Periodontal Disease Q&A
Originally published in Pet Quarterly, Vol 4, Winter 2006. Reprinted with permission.
What is periodontal
disease?
Periodontal disease is an infection
of the periodontium, the area
surrounding the tooth. The periodontium consists of four structures: gingiva (gum), alveolar bone
(socket where the tooth root is held),
cementum (outer lining of root), and
the periodontal ligament (ligament
that holds the tooth in place).
The disease is caused by bacteria,
leading to gingivitis (inflammation of the gums) and often to
periodontitis (inflammation of the
periodontium). While gingivitis
is reversible, periodontitis is not,
and it results in pockets of chronic
infection around the tooth roots.
Why should I be
concerned?
Periodontitis is painful and may
lead to premature tooth loss.
Severe infections involving the
upper teeth in dogs can create a
fistula, or opening, between the
mouth and sinus cavity, which
may cause frequent sneezing.
Advanced periodontal disease can
also predispose small-breed dogs
to fractures of the lower jaw.
In the diabetic pet, periodontitis
may lead to insulin resistance and
poor control of blood sugar. There
is also a relationship between the
severity of periodontal disease and
inflammation of the liver, kidneys,
lungs, and heart.
Are there any breeds
predisposed to
periodontal disease?
Small-breed dogs are frequently
affected by periodontal disease-it
is not uncommon to find periodontitis in dogs 2 years of age, and
advanced periodontitis and tooth
loss by the age of 4. Greyhounds
are a larger breed commonly
affected with periodontal disease.
How do I know if my
pet is suffering from
periodontal disease?
Periodontal disease hides under the
lips and gums, and unfortunately,
your pet can't tell you when he or
she is in pain. You may notice a
foul odor from your pet's mouth,
but because the disease comes on
gradually, you may miss it. Your
pet may avoid chewing hard food
or its favorite chew toys. Cats
may swallow hard food without
chewing. The best way to detect
periodontal infection in your pet
is to have an oral examination
performed by your veterinarian.
How will my
veterinarian detect
periodontal disease?
Since three of the four areas
infected by periodontal disease are
under the gum, your veterinarian
will need to use a special instrument, a periodontal probe, to detect
"pockets" around each tooth. When
a pocket is detected, it is recorded
on a dental chart, and your veterinarian will take a radiograph to
diagnose the extent of the destruc-
tion around the tooth. This is exactly
the same process your dentist uses
to detect periodontal disease in your
mouth; however, veterinary patients
require general anesthesia.
Why shouldn't I have
"anesthesia-free
dentistry" performed?
More and more pet care providers
are advertising "anesthesia-free
dentistry." Calculus,or tartar, accumulates on the crowns of the teeth and is often brown and unsightly. It is the calculus that is partially removed during "anesthesia-free dentistry." This technique neither prevents nor treats periodontal
disease. Rather, it is a cosmetic procedure. Remember, periodontal disease occurs below the gum around the roots of the teeth. It is impossible to treat these areas in pets without general anesthesia. With "anesthesia-free dentistry," the infection and disease remain hidden below the gum and pain and destruction will continue. In addition, the instruments used to remove calculus are sharp. Any unexpected movement, which can be expected from pets in pain from periodontal disease, could
cause injury to the pet's gum, lips, tongue, or eyes.
What is the difference
between a dental "prophy" and periodontal treatment?
Dental prophylaxis, often referred
to as a "prophy," is cleaning and polishing of the teeth (above and below the gum) for prevention of periodontal disease. Once periodontal disease has begun to destroy
the areas around the tooth roots, the
patient needs periodontal treatment.
The goal of treatment is to relieve pain and control periodontitis and involves not only cleaning and polishing the crowns (enamel) of the teeth, but also cleaning the pockets and tooth roots. It may also include applying an antibiotic under the gum or periodontal (gum and bone) surgery. A temporary plaque barrier (Oravet) may be applied to the crowns of the teeth to prevent plaque (which harbors bacteria) from adhering.
Because periodontitis can only be controlled, not cured, treatment must be done more often (two to four times per year) than prophylaxis. It also costs more than a basic cleaning.
Can cleaning be done
with sedation instead
of anesthesia?
Sedation for a dental cleaning is
risky. It doesn't allow for respiratory
support and doesn't prevent water,
saliva, or calculus from entering the
lungs. In many cases, it doesn't allow
intraoral radiographs to be taken.
Sedation is also time-limiting - the
procedure has to be stopped when
the sedation wears off, even if there
is more cleaning to be done.
What can be done
to decrease the risks of anesthesia for my
senior pet?
Treatment of dental disease in the senior patient invariably leads to
improved quality of life. However, pet owners' fear of anesthesia is one of the biggest deterrents to professional pet dental care.
Certain procedures can decrease the risks of anesthesia in patients, especially senior pets who may have preexisting medical illnesses. A general physical examination and blood and urine tests should be done in all patients. Your veterinarian may also recommend an ECG, chest radiographs, or an echocardiogram based on your pet's individual needs. These tests give your veterinarian information about your pet's preexisting risk factors, medications to use or avoid, and how to prepare your pet for the procedure.
During anesthesia, the pet's vital signs should be monitored continuously to prevent and detect any complications. Pain medication should be provided before, during, and after the procedure to help improve recovery from anesthesia. These procedures add expense but are essential in decreasing risk factors.
Can periodontal disease be treated
with antibiotics?
Plaque bacteria are much more
resistant to antibiotics than the bacteria
that cause most infections. Antibiotics without periodontal treatment are ineffective in managing and controlling periodontitis.
What can I do for my
pet with periodontal disease?
Following professional periodontal treatment, your veterinarian will recommend daily dental home care for your pet. The care you provide at
home between professional treatments
is essential in controlling periodontal disease and providing continued comfort for your pet.