Periodontal Disease

Typical Signalment

• Pure bred cats are particularly susceptible and include:
  • Persian
  • Maine Coon
  • Burmese
  • Siamese
• Affects majority of cats over two years of age.
• Certain breeds of dogs are thought to be susceptible to an aggressive form of the disease including:
  • Greyhounds
  • Maltese dogs
• Small breed dogs are more prone to tooth crowding, predisposing the animal to the initiation and rapid progression of the disease

Description

Periodontal diseases are bacterial plaque-induced conditions that cause inflammation of the supporting structures of the teeth. These structures include:

• gingiva
• periodontal ligaments
• cementum
• alveolar bone

Gingival hyperplasia often appears as pink, hyperaemic and ulcerated lesions that can be either firm or soft. There can be varying amounts of pigmentation reflecting the normal pigmentation of the oral mucosa. Crowns of teeth are often partially or completely covered by the hyperplastic gingiva forming a potential space or pocket between the gingiva and the crown where plaque is able to accumulate.

Gingival hyperplasia can be described as:

• Focal lesions
• Multiple focal lesions
• Generalised
• Combinations of the above

It is thought to be the result of an imbalance in the plaque/host tissue response. There are many factors that can cause this condition. These include the following:

• Drug-induced
  • Ciclosporin
  • Phenytoin
  • Calcium channel blockers
• Chronic irritation
  • Dental plaque
  • Odontoclastic resorptive lesions
  • Neoplasm
  • Mechanical irritation

Diagnosis

Clinical Signs

Depend on the severity of gingival hyperplasia and the degree to which the teeth are covered but include:

• pain on mastication
• haemorrhage (mild to moderate)
• reluctance to eat
• drooling
• dysphagia

Diagnostic Imaging

Oral radiographs should be taken to rule out concurrent conditions. One such condition is periodontitis which is demonstrated radiographically by alveolar bone loss associated with pocket formation between the tooth crown and gingiva.

Biopsy

Biopsy samples should include those areas of gingiva that show signs of inflammation with a softer than normal texture. Any gingiva with radiographic signs of bone involvement should also be sampled.

Treatment

The suspected cause of the condition should be corrected first. This may include a multimodal treatment plan aimed at controlling plaque formation including teeth brushing and providing the animal with sticks/toys that clean the teeth crowns

• Gingivectomy and gingivoplasty - should be carried out under general anaesthetic if significant pseudo-pockets are present between the gingiva and teeth crowns. The aim should be to eliminate the pseudopockets and re-establish the normal anatomy of the gingival margin.
  • Electrosurgery and Laser surgery - care must be taken with electrosurgery to avoid contact between the teeth crowns and the electrodes to prevent irreversible heat damage to the pulp.

Prognosis

The prognosis following surgical excision and histopathology is good. However, local recurrence is possible but less common if a treatment plan aimed at reducing plaque formation is implemented. A re-examination of the patient should be carried out at least every 6 months to assess for signs of recurrence and the sufficiency of plaque control measures.

References

• Tutt, C., Deeprose, J. and Crossley, D. (2007) BSAVA Manual of Canine and Feline Dentistry (3rd Edition) BSAVA

• Merck & Co (2008) The Merck Veterinary Manual