Periodontal Disease – Prevention is the BEST Treatment!

Basic Anatomy

The top part of the tooth that is visible is called the crown and is covered with enamel (the hardest substance in the body) and the bottom part of the tooth that lies below the gumline is called the root and is covered by cementum. The periodontal ligament is made up of specialized connective fibers that attach the tooth to the wall of the alveolar bone and the cementum. The innermost area of the tooth is called the pulp cavity and contains nerves and blood vessels. The pulp cavity is surrounded by a porous structure that grows throughout life called the dentin.

The gingiva, commonly referred to as gums are divided into two subsections, the marginal gingiva and the attached gingiva. The marginal gingiva is the unattached or free gingival tissue that surrounds the tooth and forms the gingival sulcus, a shallow space between the tooth and free gingiva. The attached gingiva is located between the alveolar mucosa and the marginal gingiva that is firmly attached to the cementum and bone. 

Dental Formulas 

Dogs: (incisors 3/3, canine 1/1, premolars 4/4 and molars 2/3) x 2 for a total of 42 adult teeth. Puppies have 28 deciduous teeth.

Cats: (incisors 3/3, canine 1/1, premolars 3/2 and molars 1/1) x 2 for a total of 30 adult teeth. Kittens have 26 deciduous teeth.

Mandible (lower jaw) of a dog

What is Periodontal Disease?

Periodontal disease is the most common disease affecting dogs and cats.  “Perio” meaning around and “dontal” meaning tooth; periodontal disease affects the structures around the tooth. Bacteria spreads from the crown of the tooth into the gingival sulcus creating plaque. Calculus is the term used once this plaque has hardened. Once hardened, plaque is unable to be removed by brushing. The bacteria from plaque causes an immune response that leads to inflammation. This chronic inflammatory response results in damage to the periodontal ligament and alveolar bone. Depending on the severity, periodontal disease can also cause sinus, eye and bone infections, tooth root abscesses, tooth loss, tooth fractures, pain, inflammation of the mouth (stomatitis) and tooth resorption.

Stages of Periodontal Disease

Periodontal disease is broken down into 4 stages depending on the severity of the pathology. Factors that influence staging include: mobility of the tooth, periodontal probing, gingival bleeding and dental radiographs. Periodontal disease causes attachment loss of gingiva resulting in a deeper gingival sulcus. The normal gingival sulcus depth in cats is 0.5-1mm and in dogs 1-3mm. The periodontal probe is a dental instrument used to measure the depth of the gingival sulcus. 

Stage 1

  • The gingival margin is inflamed.
  • Gingival bleeding is present on examination. 
  • There is no attachment loss.
  • Reversible 

Stage 2

  • Entire attached gingiva is inflamed.
  • There is up to 25% attachment loss.
  • Bad breath from plaque buildup may be noticeable. 
  • Mild to moderate pain.
  • Reversible

Stage 3

  • Entire attached gingiva is bright red, swollen and bleeding. 
  • Bad breath from plaque buildup is really noticeable. 
  • Moderate to severe pain that may start to affect ability to eat and normal eating behavior.
  • 25-50% attachment loss
  • May or may not be reversible 

Stage 4

  • Entire attached gingiva is bright red, swollen and bleeding and is being destroyed along with the tooth and bone.
  • Bad breath from plaque buildup is really noticeable. 
  • Severe pain that affects ability to eat and normal eating behavior.
  • 50% attachment loss
  • Spread of bacteria via the bloodstream may be negatively affecting optimal organ function (heart, kidneys, liver, etc.)
  • Irreversible

Treatment of Periodontal Disease

For stage 1 and 2 periodontal disease, a professional dental cleaning performed under anesthesia followed by regular at-home care is typically effective. Dental cleanings must be performed under anesthesia to greatly decrease the risk of severe damage that can result from patient movement. 

A professional dental cleaning includes: 

  • An oral examination (by the veterinarian)
  • Dental radiographs “x-rays” performed by technician but evaluated by the veterinarian
  • Cleaning plaque and calculus from above and below the gingival margin
  • Probing and charting (sulcus depth/tooth mobility)
  • Polishing
  • Flushing
  • Applying a sealant (optional)
  • Discharge/at-home instructions

The most common treatment for stage 3-4 includes a professional dental cleaning with possible extraction(s). The need for extraction depends on the bone height and attachment loss of a tooth. If the damage to a tooth is irreversible, it should be assumed painful whether or not the pet is showing clinical symptoms. I feel it is inhumane to decline removal of severely affected teeth. Periodontal surgery is another method of treatment that is more expensive but aims to preserve the periodontium, including a gingivectomy (removing part of the gingiva to restore normal sulcus depth), bone grafting and periodontal flap surgery (designed to effectively clean and reshape tissue to promote healing). Periodontal surgery should only be performed if at-home practice of good oral hygiene is followed afterwards. 

Prevention

(see at-home dental care article for more info)
  • daily teeth brushing
  • dental treats – look for the Veterinary Oral Health Council (VOHC) seal of approval 
  • dental diets
  • dental toys – chewing can help prevent periodontal disease, but some hard treats and toys can actually cause fractures
  • feed high quality food
  • professional dental cleanings as needed
VOHC Seal of Approval for control of tartar

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