Periodontal disease in pets

By Jan Bellows D.V.M. DipAVDC
All Pets Dental Clinic

Periodontal Disease in Pets
More than 85% of dogs and cats older than four years have periodontal concerns. There are four periodontal types of tissue: the gingiva (gum), cementum, periodontal ligament, and alveolar supporting bone.

Periodontal disease starts when plaque forms; plaque is a transparent adhesive fluid composed of mucin, sloughed epithelial cells and aerobic, and gram positive cocci. Plaque starts forming two days after dental cleaning. If the plaque is not removed, mineral salts in the food can precipitate to form hard dental calculus. The calculus is irritating to the gingival tissue, changing the pH of the mouth and allowing bacteria to survive subgingivally. By-products of these bacteria “eat away” at the tooth’s support structures, eventually causing the tooth to be lost in some cases.

There are two common grading systems commonly used to classify the degree of periodontal disease. The mobility index evaluates the looseness of the tooth. With Class I mobility, the tooth moves slightly. Class II is when a tooth moves less than the distance of its crown width. With Class III mobility the tooth moves a distance greater than its crown width. Class III teeth have lost more than 50% of their support and in most cases should be extracted.

Periodontal disease can also be 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

When periodontal disease is not treated, subgingival bacteria can continue to reproduce, creating deeper periodontal pockets through bone destruction.
Eventually, this progression can cause tooth loss and other internal medicine problems.

Imagine a giant tooth sitting in a 10-foot garbage can containing mud and industrial waste. Continue to pretend it is your job to clean the tooth and you are only supplied with equipment 5 feet long. What happens? The top is cleaned and the bottom is allowed to remain in the toxic waste until it eats through the can. How can you solve this problem? Try opening the side of the can to clean the waste out in order to save the tooth. That is the essence of periodontal surgery.

What decisions should the veterinarian make when considering periodontal surgery? A committed client, a cooperative patient, a treatable tooth, and a choice of which periodontal surgery procedure to use.

The client 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 and expense should also be considered and discussed prior to periodontal care. The patient must also 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 rather than letting the pet suffer.

Choosing appropriate teeth to operate upon is equally important. Every dental prophylaxis should include probing and charting. A periodontal probe is the single most important instrument used to evaluate periodontal health. A probe is marked in millimeter gradations and gently inserted in the space between the gingival margin and tooth. A probe will stop where the gingiva attaches to the tooth or at the apex of the alveolus if the attachment is gone.

Intraoral radiography supplies important information when deciding which teeth can benefit from surgery. Radiographs help evaluate the supportive. Radiographs should also be examined for other pathology including endodontic lesions that can be treated prior to and may effect the outcome of periodontal care.

Once the clinician is convinced that he or she is working on the right patient and tooth, the appropriate type of periodontal surgery is chosen. An ideal method allows exposure of the root surface, preserves the attached gingiva, and allows the gingiva to be resutured in a fashion to eliminate the periodontal pocket and promote reattachment to the root surface.

At one time gingivectomy was the treatment of choice to eliminate pocket depth and allow exposure of the root surface for cleaning. Unfortunately, part of the important attached gingiva is sacrificed in the gingivectomy procedure. Gingivectomies should only be used in cases of gingival hyperplasia where there is an overgrowth of tissue.

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.