P. 188

An Urban Experience
B.A. Niemiec1
1Southern Califormia Veterinary Dental Specialties, Dentistry, San Diego, USA
Periodontal disease is the number one medical condition in small animal veterinary medicine. We will begin this presentation with an overview of the current knowledge as to the pathogenesis of periodontal disease. This
will allow us to properly treat the condition. Following
this is a discussion of the local and systemic effects of periodontal disease. This will give attendees the ability to improve client compliance with dental recommendations. In addition, a  rm grasp of the disease process will improve practitioner understanding of proper treatment modalities.
Due to the plethora of new and concerning information about this condition, treatment and prevention is the subject of signi cant research. This focus has resulted in numerous new products and procedures to prevent and treat periodontal disease and this presentation is designed as an introduction to these new and future therapies.
Periodontal disease is the number one health problem in small animal patients. By two years of age, 70% of cats and 80% of dogs have some form of periodontal disease. However, there are generally few to no visible clinical signs, and therefore therapy typically comes very late in the disease. Consequently, periodontal disease may also the most undertreated disease in our patients.
Periodontal disease is generally described in two
stages, gingivitis and periodontitis. Gingivitis is the
initial, reversible stage in which the in ammation is con ned to the gingiva. The gingival in ammation
is created by plaque bacteria and may be reversed
with a thorough dental prophylaxis and consistent homecare. Periodontitis is the later stage of the disease process and is de ned as an in ammatory disease of the deeper supporting structures of the tooth (periodontal ligament and alveolar bone) caused by microorganisms. The in ammation results in the progressive destruction of the periodontal tissues, leading to attachment loss. This can be seen as gingival recession, periodontal pocket formation, or both. Mild to moderate periodontal pockets may be reduced or eliminated by proper plaque and calculus removal, however, periodontal bone loss is irreversible (without regenerative surgery). Although bone loss is irreversible, it is possible to arrest its progression.
However, it is more dif cult to maintain periodontally diseased teeth in comparison to healthy teeth. Additionally, periodontal attachment loss may be present with or without active in ammation.
Periodontal disease is initiated by oral bacteria which adhere to the teeth in a substance called plaque. Plaque is a bio lm, which is made up almost entirely of oral bacteria, contained in a matrix composed of salivary glycoproteins and extracellular polysaccharides. Calculus (or tartar) is basically plaque which has secondarily become calci ed by the minerals in saliva.
Plaque and calculus may contain up to 100,000,000,000 bacteria per gram. More importantly, bacteria become must more resistant to antiseptics and antibiotics than their free living or “planktonic” counterparts. In fact, they are 1,000 to 1,500 times more resistant to antibiotics and antiseptic concentrations need to be up to 500,000 times that which would kill singular bacteria.
Plaque on the tooth surface is known as supragingival plaque. Once it extends under the free gingival margin and into the area known as the gingival sulcus (between the gingiva and the teeth or alveolar bone), it is called subgingival plaque. Supragingival plaque likely affects the pathogenicity of the subgingival plaque in the early stages of periodontal disease. However, once the periodontal pocket forms, the effect of the supragingival plaque and calculus is minimal. Therefore, control of supragingival plaque alone is ineffective in controlling the progression of periodontal disease.
The in ammation produced by the combination of the subgingival bacteria and the host response damages the soft tissue attachment of the tooth, and decreases the bony support via osteoclastic activity. This causes the periodontal attachment of the tooth to move apically. The end stage of periodontal disease is tooth loss; however the disease has created signi cant problems prior to tooth exfoliation.
Clinical Features:
It is important to be familiar with normal features in order to identify abnormal  ndings. Normal gingival tissues are coral pink in color (allowing for normal pigmentation), and have a thin, knife-like edge, with a smooth and regular texture. There should be no demonstrable plaque or calculus on the dentition.
The  rst obvious clinical sign of gingivitis is erythema followed by edema of the gingiva. However, it is now known that the  rst evidence of gingivitis is bleeding during brushing, probing, or after chewing hard/rough toys. Therefore it is important to realize that normal appearing teeth/gums can actually be infected. If the  rst stages of gingivitis are not treated, it will progress into

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