P. 611

B.A. Niemiec1
1Southern Califormia Veterinary Dental Specialties, Dentistry, San Diego, USA
Although periodontal disease is typically less common and severe in cats in comparison to dogs, this disease process is still the number one health problem diagnosed in feline patients. By just two years of age, 70% of
cats have some form of periodontal disease. In the
vast majority of cases, however, there are little to no outward clinical signs of the disease process. Therefore, therapy often comes very late in the disease course (if at all). Consequently, periodontal disease is also the most undertreated animal health problem.
Unchecked periodontal disease has numerous dire consequences both locally and systemically. These consequences are detailed brie y in this lecture, and should be utilized to educate clients and improve compliance of therapeutic recommendations. Prior to the discussion of consequences, this article covers the pathogenesis of periodontal disease, clinical features, and diagnostic tests.
Following the discussion of periodontal disease,
this lecture will present the current treatment recommendations for periodontal disease. This includes dental prophylaxis, basic periodontal surgery, extractions and homecare. In addition, homecare and future directions will be covered.
Pathogenesis of periodontal disease: Stages of periodontal disease:
Periodontal disease is described in two stages, gingivitis and periodontitis. Gingivitis is the initial, reversible
stage of the disease process where the in ammation
is con ned to the gingiva. This in ammation 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 supporting structures of the tooth (periodontal ligament and alveolar bone) caused by these microorganisms. This in ammation results in
the progressive tissue destruction, leading to gingival recession, periodontal pocket formation, or both. Small periodontal pockets can be reduced or eliminated
by proper removal of plaque and calculus. However, periodontal bone loss is irreversible (without regenerative surgery).
Periodontal disease is initiated when oral bacteria 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 of salivary glycoproteins and extracellular polysaccharides. Calculus is essentially plaque which has become calci ed by the minerals in saliva. Bacteria within a bio lm do not act like free living bacteria; and in fact, they are 1,000 to 1,500 times more resistant to antibiotics. The plaque on the visible surface of the teeth is known as supragingival plaque. Once
it extends under the gingival margin and into the area known as the gingival sulcus it becomes known as subgingival plaque. Supragingival plaque and calculus has a slight affect the pathogenicity of the subgingival plaque in the early stages of periodontal disease, however once a periodontal pocket forms, the effect is minimal. Therefore, control of supragingival plaque alone is ineffective in controlling the progression of periodontal disease.
Clinical Features:
Normal gingival tissues are coral pink in color (allowing for pigmentation), and have a thin, knife-like edge, with a smooth and regular texture. In addition, there should be no demonstrable plaque or calculus on the dentition.
The  rst clinical sign of gingivitis is erythema of the gingiva. This is followed by edema, gingival bleeding and halitosis. Gingivitis is typically associated with calculus on the involved dentition, but is primarily elicited by PLAQUE and thus can be seen in the absence
of calculus. Alternatively, widespread supragingival calculus may be present with little to no gingivitis. It is critical to remember that calculus itself is essentially non-pathogenic. Therefore, the degree of gingival in ammation (not the amount of calculus) should be used to judge the need for professional therapy. As gingivitis progresses to periodontitis, the oral in ammatory changes intensify.
The hallmark clinical feature of periodontitis is attachment loss, which has two different presentations. In some cases, the apical migration results in gingival recession while the sulcal depth remains the same. Consequently, tooth roots become exposed and the disease process is easily identi ed on conscious exam. In other cases, the gingiva remains at the same height while the attachment moves apically, thus creating a periodontal pocket. This form is typically diagnosed only under general anesthesia with a periodontal probe. It is important to note that both presentations of attachment loss can occur in the same patient, as well as the same tooth.
An Urban Experience

   609   610   611   612   613