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[[File:Healthy gingiva cat.jpg|200px|thumb|right|Healthy gingiva]]

[[File:Healthy gingiva cat.jpg|200px|thumb|right|Healthy gingiva]]

[[File:Gingivitis.jpg|200px|thumb|right|Gingivitis]]

[[File:Gingivitis.jpg|200px|thumb|right|Gingivitis]]

[[File:PD3-visibleAL.jpg|200px|thumb|right|<font color ="red">Visible alveolar bone</font color>]]

[[File:PD3-visibleAL.jpg|200px|thumb|right|Gingival recession of canine tooth with exposed root surface]]

Periodontal disease is essentially an inflammatory response by the supporting structures of the [[:Category:Teeth - Anatomy & Physiology|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 [[:Category:Oral Diseases - Dog|dental disease in dogs]] and [[:Category:Oral Diseases - Cat|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 - Small Animal|oral hygiene]].

Periodontal disease is essentially an inflammatory response by the supporting structures of the [[:Category:Teeth - Anatomy & Physiology|teeth]] known as the periodontium. These structures include the [[gingiva]], [[Tooth - Anatomy & Physiology#Periodontal Ligament|periodontal ligaments]], [[Tooth - Anatomy & Physiology#Cementum|cementum]] and [[Tooth - Anatomy & Physiology#Alveolar Bone|alveolar bone]]. It is the most common [[:Category:Oral Diseases - Dog|dental disease in dogs]] and [[:Category:Oral Diseases - Cat|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 - Small Animal|oral hygiene]].

Periodontal disease is the result of the inflammatory response to dental plaque, i.e. oral bacteria, and is limited to the periodontium. It is probably the most common disease seen in small animal practice, with the great majority of dogs and cats over the age of 3 years having a degree of disease that warrants intervention.  

Periodontal disease is the result of the inflammatory response to dental plaque, i.e. oral bacteria, and is limited to the periodontium. It is probably the most common disease seen in small animal practice, with the great majority of dogs and cats over the age of 3 years having a degree of disease that warrants intervention.  

Periodontal disease is a collective term for a number of plaque-induced inflammatory lesions that affect the periodontium. It is a unique infection in that it is not associated with a massive bacterial invasion of the tissues. '''Gingivitis''' is inflammation of the gingiva and is the earliest sign of disease. Individuals with untreated gingivitis may develop '''periodontitis'''. The inflammatory reactions in periodontitis result in destruction of the periodontal ligament and alveolar bone. The result of untreated periodontitis is ultimately exfoliation of the affected tooth. Thus, gingivitis is inflammation that is not associated with destruction (loss) of supporting tissue – it is reversible. In contrast, periodontitis is inflammation where the tooth has lost a variable degree of its support (attachment) – it is irreversible. Infection of the periodontium may cause discomfort to the affected animal. There is also strong evidence that a focus of infection in the [[Oral Cavity Overview - Anatomy & Physiology|oral cavity]] has been associated with disease of distant organs. Consequently, prevention and treatment of periodontal diseases is, contrary to common belief, not a cosmetic issue, but a general health and welfare issue.

Periodontal disease is a collective term for a number of plaque-induced inflammatory lesions that affect the periodontium. It is a unique infection in that it is not associated with a massive bacterial invasion of the tissues. '''Gingivitis''' is inflammation of the gingiva and is the earliest sign of disease. Individuals with untreated gingivitis may develop '''periodontitis'''. The inflammatory reactions in periodontitis result in destruction of the periodontal ligament and alveolar bone. The result of untreated periodontitis is ultimately exfoliation of the affected tooth. Thus, gingivitis is inflammation that is not associated with destruction (loss) of supporting tissue – it is reversible. In contrast, periodontitis is inflammation where the tooth has lost a variable degree of its support (attachment) – it is irreversible. Infection of the periodontium may cause discomfort to the affected animal. There is also strong evidence that a focus of infection in the [[Oral Cavity Overview - Anatomy & Physiology|oral cavity]] has been associated with disease of distant organs. Consequently, prevention and treatment of periodontal diseases is, contrary to common belief, not a cosmetic issue, but a general health and welfare issue.

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''.  

Recent research into dog periodontitis has shown that the bacteria present in healthy canine mouths differ significantly from those found in healthy human mouths. Dogs lack significant numbers of streptococcal species which helps to explain why the incidence of [[Dental Caries]] is so much lower in dogs than humans. Instead, healthy canine plaque is dominated by aerobic gram negative bacteria including several ''Neisseria'' species along with ''Bergeyella zoohelcum'' and a canine ''Moraxella'' species. These differences between dog and human oral microbiology are important as they indicate that products or treatments developed for human oral care may not automatically be suitable for dog oral care. Treatments targeted at ''Streptococcus mutans'' are a case in point as we now know that dogs do not have this bacterium in their mouths. As periodontal disease progresses, the oral bacterial population shifts towards a more gram positive distribution with anaerobic species becoming more prevalent as the supply of oxygen is depleted, especially in periodontal pockets. Members of the genus Peptostreptococcae become much more prevalent, although the role of these bacteria is not yet known. Whether specific bacteria cause the onset of periodontitis has not yet been proven in either dog or human and it may be that the transition to the disease state might be facilitated by multiple different combinations of bacteria working together.

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 [[Enamel Organ#Crown|crown]] may become covered in brown chalky material. Calculus gives brittle dirty brown covering to tooth which may not affect [[Enamel Organ#Enamel|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 [[Enamel Organ#Dentine|dentine]] and infection may enter the alveolus and loosen ligaments holding tooth in and ultimately the tooth will become loose and fall out.

Dental calculus (tartar) forms when plaque is left undisturbed for a number of days. Calcium salts from saliva start to become deposited in the plaque causing it to harden and become resistant to removal. Diets high in minerals and diets consisting of soft rather than hard crunchy food exacerbate the problem. As dental plaque becomes calcified and the whole crown may become covered in brown chalky material. Calculus forms a brittle dirty brown covering to the tooth which may not affect the enamel at all but may produce mild gingivitis around the edge and the gum may start to recede. This exposes more of the crown, and may subsequently reach the level of the dentine and infection may enter the alveolus and loosen the ligaments holding tooth in and ultimately the tooth will become loose and fall out.

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

'''Gingivitis''' - Reversible inflammation of the marginal gingival tissues that does not affect the [[Tooth - Anatomy & Physiology|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.

'''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.

==Aetiology==

==Aetiology==

The primary cause of gingivitis and periodontitis is '''accumulation of dental plaque''' on the tooth surfaces. '''Calculus''' (tartar) is only a secondary aetiological factor.

The primary cause of gingivitis and periodontitis is '''accumulation of dental plaque''' on the tooth surface. '''Calculus''' (tartar) is only a secondary aetiological factor.

Dental plaque is a biofilm composed of aggregates of [[:Category:Bacteria|bacteria]] and their by-products, salivary components, oral debris, and occasional epithelial and inflammatory cells. Plaque accumulation starts within minutes on a clean tooth surface. The initial accumulation of plaque occurs supragingivally but will extend into the sulcus and populate the subgingival region if left undisturbed. The formation of plaque involves two processes, namely the initial adherence of bacteria and then the continued accumulation of bacteria due to a combination of bacterial multiplication and further aggregation of bacteria to those cells that are already attached.  

Dental plaque is a biofilm composed of aggregates of [[:Category:Bacteria|bacteria]] and their by-products, salivary components, oral debris, and occasional epithelial and inflammatory cells. Plaque accumulation starts within minutes on a clean tooth surface. The initial accumulation of plaque occurs supragingivally but will extend into the sulcus and populate the subgingival region if left undisturbed. The formation of plaque involves two processes, namely the initial adherence of bacteria and then the continued accumulation of bacteria due to a combination of bacterial multiplication and further aggregation of bacteria to those cells that are already attached.  

As soon as a tooth becomes exposed to the [[:Category:Oral Cavity - Anatomy & Physiology|oral cavity]], its surfaces are covered by the '''pellicle '''(an amorphous coating of salivary proteins and glycoproteins). The pellicle alters the charge and free energy of the tooth surfaces, which increases the efficiency of bacterial adhesion. Certain specific bacteria can adhere directly to the pellicle. These bacteria produce extracellular polysaccharides, which then aggregate other bacteria that are not otherwise able to adhere. The plaque associated with healthy [[Gingiva|gingiva]] is mainly comprised of aerobic and facultative anaerobic bacteria. As gingivitis develops, plaque extends subgingivally. Aerobes consume oxygen and a low redox potential is created, which makes the environment more suitable for the growth of anaerobic species. The aerobic population does not decrease, but with increasing numbers of anaerobes, the aerobic/anaerobic ratio decreases. The subgingival florae associated with periodontitis are predominantly [[:Category:Anaerobic bacteria|anaerobic bacteria]].  

As soon as a tooth becomes exposed to the [[:Category:Oral Cavity - Anatomy & Physiology|oral cavity]], its surfaces are covered by the '''pellicle '''(an amorphous coating of salivary proteins and glycoproteins). The pellicle alters the charge and free energy of the tooth surfaces, which increases the efficiency of bacterial adhesion. Certain specific bacteria can adhere directly to the pellicle. These have recently been shown to be mostly members of the genus ''Neisseria'' in dog plaque. These bacteria facilitate the recruitment of secondary bacterial species to the developing plaque biofilm. The plaque associated with healthy [[Gingiva|gingiva]] has a higher proportion of aerobic and facultative anaerobic bacteria. As gingivitis develops, plaque extends subgingivally. Aerobes consume oxygen and a low redox potential is created, which makes the environment more suitable for the growth of anaerobic species. The aerobic population does not decrease, but with increasing numbers of anaerobes, the aerobic/anaerobic ratio decreases. The subgingival florae associated with periodontitis are predominantly [[:Category:Anaerobic bacteria|anaerobic bacteria]].  

Dental calculus (tartar) is mineralized plaque. However, a layer of plaque always covers calculus. Both supragingival and subgingival plaque becomes mineralized. Supragingival calculus per se does not exert an irritant effect on the gingival tissues. The main importance of calculus in periodontal disease seems to be its role as a plaque-retentive surface. This is supported by well-controlled animal and clinical studies that have shown that the removal of subgingival plaque on top of subgingival calculus will result in healing of periodontal lesions and the maintenance of healthy periodontal tissues.

Dental calculus (tartar) is mineralized plaque. However, a layer of plaque always covers calculus. Both supragingival and subgingival plaque becomes mineralized. Supragingival calculus per se does not exert an irritant effect on the gingival tissues. The main importance of calculus in periodontal disease seems to be its role as a plaque-retentive surface. This is supported by well-controlled animal and clinical studies that have shown that the removal of subgingival plaque on top of subgingival calculus will result in healing of periodontal lesions and the maintenance of healthy periodontal tissues.

== Signalment ==

== Signalment ==

Pure bred cats are particularly susceptible and include: Burmese, Persian, Siamese and Maine Coon. The disease affects majority of cats over two years of age.  

Pure bred cats are particularly susceptible and include: Burmese, Persian, Siamese and Maine Coon. The disease affects the 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 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: Greyhound and Maltese. Small breed dogs are more prone to periodontitis. This may be a result of tooth crowding predisposing the animal to the initiation and rapid progression of the disease.

== Clinical Signs ==

== Clinical Signs ==

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 [[Oral Hygiene - Small Animal|dental home care]] such as [[Tooth Brushing|tooth brushing]] and [[Dental Diet|diet]].  

The owner should receive information on good daily [[Oral Hygiene - Small Animal|dental home care]] such as [[Tooth Brushing|tooth brushing]], [[Dental Diet|diet]] and [[Dental Chews|oral care chews]].  

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.

'''Periodontitis'''  

'''Periodontitis'''  

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 about the disease process and also on good daily dental home care such as tooth brushing, diet and oral care chews.  

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.

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.

'''Periodontal pockets'''

'''Periodontal Pockets'''

With pocket depths below 5mm, dental scaling and polishing should be performed, and then subgingival curettage and the placement of an antibiotic gel in the pocket may help rejuvenate the periodontal tissues and reduce pocket depth.

With pocket depths below 5mm, dental scaling and polishing should be performed, and then subgingival curettage and the placement of an antibiotic gel in the pocket may help rejuvenate the periodontal tissues and reduce pocket depth.

With pocket depths greater that 5mm, surgery is needed to either expose the root for treatment or extract. Gingival flaps or bony replacement procedures for infrabony pockets can be used to decrease pocket depths in areas of alveolar bone loss.

With pocket depths greater that 5mm, surgery is needed to either expose the root for treatment or extraction. Gingival flaps or bony replacement procedures for infrabony pockets can be used to decrease pocket depths in areas of alveolar bone loss.

{{Learning

{{Learning

|flashcards = [[Veterinary Dentistry Q&A 11]]

|flashcards = [[Veterinary Dentistry Q&A 11]]

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}}

== 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''

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

[[Category:Teeth_-_Inflammatory_Pathology]] [[Category:Oral_Cavity_and_Gingiva_-_Pathology]] [[Category:Dental_Diseases_-_Cat]] [[Category:Dental_Diseases_-_Dog]]

[[Category:Periodontal Conditions]]

[[Category:Periodontal Conditions]]

[[Category:To Do - Dentistry questions]]

[[Category:Waltham reviewed]]  

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