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If your pet has any bad breath, redness or bleeding along the gum line, drooling (which may be tinged with blood), difficulty chewing, pawing at the mouth, loose or missing teeth, facial swelling (especially under the eyes), nasal discharge, or gum recession; your pet most likely needs a dental! These symptoms lead to Periodontal disease. Request a dental procedure for your pet online! Go to our home page and click request an appointment.

 

Periodontal Disease

Periodontal disease is inflammation of some or all of the tooth’s support structures (gingiva, cementum, periodontal ligament, and alveolar bone). When compared to gingivitis, periodontitis indicates bone loss.

Periodontal disease is caused by bacteria. Initially a pellicle forms on the clean tooth. This pellicle attracts aerobic gram positive bacteria (mostly actinomyces and strepococci). Soon more bacteria adhere forming plaque. With in days the plaque thickens, underlying bacteria run out of oxygen and anaerobic motile rods and spirochetes begin to populate the subgingival area. Endotoxins released by the anaerobic bacteria cause tissue destruction and bone loss.

Microscopic lesions have been found affecting dog’s livers, kidneys, and brains in some animals with periodontal disease.

Dogs and cats from six months on may be affected.

Signs

Grade 1 Inflammation
Grade 2 Inflammation, edema, gingival bleeding upon probing
Grade 3 Inflammation, edema, gingival bleeding upon probing, pustular discharge -- slight to moderate bone loss
Grade 4 Inflammation, edema, gingival bleeding upon probing, pustular discharge, mobility -- severe bone loss

Causes

perio1.jpg (10864 bytes)
Marked bone loss
secondary to
periodontal disease

Gingivitis - (dogs) streptococcus and actinomyces species

Periodontitis - (dogs) pigmented and non pigmented Bacteroides (Porphyromonas Gingivalis, Prevoltella sp., Bacteroides sp.), Fusobacterium

Cats: Peptostreptococcus sp., actinomyces, and porphyromonas SP.

Diet: soft diet promotes periodontal disease through accumulation of plaque.

Risk Factors

Toy breeds with crowded teeth
Dogs that groom themselves causing hair to be imbedded in the gingival sulcus
Other debilitating illnesses
Poor nutrition state

Differential Diagnosis - phemphigus, lupus, oral neoplasia, stomatitis

Tests

CBC/CHEM/U/A - N/A

Imaging - Radiography an important diagnostic tool used in evaluating periodontal disease. As much as, 60% of disease is hidden below the gum line.

Early radiographic signs of grade 3 periodontal disease: loss of density and sharpness of the crestal bone. As periodontal disease progresses, loss of lamina dura mineralization apically is observed as well as furcation involvement in multirooted teeth. There are no radiographic changes in grades 1 and 2 disease (gingivitis).

Severe periodontal disease radiographically appears as loss of bone support around one or more roots. Bone loss may be horizontal-an decrease in bone height around one or more teeth, vertical (infrabony defect), or oblique (a combination of both).

felineperio.jpg (9402 bytes)
Note widened periodontal
ligament space on distal
aspect of canine due to
periodontal disease

Diagnostic Procedures:

Periodontal probing - "probing depth" distance between free gingival margin and apical extent of pocket. Probing depths greater than 2mm in the dog and 1mm in the cat are abnormal.

Attachment loss measures between cementoenamel junction (CEJ) and apical extent of pocket. Normally the gingival sulcus is located at the CEJ, any attachment loss is abnormal.

Treatment

The ultimate goal of periodontal therapy is to control plaque. A willing patient and client who is able to provide home care are important considerations in creating a therapy plan.

Grade one or two - professional cleaning, hand scaling, polishing, irrigation, application of fluoride

heska.jpg (32691 bytes)
Periceutic (oxytetracycline gel)
placed into a cleaned subgingival
pocket

Grade three - (pocket depths 3-6mm in dog, 2-4mm in cats) above plus closed root planing and subgingival curettage, and application of perioceutic gel may be indicated

Grade four - (pocket depth greater than 6mm in dog, 4mm in cat). Surgery will need to be performed to either expose the root for treatment (open flap curettage), or extraction.

perio4.jpg (14766 bytes)
Marked gingival inflammation due to tartar
accumulation leading to periodontal
disease

If 2-3mm healthy attached gingiva present: apical reposition flap to decrease pocket depth in areas of alveolar bone loss.

If not enough healthy gingiva remains for apical reposition flap: rotated flap (from adjacent gingiva), free gingival flap, or extraction may be necessary.

Bone replacement procedures - may be helpful to save teeth affected by two or three walled infrabony pockets.

Guided tissue regeneration - use of tissue barriers (Gore-Tex) separating gingival tissue and root surface

Periodontal splinting - can be used especially in the incisor areas to help stabilize mobile teeth. Criteria for splinting: normal periodontal support on both sides of the tooth (teeth) to be stabilized, strict home care, and a cooperative patient who will not chew on hard objects.

Medications - Clindamycin is an antibiotic approved for dental infections. It may be used pre treatment for a week before periodontal treatment, perioperative fifteen minutes before anesthesia, postoperative for 7-10 days, and/or in a pulse therapy fashion given the first five days of each month (extra-label).

toobrush.tif (835112 bytes)
Use of a soft-bristled
toothbrush, which will clean
under the gingival margin, is
the foundation of veterinary
dental home care

Home Care

Fluoride - Stannous fluoride preparations have advantages in helping control periodontal disease by reducing plaque by being deposited on the surface of enamel, and also decreases dental pain. 0.4% strength should be used in patients with stage 3 and 4 periodontal disease, especially those with exposed root surfaces. Available as Omni Gel and Gel Kam.

Chlorhexidine is the most effective product to inhibit plaque formation in humans. Chlorhexidine produces bacteriostatic and bactericidal effects against bacteria, fungi, and some viruses. Once absorbed it continues to be effective for up to 24 hours. In humans, to be maximally effective, chlorhexidine is swished in the mouth for one minute twice daily. The contact time of application is important for chlorhexidine to bind to the tooth and gingival sulcus. One minute oral rinsing is difficult to accomplish in animals. Chlorhexidine can be applied with a gauze sponge, cotton tipped applicators, as a spray or with finger brushes.

For animals, Chlorhexidine is available as:

VRx Products Harbor City, Ca: CHX Guard solution composed of Chlorhexidine gluconate 0.12% plus zinc gluconate which promotes healing of ulcerated tissue; CHX gel Chlorhexidine gluconate 0.12% -- the gel allows greater binding time and a pleasant taste; CHX Guard LA-long acting ZincChlorhexidate gel.
Virbac, Fort Worth, Tx: DentiVet toothpaste containing chlorhexidine gluconate, zinc, and sodium hexamethaphosphate; Hexarinse containing 0.12 chlorhexidine.
Novaldent (chlorhexidine acetate) 0.1%

Lactoperoxidase system enhanced enzyme products - have antibacterial properties decreasing plaque. (CET , CET Forte toothpastes, CET Chews, CET Spray-VRx Product, Harbor City, Ca.

The degree and type of home care products dispensed depends on:

Stages 1 and 2
Daily brushing with dentifrice
Stage 3, where periodontal disease has been established
Daily brushing with fluoride containing toothpaste
Twice weekly application of stannous fluoride gel
Pulse therapy antibiotics
Stage 4, advanced periodontal disease homecare includes
Zinc ascorbate spray 3-4 times daily
0.2% chlorhexidine spray twice daily or CHX-Guard (VRx Products) -- combination of Chlorhexidine gluconate and zinc
Pulse therapy antibiotics
At the end of two weeks, Stannous fluoride gel twice weekly can be substituted for the chlorhexidine spray

Precautions - N/A

Possible Interactions - Chlorhexidine should not be used with fluoride products at the same time. The binding of both products may inactivate each other. A thirty-minute to one-hour wait between use of a dentifrice containing fluoride, and a chlorhexidine rinse or gel is recommended.

Alternative Drugs - Tetracycline, Clavamox, Flagyl have been used to treat periodontal disease

Follow-Up

Patient Monitoring - the degree of periodontal pathology dictates recall interval -- some patients are monitored weekly while others can be evaluated every three to six months.

Pictures

felperio.jpg (12897 bytes)
Grade 1
perio2.jpg (13151 bytes)
Grade 2

Grade 3

Grade 4


<http://www.dentalvet.com/vets/periodontics/periodontal_disease.htm>

CANINE DENTISTRY

 

I was unaware that dogs have dental problems. Is it common?

Dental disease is the most common disease in dogs and cats. Over 68% of all pets over the age of three have some form of periodontal or dental disease. Most pets will show few signs of dental disease. It is up to the pet’s family and veterinarian to uncover this hidden and often painful condition.

Are dental problems the same in pets and people?

No. In man the most common problem is tooth decay which, due to the loss of calcium from the enamel, results in painful, infected cavities. In the dog tooth decay represents less than 10% of all dental problems. The most common dental problems seen in dogs are caused by periodontal disease.

 

What is periodontal disease?

Periodontal disease is a term used to describe inflammation or infection of the tissues surrounding the tooth. Accumulation of tartar and calculus on the teeth contributes to gum recession around the base of the tooth. Infection soon follows and the gums recede, exposing sensitive unprotected tooth surfaces. Untreated infection then spreads into the tooth socket and ultimately the tooth loosens and is lost.

 

Is periodontal disease very common?

It is estimated that over 68% of dogs over three years old suffer from some degree of periodontitis, making it by far the most common canine disease.

 

What is tartar and can it be prevented?

The mouth of all mammals is home to thousands of bacteria. Many of these bacteria will breed on the surfaces of the tooth and form an invisible layer called plaque or biofilm. Some of this is removed naturally by the dog’s tongue and chewing habits but if allowed to remain on the tooth surface, the plaque thickens, becomes mineralized and is then visible as tartar and ultimately calculus. The tartar presses on the gums, which recede, causing inflammation and infection called gingivitis. The gums continue to recede until ultimately the tooth socket is infected and the tooth is lost.

 

As the oral infection increases, tonsillitis and pharyngitis can also occur. In addition, the bacteria are absorbed into the blood stream and can be carried to other organs. Heart valve infections (endocardiosis or endocarditis), kidney and liver problems are frequently caused by “bad teeth”.

 

Can tartar be prevented?

Plaque becomes mineralized in some dogs much quicker than in others. Special canine chew toys as well as feeding specifically-formulated dental diets may help reduce tartar build up, as does regular home care such as tooth brushing. Today there are many products designed to reduce tartar in our dogs.

Will feeding dry food remove tartar?

Once tartar has formed it will be necessary to remove it by professional scaling and polishing under anesthesia. Pet food manufacturers have recently developed new dental diets that can help reduce the formation of plaque and tartar in your pet.

 

What is involved with a dental cleaning for my dog?

The goal of dental scaling and polishing is to remove the tartar and invisible plaque. Your veterinarian will perform pre-anesthetic blood tests to ensure that kidney and liver function are satisfactory for anesthesia. Sometimes antibiotic treatment is instituted before a full dental prophylaxis is carried out.  Your veterinarian will discuss the specific pre-dental recommendations for your pet.

 

Tooth scaling will be performed using both hand scalers and ultrasonic cleaning equipment to remove tartar both above and below the gum line. The tartar beneath the gum line causes the most significant gum recession. The teeth are then polished in order to help prevent subsequent plaque build-up. It may be necessary to carry out other procedures such as extractions at the same time. Special applications such as fluoride, antibiotic preparations and cleaning compounds may be indicated to decrease tooth sensitivity, strengthen enamel and reduce plaque accumulation and bacterial infection.

 

These procedures will be fully discussed both before your pet’s dental cleaning and when you bring your pet in for the procedure. Since it can be difficult to predict the extent of dental disease in advance of the procedure, it is imperative that your veterinarian is able to reach you during the procedure to discuss any additional treatment that may be necessary.

.

Do I have to make an appointment for my dog to have a dental scaling and polishing?

Yes. Your veterinarian will perform pre-anesthetic blood tests, examine your pet for any other underlying disorders prior to the procedure, and determine if antibiotic treatment should be started in advance.

 

How can I prevent tartar accumulation after the procedure?

Plaque and tartar begin forming in as little as six hours after your pet’s dental cleaning. A home dental care program is a must for all pets. Your veterinarian will provide you with detailed instructions onhow to brush or rinse your pet’s teeth.

 

Can I use human toothpaste?

Human dentifrice or toothpaste should not be used in dogs. These are foaming products and are not meant to be swallowed. Additionally, many types of human toothpaste contain sodium, which may cause problems in some pets.

 

 TARTAR PREVENTION

 

How does tartar form, and what does it do?

Plaque is a gummy substance that forms on the teeth within a few hours after a meal. Within twenty-four hours, plaque hardens into tartar.

 

Ta rtar is harmful in two ways. First, it serves as a place where bacteria can reside and multiply in the mouth. There is substantial scientific evidence that bacteria from tartar are absorbed into the blood stream and deposited in various organs. Heart and kidney disease often result. Second, tartar builds up along the gum line. As the tartar enlarges, it pushes the gums away from the roots of the teeth. Eventually, the teeth will loosen and fall out.

 

How can I prevent tartar formation on my dog's teeth?

After your dog's teeth have been cleaned, we recommend beginning home dental care to help reduce plaque and tartar buildup.

 

Feed your dog a veterinary-approved dental diet or a premium diet with scientifically proven tartar-reducing ingredients. These diets have been shown to greatly reduce plaque formation and tartar buildup. These diets contain unique additives and specially designed kibbles that interfere with plaque development. By limiting plaque as it forms, tartar development is greatly diminished.

 

Brushing your pet's teeth is another effective means of removing plaque before it turns into tartar. We recommend using a toothpaste made especially for dogs. Brushing should be done at least twice weekly (preferably daily), but we understand that not all dogs will tolerate it. Special finger brushes are made that make this task easier for you and your pet.

 

Use a daily oral rinse. This type of product helps reduce the bacterial count in the mouth, resulting in improved breath.

 

Having your veterinarian perform a prophylactic teeth cleaning every six to twelve months or at the first sign of tartar buildup is very beneficial to most dogs. This will prevent damage to the gums and roots.

 

  This client information sheet is based on material written by Ernest Ward, DVM.

© Copyright 2005 Lifelearn Inc. Used with permission under license. January 23, 2013

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