowed with routine professional cleanings and homecare. Please note that the bacteria that cause this disease are located under the gum line. Anesthesia free “cleanings” DO NOT address this area and are of little to no value. In fact, they can be harmful by giving the owner a false sense of security that their pet’s mouth is healthy, just because they no longer see the tartar above the gum line. Please consult with your veterinarian as to the proper therapy for your pet. For further information on veterinary dentistry, ask your Veterinarian.

    How can periodontal disease be prevented?
    Daily plaque control through tooth brushing is the key to help prevent periodontal disease. Special foods and treats are also available to help control calculus.  Some products are approved by the Veterinary Oral Health Council (www.vohc.org).

    What is the prognosis for periodontal disease?
    Gingivitis is treatable and curable with professional dental cleaning a routine dental home care. Periodontal disease is not curable once bone loss occurs, but can be controllable when properly treated and followed up with strict dental home care.

    Home dental care products that can be beneficial:
    Note: The following are products that we carry that can be beneficial for both routine home dental care and for the care of pets with periodontal disease. Additional approved products can be found on the website of the Veterinary Oral Health Council (www.vohc.org). Your veterinarian can advise you on what product(s) are appropriate for your pet’s condition.

    CET toothpaste (various flavors) for dogs and cats
    CET antimicrobial rinse
    CET Chews for dogs & cats
    Greenies dental chews for dogs & cats
    Maxiguard oral gel for dogs & cats
    Biotene rinse and gel for dogs & cats
    EFAC Periodontal softgels (Esterified Fatty Acid Complex) for dogs & cats
    Healthy Mouth water additive for dogs & cats

    The above information is based on client information from the Veterinary Information Network (VIN), originally written by Dr. Jan Bellows, and has additional information written by Dr. Brook Niemiec. Modifications to the original information by Dr. Brian Hewitt. Updated July 2011.

    Dr. Jan Bellows is a board-certified veterinary dentist. His office, Hometown Animal Hospital and Dental Clinic, is located at 17100 Royal Palm Boulevard in Weston, Florida. He can be reached for consultations at 954-349-5800.
    Date Published: 6/27/2002 2:35:00 PM
    Date Reviewed/Revised: 4/12/2007
    Copyright 2002, Veterinary Information Network & Jan Bellows, DVM, Dipl. AVDC

    Contributions to the above information are also from:

    Dr. Brook A. Niemiec, DVM, Dipl. AVDC, Fellow AVD
    Southern California Veterinary Dental Specialties
    5610 Kearny Mesa Rd, Suite B1
    San Diego, CA 92111

    Phone: 858-279-2108
    Fax: 858-573-8607

    Additional information and handouts can be found online at the web sites of:
    The American Veterinary Dental Society – http://www.avds-online.org/resources.htm
    The American Veterinary Dental College – http://www.avdc.org/?q=node/2
    Veterinary Partner web site – http://www.veterinarypartner.com
    Veterinary Oral Health Council – http://www.vohc.org