Page 1534 - Cote clinical veterinary advisor dogs and cats 4th

Periodontal Disease 777

VetBooks.ir * * Diseases and Disorders

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A B
PERIODONTAL DISEASE A, Clinical photograph of a dog with severe periodontal disease; note generalized extensive
plaque and calculus accumulation. B, Radiograph of upper jaw in same patient (labial mounting; rostral is at bottom of
image, patient’s left is on right of image). Note extensive calculus accumulation (asterisks) at the left maxillary teeth
(calculus had already been grossly removed on the contralateral side) and generalized alveolar bone loss (particularly
visible in the incisor region). (Copyright Dr. Alexander M. Reiter, University of Pennsylvania.)

normally ≤ 3 mm in dogs and ≤ 0.5 mm in bone surrounding the root, and experience • Secondary endodontic disease (perio-endo
cats) and attachment loss (distance between of and equipment/materials available to the lesions)
cementoenamel junction and bottom of veterinarian. Options include closed and • Damage to adjacent soft tissues (jaw, eye,
pocket, normally 0 mm) open periodontal debridement, periodontal tongue) during tooth extraction
• Because gingival recession occurs as part of flaps or gingival grafts to enhance gingiva • Oronasal fistula and rhinitis
periodontal tissue loss, the measured pocket around the tooth, and bone augmentation
depth may underestimate the quantity of techniques. Recommended Monitoring
attachment loss. • When mobility is rated as 2 or > 50% of Periodic re-exams:
• Pressure against the side of the tooth the root length has lost attachment, involved • At 1 month and 2-3 months after involved
determines mobility (assessed on 0-3 [least therapy or extraction is indicated. periodontal surgical procedures to ensure
to most] mobility index). • When tooth mobility is rated as 3, extraction that tissues are responding as expected and
• Dental radiography to establish a treatment is performed. that home oral hygiene performed by owner
plan for each tooth is effective (if not, rescaling/repolishing of
• Horizontal or vertical alveolar bone loss on Chronic Treatment teeth and adjustments in home oral hygiene
radiographs • Annual (or q 6 months for small-breed dogs) should be considered)
• Secondary endodontic disease on radiographs professional dental cleaning is necessary to • Maximum of 6 months between re-exams
(extension of periodontal disease to the apical control the disease. after less involved periodontal surgery and
periodontium and pulp involvement) • Home oral hygiene (toothbrushing, oral maximum of 1 year between re-exams after
rinses/gels, appropriate chew toys and treats, professional dental cleaning
TREATMENT dental diet food) to prevent progression of
periodontal disease PROGNOSIS & OUTCOME
Treatment Overview
• Each tooth is a “patient.” Nutrition/Diet • Prevention of periodontal disease by plaque
• The goal is to decrease inflammation and The dental diets available are a useful means and calculus control is very effective.
prevent further attachment loss by removal of retarding plaque and calculus accumulation. • Periodontal surgery has a better prognosis
of plaque and calculus and inflamed/infected if owner and patient cooperate with home
tissue. Drug Interactions oral hygiene instructions.
• If the owner is willing to provide long-term Gingival hyperplasia can result from long-term • Treatment of severe lesions is more problem-
home oral hygiene after initial treatment, phenytoin, cyclosporine, or amlodipine therapy. atic, and very mobile teeth should always be
moderately affected teeth may be candidates extracted.
for periodontal surgery. Possible Complications • If teeth have been lost or are extracted, the
• Distant organ disease from periodontitis- tooth that would normally occlude against
Acute General Treatment related bacteremia or systemic release of the missing tooth is more at risk of plaque
• Professional dental cleaning (scaling and inflammatory or bacterial degradation and calculus accumulation.
polishing of all teeth by a trained veterinary products; associations between periodontal
health care provider) disease and microscopic changes in the PEARLS & CONSIDERATIONS
• For moderately affected but retainable teeth kidney, liver, and cardiac muscle; systemic
(periodontal pockets > 5-6 mm and mobil- acute-phase proteins decreasing after peri- Comments
ity of 1-2), many procedures are available. odontal treatment • The impact of periodontal disease on the
Which procedure is selected depends on • Pathologic mandibular fracture due to exten- rest of the body is a topic of research.
whether the gingival cuff around the tooth sive bone loss around teeth in small-breed • A conscious oral exam should be performed
is intact, the furcation is exposed, extent of dogs whenever an animal is seen by a veterinarian

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