Periodontal Disease in Dogs

Periodontal disease is a bacterial infection of the mouth that has four distinct stages. These stages are plaque, inflamed gums, leading to diagnosed gingivitis, and finally severe periodontitis that has established gingivitis under the gum line, and may also have associated bone and tooth loss. 

Periodontal disease is the most commonly diagnosed medical condition in adult dogs, and is more serious than just a case of gingivitis, as it involves the periodontal ligament and alveolar bone both becoming inflamed.  Even though it is the most common disease in dogs and 100% preventable, more than 70% of dogs will have the disease by the time they reach two years old. 

Other than the tell tale bad breath, there aren’t many other signs visible to the untrained eye, leading to late detection and in most cases under treatment. Because of late detection, it can sometimes be linked to internal organ damage as the dog grows older. Studies have shown the link between periodontal disease in dogs and  more severe diseases. These include diseases of the kidneys, liver, heart, and lungs. Problematic pregnancies, diabetes and cancer have also been found to be linked.

Periodontal disease is a completely preventable bacterial infection that in the end stage can result in significant bone loss, loss of teeth, and diseases of certain organs.

• Bad breath
• Bleeding gums
• Sensitive mouth that will have accompanying pawing at the mouth
• Red or receding gum line
• Pus around a tooth
• Loose or missing teeth
• Decreased appetite with difficulty in chewing his food
• Upset stomach
• Drooling
• Change in behavior – more irritable and depressed

Types

Periodontal Disease has four distinct stages. 

• Stage 1 – Early gingivitis is characterized by slight plaque buildup, and light redness of the gums and no change in bone support; it is reversible at this stage 
• Stage 2 – Advanced gingivitis is characterized by plaque now under the gum line, redness and swelling of the gums, and a slight change in the bone support; at this stage it is still reversible
• Stage 3 – Early periodontitis is characterized by tartar buildup under the gum line, redness and swelling of the gums, with bleeding and receding gum line; there is about a 10 to 30% loss in bone support at this point, and it is now irreversible 
• Stage 4 – Established periodontitis is characterized by more tartar buildup under the gum line, with severe swelling;there will be loose or missing teeth, a receding gum line, pus around the teeth, bleeding gums, and deep pockets between the teeth and gums; at stage four there will be over 30% bone loss, and is irreversible

The cause of periodontal disease in dogs is also the same as it is in humans. This gum disease stems from accumulated plaque and tartar on the teeth and gums. Once tartar has been allowed to reach a certain thickness it is only removable with dental tools. 

If the plaque and tartar are not removed they will begin building up under the gum line, creating a pocket that separates the tooth from the gum. This allows for even more bacterial growth.  Once it reaches this stage, you may start seeing loose teeth, bone loss, infection, and abscesses.  There are additional factors that will aid in forming the plaque and tartar build up eventually leading to periodontal disease. These include:

• Age
• Overall health
• Diet
• Chewing habits
• Breed
• Genes 
• Tooth alignment
• Grooming
• Oral care
• Home care

If your dog has stinky breath, yellowing teeth, and a red gum line you will want to talk to your veterinarian about the possibility of periodontal disease. When you talk to your veterinary team make sure you are able to describe any changes in behavior and appetite as well. Periodontal disease can be diagnosed in two ways. 

Dental Radiographs

This will not only give your veterinarian a picture of your dog’s teeth, bones and soft tissues, but will also allow her to see any tooth decay, bone diseases, certain tumors, and infections. You do not need to worry about the safety of radiation toward your dog, as the amount in dental radiographs is very small.

Periodontal Probing

This is the same technique your dentist will use on you when you visit for an oral cleaning. The tool used is an angled metal stick that measures the depth of any pockets in order to know the exact millimeters of periodontal support.

Different treatments are used depending on the stage of periodontal disease your dog is at. Before any treatment is done, your veterinarian should do a pre-surgical exam, and could also include a pre-anesthetic blood test. These are done to ensure your dog is in overall good health and that he can bypass any potential problems. In many periodontal cases the dog is prescribed antibiotics prior to the dental treatment to head off any infections. Your dog will be under anesthesia for any treatment and under observation. Listed below are some different treatment options and what stage they are used for. 

Stage 1 and Stage 2

Your veterinarian will perform an oral cleaning, and polish the teeth. This is called prophylaxis. The veterinarian will remove the plaque and tartar build up from the teeth, and above and below the gums. The polishing helps to remove any scratches on the teeth that will help in allowing plaque and tartar to rebuild. Afterward, the veterinarian will check each tooth individually and the whole mouth for diseases.

Stage 3 and Stage 4 

The above treatment will be used for these stages as well but will also include the probing, and x-rays. This helps determine the best course of action, which can be between root planing, subgingival curettage, periodontal debridement, gingivectomy, periodontal surgery, tooth extraction, and special therapeutics.

Root planing

This is the removal of any left over tarter, diseased cementum (the layer directly under the gum line) and dentin (the layer directly over the pulp covered nerves). It also helps to smooth the surface of the roots.

Subgingival Curettage

This is the removal and diseased epithelium (where the tooth meets the gum line) and any surrounding tissues. 

Periodontal debridement

This treatment option can be done instead of a root planing and subgingival curettage. This is the removal of any bacteria and endotoxins that may be irritating the tooth and root. 

Gingivectomy

Because the space between the tissue and tooth allows for bacteria growth, this procedure removes the extra gingiva. 

Periodontal surgery and extraction

This opens a part of the gum line directly over the root in order to access the deeper levels of the tooth. Teeth may be extracted when necessary, or the owner has decided to forego other treatment options.

Special Therapeutics

This allows for synthetic materials to be put into the pockets allowing for bone and periodontal growth. Some of the materials will require antibiotics to be prescribed up to several weeks after the procedure. Other therapeutics includes tooth sealants, and plaque prevention.

Recovery will depend on the treatment but dogs with stage 3 and 4 periodontal disease will require a commitment to recovery and management from the owner. Pain medication and anti-inflammatories may be prescribed after treatment for a few weeks, as well as antibiotics, given to keep infections at bay. 

Topical medication can be used to prevent plaque but needs to be applied regularly. Your pet will not be permitted chew toys for a period of one month. Your  veterinarian will be able to suggest a specific diet after treatment for both recovery and also managing the rebuilding of plaque and tartar.

Your veterinarian will be able to show you how to create and stick to a daily tooth brushing routine, although you will need to wait until after recovery to start. For dogs with stage 3 and 4 periodontal disease, regular follow ups will be needed in order to keep an eye on the condition. Depending on the severity, your veterinarian will possibly want to re-probe about a month after treatment; otherwise quarterly visits will be needed.