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In the last few articles on pet dental health, we focused on how to maintain a healthy mouth and prevent disease from rearing it’s ugly head through diligent home care and regular professional dental cleaning procedures. Sometimes, unfortunately, problems can progress to the point that the deeper structures around the teeth become damaged. This is known as periodontal disease.

The periodontal ligament is a tough band of fibrous tissue that covers the roots of the teeth, attaching them to the underlying bone. Bacteria in the mouth are prevented from getting to these tissues by the gum or gingiva, which is attached around the base of the tooth, acting as a barrier against infection, plaque, and other nasty things.

In a normal tooth, there is a small space, usually only about a millimetre deep, between the base of the tooth, and the gingiva. This space is called the gingival sulcus. This is the place that bacteria and plaque just absolutely LOVE to collect. If we are being diligent about brushing (and flossing if you are a human), then we are constantly getting rid of this collection of bacteria and the toxins that they produce. Professional dental cleanings concentrate on removing any plaque and tartar that has collected in this sulcus, to keep the area clean and infection-free.

If we are not diligent however, bacteria continue to multiply and thrive in this very cosy environment, producing toxins which cause inflammation, and eat away at the surrounding tissues. The first sign of this process is gingivitis – a red, swollen gum along the margins of the teeth, and halitosis, that nasty, foul, doggy breath smell. If a cleaning and home care plan is instituted at this point, these changes are completely reversible.

If left unchecked, however, the bacterial toxins continue to eat away at the underlying gingival tissue, causing the gingival sulcus to become deeper and deeper. As this gingival pocket increases in size, bacteria can move further down towards the root of the tooth, and start to cause damage to the periodontal ligament holding the tooth roots in place. It now becomes more difficult to maintain a healthy mouth, as the bacteria causing the problem are living quite happily deep under the gumline, where brushing can not reach nearly as well.

Eventually, the periodontal ligament, and the bone surrounding the root of the teeth become damaged and are eaten away, causing tooth mobility (loosening), and eventually, tooth loss. Needless to say, it takes quite a long time for this process to happen and the tooth to finally fall out, but in the meantime, you can be darn sure that your pet is in a great deal of discomfort (even if he or she doesn’t show any outward signs of it).

Once things have progressed this far and periodontal disease exists, we can help to control it, but we can never cure or reverse it. It now becomes a constant battle, through good homecare and regular, routine dental cleanings, to try to stay one step ahead of the problem, and keep things from deteriorating further.

If deep pockets around the teeth exist, special periodontal procedures can be utilized to try to treat and save a tooth. Incisions can be made in the gum tissue and the gums can be peeled back, exposing the root of the tooth that is diseased to allow adequate cleaning. Special antibiotic gels can be applied into the deep pockets that last for several weeks and deal with deep infection around the roots of the teeth, allowing the diseased gums to hopefully heal and attach back to the roots of the teeth. If bone loss has occurred, special bone grafting types of materials can be placed into the areas of bone loss to try to encourage new bone to grow back.

Which of these procedures are necessary, and whether or not they should even be attempted depends on several different factors. The first, and most important, is that we have an accurate diagnosis of the problem that is occurring around each tooth. Dental radiographs (Xrays) are absolutely essential here – it is impossible to know what we are dealing with, and how advanced the disease is without taking an Xray. Several criteria are used to determine whether or not a tooth is salvageable or if it should be extracted. One of the main criteria that we use is whether or not an owner can make the commitment to perform daily, routine dental homecare after the procedure. Without regular brushing, these advanced periodontal procedures are futile – we may be able to treat the teeth now, but within a month, things will be worse than ever, unless an owner can be diligent about maintaining their pet’s teeth.

If disease is too advanced or if an owner is unable to provide the kind of home care that will be necessary, then extraction of the diseased tooth is often the best course of action for everyone. Extraction solves the problem by removing the infected tissue entirely, allowing things to heal, and inflammation and pain to disappear. Dogs generally do extremely well without some of their teeth, and when necessary, can do very well with no teeth at all. Although we try to save teeth whenever we can, it is far, far better for a pet to live with no teeth at all, than to live with constant pain from nasty, infected, diseased teeth.

Obviously, it is far better to try to prevent periodontal disease from ever happening. Unfortunately, we are a long way from this in real life – periodontal disease is one of the most common problems that veterinarians see on a daily basis all over the world. Hopefully over time, both veterinarians and pet owners will become more aware of the importance of good dental hygiene, and in the future, things end up being a lot better than they are today.

So go out there, and start brushing!

For more information on periodontal disease, with cool pictures and everything, see Dr. Gignac’s website at the following link: www.yorkvilleanimalhospital.ca/index.php?view=pageView&pageid=210