Periodontitis

Periodontitis

By: Dr. David Nielsen

Section: Overview

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 cats 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 peridontitis 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 cats 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

    Diagnosis

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

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

  • Full mouth x-rays to evaluate your cat'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 peridontal 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%), 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 and Prevention

    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 3-6 months) for re-evaluation.

    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.

    Products to use may include:

  • CET toothpaste, CET enzymatic toothpaste, Dentavet toothpaste.

  • Chlorhexidine gluconate products such as CHX rinse, CHX guard gel, Hexarinse solution and Dentivet toothpaste.

  • Hill's Feline Prescription Diet T/D (tooth diet).

     
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