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== Diagnosis ==
== Diagnosis ==
An [[Oral Examination - Introduction|oral examination]] should be performed. This is the most important part of the diagnostic procedure and should include inspection of extraoral structures (looking for swelling, atrophy or asymmetry), such as face, lips, muscles of mastication, temporomandibular joints, salivary glands, lymph nodes, maxillae and mandibles. Intraoral structures such as the dentition, gingiva, mucosa, tongue, tonsils and dental occlusion should also be thoroughly examined. On visual inspection of the intraoral structures, an animal with periodontitis may demonstrate oral mucosal ulceration, inflammed and bleeding gingiva, loss of normal gingival contour, purulent discharge from the periodontal pocket, gingival recession, loose teeth and presence of variable quantities of plaque and calculus on the tooth surface.
Periodontal disease is associated with loss of the attachment apparatus of the tooth. Clinically this is hard to detect and there is no correlation between the amount of calculus seen on the tooth and the degree of destruction. Loss of attachment usually involves the periodontal ligament, bone, root cementum and gingiva. Clinically, [[Dental Indices and Criteria#Tooth Mobility|mobile teeth]] may be evident and some teeth may have evidence of [[Dental Indices and Criteria#Gingival Recession|gingival recession]] and root exposure indicating that there is periodontal disease but for a full assessment, an examination has to be performed under [[Oral Examination Under General Anaesthesia|general anaesthesia]]. A [[Periodontal Probe|periodontal probe]] is used to assess the depth of the gingival sulcus and whether there is loss of bone or periodontal ligament. A [[Dental Indices and Criteria#Periodontal Probing Depth (PPD)|probing depth]] greater than 3mm in most dogs would be considered abnormal. This does vary based on the tooth and the size of the dog. Any depth over 0.5mm in cats would be considered abnormal. The periodontal probe is used to assess the degree of gingivitis, measure the pocket depth, check whether the tooth is mobile, whether there is bone loss between the roots ([[Dental Indices and Criteria#Furcation Involvement|furcation exposure]]) and measure the amount of gingival recession. The whole circumference of the tooth needs to be evaluated. <font color="red">(pics PD5, PD6)</font color>
There are a number of methods that grade the severity of periodontal disease. It must be remembered though that different teeth in the mouth may be affected by different severities of the disease and even around each tooth, the degree of attachment loss may vary. Grading is based on the extent of attachment loss as this is indicative of periodontal destruction.
:'''Grade 0''' = Healthy Gingiva
:'''Grade 1''' = Established gingivitis
:'''Grade 2 '''= Mild periodontitis (<25% attachment loss based on radiographs)
:'''Grade 3''' = Moderate periodontitis (25-50% attachment loss based on radiographs)
:'''Grade 4''' = Severe periodontitis (>50% attachment loss) <font color="red">(pic PD7)</font color>
Oral radiography can be used to assess periodontal disease. Cases of periodontitis will show generalised horizontal and vertical alveolar bone loss in focal areas. Radiographic signs of periodontal disease include resorption/rounding of the alveolar margin, widening of the periodontal space, loss of the lamina dura (cortical bone of the alveolus) and alveolar bone destruction.
Oral radiography should be used to assess periodontal disease. Cases of periodontitis will show generalised horizontal and vertical alveolar bone loss in focal areas. Radiographic signs of periodontal disease include resorption/rounding of the alveolar margin, widening of the periodontal space, loss of the lamina dura (cortical bone of the alveolus) and alveolar bone destruction. Find more information about [[Periodontal Disease - Radiographic Interpretation|radiographic interpretation of periodontal disease]].
== Treatment ==
Treatment of periodontitis is two stage – periodontal therapy performed under general anaesthesia, and the most important stage is then follow up home care following an oral hygiene program.
'''Gingivitis'''
'''Gingivitis'''
Treatment of gingivitis relies heavily on owner compliance. It is important to stress to the owner that the disease is reversible and treatment and control may prevent this disease from becoming peridontitis, which is a lot more severe.
Treatment of gingivitis relies heavily on owner compliance. It is important to stress to the owner that the disease is reversible and treatment and control may prevent this disease from becoming peridontitis, which is a lot more severe.
The owner should receive information on good daily dental home care such as tooth brushing and diet.
The owner should receive information on good daily [[Oral Hygiene|dental home care]] such as [[Tooth Brushing|tooth brushing]] and [[Dental Diet|diet]].
Treatment involves performing a dental scale and polish and ensuring the owner is aware that regular examinations to assess the condition of the teeth will be required from now on.
Treatment involves performing a dental scale and polish and ensuring the owner is aware that regular examinations to assess the condition of the teeth will be required from now on.
Lobprise, H. (2007) '''Blackwell's five minute consult clinical companion: small animal dentistry''' ''Wiley-Blackwell''
Lobprise, H. (2007) '''Blackwell's five minute consult clinical companion: small animal dentistry''' ''Wiley-Blackwell''