Periodontal disease is the most common clinical condition occurring in adult dogs and cats, and is entirely preventable. By three years of age, most dogs and cats have some evidence of periodontal disease. Unfortunately, other than bad breath, there are few signs of the disease process evident to the owner, and professional dental cleaning and periodontal therapy often comes too late to prevent extensive disease or to save teeth. As a result, periodontal disease is usually under-treated, and may cause multiple problems in the oral cavity and may be associated with damage to internal organs in some patients as they age.
Periodontal disease begins when bacteria in the mouth form a substance called plaque that sticks to the surface of the teeth. Subsequently, minerals in the saliva harden the plaque into dental calculus (tartar), which is firmly attached to the teeth. Tartar above the gum line is obvious to many owners, but is not of itself the cause of disease.
The real problem develops as plaque and calculus spread under the gum line. Bacteria in this ‘sub-gingival’ plaque set in motion a cycle of damage to the supporting tissues around the tooth, eventually leading to loss of the tooth. Bacteria under the gum line secrete toxins, which contribute to the tissue damage if untreated. These bacteria also stimulate the animal’s immune system. The initial changes cause white blood cells and inflammatory chemical signals to move into the periodontal space (between the gum or bone and the tooth). The function of the white blood cells is to destroy the bacterial invaders, but chemicals released by the overwhelmed white blood cells cause damage to the supporting tissues of the tooth. Instead of helping the problem, the patient’s own protective system actually worsens the disease when there is severe build-up of plaque and tartar.
Periodontal disease includes gingivitis (inflammation [reddening] of the gums) and periodontitis (loss of bone and soft tissue around the teeth). There is a wide range in the appearance and severity of periodontal disease, which often cannot be properly evaluated or treated without general anesthesia for veterinary patients. Effects within the oral cavity include damage to or loss of gum tissue and bone around the teeth, development of a hole (‘fistula’) from the oral cavity into the nasal passages causing nasal discharge, fractures of the jaw following weakening of the jaw bone, and bone infection (‘osteomyelititis’).
Periodontal disease can cause more problems than tooth pain. Dogs with unchecked gum inflammation may be at higher risk for heart, kidney, and liver disease as bacteria from the mouth enter the bloodstream and are carried around the body.
Stages of Periodontal Disease: Stage 1 of gum disease in dogs consists of mild redness or inflammation of the gums, without periodontal pockets between the gum and tooth. For this stage a cleaning above and below the gum line is the only treatment required. "This is where we would like to see the patient," Beckman says, but "unfortunately we don’t come across this very often."
Stage 2 occurs once there are periodontal pockets between the gum and tooth, but before any significant bone involvement. Here the gum tissue and tooth root are cleaned, rinsed, and treated with a gel to help reattach the gum to the tooth root.
Stage 3 gum disease in dogs is when periodontal pockets around the teeth go deeper than 5 millimeters, which means there's now bone loss. "Depending upon the anatomy of the bone loss, many times we can expose the defect by opening a gum flap and cleaning out the diseased tissue around the tooth root and bone," says Beckman, then use special therapies to grow new tissue and bone.
Stage 4 is when bone loss is over 50%, and tooth extraction is the only treatment.
Treatment Treatment of periodontal disease is multi-faceted. If your pet has tartar or large amounts of plaque present, professional dental cleaning is required, which includes a thorough oral examination, scaling and polishing. Abnormalities found are recorded on a dental chart. Dental radiographs are required to correctly diagnose and assist in treatment of patients with extensive disease. When periodontitis is present, several treatment options may be employed to save the teeth. The patient’s overall health, the cost of specific treatments, and the owner’s willingness to provide home oral hygiene must be taken into account prior to performing periodontal therapy - without likelihood of diligent homecare subsequently, periodontal therapy is not indicated, and severely involved teeth should be extracted.
Preventing Dental Disease
The only scientifically proven way to decrease plaque and tartar is the same for dogs as it is for humans — daily brushing combined with routine tartar removal by a health professional.
The Kibble Myth Many people believe that feeding dry food will keep their pet’s teeth clean and healthy. If this were true, then majority of pets would have sparkling healthy teeth! But the fact is, over 80% of pets have significant periodontal disease by age 3, according to the American Veterinary Dental Society.
Kibble actually does nothing to prevent tartar from accumulating. And it may even contribute to dental disease. Kibble contains carbohydrates. Carbohydrates break down to sugar. Sugar causes increased plaque and feeds the oral bacteria. Plaque leads to tartar, gingivitis, and periodontal disease. One study showed that dental health declined within just 17 days of switching from a raw to a kibble diet in dogs. Another study showed dental calculus was significantly higher in cats fed commercial diets versus feral cats eating wild prey.
Pets fed raw diets or home cooked diets supplemented with raw meaty bones will have significantly less tartar. If your pet has never had raw meaty bones, be sure to research how to feed them. NEVER feed cooked bones, as these are brittle and can splinter, causing broken teeth and bowel perforations. Read more from Dr Becker and Dr Judy Morgan