What you should know about periodontal disease - DVM
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What you should know about periodontal disease
Prevention worth a pound of cure; coach clients on identifying the four stages

DVM InFocus

Stages I and II are reversible with proper treatment, which includes removal of supra- and subgingival calculus, polishing, periodontal probing and charting, intraoral radiographs (to evaluate amount of bone loss, resorptive lesions, carious lesions, tooth vitality, endodontic disease), fluoride treatment (to strengthen enamel, desensitize any exposed dentinal tubules, provide some temporary bacterial resistance) and OraVet™ (Merial). Antibiotics will not cure periodontal disease. They, if indicated by preoperative bloodwork or pre-existing health condition, may be used; however they should never be used as a stand-alone treatment. A patient should be re-evaluated in nine to 12 months.

Stages III and IV hold a guarded to grave prognosis for the tooth based on the degree of attachment loss, owner's willingness and ability to provide home care, and the veterinarian's knowledge and capability of providing dental diagnostics and treatment options. Additional steps beyond the care mentioned for stages I and II include, as indicated:

  • Gingivoplasty to reduce "pseudo-pocket" depth, usually secondary to gingival hyperplasia;
  • Reverse bevel incision to remove diseased gingival margin (more advanced procedures, wet lab training recommended);
  • Subgingival curettage to remove diseased tissue, microflora and debris from the gingival sulcus using a sharp curette;
  • Closed root planing (periodontal pockets <5mm) using a sharp curette to remove subgingival plaque and calculus and create a smooth root surface, then placement of a perioceutic gel;
  • Open root planing (periodontal pockets >5mm), requires flap surgery;
  • Guided tissue regeneration using an osseoconductive product;
  • Exodontia.

These patients should be re-evaluated every two to four months based on the extent of the periodontal disease, response to treatment, and the ability to provide home care.

If periodontal disease goes untreated and is allowed to progress, the patient will be fighting this infection/disease process constantly, and the tooth/teeth will be lost due to the advancing loss of the periodontium.

Knowledge of the oral structure and its anatomy, combined with proper dental equipment and instrumentation, good lighting, magnification, and a willing owner and amenable patient are vital to the treatment and prevention of periodontal disease. Essential equipment used for the diagnosis and treatment of periodontal disease are a periodontal probe/explorer, appropriate dental chart, intraoral radiography capabilities, ultrasonic or sonic scaler, a sharp curette and a dental unit with an air/water syringe.

Brushing the teeth is still the "gold standard" for plaque removal and prevention, or delaying the onset of periodontal disease. Studies have shown brushing must be done a minimum of three to four times per week to provide a noticeable benefit. Clients must be taught how to desensitize their pet to having its muzzle and oral cavity manipulated before any type of brushing can be implemented.

Positive reinforcement and "baby steps" are a must for successful home dental care. My steps include petting the muzzle, lifting the lips to see all of the teeth, opening the mouth to see the tongue and the pharyngeal area, brushing the teeth with a plain finger, brushing with a finger and animal toothpaste (there will be licking and swallowing due to the paste), brushing with animal toothpaste and appropriate sized soft-bristled tooth brushes or fingertip tooth brushes.

Note: Each of these steps might take days, weeks or months depending on the patient. Bristles are very important to reach into the gingival sulcus, which is the primary place for plaque and calculus build-up that is the beginning of gingivitis, Stage I periodontal disease. It is not recommended that clients try to brush calculus off because it will not work. Brushing harder will cause pain and might damage the gingival tissues.

Products that successfully meet pre-set criteria for effectiveness in controlling plaque and/or calculus deposition in dogs and cats can be found on the Veterinary Oral Health Council's Web site ( http://www.vohc.org/).


Source: DVM InFocus,
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