Periodontal Disease
Periodontal disease is a completely preventable condition, yet it is the most common health problem that we see in small animals here at Perkins Road Veterinary Hospital. Periodontitis is an advanced infection which leads to attachment loss, bone, and soft tissue destruction. If periodontitis is caught early, the process may be reversed or halted with advanced procedures, saving teeth. If not, the end result is surgical extractions.
Periodontal disease consists of two stages – gingivitis and periodontitis. Gingivitis, which is inflammation of the gingiva, is reversible. Periodontitis is an infection of bone, not teeth. It is inflammation caused by microorganisms that result in progressive destruction of periodontal tissues that leads to attachment loss. It can be seen as a gingival recession, periodontal pocket formation, or both. Mild to moderate periodontal pockets may be reduced or eliminated by proper plaque and calculus removal. However, periodontal bone loss is irreversible (without regenerative surgery).
Plaque
Plaque is the culprit of all periodontal disease. Plaque is a biofilm made up almost entirely of bacteria adhered to a pellicle attached to the tooth’s enamel. Minerals in the saliva turn plaque into a hardened substance called calculus. Plaque and calculus may contain up to 100,000,000,000 bacteria per gram. Bacteria in the biofilm do not act like free living bacteria, and in fact are up to 1000-1500 times more resistant to antibiotics. It is hidden plaque (under the gum line/in the gingival sulcus) that causes disease and destruction of oral soft tissue and bone.
Severe Local Consequences
Oronasal Fistulas – Created by the progression of periodontal disease of the maxillary canines, maxillary incisors, and maxillary premolars, results in communication of the oral and nasal passages, creating a severe infection: clinical signs may include a chronic nasal discharge, sneezing, and occasionally anorexia and halitosis. However, if a deep periodontal pocket is discovered before a fistula is formed, periodontal surgery may save teeth and prevent fistula formation.
Class II perio-endo abscess – Occurs when periodontal loss progresses towards the tooth root and gains access to the endodontic system (root canal and pulp chambers). This process usually requires a surgical extraction.
Pathologic Fracture – This devastating process occurs in the mandible due to severe periodontal bone loss creating a weakened jaw. If enough healthy bone remains, jaw fracture repair is required. If too much bone has been destroyed, the only option is jaw bone removal (mandibulectomy).
Oral cancer – The chronic inflammatory state associated with periodontal disease has been linked to oral cancer.
Osteomyelitis – Dental disease is the number one cause of osteomyelitis, which is an area of dead, infected bone.
Severe Systemic Manifestations
It is well documented that inflammation from the gingiva and periodontal tissues allows the body’s defense to attack the invaders which also allows these bacteria to gain access to the body. Recent animal studies suggest that these bacteria negatively affect the kidneys, heart, liver, brain and lungs. There are also studies that strongly link periodontal disease to an increased insulin resistance, resulting in poor control of diabetes mellitus as well as increased severity of diabetic complications.
The Complete Dental Treatment – COHAT (Comprehensive Oral Health Assessment and Treatment)
The presence of plaque/gingivitis, periodontal disease, and broken teeth are all indications for a dental treatment to be performed. A dental prophylaxis on the other hand is a dental treatment that is limited to patients with NO established periodontitis, therefore it is a treatment aimed at preventing the formation of periodontal disease.
Steps in COHAT:
- 1. Complete Oral Exam
- 2. Cone Beam CT – it is impossible to make an accurate oral assessment and diagnosis without advanced imaging, dental x-rays are the bare minimum required
- 3. Develop a treatment plan
- 4. Removal of subgingival and supragingival plaque and calculus
- 5. Polish all enamel
- 6. Lavage the gingival sulcus
- 7. Homecare advice/instructions at time of discharge
Procedures performed if periodontitis is present:
- 1. Root planning – open vs closed
- 2. Perioceutic placement to reduce pocket depths, promote gingival healing and re-attachment
- 3. Guided tissue regeneration to restore lost bone
- 4. Surgical Extractions
Prevention
- 1. Regular COHAT’s
- 2. Daily brushing – gold standard
- 3. Diet – Hill’s t/d
- 4. Treats – Greenies, Tartar Shield, CET Veggiedent, Oravet Chews (NEVER allow your pet to chew on ice, cow hooves, bones or hard plastic treats!) – these are the #1 cause of broken teeth
- 5. Healthy Mouth Water Additive
Click here to find diets and treats that have the VOHC seal of approval for reducing plaque and tartar.