Periodontal disease is frequent in dogs and cats. It is present in eighty-five percent of all pets over six years of age.
The periodontal structures are the ones involved that are the structures AROUND the tooth, including the gingiva, cementum, periodontal ligament, and alveolar bone.
Periodontitis is inflammation of the periodontal area, gingivitis is inflammation of the gums, and periodontal abscesses are present when there is pus present in the periodontal area around the tooth. Periodontal disease presents as loose teeth, abscesses, odor in the mouth, hemorrhage from the gingival sulcus, ulcers on the gums that contact the teeth affected and intranasal tooth migration.
There are stages of periodontal disease in dogs starting with gingivitis or inflammation of the gums. The free gingival margin is that knifelike portion of the gums that is against the enamel of the tooth but not attached. It should be thin and pink and rest closely to the tooth. Early gingivitis is seen as swelling of the free gingival margin and increased redness in that area. There is an increased tendency for the gum tissue to bleed.
PLAQUE is the offending substance that adheres to the tooth above the gum (supra-gingival). Plaque is the soft, colorless film on the surface of the tooth. It is composed primarily of bacteria and water. Its formation is enhanced by irregularities in the tooth surface.
TARTAR or CALCULUS is calcification or mineralization of the plaque. The calcium comes from the saliva and the salivary duct empties beneath the tongue and at the upper fourth premolar location. These are the first places tartar accumulates.
Treatment of gingivitis is aimed at removing the plaque and reducing the resultant inflammation of the teeth. The consistent removal of plaque will give predictable results. A solution of Nolvasan® is used to flush the areas after brushing. We recommend feeding the Hill’s Prescription Diet® Canine t/d® and the C.E.T.® system that employs an enzyme that dissolves the plaque and helps in its removal. Also there are new chew toys for dental disease that remove plaque and reduce tartar formation such as the Nyla Knot® and the Dental Exerciser®.
Periodontitis in Pets
Periodontitis in pets is the extension of the inflammation beyond the gingival sulcus to the deeper periodontal structures and the bone.
The free gingival margin may recede as a result of loss of bone attachment to the tooth. When this occurs the cemento-enamel junction and root surface will be visible. In severe cases, the area between roots of the same tooth may be exposed. In some cases the gums do not recede but they grow resulting in gingival hyperplasia (excessive growth of the gums around the teeth). The periodontal probe can be used to measure the depth of the gingival sulcus. If the attachment of the gum to the tooth at the bone level has receded then the sulcus will be deeper. This deep sulcus is formed by recession of the bone down the root of the tooth. The gum tissue cannot attach itself to the tooth unless the bone is also attached. The sulcus deepens as the bone recedes. The bone recedes due to inflammation and infection in the sulcus, which is stimulated by plaque and tartar accumulation. As the sulcus deepens, more food and plaque can accumulate predisposing tartar formation and more inflammation. Bleeding always accompanies this form of disease. Radiographs will show recession of the bone from the neck and the root to the tooth.
Treatment of periodontitis involves removal of plaque from the supragingival and subgingival areas. The gingival sulcus must be cleaned on a daily basis. The areas that have exposed roots must be irrigated with Nolvasan® solution. The areas between roots must be cleaned with pipe cleaners.
Surgical measures may be necessary to remove the pocket that is accumulating the plaque.
These infections of the root of the tooth will cause pus to ulcerate through the gum tissue, causing swelling and pain above the tooth root. Treatment would be to cure the periodontitis and perform a root canal to save the tooth.
A dental cleaning is an important part of general health care maintenance for your pet. The teeth are a potential source for life threatening infections to the heart, liver and kidney if periodontal disease develops. Pet’s teeth are very similar to human’s teeth and dental disease is very common in pets. Routine dental care is recommended. Maintaining good oral health will greatly improve the health and breath of your pet. Cleaning of the teeth here in our hospital followed with home care is the best way to insure the long life of your pet’s teeth.
The most common presentation for an abscessed tooth is an acute onset of facial swelling just under the eye. The Physical Examination many times shows a slab fracture of the fourth premolar. Radiographs are recommended and will usually demonstrate a tooth root abscess. Surgery is usually recommended to remove the tooth. Tooth removal of this three-rooted tooth requires splitting each root from the crown then elevating each root independently from its socket.
Teeth are extracted when the teeth are not easily salvageable or when their presence is no longer healthy for the pet. Tooth removal is permanent and may lead to the deterioration of the jaw or other teeth because of the change in forces that may occur when a tooth is removed. Many clients do not understand the ramifications of tooth loss to the overall oral health of the pet. If available or possible, the tooth should be salvaged by either endodontic or periodontic therapy or both.
Oral Nasal Fistula
During dental procedures the removal of a tooth may leave a hole which communicates with the nasal cavity. This hole formed because of chronic infection of the apical portion of the tooth root. This disease is called an oral-nasal fistula. Without proper care this hole may never heal. Surgical creation of a gum tissue flap to close the hole is necessary. An oral nasal fistula in dogs may be discovered at the time of a dental procedure if the tooth has already fallen out.
Root canals are used to prevent the loss of a tooth when the pulp cavity is open or damaged. Open exposed nerve roots are extremely painful and subject to infection. Broken teeth are the most common cause for root canals. This therapy should be done in the absence of infection. The root canal is cleaned of the nerve and blood vessels which is replaced with a type of cement that seals the tooth and prevents infection and pain. Root canal therapy is a procedure that attempts to create a dead but intact tooth and root. Occasionally these fail, requiring extraction of the tooth. Dental cleaning may be needed every six months or yearly depending on your pet’s tartar accumulation rate.
Stomatitis is inflammation of the entire mouth. There are several causes including ingestion of toxic substances, renal failure and electrical shock but the most common cause is severe dental disease. Most pets are presented for exam due to a foul odor from the breath as well as lack of appetite. An oral examination should be performed to confirm that the ulceration present and odor originates from the gum tissues.