Gingivitis

Introduction

Gingivitis is one of the most common dental disease in dogs and cats and the major cause of tooth loss in both species. There are numerous factors that contribute to the formation of the disease but the primary agent is dental plaque. Plaque accumulates at the gingival margin, partly due to insufficient oral hygiene. The disease may also occur in horses.

Initially the bacterial flora tend to be non-motile aerobes or facultative anaerobes. However, as the supply of oxygen is reduced by supragingival plaque accumulation and pocket formation, the bacterial flora become more motile and anaerobic. Important bacterial flora responsible include Porphyromonas gingivalis, Bacteroides asaccharolyticus, Fusobacterium nucleatum, Actinomyces viscosus and Actinomyces odontolyticus.

Gingivitis is the early form of periodontal disease and often but not always progresses to periodontitis. It is the reversible inflammation of the marginal gingival tissues that does not affect the periodontal ligament or the alveolar bone. Gingival inflammation starts because of dental calculus (tartar) from diets high in minerals and diets consisting of soft rather than hard crunchy food. Dental plaque becomes calcified and whole crown may become covered in brown chalky material. Calculus gives brittle dirty brown covering to tooth which may not affect enamel at all but may produce mild gingivitis round edge and the gum may start to recede. This exposes more of crown, may reach level of dentine and infection may enter the alveolus and loosen ligaments holding tooth in and ultimately the tooth will become loose and fall out.

Signalment

Pure bred cats are particularly susceptible and include: Burmesem, Persian, Siamese, Maine Coon.

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 and include: Greyhound, Maltese

Small breed dogs are more prone to tooth crowding, predisposing the animal to the initiation and rapid progression of the disease

Clinical Signs

Clinical signs include fetid breath odour (halitosis), excessive salivation, blood in saliva, dysphagia, pain on mastication and difficulty eating.

Diagnosis

Clinical signs are indicative of oral disease.

An 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 assymmetry), 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 there will usually just be inflammation of the gingiva unless the disease has progressed to periodontal disease.

Periodontal disease can be staged:

• Stage 0 - Normal and healthy periodontium
• Stage 1 - Periodontal disease/Gingivitis (0% attachment loss, pocket depth <0.5mm)
• Stage 2 - Early periodontal disease (<25% attachment loss, pocket depth <1.0mm)
• Stage 3 - Moderate periodontal disease (25-50% attachment loss, pocket depth <2.0mm)
• Stage 4 - Severe periodontal disease (>50% attachment loss, pocket depth >2.0mm)

Treatment

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. One will need to educate the owner of the disease process and also educate them on good daily dental home care such as tooth brushing and diet.

Perform a dental scale and polish and ensure the owner is aware that regular examinations to assess the condition of the teeth will be required from now on.

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 Merial

Expert Review - Small Animal