Periodontal disease in the horse - DVM
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Periodontal disease in the horse
Understanding of causes, proper treatment of dental disease can lead to good prognosis


DVM360 MAGAZINE


Examination

"All parts of the periodontium must be examined for accurate determination of attachment loss," Klugh says. "This includes characteristics and measurement of the gingiva, cementum, alveolar bone and periodontal ligament.

"Oral examination begins with removal of feed debris. The condition of the tooth and periodontium is examined for gingival inflammation, ulceration and recession, condition of the sulcular epithelium, pocket depth and mesial/distal length, condition of the cementum and tooth mobility," Klugh explains.

"Determination of the degree of advancement of the disease is critical in treatment and prognosis."

Treatment

Occlusal equilibration is the first step in treatment of mild to moderate periodontal disease. Upon noting disease of an affected tooth with accumulation of debris or orthodontic movement, the opposite arcade is examined for an overlong tooth located in an opposite position to it, which is then reduced. "Many cases of Stage 1 or Stage 2 disease are quickly resolved by reducing overlong occlusal surfaces on the opposing arcade," Klugh says.

After resolving the occlusal problem, food debris should be removed, and once the periodontium is clinically characterized further treatment may be undertaken.

Debridement of the infected space is critical. Diseased epithelium and underlying connective tissue are removed by scraping the lining of the peridontial pocket to eliminate all necrotic tissue. There will be some bleeding of healthy tissue. "Debridement of necrotic cementum prevents extension of the decay process in an apical and peripheral direction, thus arresting the condition," Klugh explains.

Stage 1 mobile teeth usually are found in aging equine patients with periodontal disease. "These teeth usually require only removal of sharp enamel points that may abrade oral soft tissues," Klugh says.

Stage 2 mobile teeth are treated by reducing the opposing tooth such that the pair are not in occlusion. "By resting the mobile tooth from the forces of mastication, the inflammation of the damaged periodontal ligament resolves," Klugh explains.

Stage 3 mobile teeth, those with occlusal movement greater than 3 mm, are extracted. In addition, the alveolar socket may be patched if necessary.

The use of perioceutic agents should be considered as secondary treatment, but not relied on exclusively. These can provide antibacterial benefit and have other therapeutic advantages.

Citric acid-containing products demineralize the cementum, thereby exposing cementum collagen and promoting formation of new attachment.

"Doxycycline inhibits collagen breakdown by the enzyme collagenase, which is elaborated from bacteria and polymorphoneuclear cells during the inflammatory process," Klugh says.

Ascorbic acid aids in collagen formation, and zinc-containing products have antibacterial effects. Chlorhexadine has antibacterial effects that last for several hours after oral rinse, due to its absorption by oral epithelial cells. Products containing disinfectants are very effective in treating periodontal disease.

With understanding of the causes of periodontal disease and proper treatment, prognosis for a successful outcome is excellent.

Risk of systemic disease

A study of more than 59,000 dogs with a history of Stage 1, 2 and 3 periodontal disease "revealed a significant relationship between periodontal disease and an increased risk of endocarditis and cardiomyopathy in pet dogs," according to Lawrence Glickman, VMD, DrPH, and colleagues at Purdue University's Department of Comparative Biology, School of Veterinary Medicine. Though there is no similar research data in horses, most equine dentistry experts agree that the potential risk of systemic disease in horses warrants research.

Case example

An example of periodontal disease in a 19-year-old paint mare demonstrates a few important principles. One is that initial basic wound treatment proved to be important, along with reduction of the opposing arcade's excessive transverse ridge. A second principle is the ability of the periodontium to repair its own soft tissue.

The mare presented with a 7-mm pocket that extended well into the interproximal space (Photo 1, p. 2E). The opposing arcade's excessive transverse ridges were reduced and the pocket debrided.

The next year, the pocket was smaller, at 5 mm in depth, and new soft tissue attachment on the palatal side had formed. The underlying bone loss remained, thus preventing complete healing of the pocket (Photo 2, p. 2E), but the underlying concept of limitation of disease extension was demonstrated.

Kane is a Seattle-based writer.


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Source: DVM360 MAGAZINE,
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