Page 1532 - Cote clinical veterinary advisor dogs and cats 4th

776 Periodontal Disease

• Castration reduces or eliminates the risk • Consider epidural anesthesia. SUGGESTED READING
of benign prostatomegaly and secondary • Ice pack on the area to decrease swelling Shaughnessy M, et al: Internal obturator muscle
VetBooks.ir Technician Tips Client Education dogs: 34 cases (1998–2012). J Am Vet Med Assoc
and ease discomfort
perineal hernia.
transposition for treatment of perineal hernia in
246:321-326, 2015.
• Important points regarding postoperative
care • Prevention and control of risk factors such AUTHOR: Jacob A. Rubin DVM, DACVS
as constipation, prostatomegaly, and colitis
EDITOR: Elizabeth A. Swanson DVM, MS, DACVS
○ Maintain appropriate level of analgesia. • Surgery is the definitive treatment for perineal
○ Prevent tenesmus to avoid undue stress hernia.
on surgical repair.

Periodontal Disease Client Education
Sheet

Clinical Presentation
BASIC INFORMATION DIAGNOSIS
DISEASE FORMS/SUBTYPES
Definition • Severity of inflammation varies relative to Diagnostic Overview
Plaque-induced inflammation of the gingiva, extent of plaque and calculus accumulation Initial diagnosis is based on oral exam in the
periodontal ligament, and alveolar bone and local/general immunologic health. conscious patient. Anesthetized oral exam and
• Juvenile periodontitis, rapidly progressive dental radiographs determine full extent of the
Synonyms periodontitis, acute periodontitis, and disease, treatment plan, and prognosis.
Gingivitis (inflammation of gingiva), peri- chronic periodontitis
odontitis (inflammation of deeper periodontal Differential Diagnosis
tissues) HISTORY, CHIEF COMPLAINT • Periodontal disease is almost always present
• Halitosis (p. 402) when other oral diseases are present.
Epidemiology • Teeth covered by calculus (tartar) • Oral tumors (pp. 711 and 714) may appear as
SPECIES, AGE, SEX • Gingiva: swollen, bleeding, or ulcerated ulcerated gingival lesions, but unlike tumors,
• Most common disease in companion animals; • If oronasal fistulas, nasal discharge periodontal disease is typically symmetrical,
affects dogs and cats of any breed and teeth with greater amounts of plaque
• More common and severe in small-breed PHYSICAL EXAM FINDINGS and calculus deposition are more severely
dogs Wide variation in the severity of the disease affected.
• More severe with increasing age may become apparent when comparing one • Gingival enlargement due to hyperplasia: firm
part of the mouth with another in the same and symmetrical gingiva, irregular surface
GENETICS, BREED PREDISPOSITION animal. Exam of molars is crucial. contour, partly or completely covering the
Small-breed dogs have relatively large teeth • Halitosis, plaque, and calculus (although tooth crown; usually not inflamed or ulcer-
compared with small size of jaws, causing their absence does not rule out a diagnosis ated; juvenile hyperplastic gingivitis seen in
crowding of teeth. of periodontal disease) young adult cats
• Gingivitis, gingival bleeding (on probing • Abnormalities in periodontal disease are
RISK FACTORS or spontaneously), gingival recession (root limited to gingiva, periodontal ligament,
• Soft-food diet; lack of dietary abrasion exposure) and alveolar bone. Abnormalities in other
permits accumulation of plaque and • Furcation exposure (space between roots oral tissues/locations may be secondary to
calculus of multirooted teeth), periodontal pocket periodontal disease (inflammatory tooth
• Malocclusion (dental crowding) formation resorption, draining tracts, osteomyelitis) or
• Mobile, displaced, and missing teeth manifest as a different condition (stomatitis,
CONTAGION AND ZOONOSIS • Pathologic jaw fracture tumors).
All clinically normal animals carry the putative • Oronasal fistula (p. 720), often with chronic
causative organisms in their mouths. There is a rhinitis Initial Database
potential risk of bacterial transmission between • General physical exam, CBC, and serum
dogs or cats and people. Etiology and Pathophysiology chemistry profile; urinalysis in selected cases
• Caused by bacteria in dental plaque adjacent to identify extraoral disease (e.g., renal,
GEOGRAPHY AND SEASONALITY to gingival margin and in gingival sulcus/ hepatic) that could contribute to halitosis,
Dogs and cats in less developed parts of periodontal pocket (primarily gram-negative and for anesthesia planning
the world are less prone to develop severe anaerobic rods and spirochetes) • Conscious oral exam: lower jaw manipulation
periodontal disease because they have a more • Gingival inflammation leads to destruction of should be done carefully in small-breed dogs
varied diet that encourages natural chewing periodontal ligament, causing resorption of because bone resorption around mandibular
activity. alveolar bone and gradual loss of attachment teeth can risk pathologic fracture.
of the tooth to the jaw (increased mobility)
ASSOCIATED DISORDERS • Gingiva may recede with worsening bone Advanced or Confirmatory Testing
Coexists with many other oral conditions (gin- loss or remain in place with a deepening Oral exam under general anesthesia:
gival hyperplasia, tooth resorption, endodontic pocket between the gingiva and root as the • Visual exam of color and swelling of gingiva
disease and osteomyelitis) and may mask the bone loss worsens. • Insertion of periodontal probe between
appearance of diseases with a worse prognosis • Inflammation resolves after the tooth (and gingiva and crown or exposed root to assess
(oral neoplasms); found in almost every animal its root) is out, and gingiva grows over the periodontal pocket depth (distance between
with stomatitis (p. 943) edentulous area. gingival margin and bottom of pocket,

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