Could my Dog or Cat have Periodontal Disease?
COULD MY DOG OR CAT HAVE PERIODONTAL DISEASE?
by Jan Bellows, D.V.M.
Diplomate, American Veterinary Dental College
9111 Taft Street Pembroke Pines, Florida
954-432-1111
Teeth are anchored in periodontal tissues consisting of gingiva (gums),
ligaments, cementum, and supporting bone. More than 85% of dogs and cats
older than four years have periodontal disease.
Periodontal disease starts with the formation of plaque, a transparent
adhesive fluid composed of bacteria. Plaque starts forming within eight
hours after a thorough dental cleaning. When plaque is not removed, mineral
salts in the saliva precipitate forming hard calculus. Calculus is irritating
to gingival tissue. By-products of the bacteria "eat away" the tooth's
support structures eventually causing pain and periodontal disease.
There are two grading systems commonly used to classify the degree of
periodontal disease. Mobility index evaluates tooth movement within the
socket. With Class I mobility, the tooth only moves slightly. Class II
describes tooth movement less than the distance of a crown width. Class III
mobility occurs when there is movement greater than a crown width. Class
III reflects severe periodontal disease in which the teeth have lost more
than 50% of their support and usually need extraction.
Periodontal disease can also be graded from stages one to four. The first
two stages are classified as gingivitis the last two as periodontitis. In
stage one, plaque extends to the gum line causing inflammation of the
gingiva. Stage two gingivitis, is marked by inflammation and swelling.
Gingivitis can usually be reversed by thorough teeth cleaning by a
veterinarian while the dog or cat is anesthetized. If treated early, the gums
can return to normal appearance and function. If untreated, periodontitis can
result. Stage three periodontal disease occurs when there is bone loss in
addition to gingival inflammation and infection. In stage four periodontal
disease, there is a progression of the bone loss usually creating tooth
mobility.
Once bone loss from periodontal disease has occurred, therapy more involved
than routine cleaning is needed. What factors should the pet owner or
breeder consider before periodontal surgery? A cooperative patient, a
treatable tooth, and choice of which periodontal procedure to use. The
owner of a dog or cat with periodontal disease needs to be committed to save
their animal's teeth. This commitment includes daily brushing to remove
plaque, which begins to build within eight hours after the previous
brushing. Frequent veterinary dental re-examinations are required, and
expense should be considered. The patient must also be a willing partner. If
a dog or cat will not allow home care the best dental surgeon and most caring
owner will not make a difference. Unless there is strong owner commitment
and patient compliance, it is wiser to extract a tooth rather than letting
the pet suffer.
Choosing appropriate teeth to operate upon is equally important. Every dental
procedure by a veterinarian should include probing and charting. A
periodontal probe is an important instrument used to evaluate periodontal
health. A probe is marked in millimeter gradations and gently inserted in the
space between the gingival margin and tooth. The probe will stop where
gingiva attaches to the tooth or at the bottom of the socket if the
attachment is gone. Dogs without periodontal disease should have less than
two millimeter probing depths and cats less than one. Each tooth should be
probed on four sides. Probing depths of all teeth are noted on the dog or
cat's medical record and a treatment plan formatted.
Pocket depths up to five millimeters can usually be cleaned adequately with
hand instruments while the patient is anesthetized. Depths greater than five
millimeters need surgical care, to evaluate and clean the root surfaces, or
extract the tooth.
Intraoral x-rays supply important information when deciding which tooth
will benefit from surgery. X-rays help evaluate supportive bone around the
teeth. As a general rule, if there is greater than 50% bone loss around a
tooth, only advanced surgical procedures may provide long term success
(picture 13). X-rays are also examined for other pathology which should be
treated prior to and may effect the outcome of periodontal care.
Once the veterinarian is convinced that he or she is working on a cooperative
patient and tooth that can benefit from care, appropriate type of periodontal
surgery is chosen. An ideal method allows exposure of the root surface for
cleaning, preserves attached gingiva, and allows the gum to be reconnected
in a fashion that eliminates the periodontal pocket.