Three steps for veterinarians to effective periodontal disease diagnosis

Three steps for veterinarians to effective periodontal disease diagnosis

Visual examination, anesthetized probing and intraoral radiography can help veterinarians assess each patient's level of disease.
Sep 01, 2012

Most pet owners are unaware their dogs or cats have periodontal disease. They think their animals' malodorous breath is normal and expected. Unfortunately, many of these loved pets wind up suffering needlessly while their diseases progress, often to the point of surgical extraction. What can you do in the early stages to make a difference?

Embrace the concept that periodontal disease is not a one-size-fits-all malady diagnosed when the odor is so bad you need to leave the exam room doors open, bleeding of the gingiva is visible upon light wiping with gauze and affected teeth are mobile. Periodontal disease encompasses myriad presentations, treatments and outcomes. Diagnosis is the key to unlocking the puzzle early.

To be sure, diagnosing which type and the severity of disease is neither easy nor simple, but it is important and doable in general practice. Exam room visual diagnostics, anesthetized probing and intraoral radiographs are the steps to achieve periodontal diagnostic success.

Step 1: Visual examination

Photo 1A: A doctor taking an exam room image of a dog’s periodontal inflammation.
Regardless of what a patient is presented for, every thorough physical examination must include the face and oral cavity. The mouth should not be bypassed because an animal comes in for, say, a skin problem. Often, because the teeth are out of sight, they're also out of mind until advanced disease is noted.

Photo 1B: The image is wirelessly transmitted to an iPad for the doctor to share with the client.
By gently raising the upper lips, most of the buccal surfaces of the teeth, gingiva and oral mucosa can be observed for inspection. Additionally, this is a good time to take a digital image (if your practice is so equipped) of what you see, download it to a computer screen or tablet and then print it for the client to take home (Photos 1A and 1B).

Photo 2: An OraStrip score of 5, indicating high levels of thiols consistent with advanced periodontal disease.
OraStrip (PDx BioTech), a small strip you can swipe along a patient's oral mucosa, turns from white to yellow in front of your client's eyes if the pet is producing significant thiols secondary to anaerobic bacteria from periodontal disease. When the strip color is compared to the supplied chart, the client can visually appreciate the problem that needs addressing (Photo 2). We use OraStrip diagnostic tests in every animal's semiannual and annual examination, and every day we get cases that visually appear normal but have abnormal strip test scores that, upon closer inspection under anesthesia, turn out to be significant periodontal disease.