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Dental Disease

Periodontal Disease


This is a completely preventable disease!!!
Periodontal disease is the most common health problem seen in small animals. It affects 80% of dogs and 70% of cats over the age of 3 years. However, there are generally no outward clinical signs of this disease process, and therefore, therapy typically comes too late in the disease. This causes dogs and cats to suffer silently for many months to years. It consists of two stages – gingivitis and periodontitis. Gingivitis, which is inflammation of the gingiva, is reversible. Periodontitis is 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 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 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
Oral-nasal fistulas – created by the progression of periodontal disease of the maxillary canines, 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 the tooth.

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), surgical extraction is likely

Pathologic Fracture – typically occurs in the mandible due to severe periodontal loss and weakened bone, carries a guarded prognosis due to inadequate amount of normal bone in the area needed for healing
Oral cancer – the chronic inflammatory state 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. Radiographs – you CANNOT diagnose periodontal disease without dental x-rays
3. Develop a treatment plan
4. Removal of subgignival 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 Hextra (NEVER allow your pet to chew on ice, cow hooves, bones or hard plastic treats!) – these are the #1 caused of broken teeth
5. Oravet – weekly applied dental sealant


Click here to find diets and treats that have the VOHC seal of approval for reducing plaque and tartar.


Oral diseases are a very common finding in pet's mouths. In fact, periodontal disease is the most common disease in cats and dogs over the age of three. Unfortunately, oral diseases are also one of the most under-diagnosed problems in veterinary medicine. These issues are very destructive to the oral soft tissue, bone and are very painful. Don't expect your pet to show you signs that they have oral pain. It is well known that pets are very good at masking signs of pain. When they are faced with a decision to continue to eat or starve, they almost always chose to keep eating. Below are some pictures of a few cases I've treated. A description will follow the pictures.

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These 3 pictures are of severe periodontal disease. All teeth pictured required extractions due to severe tissue and bone destruction. At their 2 week, post surgical recheck, all patients were doing great. Their owners reported that that were very happy, eating great and acting like younger dogs. A lot of people believe their pets are less active because they are aging. Living with chronic disease and infection can cause depression, lethargy and inactivity.

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These are pictures of a cat with multiple issues. The picture on the left shows severe gingivitis, a fractured canine tooth below the gingiva that is abscessed. The picture on the right shows a fractured mandibular canine, severe gingivitis and teeth with root exposure. This cat had full mouth extractions due to end stage periodontal disease. Since his surgery, he only eats dry food and has gained weight. The owners report a much happier and more affectionate cat.

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On the left is a picture of a luxated canine tooth from a dog fight. The tooth was saved but needed a few different procedures. The first step was to replace the tooth into it's normal position. The lacerated gingiva was sutured and a fixed implant was placed in the dogs mouth to keep the tooth from moving and allow the fractured maxilla to heal. Thirty days later the implant was removed and a root canal was performed. The x-ray shows what the inside of the tooth looks like after a root canal. The picture on the bottom is of the tooth following the root canal. The dog did great and his 6 month follow up x-rays showed that the root canal was a success.

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These are pictures of cat teeth. Each cat has a diseased tooth called a resorptive lesion. Resorptive lesions destroy the structure of the tooth. When they occur above the gum line, they are extremely painful. They expose the dentin of the tooth (sensitive part) to oral bacteria, water, food, touch etc. We do not know what causes these lesions. We cannot halt the progression or save the tooth. All teeth exhibiting resorptive lesions above the gum line need to be extracted.

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This is a very common problem seen in young dogs, particuarily small breeds. This is called retained deciduous teeth or failure to loose their baby teeth. When this occurs, the baby teeth must be extracted. They are occupying a space that is only made for one tooth and cause crowding and malocclusion. If they are not extracted, they will jeopardize the health of the permanent tooth. The picture on the right shows how big the roots of these teeth are. Not only are they large, but they are very fragile. It is common for the root to break during the extraction process. sometimes it requires oral surgery to remove the complete tooth. Leaving broken roots behind is not an option.

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This is a condition called mandibular distocclusion - mandible is shorter than maxilla. If the condition is severe enough to cause palatal trauma, it needs to be corrected. Options to correct the trauma and associated pain include : orthodontics, crown reduction with vital pulpotomy (restoration) and extracting the teeth causing pain/trauma. These pictures show the significant trauma cause by the malocclusion and the correction with crown reduction and vital pulpotomy.

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ORAL TUMORS/CANCER

The picture on the left is of a dog with a tumor called acanthomatous ameloblastoma around a mandibular canine tooth. This type of cancer does not metastasize, but if very aggressive locally. Surgery with clean margins is curative. A partial mandibulectomy was performed and the dog shows no signs of recurrence 18 months later. The second picture is of a much more aggressive type of oral cancer called oral melanoma. This dog had had major oral surgery (entire mandible on one side removed) followed by 5 weekly Melanoma vaccines. She has had no issues eating and the owners are thrilled with the outcome. She is already months pasts her life expectancy had she not had surgery.

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This is a titanium crown that was placed on a dog's canine tooth. Crowns are used to protect damaged teeth and to strengthen teeth after getting a root canal.