Periodontal Disease
This is a diagram of a perfectly healthy tooth.
In reality it only exists for a short while immediately after effective toothbrushing on a previously calculus free tooth.
The important areas to note are: the sub-gingival space (the area between the tooth and the gum), the height of the bone support and the lack of any inflammation.
The following series of diagrams shows one way in which periodontal disease can develop. Sometimes actual disease does not exactly follow this pattern - periodontal disease can occur with relatively little calculus formation for example.
Plaque
Plaque rapidly accumulates on teeth - often within just a few hours of brushing.
Plaque comprises a mixture of living and dead bacteria and other organic matter. You can see it on your own teeth if you forget to brush them at night - the next morning you will be able to scrape a thin mucus like film from the surface of your teeth.
Plaque loves to get into the sub-gingival space - that little groove between the tooth and the gum.
It also spreads down over the gums themselves - if left unattended it can cover most of the tissues inside the mouth.
Gingivitis
The activity of the bacteria in the plaque and the production of toxins starts to affect the surrounding gums (gingiva).
Inflammatory cells start to move in, there is an increase in circulation to the area and there is some swelling. There may also be some pain present.
All of these are signs of inflammation or gingivitis.
Calculus
Minerals from the saliva combine with plaque to form a hard, rocky substance called Calculus (it is also known by the term Tartar).
The calculus tends to accumulate fastest in the areas next to the outlets for the salivary glands. The outside of the upper cheek teeth and the inside of the lower incisors are often the areas first (or most severely) affected.
Calculus has a rough surface and therefore presents a greater surface area (and a degree of protection) that allows even more plaque to accumulate. This in turn becomes mineralised to form more calculus - a truly viscious circle.
There are great individual variations in the degree of formation of calculus. Two litter mates, sharing the same household, same food etc may have differing amounts of dental disease. However, some breeds (for example Yorkshire Terriers and Poodles) seem to be more commonly affected than others.
Some of the main factors that seem to influence the development of plaque & calculus are:
- Diet - Dry or Soft food
- Toothbrushing
- Use of Oral Hygiene treats (e.g. Pedigree Dentastix & Whiskas Dentabits) to encourage "oral exercise"
- Mouth breathing
- Shape & alignment of the teeth
- Systemic Health - other diseases can affect the mouth's ability to defend itself.
Early Periodontitis
The inflammation around the tooth becomes more severe.
The inflammtion starts to extend down into the Periodontal Space.
The tooth is held in its boney socket by a complex mesh of fibres known as the Periodontal Ligament. The inflammation starts to extend down into this area.
Pressure on the gums can often lead to bleeding and free pus can sometimes be seen around the teeth. Pain can sometimes be a feature - but our pets are often incredibly stoic and will probably still eat OK.
Bacteria from the mouth will enter the blood stream and can start affecting distant organs - such as the heart or the kidneys.
Late Periodontitis
The actions of the toxins from the bacteria and the activities of the inflammatory cells start to lead to damage to the bone surrounding the tooth.
The bone starts to receed. The loss of periodontal bone, together with the damage done to the periodontal ligament starts to lead to a loosening of the teeth. At this stage the gums will often bleed spontaneously when being examined. Pus will be seen around the teeth and pressure on the gums will cause it to ooze up from around the teeth.
This mouth is painful - even if our pets are not obviously letting us know. The bacteria entering the bloodstream can lead to pets starting to feel ill in themselves at this stage. However it is often a more subtle change - being more sleepy, less reluctant to exercise. Owners often only notice how "sick" their pet actually was (rather than just "ageing") after proper dental treatment is carried out & they are restored to better health. Systemic antibiotics are often needed to counter the effects of the spreading bacteria on other organs.
End Stage Disease
The damage to the supporting structures of the tooth continues. There is further loss of bone and periodontal ligament.
The tooth will often be obviously loose in its socket - hanging there by a thread.
The infection can spread down the periodontal ligament to kill the tooth by infecting its root. Tooth root abscesses can form.
Eventually the tooth will be shed from the mouth. If the infection in the bone (osteomyelitis) is not too severe then the gums and mouth may gradually heal. However to get to this stage pets will have been through many months of pain and will have the effects of millions of bacteria bombarding their bloodstream and affecting other internal organs.
Whilst many teeth are often affected, sometimes periodontal disease can be localised affecting only one or two teeth.
Periodontal Disease is irreversible.
Prevention and early treatment is key.
Did You Know?
Why is a GA needed
The most important area to clean is UNDER the gumline. Our patients won't sit still for this!
