Periodontitis

Last changed: 10 July 2019

Inflammation of the tissues that support the tooth in the jaw is known as periodontitis.

It is caused by a bacterial colonisation on the tooth surface (plaque) and the body´s immune response. As the tissues become inflamed the gingiva swells, becomes red and bleeds on probing and a pocket forms between the tooth and the gingiva. Bacteria migrate in the pocket along the tooth surface and consume oxygen whereby more aggressive bacteria, which can survive without oxygen, start  to multiply. The body tries to eliminate these bacteria but as a consequence severe destruction of the tooth supporting structures (gingiva, periodontal ligament, alveolar bone and tooth cement) takes place, eventually resulting in tooth mobility and loss. Periodontal disease can be divided into a more chronic form with severe plaque deposits and a more aggressive form which is characterized by a severe inflammation in response to a minimal plaque deposit. Animals suffering from the more aggressive form of periodontits often present with severe pain and ulcerations of the oral mucosa. Periodontal disease is not caused by tarter. Tarter consists of mineralised dead bacteria. Tarter does, however, due to its uneven surface, provide a larger area for bacteria to adhere.

Why is it important to treat and prevent periodontitis?
Periodontits constitutes a chronic infection and each time an animal with periodontitis chews bacteria and their biproducts leak into the blood stream. Within human medicine, correlations between periodontal disease and other diseases such as heart disease, kidney disease and diabetes mellitus have been established.  Further, mobile teeth are at risk to ber fractured  when chewing . Periodontal disease can also cause the formation of abcesses and bone infection. In severe cases, periodontitis can lead to fractures of the lower jaw and to the formation of oronasal fistulas (holes between the mouth and nose) which in turn causes a chronic inflammation in the nose.

How can I prevent periodontal disease?
Just as it is for humans, daily tooth brushing is the corner stone for disease prevention. Make sure that no foreign bodies such as sticks, fur or food particles get stuck between teeth since this will cause a very aggressive localised periodontitis. Clorhexidine oral rinses can be used in inflamed areas bur may stain the teeth and gingiva. Retained milk teeth also lead to localised periodontitis and should be removed at an early age. Dogs with short jaws will have rotated teeth which also predisposes for periodontitis. Treats and tooth pastes can be used as rewards and also make tooth brushing more acceptable for your pet but cannot replace tooth brushing. Chewing is also beneficial for oral health. Routine oral examination and professional tooth cleaning are also important for maintaining good oral health.

Tooth brushing
It is never too late to start but it is easier if you start when your pet is a puppy or kitten. There are finger swabbs on the market that can be used to make your pet accustomed to tooth brushing but a small toothbrush (periatric) or electrical tooth brush gives much better results. Make a routine around brushing and do it daily.
Cats can be a little challenging. Older cats commonly suffer from TR (see below) and it is important that all teeth with TR lesions are treated prior to initiating tooth brushing since TR is painful. There are many instruction vidies avaiable on U tube. 

What is a professional tooth cleaning?
Animals undergoing oral procedures should be anesthetized and have a breathing tube in place to avoid aspiration of tarter and bacteria to the lungs. A dental charting is performed, pocket depths evaluated, degree of bone destruction, tooth fractures, tooth mobility and other signs of disease are documented. Radiographs are taken to evaluate dental health. Tarter and plaque under the gum line and on the exposed tooth are removed. The teeth are polished and exposed roots are treated with a fluoride varnish. A treatment plan for each patient is documented.

Tooth Resorption
Tooth resorption (TR) previously referred to as Feline Odontoclastic Resorption Lesions (FORL) is one of the most common dental diseases affecting the domestic cat with reported occurrence rates ranging between 14.3% to 85 % depending on diagnostic method used and patient selection. A strong positive correlation between aging and the prevalence of TR has been established . The disease is characterized by a progressive resorption of dental structures coupled with reparative processes. In accordance with the American Veterinary Dental College, TR can be classified into five different stages depending on the degree of resorption. Tooth resorption can be further classified into three different types based on the radiographic appearance. In Type I lesions, a normal periodontal ligament space can be identified on radiographs while in Type II lesions replacement resorption has occurred and the periodontal space cannot be followed in at least some areas. Type III lesions are defined as a combination of Type I and II in the same tooth15. Diagnosis of TR is based on clinical appearance and radiographic findings. The long term success rate for restorations of TR lesions have been disappointing . Today, extraction of teeth with Type I lesions and crown amputation of Type II lesions with no signs of periodontitis or bone pathology is generally recommended. For illustrations see the American Veterinary dental college’s webpage and look under nomenclature. TR is by veterinary dentist considered very painful but since the occurrence rate increases with age many times oral pain is misinterpreted as aging. Many cats with TR will not eat while some still eat but become more withdrawn.  Even dogs can suffer from TR but not as commonly as cats.The cause is as yet unknown..

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Ann Pettersson

VMD
Specialist in dogs and cats disease
Swedish specialist in dentistry dogs and cats
Associate professor in odontology, lecturer in surgery
Department of Clinical Sciences


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