Periodontal disease is one of the most common problems seen in veterinary practice.
It occurs in two forms: The first is gingivitis, a reversible inflammation of the gums. The second is periodontitis, an inflammation of the deeper structures supporting the teeth.
Gingivitis develops when bacteria build up between the teeth and gums, leading to irritation, inflammation, and bleeding. The edges of healthy gums fit tightly around the teeth. In a dog with gingivitis, rough dental calculus builds up in an irregular fashion along the gum line, producing points at which the gum is forced away from the teeth. This creates small pockets that trap food and bacteria. In time, the gums become infected.
Dental calculus (also called tartar) is composed of calcium salts, food particles, bacteria, and other organic material. It is yellow-brown and soft when first deposited. At the soft stage it is called plaque. The plaque quickly hardens into calculus. Calculus collects on all tooth surfaces, but is found in the greatest amounts on the cheek side of the upper premolars and molars.
This buildup of calculus on the teeth is the primary cause of gum inflammation. This occurs to some extent in all dogs over the age of 2. Certain breeds, such as Poodles, and smaller dogs seem to form calculus more readily. Dogs who eat dry kibble and chew on bones or dog biscuits have less calculus buildup than dogs who eat only soft, canned foods.
A characteristic sign of gingivitis is bad breath. The halitosis may have been present for some time—even accepted as normal. The gums appear red and swollen, and bleed easily when touched. Pressing on the gums may cause pus to ooze from the gum line.
Treatment: Treatment is directed toward preventing gingivitis from progressing to periodontitis and delaying the progress of periodontitis once it is established.The teeth should be professionally cleaned, scaled, and polished to remove all plaque and calculus. Many veterinarians now use ultrasonic dental units, similar to the ones used on people, for cleaning dogs’ teeth. For optimum results, the dog should be heavily sedated or given a general anesthetic.
The cleaning should be followed with a regular regimen of home oral care. Oxyfresh washes and rinses are also helpful. See Taking Care of Your Dog’s Teeth for suggestions on how to prevent plaque and tartar buildup.
Periodontitis develops as a continuation of gingivitis. The teeth are held in their bony sockets by a substance called cementum and a specialized connective tissue called the periodontal membrane. As the gum infection attacks the cementum and periodontal membrane, the roots become infected, the teeth begin to loosen, and eventually they detach. This is a painful process. Although the dog’s appetite is good, she may sit by her food dish, eat reluctantly, and drop food from her mouth. Drooling is common. A root abscess can rupture into the maxillary sinus or nasal cavity, producing a purulent unilateral nasal discharge, an oralnasal fistula, or a swelling below the eye.
Treatment: The teeth should be professionally cleaned, as described for gingivitis. Severe infections may necessitate removing a portion of the diseased gum (a procedure called gingivectomy). In a dog with advanced periodontitis, it may be necessary to extract some or all of the teeth before healing can begin. Once the gums are healed, a dog without teeth is able to eat surprisingly well. Antibiotics are given for one to three weeks, depending on the severity of the disease.
Aftercare at home involves rinsing the mouth with 0.2 percent chlorhexidine solution (Peridex or Nolvadent) once or twice a day. Soak a cotton ball and gently swab the gums and teeth, or use a plastic syringe and squirt the antiseptic directly onto the teeth and gums. You can also brush the dog’s teeth with a dog tooth brush and a toothpaste made especially for dogs that contains chlorhexidine. Massage the gums with your finger, a piece of linen, or a soft gauze pad, using a gentle circular motion, while pressing on the outside surface of the gums. Continue the mouth washes and massages until the gums are healthy. Feed a soft diet consisting of canned dog food mixed with water to make a mush. Once healing is complete, switch to a good home dental program.
A product called Stomadhex, available through your veterinarian, may prove to be an effective substitute for the aftercare just described. Stomadhex is a small adhesive patch that sticks to mucous membranes. The patch is applied to the inside surface of the upper lip. It stays in place for several hours and slowly releases chlorhexidine and a vitamin called nicotinamide that promotes oral hygiene. The sustained release delivery system helps to prevent dental plaque and tartar and aids in controlling bad breath. The patch is applied daily for 10 days following a dental procedure, or as recommended by your veterinarian.
Pfizer has just released a new vaccine aimed at the primary bacteria found in cases of periodontitis: Porphyromonas denticanis, gulae and salivosa. The vaccine is aimed at preventing and helping in the treatment of periodontitis. It is currently undergoing more efficacy tests and is not recommended at this time.