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== Introduction<br> ==

== Introduction ==

Periodontal disease is essentially an inflammatory response by the supporting structures of the teeth known as the periodontium. These structures include the gingiva, periodontal ligaments, cementum and alveolar bone.  

Periodontal disease is essentially an inflammatory response by the supporting structures of the teeth known as the periodontium. These structures include the [[gingiva]], [[Enamel Organ#Periodontal Ligament|periodontal ligaments]], [[Enamel Organ#Cementum|cementum]] and [[Enamel Organ#Alveolar Bone|alveolar bone]].  

It is 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.

It is 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.

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.  

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 and periodontitis are the two main forms of the disease. Gingivitis is the early form of the disease and often but not always progresses to periodontitis.

[[Gingivitis]] and periodontitis are the two main forms of the disease. Gingivitis is the early form of the disease and often but not always progresses to periodontitis.

'''Gingivitis''' - Reversible inflammation of the marginal gingival tissues that does not affect the periodontal ligament or the alveolar bone.  

'''Gingivitis''' - Reversible inflammation of the marginal gingival tissues that does not affect the periodontal ligament or the alveolar bone.  

'''Periodontitis''' - Inflammation and irreversible destruction of the tooth's supporting structures that includes the gingiva, periodontal ligament, alveolar bone and root cementum. It usually occurs after years of plaque accumulation and gingivitis. The epithelial attachments of the tooth regress apically and there is absorption of the associated alveolar bone, resulting in permanent loss of tooth support. <br>

'''Periodontitis''' - Inflammation and irreversible destruction of the tooth's supporting structures that includes the gingiva, periodontal ligament, alveolar bone and root cementum. It usually occurs after years of plaque accumulation and gingivitis. The epithelial attachments of the tooth regress apically and there is absorption of the associated alveolar bone, resulting in permanent loss of tooth support.  

Certain breeds of dogs are thought to be susceptible to an aggressive form of the disease and include: Greyhound and Maltese. Small breed dogs are more prone to tooth crowding, predisposing the animal to the initiation and rapid progression of the disease.  

 

 

 

Certain breeds of dogs are thought to be susceptible to an aggressive form of the disease and include:

 

Image:Greyhound.jpg|''Greyhound'' <p> ToB 2005, WikiMedia Commons

Image:Maltese.jpg|''Maltese'' <p> sannse 2003, WikiMedia Commons

 

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

 

 

 

Clinical signs include fetid breathe odour (halitosis), excessive salivation, blood in saliva, dysphagia,&nbsp;pain on mastication and&nbsp;difficulty eating. There may also be&nbsp;loose teeth. The animal may be lethargic and show signs of&nbsp;weight loss and poor grooming.  

== Diagnosis ==

== Diagnosis ==

Clinical signs are indicative of oral disease.  

Clinical signs are indicative of oral disease.  

An oral examination should be performed.&nbsp;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&nbsp;face,&nbsp;lips, muscles of mastication,&nbsp;temporomandibular joints,&nbsp;salivary glands,&nbsp;lymph nodes,&nbsp;maxillae and mandibles. Intraoral structures such as the&nbsp;dentition, gingiva,&nbsp;mucosa, tongue,&nbsp;tonsils and dental occlusion should also be thoroughly examined. On visual inspection of the intraoral structures, an animal with periodontitis may demonstrate&nbsp;oral mucosal ulceration, inflammed and bleeding gingiva,&nbsp;loss of normal gingival contour,&nbsp;purulent discharge from the periodontal pocket, gingival recession,&nbsp;loose teeth and presence of variable quantities of plaque and calculus on the tooth surface.  

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 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.  

A thorough periodontal examination of dogs should always be performed under general anaesthesia. The examination under general anaesthesia in cats allows a more detailed evaluation of the oral cavity.&nbsp;The periodontal examination is performed using a periodontal probe which is gently run under the gingival margin of each tooth. An evaluation is made of the&nbsp;amount of plaque and calculus present on the tooth surface, the&nbsp;degree of gingivitis and the presence of [[Gingival Hyperplasia|gingival hyperplasia]] or recession. The degree of attachment loss and boney resorption at the furcation is also investigated as well as the&nbsp;mobility of individual teeth.  

A thorough periodontal examination of dogs should always be performed under general anaesthesia. The examination under general anaesthesia in cats allows a more detailed evaluation of the oral cavity. The periodontal examination is performed using a periodontal probe which is gently run under the gingival margin of each tooth. An evaluation is made of the amount of plaque and calculus present on the tooth surface, the degree of gingivitis and the presence of [[Gingival Hyperplasia|gingival hyperplasia]] or recession. The degree of attachment loss and bone resorption at the furcation is also investigated as well as the mobility of individual teeth.  

The disease can then be staged:  

The disease can then be staged:  

*'''Stage 0 - Normal and healthy periodontium'''  

*'''Stage 0 - Normal and healthy periodontium'''  

*'''Stage 1 - Periodontal disease/Gingivitis''' (0% attachment loss, Pocket depth &lt;0.5mm)  

*'''Stage 1 - Periodontal disease/Gingivitis''' (0% attachment loss, Pocket depth <0.5mm)  

*'''Stage 2 - Early periodontal disease''' (&lt;25% attachment loss, Pocket depth &lt;1.0mm)  

*'''Stage 2 - Early periodontal disease''' (<25% attachment loss, Pocket depth <1.0mm)  

*'''Stage 3 - Moderate periodontal disease''' (25-50% attachment loss, Pocket depth &lt;2.0mm)  

*'''Stage 3 - Moderate periodontal disease''' (25-50% attachment loss, Pocket depth <2.0mm)  

*'''Stage 4 - Severe periodontal disease''' (&gt;50% attachment loss, Pocket depth &gt;2.0mm)

*'''Stage 4 - Severe periodontal disease''' (>50% attachment loss, Pocket depth >2.0mm)

 

 

== Treatment ==

== Treatment ==

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

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 root surface debridement. Teeth with severe peridontitis will need to be extracted and periodontal surgery may be necessary.

Perform a dental scale and polish and root surface debridement. Teeth with severe periodontitis will need to be extracted and periodontal surgery may be necessary.

Regular examinations to assess the condition of the teeth are vital and the owner needs to be made aware of this.

Regular examinations to assess the condition of the teeth are vital and the owner needs to be made aware of this.

== References ==

== References ==

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

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

*Merck &amp; Co (2008) '''The Merck Veterinary Manual'''

Merck &amp; Co (2008) '''The Merck Veterinary Manual'''

[[Category:Teeth_-_Inflammatory_Pathology]] [[Category:Oral_Cavity_and_Gingiva_-_Pathology]] [[Category:To_Do_-_Review]] [[Category:Oral_Diseases_-_Cat]] [[Category:Oral_Diseases_-_Dog]]

[[Category:Teeth_-_Inflammatory_Pathology]] [[Category:Oral_Cavity_and_Gingiva_-_Pathology]] [[Category:Expert_Review - Small Animal]] [[Category:Oral_Diseases_-_Cat]] [[Category:Oral_Diseases_-_Dog]]