Periodontal Disease in Dogs and Cats

Laurie Anne Walden, DVM

Periodontal disease (disease of structures that support the teeth) is one of the most common medical problems of dogs and cats. This condition, which leads to bone loss around the tooth roots, causes the teeth to loosen and fall out.
 
Although periodontal disease can be painful, animals often don’t show any outward symptoms until the disease is advanced. Periodontal disease may also increase the risk of heart, liver, and kidney problems. Regular dental care at home and periodic dental cleanings under anesthesia are the best ways to prevent periodontal disease.
 
Causes
Periodontal disease is caused by bacteria in the mouth—or more specifically, the body’s immune response to bacteria. Oral bacteria produce plaque, a sticky substance that coats the teeth. If not removed, plaque hardens into tartar. Bacteria, plaque, and tartar near the gumline activate the immune system, causing inflammation.
 
The earliest stage of oral inflammation is gingivitis, or inflammation of the gums. Periodontal disease is more severe inflammation that affects the bone and other tissues around the tooth roots. Gingivitis is reversible with professional dental cleaning (including under the gums) and home dental care. Periodontal disease, which destroys the structures holding the teeth in place, is not reversible.
 
The biggest risk factor for periodontal disease is the presence of plaque and tartar on the teeth. Other things that increase the risk are genetics, older age, crowded teeth, thin bone around the teeth (for example, in toy dog breeds), poor nutrition, and possibly medical conditions that reduce resistance to infection.[1] A study of 109 otherwise healthy cats found that all of them had some degree of periodontal inflammation.[2]
 
Symptoms
Dogs and cats can have remarkably bad dental disease without showing any symptoms of discomfort. Unpleasant mouth odor might be the only symptom that pet owners notice. Because periodontal disease affects the tooth roots, it’s hidden from view in the early stages. It’s more obvious once bone has been lost to the point that the tooth roots are exposed or teeth start falling out.
 
The symptoms, if any, begin with symptoms of gingivitis and get worse as the inflammation becomes more severe:

• Bad breath
• Red or bleeding gums
• Excessive drooling
• Reluctance to eat (mouth pain)
• Loose or missing teeth

 
Diagnosis
Very advanced periodontal disease causes changes that can be seen on oral examination of an awake animal. Diagnosing earlier stages and assessing the extent of the disease require examination with the animal under anesthesia. The diagnosis is made by examining the entire mouth, probing the gums to find pockets of inflammation/infection, and taking dental radiographs (if available) to get a look at the tooth roots and the surrounding bone.
 
Treatment and Prevention
Gingivitis and early stages of periodontal disease are managed with dental cleaning under anesthesia followed by home dental care. Anesthesia is necessary because plaque and tartar must be removed from the parts of the teeth under the gums. Scraping tartar off the teeth of an awake animal is not enough. It makes the teeth look better, but it does nothing to treat the real problem and can make things worse by delaying a more thorough cleaning.
 
Teeth with later stages of periodontal disease are treated surgically. The procedure used depends on the stage of disease and the condition of the bone. Sometimes a tooth can be saved with an endodontic procedure like a root canal, but in many cases extraction of the tooth is the best option.
 
Plaque starts to form on teeth again soon after a dental cleaning, so regular home dental care is ideal. Brushing the teeth with pet (not human) toothpaste is the standard of care for animals that allow it. Many other products to help remove dental plaque are available. See the blog post on dental home care for some ideas and talk to your veterinarian about products that would work for your pet.

References
1. Wallis C, Holcombe LJ. A review of the frequency and impact of periodontal disease in dogs. J Small Anim Pract. 2020;61(9):529-540. doi: 10.1111/jsap.13218
2. Girard N, Servet E, Biourge V, Hennet P. Periodontal health status in a colony of 109 cats. J Vet Dent. 2009;26(3):147-155. doi: 10.1177/089875640902600301
 
Photo by Chris Smith

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