"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."
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,"
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
"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.
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.