Dental Care

Periodontal 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

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.

1. Complete Oral Exam
2. Radiographs - important to diagnose periodontal disease
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
2. Perioceutic placement to reduce pocket depths, promote gingival healing and re-attachment
3. Surgical Extractions

Prevention

1. Regular Dental Prophylaxis
2. Daily brushing or application of Maxiguard gel
3. Diet - Hill's t/d
4. Treats - CET Hextra (NEVER allow your pet to chew on ice, cow hooves, bones or hard plastic treats! - these are the #1 cause of broken teeth)
5. Oravet - weekly applied dental sealant