{"id":127394,"date":"2024-11-18T20:31:55","date_gmt":"2024-11-18T20:31:55","guid":{"rendered":"https:\/\/todaysveterinarynurse.com\/?p=127394"},"modified":"2024-11-18T20:31:55","modified_gmt":"2024-11-18T20:31:55","slug":"periodontal-disease-in-dogs-and-cats","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/dentistry\/periodontal-disease-in-dogs-and-cats\/","title":{"rendered":"Periodontal Disease in Dogs and Cats"},"content":{"rendered":"<div class=\"su-spacer\" style=\"height:20px\"><\/div><div class=\"su-note\"  style=\"border-color:#d8d8d8;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><div class=\"su-note-inner su-u-clearfix su-u-trim\" style=\"background-color:#f2f2f2;border-color:#ffffff;color:#333333;border-radius:3px;-moz-border-radius:3px;-webkit-border-radius:3px;\"><b>Abstract<\/b><\/p>\n<p class=\"p1\">Frequently overlooked by both veterinary professionals and pet owners, periodontal disease can often be prevented with a combination of home care, regular veterinary examinations, and professional dental cleanings. This article describes the localized effects of untreated periodontal disease, the basics of professional dental care, and how to educate clients about preventing dental disease in their pets.<\/p>\n<p><b>Take-Home Points <\/b><\/p>\n<ul>\n<li class=\"p1\">Periodontal disease is the most common health condition in cats and dogs and is often undertreated.<\/li>\n<li class=\"p1\">Gingivitis and periodontitis are the 2 stages of periodontal disease. Bacterial plaque is the primary etiologic agent.<\/li>\n<li class=\"p1\">Factors that affect immune response can make animals more susceptible to the effects of periodontal disease.<\/li>\n<li class=\"p1\">A thorough periodontal examination must be performed under general anesthesia.<\/li>\n<li class=\"p1\">Without home care, the effectiveness of professional periodontal therapy is severely limited.<\/li>\n<\/ul>\n<\/div><\/div>\n<p class=\"p1\"><span class=\"s1\">P<\/span><span class=\"s1\">eriodontal disease is a serious condition with significant implications for the overall health of dogs and cats. This article provides an overview of the pathology and contributing factors and explains how veterinary nurses can educate pet owners about proactive steps to prevent this common oral disease. <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Periodontal disease is among the most frequently diagnosed conditions in companion animals, affecting up to 80% of dogs and 70% of cats by 2\u00a0years of age.<sup>1,2<\/sup> It consistently ranks among the top 2 or 3 disorders affecting companion dogs, particularly small and toy breeds.<sup>2<\/sup> Most pets, however, have few or no visible clinical signs of disease, resulting in therapy often being administered late in its progression. As a result, periodontal disease is among the most undertreated health issues in animals. Furthermore, if left untreated, it can have numerous, severe local and systemic consequences. <\/span><\/p>\n<h2 class=\"p3\">Pathology<\/h2>\n<p class=\"p2\"><span class=\"s1\">Periodontal disease is a bacterial inflammation of the periodontium, or periodontal tissues. It is characterized by 2 stages: gingivitis and periodontitis.<sup>2<\/sup><\/span><\/p>\n<h3 class=\"p4\">Gingivitis<\/h3>\n<p class=\"p2\"><span class=\"s1\">Gingivitis is the early, reversible stage of periodontal disease, characterized by inflammation limited to the gingiva (<\/span><span class=\"s2\"><b>FIGURE 1<\/b><\/span><span class=\"s1\">).<sup>2<\/sup> Plaque bacteria initiate gingival inflammation, which can be reversed with professional dental cleaning and consistent home care. Without proper treatment, gingivitis can progress to periodontitis.<\/span><\/p>\n<div id=\"attachment_127396\" style=\"width: 410px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig1.png\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-127396\" class=\" wp-image-127396\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig1.png\" alt=\"\" width=\"400\" height=\"216\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig1.png 1008w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig1-300x162.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig1-768x415.png 768w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/><\/a><p id=\"caption-attachment-127396\" class=\"wp-caption-text\">Figure 1. Early stages of gingivitis in a dog, localized along the gingiva with minimal plaque on the tooth surfaces. A professional dental cleaning can reverse gingival inflammation and prevent further progression of periodontal disease at this stage.<\/p><\/div>\n<h3 class=\"p4\">Periodontitis<\/h3>\n<p class=\"p2\"><span class=\"s1\">Periodontitis is an inflammatory condition affecting the deeper supporting structures of the tooth, including the periodontal ligament, cementum, and alveolar bone (<\/span><span class=\"s2\"><b>FIGURE 2<\/b><\/span><span class=\"s1\">).<sup>2<\/sup> Periodontitis occurs when bacteria break through the epithelial barrier and move deeper into periodontal tissues.<sup>3<\/sup> This causes the gingiva to separate from the alveolar bone, leading to attachment loss and creating a periodontal pocket. Periodontal bone loss can be present with or without active inflammation and is considered irreversible, meaning that lost bone cannot be regained without advanced regenerative surgeries.<sup>2<\/sup><\/span><\/p>\n<div id=\"attachment_127397\" style=\"width: 461px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig2.png\"><img decoding=\"async\" aria-describedby=\"caption-attachment-127397\" class=\" wp-image-127397\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig2.png\" alt=\"\" width=\"451\" height=\"230\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig2.png 1881w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig2-300x153.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig2-1024x522.png 1024w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig2-768x392.png 768w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig2-1536x783.png 1536w\" sizes=\"(max-width: 451px) 100vw, 451px\" \/><\/a><p id=\"caption-attachment-127397\" class=\"wp-caption-text\">Figure 2. Tooth anatomy. Illustration: Kip Carter<\/p><\/div>\n<p class=\"p2\"><span class=\"s1\">Periodontal disease begins when bacterial plaque accumulates on teeth. Plaque is a biofilm consisting of bacteria enclosed in a matrix of salivary glycoproteins and extracellular polysaccharides, and it attaches to clean teeth within 24 hours if left undisturbed.<sup>2<\/sup> In a healthy mouth, almost all plaque bacteria are aerobic species; however, most plaque bacteria involved in periodontal disease are anaerobic species.<sup>2 <\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Plaque on the visible tooth surface is known as supragingival plaque; when it extends under the free gingival margin into the gingival sulcus, it becomes subgingival plaque.<sup>2<\/sup> Progression of periodontal disease cannot be managed by controlling supragingival plaque alone.<sup>2<\/sup> The bacteria in subgingival plaque release toxins and metabolic byproducts, leading to inflammation and damage to the gingival tissues.<sup>2 <\/sup>This inflammatory response attracts white blood cells and other inflammatory mediators to the periodontal pocket, worsening inflammation and tissue damage.<sup>2 <\/sup>As inflammation progresses, the attachment of the tooth is compromised, eventually leading to tooth loss. Periodontal disease progression is influenced by bacterial virulence as well as the host\u2019s immune response.<sup>2<\/sup> <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Calculus is plaque that has become mineralized by salivary interaction and consists of a mixture of calcium carbonate and calcium phosphate (<span class=\"s2\"><b>FIGURE<\/b><\/span><\/span><span class=\"s2\"><b>\u00a03<\/b><\/span><span class=\"s1\">).<sup>4<\/sup> It is relatively nonpathogenic, but it is an irritant and creates a surface to which plaque can adhere.<sup>5<\/sup> Removal is difficult and requires professional treatment under anesthesia.<sup>4<\/sup> To effectively prevent periodontal disease, the tooth surface must be cleaned frequently and thoroughly before plaque accumulation progresses to calculus formation.<\/span><\/p>\n<div id=\"attachment_127398\" style=\"width: 360px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig3.png\"><img decoding=\"async\" aria-describedby=\"caption-attachment-127398\" class=\" wp-image-127398\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig3.png\" alt=\"\" width=\"350\" height=\"274\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig3.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig3-300x235.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig3-768x601.png 768w\" sizes=\"(max-width: 350px) 100vw, 350px\" \/><\/a><p id=\"caption-attachment-127398\" class=\"wp-caption-text\">Figure 3. Heavy calculus accumulation on the maxillary premolars with noticeable gingivitis in a cat. Calculus removal requires a dental cleaning under anesthesia.<\/p><\/div>\n<h3 class=\"p4\">Other Factors Influencing Periodontal Disease<\/h3>\n<p class=\"p2\"><span class=\"s1\">Factors such as genetics, excessive endogenous or exogenous corticosteroids, malnutrition, and systemic diseases can affect the immune response, making pets more susceptible to periodontal disease progression.<sup>6<\/sup><\/span><\/p>\n<p class=\"p5\"><b>Genetics<\/b><\/p>\n<p class=\"p2\"><span class=\"s1\">Maltese dogs are prone to familial plaque-associated gingivitis and ulcerative stomatitis, while miniature schnauzers often experience early-onset adult periodontitis.<sup>4<\/sup> Gingival hyperplasia, a condition characterized by the overgrowth of gum tissue, is prevalent in boxers and commonly affects medium to large breeds.<sup>4<\/sup> Siamese, Somali, and Maine coon cats potentially have a genetic predisposition for feline juvenile-onset periodontitis.<sup>7<\/sup> <\/span><\/p>\n<p class=\"p5\"><b>Nutrition<\/b><\/p>\n<p class=\"p2\"><span class=\"s1\">Deficiencies in vitamins A, C, D, and E and the B vitamins folic acid, niacin, pantothenic acid, and riboflavin have been associated with gingival disease.<sup>1,2 <\/sup>Diets lacking sufficient calcium can lead to nutritional secondary hyperparathyroidism, a condition that can also contribute to periodontal issues.<sup>2<\/sup> Homemade diets often lack nutrients that are present in commercially prepared pet food meeting the nutritional guidelines established by the Association of American Feed Control Officials.<sup>2<\/sup><\/span><\/p>\n<p class=\"p5\"><b>Systemic Disease<\/b><\/p>\n<p class=\"p2\"><span class=\"s1\">Systemic diseases can exacerbate periodontal disease if the host has an improper immune response.<sup>7<\/sup> Diabetes mellitus, which increases susceptibility to infections and hinders wound healing, is known to significantly affect periodontal health.<sup>7<\/sup><\/span><\/p>\n<h2 class=\"p3\">Clinical Evaluation<\/h2>\n<p class=\"p2\"><span class=\"s1\">A comprehensive periodontal evaluation involves visual inspection, periodontal probing and exploring, and individual assessments of tooth abnormalities. The conscious examination is important, but a thorough examination is only possible under general anesthesia.<sup>8<\/sup> All clinical findings should be documented in the patient\u2019s record.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">The veterinary professional should begin by evaluating the patient\u2019s medical and dental history with the client present. The head should be evaluated for symmetry, noting any abnormalities, and whether halitosis is present.<sup>9<\/sup> Inflammation in the oral cavity can contribute to swelling of the sublingual and submandibular lymph nodes.<sup>9<\/sup> The occlusion should be briefly assessed but evaluated more thoroughly prior to anesthesia and intubation.<sup>9<\/sup> The jaw and temporomandibular joint should be palpated for pain or discomfort.<sup>9<\/sup> <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Healthy gingiva should appear coral pink (or exhibit normal pigmentation) with a thin edge and smooth texture.<sup>2<\/sup> Redness, swelling, and bleeding of the gingiva, particularly upon probing or brushing, are early clinical signs of gingivitis.<sup>6<\/sup> However, the absence of visible gingivitis does not rule out periodontal disease, as significant attachment loss can occur without noticeable gingival inflammation.<sup>8<\/sup> Gingival recession (exposure of the tooth roots) is another visible indicator of periodontal disease.<\/span><\/p>\n<h2 class=\"p3\">Importance of Dental Radiographs<\/h2>\n<p class=\"p2\"><span class=\"s1\">Most dental pathology lies below the gingiva. Therefore, preoperative dental radiographs are essential for a thorough periodontal evaluation, endodontic diagnosis, and treatment planning. A full set of dental radiographs should be obtained at every dental procedure, as about 40% more pathology is revealed by dental radiographs than by visual examination alone.<sup>2<\/sup> Studies have shown that 27.8% of dogs and 41.7% of cats may harbor clinically significant dental lesions, such as root resorption, dentigerous cysts, and other conditions that may mimic periodontal disease, that could be overlooked without a comprehensive full-mouth radiographic examination (<span class=\"s2\"><b>FIGURE<\/b><\/span><\/span><span class=\"s2\"><b>\u00a04<\/b><\/span><span class=\"s1\">).<sup>2,10-12<\/sup><\/span><\/p>\n<div id=\"attachment_127399\" style=\"width: 359px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig4.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-127399\" class=\" wp-image-127399\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig4.png\" alt=\"\" width=\"349\" height=\"438\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig4.png 720w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig4-239x300.png 239w\" sizes=\"(max-width: 349px) 100vw, 349px\" \/><\/a><p id=\"caption-attachment-127399\" class=\"wp-caption-text\">Figure 4. Dental radiograph of the lower left quadrant in a cat showing bone loss, the beginning stages of tooth resorption, and gemination of the fourth premolar. Courtesy Ren\u00e9e Pynn, LVT, Brookfield Animal Hospital, Brookfield, Connecticut<\/p><\/div>\n<p class=\"p2\"><span class=\"s1\">Dental radiographs enable visualization of the tooth root structure, periodontal tissues, and the surrounding bone. The severity of periodontal disease is primarily determined by the amount of attachment loss. This refers to the distance between the cementoenamel junction, where the enamel meets the root of the tooth, and the current attachment point of the gingiva to the tooth. Attachment loss is assessed by measuring periodontal pocket depth with a periodontal probe and by assessing the percentage of bone loss with dental radiographs.<sup>8,13<\/sup> Periodontal pocket depth is measured from the free gingival margin to the bottom of the pocket, and any measurement deeper than 3 mm in dogs or 1 mm in cats (in the absence of gingival overgrowth) is considered a true periodontal pocket.<sup>8<\/sup> Using a percentage of attachment loss rather than a strict measurement is more helpful due to the variation in root length between teeth and breeds.<sup>13<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">As periodontal disease progresses, it leads to the destruction of alveolar bone, which supports and anchors the teeth. Radiographs can assess the degree of alveolar bone loss, which can be either horizontal, appearing as an even reduction in bone height along the cementoenamel junction, or vertical, which appears as bone loss that follows 1 or more roots apically.<sup>12<\/sup> Horizontal bone loss is often accompanied by gingival recession.<sup>6<\/sup> Radiographs help to accurately stage periodontal disease in conjunction with periodontal probing (<\/span><span class=\"s2\"><b>BOX 1<\/b><\/span><span class=\"s1\">).<sup>12<\/sup><\/span><\/p>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 1 Stages of Periodontal Disease<sup>12,14<\/sup><\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\">\n<ul>\n<li><strong>Normal (PD 0):<\/strong> No clinical evidence of gingival inflammation or periodontitis.<\/li>\n<li><strong>Stage 1 (PD 1):<\/strong> Gingivitis only. No attachment loss is seen, and the height and architecture of the alveolar margin are normal (<strong>FIGURE A<\/strong>).\n<div id=\"attachment_127404\" style=\"width: 260px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigA.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-127404\" class=\" wp-image-127404\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigA.png\" alt=\"\" width=\"250\" height=\"218\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigA.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigA-300x261.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigA-768x668.png 768w\" sizes=\"(max-width: 250px) 100vw, 250px\" \/><\/a><p id=\"caption-attachment-127404\" class=\"wp-caption-text\">Figure A. Periodontal disease stage 1. Mild gingivitis and no bone loss present.<\/p><\/div><\/li>\n<li><strong>Stage 2 (PD 2):<\/strong> Early periodontitis. Clinical signs include gingival inflammation, swelling, and bleeding on probing. Attachment loss is less than 25%, or, at most, there is a stage 1 furcation involvement in multirooted teeth. There are early radiographic signs of periodontitis. Attachment loss is measured either by probing or by measuring the distance of the alveolar margin from the cementoenamel junction relative to the length of the root on radiographs (<strong>FIGURE<\/strong><strong>\u00a0B<\/strong>).\n<div id=\"attachment_127405\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigB.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-127405\" class=\" wp-image-127405\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigB.png\" alt=\"\" width=\"300\" height=\"172\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigB.png 1008w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigB-300x172.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigB-768x440.png 768w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-127405\" class=\"wp-caption-text\">Figure B. Periodontal disease stage 2. Early periodontitis with gingival inflammation beginning to extend under the gingiva.<\/p><\/div><\/li>\n<li><strong>Stage 3 (PD 3):<\/strong> Moderate periodontitis. Clinical signs include gingival inflammation and swelling, bleeding on probing, and gum recession or hyperplasia. Attachment loss is 25% to 50% as measured by probing or by measuring the distance of the alveolar margin from the cementoenamel junction relative to the length of the root on radiographs, or there is a stage 2 furcation involvement in multirooted teeth (<strong>FIGURE<\/strong><strong>\u00a0C<\/strong>).\n<div id=\"attachment_127406\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigC.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-127406\" class=\" wp-image-127406\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigC.png\" alt=\"\" width=\"300\" height=\"134\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigC.png 1152w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigC-300x134.png 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigC-1024x458.png 1024w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigC-768x343.png 768w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><p id=\"caption-attachment-127406\" class=\"wp-caption-text\">Figure C. Periodontal disease stage 3. Moderate periodontitis characterized by the advancement of gingival inflammation under the gingiva, creating periodontal pockets and causing attachment loss.<\/p><\/div><\/li>\n<li><strong>Stage 4 (PD 4):<\/strong> Advanced periodontitis. Clinical signs include gingival inflammation and swelling, bleeding on probing, and gum recession or hyperplasia. Attachment loss is more than 50% as measured by probing of the clinical attachment level or by measuring the distance of the alveolar margin from the cementoenamel junction relative to the length of the root on radiographs, or there is a stage 3 furcation involvement in multirooted teeth (<strong>FIGURE<\/strong><strong>\u00a0D<\/strong>).\n<div id=\"attachment_127407\" style=\"width: 260px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigD.png\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-127407\" class=\" wp-image-127407\" src=\"https:\/\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigD.png\" alt=\"\" width=\"250\" height=\"281\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigD.png 864w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigD-267x300.png 267w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_FigD-768x863.png 768w\" sizes=\"(max-width: 250px) 100vw, 250px\" \/><\/a><p id=\"caption-attachment-127407\" class=\"wp-caption-text\">Figure D. Periodontal disease stage 4. Advanced periodontitis with severe gingival inflammation, significant bone loss, and stage 3 furcation exposure on multirooted teeth.<\/p><\/div><\/li>\n<\/ul>\n<p><em>PD\u2009=\u2009periodontal disease<\/em><\/div><\/div>\n<p class=\"p2\"><span class=\"s1\">Postoperative radiographs are also important, particularly after extractions, to ensure that no root fragments are left behind and to document that the procedure was performed correctly.<sup>15<\/sup><\/span><\/p>\n<h2 class=\"p3\">Local and Systemic Consequences of Periodontal Disease<\/h2>\n<p class=\"p2\"><span class=\"s1\">Local consequences of periodontal disease can be severe and have significant effects on the overall health and wellbeing of companion animals. One common consequence of severe periodontitis is the development of oronasal fistulas.<sup>16<\/sup> An oronasal fistula is a passage that forms between the oral and nasal cavities due to the progressive loss of periodontal tissue. This most frequently occurs on the palatal surface of maxillary canine teeth but can occur on any maxillary tooth.<sup>2<\/sup> The resulting communication between the mouth and nose can cause chronic nasal inflammation (rhinitis).<sup>2<\/sup> Oronasal fistulas are most often observed in older small-breed and chondrodystrophic dogs, such as dachshunds, but can occur in any canine or feline breed.<sup>2<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Class II periodontal-endodontic lesions occur when periodontal disease progresses towards the apex of the tooth, allowing bacteria to enter the endodontic system and spread infection via the pulp chamber.<sup>2<\/sup> The most frequent location in small animals is the distal root of the mandibular first molar, although any multirooted tooth can be affected.<sup>17<\/sup> These lesions are most prevalent in older small- and toy-breed dogs.<sup>17<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Pathologic jaw fractures commonly occur in the mandible, specifically at the site of a tooth with preexisting periodontal disease. Small and toy dog breeds are predisposed, but they can occur in any canine breed and in cats.<sup>17<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">The proximity of the tooth root apices of the maxillary molars and fourth premolars puts optic tissues at risk for damage.<sup>2<\/sup> Severe periodontitis can cause inflammation close to the orbit, creating retrobulbar abscesses that may lead to blindness from rupture of the globe.<sup>2,17<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Chronic osteomyelitis, characterized by an area of dead, infected bone, is another significant consequence of periodontal disease. Osteomyelitis does not respond effectively to antibiotic therapy, and effective treatment typically involves extensive surgical debridement to remove all necrotic tissue.<sup>17<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Human studies have shown an increased incidence of oral neoplasia linked to chronic periodontal disease, potentially due to the sustained inflammation present with periodontitis,<sup>2<\/sup> but no similar studies currently exist in veterinary medicine.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Evidence demonstrating the direct correlation between systemic disease and oral and dental infections is difficult to find. However, chronic inflammation from periodontitis is recognized as having a negative impact on overall systemic health in human medicine.<sup>18<\/sup> Inflammatory mediators, cytokines, and bacterial endotoxins from periodontal pathogens can spread through the vascular system, potentially causing histologic changes in distant organs.<sup>19<\/sup> More veterinary studies are needed to fully investigate the negative effects of periodontal disease in companion animals.<\/span><\/p>\n<h2 class=\"p3\">Periodontal Disease Therapy<\/h2>\n<p class=\"p7\"><span class=\"s1\">Plaque removal and control consists of 4 aspects, depending on the level of disease<sup>2<\/sup>:<\/span><\/p>\n<ul>\n<li class=\"p8\"><span class=\"s1\">Professional dental cleaning, known as a comprehensive oral health assessment and treatment (COHAT) <\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">Active and passive home care <\/span><\/li>\n<li class=\"p8\"><span class=\"s1\">Periodontal surgery <\/span><\/li>\n<li class=\"p9\"><span class=\"s1\">Extraction<\/span><\/li>\n<li class=\"p4\">Dental Cleaning<\/li>\n<\/ul>\n<p class=\"p7\"><span class=\"s1\">A professional dental cleaning is performed under general anesthesia to ensure meticulous cleaning and minimal patient stress and discomfort.<sup>20<\/sup> Protocols may vary, but the following steps are recommended:<\/span><\/p>\n<ul>\n<li class=\"p8\"><span class=\"s1\"><b>Presurgical exam and consultation. <\/b>Before the procedure, the veterinary nurse obtains the patient\u2019s history and performs an oral examination. They provide the veterinarian an accurate evaluation of the patient prior to the doctor entering the exam room.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Chlorhexidine lavage. <\/b>The oral cavity harbors a significant bacterial load. To reduce the risk of bacteremia, aerosolization of bacteria during scaling, and contamination of the surgical area, the patient\u2019s mouth is rinsed with a chlorhexidine gluconate solution, typically at a 0.12% or 0.2% concentration.<sup>2,8,20<\/sup><\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Oral evaluation, periodontal probing, and dental charting. <\/b>A comprehensive oral examination is performed to evaluate the health of all oral tissues, including the teeth, gingiva, tongue, palate, and throat.<sup>8<\/sup> All findings are recorded on a dental chart.<sup>8,20<\/sup><\/span>\n<ul>\n<li class=\"p10\"><span class=\"s1\">Plaque and calculus are evaluated through observation.<sup>21<\/sup> The plaque index (PI) and calculus index (CI) serve as quantitative measurements and are graded from 0 to 3 to document the presence of plaque or calculus (PI0 to PI3 and CI0 to CI3, respectively) on individual tooth surfaces. A grade of 0 means that no plaque or calculus is visible, while a grade of 3 indicates that most of the tooth surface is covered.<sup>21<\/sup><\/span><\/li>\n<li class=\"p10\"><span class=\"s1\">Gingivitis is assessed through a combination of visual inspection and periodontal probing.<sup>21<\/sup> The gingivitis index (GI) measures detected gingival inflammation on a scale of 0 to 3 (GI0 to GI3); a grade of 0 indicates no gingival inflammation or bleeding present with probing, and a grade of 3 indicates that severe inflammation and bleeding are present.<sup>21<\/sup><\/span><\/li>\n<li class=\"p10\"><span class=\"s1\">Gingival sulcus depth is measured using a graduated periodontal probe (<span class=\"s2\"><b>FIGURE<\/b><\/span><\/span><span class=\"s2\"><b>\u00a05A<\/b><\/span><span class=\"s1\">) gently inserted into the sulcus at several points around each tooth to assess the pocket depth. Normal sulcal depth typically ranges from 0 to 3 mm in dogs and 0 to 1 mm in cats.<sup>21<\/sup> Measurements exceeding this range indicate periodontal pockets and signify a loss of attachment between the tooth and the supporting structures.<sup>21<\/sup> The degree of gingival recession or enlargement is important to document but can result in abnormal probing depths that do not accurately reflect attachment loss.<sup>6,21\u00a0<\/sup><\/span><\/li>\n<li class=\"p10\"><span class=\"s1\">Probing also evaluates tooth mobility, which is measured on a scale based on the extent of movement along its axis in millimeters.<sup>21<\/sup><\/span><\/li>\n<li class=\"p10\"><span class=\"s1\">Using a dental explorer (<span class=\"s2\"><b>FIGURE<\/b><\/span><\/span><span class=\"s2\"><b>\u00a05A<\/b><\/span><span class=\"s1\">) assists with palpating areas of suspected tooth abnormalities, such as fractures, tooth resorption, or furcation exposure.<sup>8<\/sup> <\/span><\/li>\n<\/ul>\n<\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Removal of gross calculus. <\/b>Large visible deposits of calculus are removed using calculus-removing forceps (<span class=\"s2\"><b>FIGURE<\/b><\/span><\/span><span class=\"s2\"><b>\u00a05B<\/b><\/span><span class=\"s1\">) to improve the effectiveness of subsequent scaling with finer instruments.<\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Supragingival scaling. <\/b>Supragingival scaling targets plaque and calculus located above the gum line.<sup>8<\/sup> This step can be done manually with hand scalers (<span class=\"s2\"><b>FIGURE<\/b><\/span><\/span><span class=\"s2\"><b>\u00a05C<\/b><\/span><span class=\"s1\">) or with an ultrasonic scaler equipped with a tip designed for supragingival use.<sup>8,20<\/sup><\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Subgingival scaling. <\/b>This step focuses on removing plaque and calculus from below the gingiva within the gingival sulcus.<sup>8<\/sup> It is important to use fine instruments, such as specialized curettes (<span class=\"s2\"><b>FIGURE<\/b><\/span><\/span><span class=\"s2\"><b>\u00a05D<\/b><\/span><span class=\"s1\">) or thin ultrasonic scaler tips, along with proper irrigation to prevent heat buildup and damage to the tooth and gingiva, which can be uncomfortable for the patient.<sup>8,20<\/sup> <div class=\"su-image-carousel  su-image-carousel-has-spacing su-image-carousel-crop su-image-carousel-crop-4-3 su-image-carousel-has-lightbox su-image-carousel-has-outline su-image-carousel-adaptive su-image-carousel-slides-style-default su-image-carousel-controls-style-dark su-image-carousel-align-center\" style=\"max-width:70%\" data-flickity-options='{\"groupCells\":true,\"cellSelector\":\".su-image-carousel-item\",\"adaptiveHeight\":false,\"cellAlign\":\"left\",\"prevNextButtons\":true,\"pageDots\":false,\"autoPlay\":5000,\"imagesLoaded\":true,\"contain\":true,\"selectedAttraction\":0.025,\"friction\":0.28}' id=\"su_image_carousel_69e8ba86ee1e4\"><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5A.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"Figure 5. Oral examination tools. (A) Periodontal probe and explorer.\"><img loading=\"lazy\" decoding=\"async\" width=\"456\" height=\"1024\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5A-456x1024.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5A-456x1024.png 456w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5A-134x300.png 134w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5A.png 576w\" sizes=\"(max-width: 456px) 100vw, 456px\" \/><span>Figure 5. Oral examination tools. (A) Periodontal probe and explorer.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5B.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"Figure 5B. Calculus-removing forceps\"><img loading=\"lazy\" decoding=\"async\" width=\"580\" height=\"1024\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5B-580x1024.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5B-580x1024.png 580w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5B-170x300.png 170w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5B.png 648w\" sizes=\"(max-width: 580px) 100vw, 580px\" \/><span>Figure 5B. Calculus-removing forceps<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5C.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"Figure 5C. Hand scaler.\"><img loading=\"lazy\" decoding=\"async\" width=\"378\" height=\"1024\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5C-378x1024.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5C-378x1024.png 378w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5C-111x300.png 111w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5C.png 504w\" sizes=\"(max-width: 378px) 100vw, 378px\" \/><span>Figure 5C. Hand scaler.<\/span><\/a><\/div><\/div><div class=\"su-image-carousel-item\"><div class=\"su-image-carousel-item-content\"><a href=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5D.png\" target=\"_blank\" rel=\"noopener noreferrer\" data-caption=\"Figure 5D. Subgingival curette.\"><img loading=\"lazy\" decoding=\"async\" width=\"405\" height=\"1024\" src=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5D-405x1024.png\" class=\"\" alt=\"\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5D-405x1024.png 405w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5D-119x300.png 119w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2024\/11\/Arbach_TVNWinter25_PeriodontalDisease_Fig5D.png 504w\" sizes=\"(max-width: 405px) 100vw, 405px\" \/><span>Figure 5D. Subgingival curette.<\/span><\/a><\/div><\/div><\/div><script id=\"su_image_carousel_69e8ba86ee1e4_script\">if(window.SUImageCarousel){setTimeout(function() {window.SUImageCarousel.initGallery(document.getElementById(\"su_image_carousel_69e8ba86ee1e4\"))}, 0);}var su_image_carousel_69e8ba86ee1e4_script=document.getElementById(\"su_image_carousel_69e8ba86ee1e4_script\");if(su_image_carousel_69e8ba86ee1e4_script){su_image_carousel_69e8ba86ee1e4_script.parentNode.removeChild(su_image_carousel_69e8ba86ee1e4_script);}<\/script><\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Polishing. <\/b>After scaling, the teeth are polished using a low-speed handpiece with a prophy cup and a mildly abrasive prophy paste.<sup>20<\/sup> Polishing serves to smooth out any microscopic scratches or irregularities on the tooth surface left behind by the scaling process, making it more difficult for plaque to reattach.<sup>20<\/sup><\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Sulcal lavage. <\/b>The gingival sulcus is irrigated again with water or a chlorhexidine solution to flush away any debris remaining from the scaling and polishing process.<sup>8,20<\/sup><\/span><\/li>\n<li class=\"p8\"><span class=\"s1\"><b>Dental radiography. <\/b>As previously described, full-mouth radiographs should be obtained at every dental procedure for complete assessment of all teeth.<\/span><\/li>\n<li class=\"p9\"><span class=\"s1\"><b>Treatment planning and\/or additional therapy. <\/b>Based on the visual, documented, and radiographic findings, the veterinarian can develop a treatment plan and, with the owner\u2019s consent, perform additional therapies if necessary. A multimodal analgesic protocol utilizing a combination of medication classes is an essential part of the patient\u2019s treatment and recovery.<\/span><\/li>\n<\/ul>\n<h3 class=\"p4\">Home Care<\/h3>\n<p class=\"p2\"><span class=\"s1\">Plaque at and below the gingiva, not supragingival plaque and calculus, is the primary contributor to inflammation and periodontal disease.<sup>2<\/sup> Home care consists of active and passive methods to remove this plaque. A combination of both types of methods is ideal.<sup>2<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Several active home care methods are described in <\/span><span class=\"s2\"><b>BOX 2<\/b><\/span><span class=\"s1\">. Brushing is the gold standard and most effective way to remove plaque at and below the gingiva.<sup>21<\/sup><\/span><\/p>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 2 Active Home Care Materials and Methods<sup>2,21<\/sup><\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\"><strong>Toothbrushing<\/strong><\/p>\n<ul>\n<li><strong>Brushes:<\/strong> The right brush depends on the size and tolerance of the animal. Veterinary-specific toothbrushes include double-sided, triple-sided, and circular feline brushes. Gauze or washcloths cannot effectively clean below the gum line and are generally not recommended.<\/li>\n<li><strong>Toothpaste:<\/strong> Avoid using human toothpaste, as it often contains ingredients like xylitol, fluoride, and detergents that can be harmful to pets if swallowed. Veterinary-specific toothpastes formulated for animals are safe if ingested. These toothpastes come in various flavors appealing to dogs and cats.<\/li>\n<li><strong>Technique:<\/strong> The brush should be angled at 45\u00b0 towards the gum line, ensuring contact with both the tooth surface and the gum margin. This technique helps disrupt plaque accumulation in these key areas.<\/li>\n<li><strong>Frequency:<\/strong> Daily toothbrushing is ideal to effectively prevent plaque buildup. For dogs with existing periodontal disease, twice-daily brushing might be recommended. Brushing every other day has not proven effective in controlling gingivitis. If daily brushing is not feasible, aiming for at least 3 times a week is considered the minimum for dogs in good oral health. Consistency is important, as interrupting brushing for even a month can return gingival inflammation to pretreatment levels.<\/li>\n<\/ul>\n<p><strong>Antiseptic rinses<\/strong><\/p>\n<p>While antiseptic rinses offer an additional layer of defense against plaque and gingivitis, their effectiveness relies on consistent use and product selection.<\/p>\n<ul>\n<li><strong>Chlorhexidine<\/strong> is a highly effective antiseptic with minimal systemic absorption and a long-lasting effect. It effectively decreases gingivitis with consistent use over time. However, its palatability can be a challenge, potentially hindering owner compliance.<\/li>\n<li><strong>Zinc ascorbate gel<\/strong> has shown efficacy in reducing plaque and gingivitis. Its tasteless nature is considered a significant advantage for improving acceptance. Ascorbic acid (vitamin C), present in these gels, might also contribute to gingival healing by supporting collagen synthesis.<\/div><\/div><\/li>\n<\/ul>\n<p class=\"p2\"><span class=\"s1\">Passive home care methods require minimal effort from the owner and rely on the animal\u2019s natural chewing behaviors (<\/span><span class=\"s2\"><b>BOX 3<\/b><\/span><span class=\"s1\">).<sup>2<\/sup> While not as effective as toothbrushing, they can still offer some benefits.<sup>21<\/sup> Recommended products used for passive home care (e.g., specially formulated diets, chews, treats, water additives) should meet established standards set by the Veterinary Oral Health Council (VOHC) demonstrating effectiveness in controlling plaque and\/or tartar.<sup>2<\/sup><\/span><\/p>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 3 Passive Home Care Methods<sup>2,21<\/sup><\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\"><span class=\"s1\"><b>Tartar control diets<\/b><\/span><\/p>\n<p class=\"p1\">These therapeutic diets feature larger kibble sizes than standard pet food and aim to reduce tartar and plaque buildup through 2\u00a0main mechanisms: mechanical abrasion and chemical action.<\/p>\n<ul>\n<li class=\"p1\"><b>Mechanical abrasion:<\/b> The larger kibble size encourages increased chewing and provides an abrasive action to scrape plaque off teeth. Specific therapeutic dental diets also have a fiber alignment that differs from a regular kibble (aligned versus crisscrossed). When the tooth penetrates the kibble, the kibble does not shatter, instead scraping the tooth surface like a squeegee.<\/li>\n<li class=\"p1\"><b>Chemical action:<\/b> Other dental diets may include:\n<ul>\n<li class=\"p1\"><b>Sodium hexametaphosphate (SHMP)<\/b>, a chelating agent that binds with calcium in saliva, hindering the formation of calculus. SHMP does not directly address plaque, but it limits the surface area available for plaque to accumulate.<\/li>\n<li class=\"p1\"><b>Green tea polyphenols<\/b>,<b> <\/b>which possess antibacterial properties and act as an additional defense against plaque. Their efficacy in pet food requires further research, but they represent a potential area of development in dental care.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p1\"><span class=\"s1\"><b>Chews and treats<\/b><\/span><\/p>\n<p class=\"p1\">Selecting properly formulated chew-based products is important for optimal effectiveness, particularly for the molars and premolars, where chewing action is most concentrated.<\/p>\n<p class=\"p1\"><span class=\"s1\"><b>Water additives, oral sprays, and rinses<\/b><\/span><\/p>\n<p class=\"p2\">While these are a potential passive home care option, they are generally insufficient without active home care due to the strong adherence of plaque to teeth and biofilm\u2019s increased resistance to antiseptics.<\/div><\/div>\n<p class=\"p2\"><span class=\"s1\">Passive methods generally have higher owner compliance rates than active methods because they require less effort. One major limitation is that animals do not typically chew using all their teeth, potentially leaving some areas untouched and susceptible to plaque accumulation.<sup>2<\/sup> Passive home care is most beneficial for premolars and molars, while active care remains imperative for the incisors and canines.<sup>2<\/sup> <\/span><\/p>\n<h3 class=\"p4\">Periodontal Surgery<\/h3>\n<p class=\"p2\"><span class=\"s1\">The veterinarian may recommend periodontal surgery for more advanced periodontitis cases that extend beyond a routine dental cleaning. Indications for periodontal surgery may be pockets measuring more than 5 to 6 mm in dogs or 1 to 4 mm in cats, stage 2 or 3 furcation exposure, or inaccessible root structures. Periodontal surgery aims to either regenerate lost tissue or reshape existing tissue.<sup>22<\/sup><\/span><\/p>\n<h3 class=\"p4\">Extraction<\/h3>\n<p class=\"p2\"><span class=\"s1\">When periodontal disease has progressed to a point where other periodontal therapies are unlikely to be successful in saving the tooth, extraction becomes a necessary treatment option. As per the American Veterinary Dental College, extractions are considered a surgical procedure and can only be performed by a licensed veterinarian. Veterinary nurses can discuss postoperative care with the owner, including pain management, oral hygiene, monitoring extraction sites, and dietary modifications.<\/span><\/p>\n<h2 class=\"p3\">Client Education and Disease Prevention<\/h2>\n<p class=\"p2\"><span class=\"s1\">Client education is a critical step in preventing and diagnosing periodontal disease. Veterinary nurses can begin the conversation with the pet owner on the importance of oral health and how periodontal disease is among the most common diseases observed in the veterinary profession.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">This conversation should begin with the pet\u2019s first veterinary visit, and clients can be taught how to recognize signs of oral disease at home. <\/span><span class=\"s2\"><b>BOX 4<\/b><\/span><span class=\"s1\"> lists common clinical signs of oral pain; however, it is important to note that the absence of obvious signs of pain does not mean the pet is not experiencing oral discomfort.<\/span><\/p>\n<div class=\"su-box su-box-style-default\" id=\"\" style=\"border-color:#606060;border-radius:3px;\"><div class=\"su-box-title\" style=\"background-color:#939393;color:#FFFFFF;border-top-left-radius:1px;border-top-right-radius:1px\">BOX 4 Common Clinical Signs of Oral Pain<\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:1px;border-bottom-right-radius:1px\">\n<ul>\n<li>Bad breath (halitosis)<\/li>\n<li>Red, inflamed gums (gingivitis)<\/li>\n<li>Bleeding gums<\/li>\n<li>Increased drooling<\/li>\n<li>Head shyness<\/li>\n<li>Pawing at the mouth<\/li>\n<li>Difficulty eating<\/li>\n<li>Weight loss<\/li>\n<li>Changes in behavior<\/li>\n<li>Swelling of the face or jaw<\/li>\n<li>Tooth grinding (bruxism)<\/li>\n<li>Tongue hanging outside the mouth<\/li>\n<li>Reluctance to chew on toys<\/div><\/div><\/li>\n<\/ul>\n<p class=\"p2\"><span class=\"s1\">Regular oral examinations by a member of the veterinary team are essential for detecting and treating oral disease in pets. Clients should be informed about the difference between nonprofessional dental scaling and a professional dental cleaning. In 1 study, dogs that received nonprofessional dental scaling at least once a year had an increased risk of periodontal disease.<sup>1<\/sup><\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Daily plaque control is essential to prevent periodontal disease. Veterinary nurses can demonstrate toothbrushing techniques, advise on selecting VOHC-approved dental products, and help clients incorporate dental care into their pet\u2019s daily routine. The use of visual aids such as skull models, dental charts, before-and-after photos, and videos to illustrate the effectiveness of routine care, professional dental cleaning, and treatment can enhance client understanding and compliance. <\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">Veterinary nurses play a key role in addressing common client concerns. They can reassure pet owners by explaining advancements in anesthetic safety and monitoring, emphasizing the importance of preanesthetic bloodwork as well as the benefits of multimodal pain management strategies and individualized anesthetic protocols. In addition, they can educate clients on the value of COHATs, stressing the long-term cost savings associated with preventing dental disease. If finances are an issue, veterinary nurses can provide information on payment options, such as pet insurance and third-party financing.<\/span><\/p>\n<p class=\"p2\"><span class=\"s1\">By effectively educating clients on pet oral health, veterinary nurses can enhance patient care and wellbeing, strengthen the human\u2013animal bond, and boost client satisfaction. This not only improves the practice\u2019s reputation for providing quality dental services, but also elevates the veterinary nurse\u2019s professional standing by demonstrating their expertise and value within the veterinary team. <\/span><\/p>\n<h2 class=\"p3\">Summary<\/h2>\n<p class=\"p2\"><span class=\"s1\">Lifelong periodontal care is advantageous for both the animal and owner. Plaque control is the foundation of periodontal therapy. Regular professional dental cleanings, early intervention, and early education of clients on the importance of home care ensure the greatest benefits. Prevention of periodontal disease is the primary goal in order to avoid irreversible damage that necessitates more invasive treatments. Recognizing the pathology and contributing factors of periodontal disease enables pet owners to take initiative in prevention and management, ultimately safeguarding the overall health of their pets. <\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Recognizing the pathology and contributing factors of periodontal disease enables pet owners to take initiative in prevention and management, ultimately safeguarding the overall health of their 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