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Periodontal Disease 985

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Figure 47-3. Host-bacterial interactions in the pathogenesis of periodontal disease. Periodontal disease is cyclic with bursts of tissue destruc-
tion followed by periods of healing and relative quiescence. Four stages in the pathogenesis of periodontal disease have been proposed: 1)
Microbial colonization. Salivary pellicle is deposited on the enamel surface and is soon colonized by oral bacteria that multiply forming plaque.
2) Microbial invasion. Plaque bacteria and their by-products invade the gingival tissues and initiate a host inflammatory response. 3) Tissue
destruction. Direct toxic effects of bacteria and their by-products and indirect host-mediated toxic responses lead to destruction of periodontal
tissue. 4) Healing. Periods of disease remission are characterized by a reduction in the inflammatory response and gingival healing. (Adapted
from Genco RJ, Goldman HM, Cohen WD, eds. Contemporary Periodontics. St Louis, MO: CV Mosby Co, 1990; 189.)

Although much of the evidence is based on documentation
of correlations between oral and systemic health, and the effect Table 47-2. Stages of periodontal disease.*
of systemic diseases on the health of the oral cavity (particular- Stage 0 Clinically normal
ly in the case of diabetes) (Mealey,1998; Levin et al,1996),data No gingival inflammation or periodontitis clinically
are emerging that suggest a more causal and two-way relation- evident.
Stage 1 Gingivitis only
ship that makes a case for periodontal therapy as an adjunctive No attachment loss. Height and architecture of the
treatment to classic disease therapies (D’Aiuto et al, 2004; alveolar margin are normal.
Montebugnoli et al, 2005; Montebugnoli, 2004; Farooqi et al, Stage 2 Early periodontitis
Less than 25% attachment loss or Stage 1 furcation
2004; Kiran et al, 2005; Mealey, 2000; Miller et al, 1992; involvement in multirooted teeth.
Pucher and Stewart, 2004; Taylor et al, 2004; Rahman et al, Stage 3 Moderate periodontitis
2005; Mercanoglu et al, 2004). 25 to 50% attachment loss or Stage 2 furcation
involvement in multirooted teeth.
In dogs, numerous reports speculate on the association Stage 4 Advanced periodontitis
between chronic periodontal disease and conditions affecting Greater than 50% attachment loss or Stage 3 furca-
the heart valves and pulmonary airways (Hamlin, 1990; tion involvement in multirooted teeth.
*Adapted from AVDC.org. Wolf HF, Rateitschak EM, Rateitschak
Prueter and Sherding, 1985; Calvert and Dow, 1990; Bona- KH, et al. Color atlas of dental medicine: Periodontology, 3rd ed.
gura, 1981). Furthermore, a positive correlation has been Stuttgart, Germany: Georg Thieme Verlag, 2005.
found between the severity of periodontal disease and
histopathologic changes in the kidneys, myocardium and liver
(DeBowes et al, 1996). Periodontal infections allow bacterial Ide et al, 2004; D’Aiuto et al, 2004, 2005; Joshipura et al,
migration into lymphatic and blood vessels, resulting in bac- 2004; Lowe, 2004; Holzhausen et al, 2004). The host defens-
teremia and are associated with increased levels of many of the es of normal healthy pets can effectively clear transient bac-
systemic markers associated with the diseases described teremia; however, blood-borne bacteria may colonize distant
above, including C-reactive protein, proinflammatory cyto- sites in patients impairing immune function and/or compro-
kines, serum cholesterol, plasma fibrinogen, white blood cells mising organ function, including development of atheroscle-
and blood glucose (Harari et al, 1993, 1991; Slade et al, 2000; rotic lesions (Calvert and Green, 1986; Glurich et al, 2002).