Periodontal disease (also referred to as periodontitis) is regarded as the most prevalent disease in pets. In fact, a majority of pets age three display clinical signs of periodontal disease.
Veterinarians have held that periodontal disease is the consequence of poor oral hygiene. It's why pet owners are told to brush their pets' teeth and have routine anesthetic cleanings done. However, we now understand that periodontal disease occurs regardless of hygiene for most pets. There's no amount of brushing, scaling, or polishing that will completely eliminate the underlying disease process.
Periodontal disease is a progressive process by which the structures that surround the teeth become inflamed. This includes the gums, bone, cementum (a bony material that surrounds the root), and the periodontal ligament (which attaches the tooth to the bone), all of which encase and support the teeth.
Periodontal disease occurs when a thin layer of bacteria-containing film coats the structures surrounding the teeth. This biofilm is referred to as plaque, which eventually hardens into a crusty substance called tartar. The bacteria involved throughout this process secrets toxins, which ultimately leads to the inflammation of the periodontal tissues.
Since periodontal disease is a progressive process, older pets tend to suffer disproportionally from more advanced stages of the disease.
Symptoms and Identification
Periodontal disease in both cats and dogs is often categorized into four discrete clinical stages:
Stage 1: Gingivitis (puffy, red gums).
Stage 2: Early disease with less than 25% loss of attachments to tooth roots.
Stage 3: Moderate disease with some exposure of tooth roots and 25%-50% of attachment loss. The space between roots (called a furcation) will become visible during this stage.
Stage 4: Severe disease with more than 50% loss of attachment to roots and highly visible furcations.
In all stages, a varying degree of oral malodor is detectible, though it does tend to get much worse in more advanced stages of the disease. Terrible breath is the most common sign of disease noticed by pet owners, followed closely by dental discoloration caused by obvious tartar buildup.
Tooth loss and oral pain may also become evident, but not always. In most cases, dogs and cats will hide any signs of pain. However, owners who are alerted to signs of periodontal discomfort may note the following as the disease progresses:
Salivating excessively or discoloration around mouth indicative of chronic wetness
Reduced food consumption (often despite an obvious interest in the food bowl)
Messy eating, with kibble or morsels left outside the food bowl
Pawing at the mouth or rubbing the mouth on surfaces
Bleeding at the gumline
A wound under the eye is also possible for dogs with tooth root abscesses in their upper molars or premolars.
Sepsis, an infection of the blood, is a possible outcome of advanced periodontal disease and can lead to kidney, liver, and heart valve infections.
The trouble with classifying periodontal disease is that the mouth is impossible to fully assess without examination under anesthesia. This is because assessing attachment loss is only possible after removing tartar, probing the gums, and, potentially, taking dental X-rays.
Routine annual or semi-annual cleanings give veterinary professionals an excellent opportunity to examine a patient's periodontal disease status.
Note: Non-anesthetic dental cleanings are not considered effective to thoroughly assess periodontitis as it's impossible to clean below the gumline or determine the loss of attachment during this procedure. As such, it's considered purely cosmetic.
A significant genetic component has been noted for periodontal disease. In general, smaller breeds are predisposed, including Yorkshire Terriers, Maltese, and Miniature Poodles. However, there are some large breeds who also suffer periodontal disease. Greyounds and other sighthounds, for example, are also highly predisposed to periodontal disease.
Treatment typically involves the following:
Scaling and Polishing Under Anesthesia
This removes the tartar and film of bacteria coating the teeth. A deep scaling of affected areas is often undertaken, and fluoride is usually added to this regimen. This is typically done every four months in severe cases, every six months in moderate cases, and every twelve months in mild cases. Annual prophylactic dental cleaning is recommended in all others.
This is a procedure where the exposed root of the tooth receives a deep scaling.
These are often applied to the pockets of the affected teeth to aid in recovery.
Extracting teeth requires surgery and is needed when teeth have lost a large percentage of their attachments. Each time a tooth is extracted, the area needs to be carefully sutured closed.
If there's a significant risk of bacteria entering the bloodstream during a surgical procedure, antibiotics are administered before, during, and/or afterwards.
Oral Antibiotics (instead of surgery)
There are some cases that teeth extractions are not feasible, generally, these are patients whose anesthetic risk is too high for surgical intervention. Oral antibiotics are used to keep bacterial infections under control. Frequent use of antibiotics in these cases is controversial due to the issue of bacterial resistance.
Note: Once bone loss has occurred, periodontal disease is not considered curable. Only stage 1 periodontal disease (gingivitis) is curable. The treatments for stage 2 through 4 patients are aimed at controlling the disease. Home care is recommended for pets with and without periodontal disease. This includes:
Tooth brushing. This is considered preventative, but should be part of a regular home-care treatment regimen for all patients with any degree of periodontal disease. Daily brushing, if feasible, is recommended for all dogs and cats.
Applying plaque-prevention gels to the teeth daily can help.
Chews and other tartar control products may also be beneficial.
Note: There are many ineffective products on the market. Look to the Veterinary Oral Health Council (VOHC.org) for products that are tried and true.
The cost of diagnosis and treatment varies greatly depending on the degree of disease. Once surgical intervention is required, the cost can run into the low thousands of dollars. However, because of the progressive nature of the disease, treatment can be done in stages, which makes financial considerations less overwhelming for many owners.
Prevention of periodontal disease is possible in many cases with daily brushing and routine annual scaling and polishing.