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• Prevalence: Periodontal disease is the most common disease affecting dogs and cats.

• Veterinary Technician Role: It's crucial for veterinary technicians to understand the pathophysiology, recognize the stages of periodontal disease, and assist in treatments.

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Pathophysiology

• Age and Size Factors:

  • Older animals are more prone to periodontal disease.

  • Smaller dogs (toy and small breeds) are more likely to develop it compared to medium or large dogs.

• Cause:

  • Plaque accumulation on teeth leads to gingival inflammation.

  • If untreated, plaque leads to a shift in bacteria from gram-positive aerobic to gram-negative anaerobic, causing deeper periodontal tissue damage.

  • Untreated periodontal disease can lead to both local and systemic health issues.

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Stages of Periodontal Disease

1. Gingivitis (Stage I):

   • Inflammation limited to the gums (gingiva).

   • No attachment loss yet.

   • Symptoms include swollen gums, bleeding on probing, and plaque accumulation.

2. Early Periodontitis (Stage II):

   • Attachment loss up to 25%.

   • Bone loss may be observed radiographically (horizontal).

   • Teeth remain stable but show early signs of damage.

3. Moderate Periodontitis (Stage III):

   • Attachment loss between 25% and 50%.

   • Teeth may begin to loosen.

   • Vertical bone loss and infrabony pockets are present.

4. Severe Periodontitis (Stage IV):

   • Attachment loss exceeds 50%.

   • Significant bone loss.

   • Teeth become very loose or fall out.

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Treatment Modalities

• Treatment aims to manage disease, prevent progression, and restore oral health.

• General health evaluation is critical to ensure the animal is stable before starting treatment.

• The following treatments are commonly used:

Specific Treatment Modalities

• Exodontia 

  • Indication: Advanced Stage IV periodontal disease where more than 70-80% of the tooth root is affected.

  • Purpose: Extracting diseased teeth helps eliminate infection, and can improve overall health.

  • Consideration: In some cases, extraction is preferred over advanced treatments, especially in animals where anesthesia is risky or when the owner can't provide proper home care.

• Oronasal Fistula Repair

  • Cause: Advanced periodontal disease can lead to fistulas (abnormal openings) between the oral cavity and nasal or sinus passages.

  • Symptoms: Sneezing, nasal discharge, and discomfort.

  • Treatment: Surgical repair using a mucoperiosteal flap to close the fistula, often followed by tooth extraction if the diseased tooth caused the fistula.

• Polishing

  • Polishing:

    • After scaling, teeth are polished to smooth rough surfaces caused by plaque and tartar removal.

    • Prevents further plaque accumulation.

    • Technique: Low-speed handpiece with prophy paste, rotating the polishing cup gently over the tooth surfaces.

  • Irrigation:

    • The gingival sulcus is flushed with a chlorhexidine solution to remove debris and reduce bacteria.

    • Helps to further decrease bacterial counts and support healing.

• Periodontal Probing and Charting

  • Probing: Measuring the depth of the gingival sulcus/pocket with a periodontal probe to assess the extent of attachment loss.

  • Charting: Accurate records of pocket depth and attachment loss are critical for tracking disease progression and planning treatment.

• Perioceutics

  • Definition: Localized medications placed into periodontal pockets to treat active disease.

  • Example: Doxycycline solution, which forms a gel in the pocket to help rejuvenate the periodontium.

  • Benefits: Effective for treating localized infections and improving healing in dogs with painful oral ulcers or where home care is difficult.

• Subgingival Scaling/Curettage

  • Root Planing: Smoothing the tooth’s root surface to make it less likely to accumulate debris and bacteria.

  • Subgingival Scaling: Removing calculus and plaque below the gumline, essential for halting disease progression.

  • Curettage: Removing diseased soft tissue from the periodontal pocket, promoting healing and tissue regeneration.

• Supragingival Scaling

  • Scaling: Removal of visible plaque and tartar from the tooth surface.

  • Tools:

    • Ultrasonic piezoelectric and magnetostrictive scalers are commonly used.

    • Sonic scalers are less effective but gentle, with minimal heat production.

    • Rotary scalers are least efficient and can damage enamel, so they are not recommended.