Dog: Periodontal Disease
Other common/scientific names: Periodontitis, Plaque, Tartar, Calculus, Gingivitis
The word periodontal is derived from perio meaning around and dontal meaning tooth. Therefore, periodontal disease is disease or inflammation around the outside of the tooth. Periodontal disease happens in stages and can go unnoticed by owners until quite severe.
A dog’s tooth is composed of the inner pulp which provides nutrition and nerve supply to the tooth and the dentin or middle layer. The dentin is covered by enamel on the crown or top part of the tooth and it is covered by cementum in the root of the tooth. The root portion of the tooth sits in a bony socket of the jawbone and is held in place by the periodontal ligament which attaches the cementum layer to the bone.
The four areas involved in periodontal disease are the gingiva (gum), cementum, periodontal ligament and supporting bone.
|Abb. GGTFYN76: Schematic illustration of the canine tooth, its roots, gum and jaw bone.
Periodontal disease is caused by plaque which is the transparent adhesive fluid composed of food, mucous, cells and bacteria. The bacteria in plaque causes an inflammatory response that begins to damage the tissue surrounding the teeth. If the plaque is not removed, mineral salts from food and saliva develop into hard dental tartar (calculus). Tartar can be found above or below the gum line creating an environment for bacterial growth below the gingiva. This leads to damage to the periodontal ligament, gum pain, bone loss and eventually tooth loss. Bacteria surrounding the tooth root and gingiva gain access to the blood stream resulting in a bacteremia. Studies have shown that dogs with severe periodontal disease develop damage to internal organs which can result in chronic renal failure, heart failure and hepatitis. Damage to these organs lead to chronic medical conditions which shorten a dog’s lifespan.
The most obvious clinical sign is halitosis or bad breath. Other signs include drooling, red, bleeding gums (gingivitis), lack of appetite and weight loss. Tartar formation appears as brown, tan or gray hard, gritty material adhered to the teeth. The dog may or may not show oral pain by dropping food, chewing on one side or refusal to eat hard kibble. Dogs with severe periodontitis can have infected pockets with pus oozing from the gums, loose teeth and teeth that fall out.
Periodontal disease is classified into four stages: Stage I (gingivitis), Stage II (early), Stage III (moderate) and Stage IV (severe).
|Abb. GGDGDM8J: Early Periodontal Disease.
|This photograph illustrates Stage II periodontal disease. Note the red gums and the gray colored tartar.
|Abb. GGDGEXYQ: Moderate Gingivitis.
|This is a photograph of a dog with Stage III periodontal disease. Tartar is evident on most of the teeth.
|Abb. GGDGGF1L: Severe Periodontal Disease.
|This is a photograph of a dog with Stage IV periodontal disease. Pocket formation, loose teeth and bone loss are evident.
Diagnosis of periodontal disease is made by physical examination. Intraoral radiographs can help determine the extent of the disease. Because dogs with Stage IV periodontitis may have kidney, heart or liver damage, a complete blood count (CBC), serum biochemistry and urinalysis should be performed to assess organ function.
Treatment will depend on the severity and stage of periodontal disease. Mild cases in Stage I may benefit from at home brushing to prevent further tartar formation. However, most cases of periodontal disease will require a manual scaling, ultrasonic cleaning and polishing under general anesthesia performed by a veterinarian. While under general anesthesia, the gingiva is examined for detachment and pocket formation. Large pockets will need to be flushed to remove infection and debris. Manual scaling will remove tartar above and below the gum line. Loose teeth may need to be extracted. An ultrasonic cleaner is used to help remove tartar on the crown and the teeth are then polished to smooth the enamel. Various topical oral products can be applied after cleaning to help prevent and reduce plaque and tartar formation.
In severe cases, antibiotics are administered before and after the dental cleaning. Pain medication may be necessary while the tissues heal.
Mild cases of periodontal disease respond well to a professional dental cleaning provided the owners are committed to follow up home care. However, there does seem to be a predilection for developing periodontitis and some dogs will require annual dental cleanings despite diligent home care. Severe cases of periodontal disease may require many teeth extractions.
Just as with people, periodontal disease in dogs can be prevented by brushing their teeth. This is by far the best method of prevention. There are several products and diets marketed for dental health that while they are not the gold standard of prevention, they can aid in maintaining a healthier mouth for your dog.
Toothpaste and Brushing
While daily brushing is best, brushing three times a week has been shown to prevent plaque buildup. Toothbrushes made for dogs will be easier to use than human toothbrushes. Likewise, toothpaste formulated and flavored for dogs should be used. Human toothpastes contain sudsing agents which are not meant to be swallowed and should be avoided in dogs.
Dental wipes, rinses and pads can be used for dogs which will not allow brushing. These products wipe off plaque deposits but will not remove food particles from the gum socket. While not ideal, they are the next best thing to brushing.
Specially formulated dental treats can be used to reduce plaque. Again, while not as effective as brushing, dental chews are better than doing nothing. Consult your veterinarian for recommended products.
A common misconception is that feeding any hard kibble diet will prevent dental disease. Some dogs swallow the kibble whole without chewing. A small kibble is not as effective at removing plaque. Also, kibble is only effective on the premolars and molars. With that said, there are dental diets marketed that have been shown to aid in removing plaque. Consult your veterinarian for recommended diets and feeding tips.
Teaching your dog to accept having his/her mouth opened will help your veterinarian to thoroughly examine the teeth. Most dogs can be taught to tolerate brushing through a consistent, positively rewarded training protocol. New puppies should be taught at an early age to allow teeth brushing.
Update version: 4/24/2014, © Copyright by www.enpevet.de
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