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Periodontal Disease and Comprehensive Oral Radiographic Evaluations

Digital Dental Radiograph of a Feline Tooth Resorption.

Periodontal disease is an entirely preventable yet extremely common disease affecting the mouth of cats and dogs. As bacteria accumulates in the mouth it forms plaque, which sticks to the visible part of the tooth (the crown) and eventually hardens or calcifies into tartar. Plaque and tartar then build up underneath the gums (gingiva) and the bacteria underneath the gums will secrete a toxin that destroys the surrounding tissue. This results in damage to the bone that holds the root in place and it begins to erode away. When periodontal disease develops, the tooth becomes painful and loses its integrity. Dogs and cats will rarely actually stop eating due to periodontal disease or show sign of discomfort. Additionally, periodontal disease may not be clearly evident by examining and probing the tooth alone since a large degree of periodontal disease occurs underneath the gingiva. Taking an x-ray of a tooth is much more sensitive at diagnosing periodontal disease because it allows us to evaluate what is occurring underneath the gingiva beyond the naked eye.

Therefore, routine Comprehensive Oral Radiographic Evaluations, or “CORE” procedures, are the best way to diagnose and address periodontal disease early and prevent dogs and cats from suffering from oral pain. Teeth that are not severely diseased will be cleaned with an ultrasonic scaler and will be evaluated for periodontal disease by close examination, probing around the gum line, and taking an x-ray of the root(s). Teeth that show evidence of periodontal disease will likely need to be extracted, or removed. Dogs have 42 teeth and cats have 30 teeth, so they often are able to compensate just fine without one or several teeth. Furthermore, once a tooth becomes diseased, it is no longer a functioning tooth so it serves no purpose to leave it in the mouth.

Tooth resorption is common in cats but can also occur in dogs. Tooth resorption involves spontaneous, progressive holes that start in a layer of the tooth called the cementum and progress to the crown and/or root of the tooth. Tooth resorption is painful. Therefore, we recommend addressing any tooth resorption as soon as possible to prevent ongoing pain and discomfort. Treatment involves extraction of the entire tooth or amputation of the crown. Attempting to preserve or restore the tooth is not recommended.

What age should your pet have their first Comprehensive Oral Radiographic Evaluation? That answer can be best determined by your pet’s veterinarian, as it is entirely dependent on the individual. Smaller or toy breed dogs are much more likely to develop periodontal disease at a young age due to genetics, tooth crowding, and chewing habits, among other things, and often need to have their first CORE procedure by age 3 or 4 years. Some cats are born with stomatitis, which is a condition where their immune system over-reacts to any bacteria on the teeth or gums and mounts a significant immune response, causing profound inflammation of the gums. These cats need much more attention to their oral health and will likely need their first CORE procedure at a younger age, as any prolonged bacteria or plaque accumulation will result in severe periodontal disease and often multiple teeth needing to be extracted. Frequency of CORE procedure is also highly dependent on home oral care. Brushing teeth is the number one way to prevent periodontal disease and should ideally be performed daily. There are dog and cat toothbrushes or finger brushes as well as toothpaste that can be found at veterinary clinics and some pet stores. There are many commercial chews that might be successful in preventing periodontal disease as well.

What happens when your dog or cat breaks a tooth? Fractured teeth should always be evaluated by a veterinarian immediately. The most common causes of fractured teeth are hard chewing or some degree of trauma. Avoid allowing your pet to chew on anything so hard that it doesn’t give when you press your fingernail against it, like Nyla bones and deer antlers. Kongs are ideal chew toys as they are durable, yet soft, and much less likely to break teeth. When a tooth becomes fractured, a veterinarian must determine whether there is pulp exposure. The pulp is the blood supply of the tooth. If the blood supply of the tooth is exposed this allows for bacteria to travel up to the root of the tooth and result in disease of the root, or endodontic disease. In some circumstances, an abscess of the root can occur and a patient can present with a swollen, painful face that develops very suddenly. Teeth that are fractured with pulp exposure should be extracted.

Why else is oral health so important beyond making sure an animal is not in any discomfort? Similar to humans, dental health is very closely integrated with overall systemic health. For instance, bacteria in the mouth and chronic inflammatory response to dental disease can prevent diabetic patients from being stabilized and can allow for more rapid progression of chronic kidney and liver disease. Therefore, preventative oral care is superior to waiting until severe periodontal disease is evident. This will help improve overall systemic health, prevent pain or discomfort while eating, and minimize the likelihood of teeth needing to be removed due to profound periodontal disease.

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