Dental disease is a broad term that does not define any specific pathology in the oral cavity. Rather it
is all encompassing term suggesting a lack of oral health that needs some form of intervention.
The most common disease in dogs and cats is periodontal disease. It affects 60-80% of dogs and cats over the age of 3. It is a bacterial infection of the periodontal ligament that anchors the teeth to the skull or jaws. That in combination with the bodies own immune response to try and eradicate the infection leads to loss of the periodontal ligament and bone.
Healthy right upper premolars
Right upper premolars with severe periodontal disease
This infection produces periodontal pockets around the tooth that are essentially pockets filled with pus. Just as with periodontal disease in humans there is a genetic component to the disease and it is prevalent in small breed dogs. The most common signs we see are halitosis (horrible smelling breath), reluctance to chew or play with toys, sneezing, scratching at the face and quivering of the jaw. If left untreated, like rust on your car the disease will fester under the gum line and can spread to adjacent teeth.
Treatment of Periodontal disease
Treatment requires professional dental cleaning under general anesthesia along with full mouth radiographs to asses the amount of periodontal loss. Some non professionals will offer “cleanings” without anesthesia. This procedure is purely cosmetic and causes more harm than good. It also gives pet owners the false misconception that they have helped their pets oral health. Cleaning above the gum line without cleaning the subgingival periodontal pockets is like painting over the rust on your car. The disease is left to fester under the gum line. The American Veterinary Dental College has a position statement about this.
Subgingival curettage is scaling away tartar, bacteria and inflammatory debris from the periodontal pocket with sharp instruments. This procedure is painful and cannot be done on an awake animal as they will not listen or understand like we do to our hygienist. This treatment is effective in periodontal pockets from 3-5mm deep. If successful these pockets will fill up with gingival tissue (junctional epithelium).
Periodontal surgery involves cutting the gums away from the tooth. This allows deep pockets to be cleaned in a way that not possible from above the gum line. This procedure is indicated if periodontal pockets are greater than 5mm. The flap is stitched closed once the pocket is clean. If successful these pockets will fill up with gingival tissue (junctional epithelium).
Guided Tissue Regeneration
If bone growth is desired then any boney defects are filled with a bone conductive material and then covered with a barrier membrane made from an antibiotic gel and then the gums are stitched back in place.
Both of these procedures are indicated in periodontal pockets greater than 5 mm as they cannot be appropriately cleaned from above the gum line. If either of these procedures are to be successful then the owners absolutely need to brush the teeth daily and follow-up yearly dental cleanings so these teeth can be monitored closely to ensure that the treatment has been successful.
If owners are unable or unwilling to perform daily oral homecare or cannot commit to yearly cleanings then these procedures are not recommended and teeth with periodontal pockets deeper than 5mm should be extracted. Remember the goal is a healthy pain free mouth.