{"id":103,"date":"2015-01-01T16:31:55","date_gmt":"2015-01-01T16:31:55","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=103"},"modified":"2022-02-15T15:54:01","modified_gmt":"2022-02-15T15:54:01","slug":"proper-diagnosis-of-periodontal-disease","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/dentistry\/proper-diagnosis-of-periodontal-disease\/","title":{"rendered":"Proper Diagnosis of Periodontal Disease"},"content":{"rendered":"

Periodontal disease is the number one problem in small animal medicine.1,2<\/sup> In fact, the classic university study reported that, by 2 years of age, 80% of dogs and 70% of cats have some form of periodontal disease.3<\/sup><\/p>\n

In contrast, a recent large clinical study from general practices reported that by 10 years of age, only 24% of patients were clinically diagnosed with periodontal disease.4<\/sup> Therefore, it appears this disease is significantly under diagnosed, likely due to lack of dental education.<\/p>\n

The significant adverse consequences of periodontal disease (Table<\/strong>) show why diagnosis is so important.5,6<\/sup> Veterinarians have many misconceptions about periodontal disease. This article outlines some common pitfalls encountered by veterinarians and provides some practical tips that can be implemented in general practice. (See Dental Definitions<\/strong>.)<\/p>\n

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Dental Definitions<\/strong><\/h3>\n

Calculus:<\/strong> Hardened dental plaque (also called tartar); its rough surface provides an ideal medium for further plaque formation. Dental plaque becomes hardened as a result of continued accumulation of minerals from saliva
\nClosed Root Planing:<\/strong> Nonsurgical periodontal therapy that removes plaque, calculus, and granulation tissue from the root surface and smooths the diseased\/roughened root (also called scaling\/root planing)
\nPlaque:<\/strong> Biofilm\u2014formed by colonizing bacteria\u2014that develops naturally on teeth and attaches to their smooth surfaces; hardened plaque becomes calculus
\nProbing:<\/strong> Process that identifies periodontal pockets and evaluates their depth; helps determine extent of periodontal disease during oral examination
\nScaling: <\/strong>Dental cleaning technique that removes supragingival and subgingival plaque and calculus; typically performed along with polishing of the teeth<\/p>\n<\/div>\n

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Fallacy #1. The amount of calculus on teeth is an accurate measurement of periodontal disease.<\/strong><\/h3>\n

While it is true that periodontal disease is typically associated with calculus, it is primarily elicited by plaque and, thus, can be seen in the absence of calculus (Figure 1<\/strong>).7-9<\/sup> Conversely, widespread supragingival calculus may be present with little to no periodontal disease (Figure 2<\/strong>).<\/p>\n

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FIGURE 1. Intraoral picture of the right maxillary fourth premolar (in a dog) with significant gingival inflammation (affecting the entire attached gingiva, blue arrows) despite minimal calculus.<\/p><\/div>\n

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FIGURE 2. Intraoral picture of the left maxillary fourth premolar (in a cat); note lack of inflammation but significant calculus on the tooth, which even overrides the gingiva.<\/p><\/div>\n

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Key Point<\/h3>\n

It is critical to remember that, while calculus acts as an irritant, it is in and of itself essentially nonpathogenic.3,8,9<\/sup><\/p>\n<\/blockquote>\n

Use the degree of gingival inflammation to judge the need for professional therapy\u2014not the amount of calculus.10<\/sup> While this is a radical change in thought, it is a much more accurate measure of disease. However, evaluation of degree of visible gingival inflammation may still lead to underestimation of the severity of periodontal disease (see Fallacy #2<\/strong>).9<\/sup><\/p>\n

PRACTICAL TIP:<\/strong> Lights\/solutions that identify plaque\/calculus can be used in conscious patients in the examination room to demonstrate the level of calculus (Figure 3<\/strong>). Plaque and early calculus can be invisible to the naked eye in natural light. Therefore, they can easily be missed, especially on wet teeth. Plaque-disclosing solutions and lights allow veterinarians to visually identify plaque\/calculus.<\/p>\n

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FIGURE 3. Plaque-disclosing light used on maxillary incisors (dog): The teeth appear to be fairly clean (A), but the light reveals extensive plaque accumulation (B). Plaque-disclosing solution applied to a maxillary fourth premolar (C).<\/p>\n

FALLACY #2. Color change of the gingiva is the first sign of periodontal disease.<\/strong><\/h3>\n

The first clinical sign of gingivitis was believed to be color change of the gingiva, termed marginal gingivitis<\/em>.11,12<\/sup> While this is a reliable sign of disease, it is now known that increased gingival bleeding on probing or brushing occurs first.11,13<\/sup> In fact, bleeding is a more objective measure of inflammation than subtle color change. In addition, gingival color change is not a reliable indicator in dark pigmented patients (Figure 4<\/strong>).<\/p>\n

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FIGURE 4. Intraoral picture of patient with dark gingiva and minimal to no calculus; however, significant bleeding is apparent upon probing, indicating that gingivitis is present.<\/p><\/div>\n

PRACTICAL TIP:<\/strong> Consider carefully probing or brushing tractable patients’ teeth on conscious examination to demonstrate level of inflammation. In addition, ask clients about a history of bleeding during brushing or after chewing hard\/rough toys.8,12,14<\/sup> If either of these are positive, a diagnosis of early gingivitis can be made despite a lack of gingival color change.10<\/sup><\/p>\n

FALLACY #3. A visual oral examination is sufficient for diagnosis of periodontal disease.<\/strong><\/h3>\n

This is completely untrue for both conscious and anesthetized examinations. Significant gingivitis can exist without periodontal pockets and, conversely, deep periodontal pockets can be present without significant gingival inflammation (Figure 5<\/strong>).9<\/sup><\/p>\n

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FIGURE 5. Deep (15-mm) periodontal pocket on right mandibular first molar (in a dog) despite relatively normal appearance of gingiva; only periodontal probing under general anesthesia allowed identification of this pocket.<\/p><\/div>\n

Periodontal Probe<\/strong><\/h3>\n

Normal sulcal depths in:12,15-17<\/sup><\/p>\n