Periodontitis in Dogs

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Periodontitis is the inflammation of the structures that support teeth, the gum tissue, periodontal ligament, alveolus (small cavity) and cementum (bonelike connective tissue covering the root of a tooth and assisting in tooth support). It is one of the most common infectious diseases in the world in dogs and is caused by bacteria that make up plaque.

It is the leading cause of tooth loss and, in human dentistry, periodontitis is called the silent killer due to its destructive nature. The total impact is difficult to measure scientifically, but periodontitis is the number one source of the bacteria that causes aspiration pneumonia in humans. Small amounts of the same bacteria in periodontal disease are released into the bloodstream (bacteremia) when we chew or brush our teeth everyday. The significance of these events is not yet determined. Periodontitis causes tooth and bone loss, which can even lead to jaw fracture.

Periodontitis can be seen at almost any age and affects over 80 percent of dogs over three years of age.

Other dental problems can have symptoms similar to that of periodontitis in your pet. Therefore, excluding other diseases is important before establishing a diagnosis of periodontitis. Other diseases may include:

  • Gingivitis (inflammation of the gingiva) can be a precursor to periodontitis and looks similar, but does not have deep pockets (as measured by a periodontal probe).

  • Endodontic lesions which can be mixed with or can be precipitated from periodontal lesions

  • Periapical (surrounding tooth) abscesses, fractured teeth and any other cause of tooth pain

  • Fractured mandible secondary to periodontal disease
  • What to Watch For

  • Bad breath
  • Bleeding gums
  • Tooth loss
  • Ulcers in the mouth
  • Loose teeth
  • Tooth extrusion
  • Gum recession
  • Poor appetite
    • Periodontitis can occur if severe tartar is left untreated. The yellow-brown discoloration on the teeth in this photograph is tartar buildup.

    • This dog has severe periodontitis. Note the severe tartar on the teeth.

    • With patience and persistence, most dogs eventually tolerate having their teeth brushed at least three times a week.

     

    Diagnosis

    Diagnostic tests are needed to recognize canine periodontitis and exclude other diseases. Tests may include:

  • A complete medical history and physical examination concentrating on a thorough oral exam of your dog, perhaps while he is anesthetized.

  • Full mouth x-rays to evaluate your dog's teeth. Seventy percent of the tooth structure is below the gumline and periodontitis cannot be properly diagnosed without them.

  • Complete periodontal probing and dental charting. General anesthesia is needed for a thorough oral examination and periodontal probing (a blunt probe that is used to check the gum/tooth interface).

    Additional diagnostic tests may include:

  • Blood chemistries, a complete blood count (CBC), and urinalysis to determine the general health of the patient. It is also recommended prior to anesthesia.

  • Anaerobic culture and sensitivity for chronic cases of periodontitis
  • Treatment

    Teeth can generally be salvaged until they have lost 75 percent of their bone support from one or more roots. Your veterinarian may recommend the following:

  • Antimicrobial drugs may be indicated one hour before oral procedures. Examples of antimicrobials are those that target gram negative anaerobic bacteria that can commonly occur in the mouth. Drugs may include clindamycin and a combination of enrofloxacin and metronidazole. Anesthesia is required for treatment of periodontitis. Anesthesia is followed by:

  • Chlorhexidine(0.12 percent), a disinfectant that is often sprayed in the oral cavity during the procedure to reduce aerosolized bacteria (bacterial spread by the air) during the procedure

  • Ultrasonic scaling (cleaning the teeth both above and below the gumline) and tooth polishing.

  • Root planing (which is scaling [scraping/cleaning the teeth] deep below the gumline).

  • Periodontal pockets may require surgical periodontal flaps in order to root plane away the calculus and bacterial biofilms (large interrelated groups of bacteria that are virtually impenetrable without mechanical disruption and which are somewhat resistant to antibiotics).

  • Single pockets may benefit from a locally instilled product that gives off an antibiotic for up to two weeks.

  • Extractions (removing the tooth) may be required if a tooth is unsalvageable (as indicated by full-mouth X-rays).
  • Home Care

    The basic principle is that active periodontal disease will not develop around a clean tooth. Daily tooth brushing is the single most important home care act that you can do. Dental care diets or treats can also be helpful to maintain a healthy mouth. Chlorhexidine rinses or toothpastes are excellent at killing plaque above the gumline and should be used daily in chronic or refractory cases.

    Periodontal lesions can be progressive so it is important they are monitored closely. Follow-up with your veterinarian as directed (often every 3 to 6 months) for re-evaluation.

    Preventative Care

    Again, daily tooth brushing using a pet dental product is the most important thing you can do to prevent periodontal disease. Options include chlorhexidine gels, toothpastes, rinses and regular toothpastes. In addition, dental examinations every three to six months by your veterinarian are important. He or she may recommend frequent ultrasonic scalings and root planings.

    A new vaccine that that targets the bacteria involved in the disease processed is under development by Pfizer®. It is called "Porphyromonas" vaccine is slated for release sometime in mid 2006.

    Because other dental problems can lead to similar symptoms in your dog, excluding them before establishing a diagnosis of periodontitis is important.

  • Gingivitis is a precursor to periodontitis and looks similar, but does not have deep pockets.

  • Endodontic lesions, which can be mixed with or can be precipitated from periodontal lesions, may be present.

  • Periapical (surrounding the tooth) abscesses, fractured teeth, and any other cause of tooth pain may be present.

  • Fractured mandible, secondary to periodontal disease, may be present.
  • Veterinary care should include diagnostic tests and subsequent treatment recommendations.

    Diagnosis In-depth

    Diagnostic tests are needed to recognize canine periodontitis. Tests may include:

  • Your veterinarian should complete a thorough dental history and dental examination. Periodontitis can be seen at almost any age and affects more than 80 percent of dogs over 3 years of age.

  • Full mouth radiographs (X-rays) are usually very important because 70 percent of the tooth structure is below the gumline and periodontitis cannot be properly diagnosed without them.

  • Periodontal probing and dental charting may be done.

  • Radiographs (X-rays) may determine the type of therapy for teeth that have bone loss because 90 percent of teeth that have 90 percent bone loss can be saved.

  • Chronic, refractory cases may benefit from anaerobic culture and sensitivities.
  • Treatment In-depth

    Treatment for canine periodontitis may include one or more of the following:

  • Antimicrobials may be given one hour pre-operatively if indicated. Examples of antimicrobials are those that target gram-negative anaerobic bacteria such as clindamycin and a combination of enrofloxacin and metronidazole.

  • Chlorhexidine (0.12 percent) may be sprayed in the oral cavity which may reduce aerosolized bacteria by 95 percent at the start, middle and end of the procedure.

  • Ultrasonic scaling (removing tarter from teeth), both supra- and sub-gingival (above and below the gum line), and root planning (scraping of the tooth to remove bacteria) may be performed by an experienced veterinarian.

  • Periodontal pockets (deep space between the gum and root of the tooth) greater than 5 mm may require surgical periodontal flaps in order to effectively root plane away the calculus and bacterial biofilms.

  • Single pockets may benefit from a locally instilled perioceutic product.
  • Follow-up

    The best treatment for your dog is a combination of home care and professional veterinary care. Home care is critical to the prognosis/outcome of canine periodontitis.

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