Periodontal Disease and Treatment: Dental Scaling

According to the American Veterinary Dental Society (AVDS), Periodontal disease is the most common clinical disease seen in adult dogs and cats. At three years or older, dogs and cats begin to exhibit signs of periodontal disease. It is completely preventable and reversible in many cases, however, the more severe cases can only prevent further damage with the appropriate tailor-made treatments. In order to effectively prevent, treat, or slow down the destructive effects of periodontal disease, veterinarians need to ensure they are performing the most crucial step of dental scaling: subgingival curettage.

 

The impact of periodontal disease

Periodontal disease refers to gingival inflammation induced by the bacteria found in plaque and encompasses both gingivitis and periodontitis. Gingivitis refers to inflammation that extends only to the gingiva and not the surrounding periodontal structures. If treated, gingivitis is reversible. If untreated, it may lead to periodontitis as plaque migrates and calculus accumulates under the gingival margin. The proportion of anaerobic bacteria increases in subgingival plaque and triggers an inflammatory response that then destroys surrounding tissues, such as periodontal ligaments and alveolar bone. Destruction of these supportive tissues is permanent.

Periodontitis can have both local and systemic ramifications. Local manifestations include oral pain, periodontal abscesses, oronasal fistulas, osteomyelitis, and pathologic fractures. [include photos] Systemically, periodontal disease can lead to morphologic changes in the kidneys, heart, and liver.

 

Treatment of periodontal disease

The treatment for periodontal disease is a professional dental cleaning under general anesthesia and home care maintenance. Together, these methods help to remove plaque that triggers the inflammation responsible for damaging tissue.

Homecare

To remove superficial plaque, home care such as teeth brushing and antiseptic applications are great routine practices.

Vet care

Professional cleanings done by your vet removes mineralized plaque in the form of tartar and calculus from both below and above the gum line. The treatment of gingivitis is aimed at restoring the health of the gingiva and preventing the onset of periodontitis. Treatment of patients with periodontitis aims to prevent localized disease progression and the spread of disease to other teeth.

 

Periodontal probing

Before a dental cleaning, your vet will perform an oral exam. During this exam, a periodontal probe is used to measure the subgingival pockets. The probe is rounded with a blunt tip that has graduated markings that are gradually inserted at each point in the gingival sulcus. Patients with gingivitis have normal periodontal sulcus depths. However, patients with periodontitis have deeper probing depths than what is typical. The pathogenic periodontal pockets are a result after inflammation progressively destroys the periodontal ligament and causes the epithelial attachment to migrate toward the root’s apex. Vertical alveolar bone loss can also increase periodontal pocket depth.

 

Subgingival curettage

An integral step to the treatment of periodontal disease is the removal of plaque and calculus above and below the gingival margin. Once the subgingival surface remains free of plaque and debris, the sulcular epithelium can reattach to the tooth root. A failure to remove subgingival calculus will prevent reattachment and allow periodontitis to progress.

According to the American Veterinary Dental Society:

“The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket … where periodontal disease is active.”


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