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 destruction 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.

Originally published in Pet Quarterly, Vol 4, Winter 2006. Reprinted with permission.