P. 612

An Urban Experience
Severe local consequences:
In addition to tooth loss, there are several local severe sequela of severe periodontal disease seen in cats. There are others that are seen in dogs, but since they are rare in cats, they will not be discussed here.
The most common of these local consequences is an oronasal  stula (ONF). ONFs are typically seen in older felines. ONFs are created by the progression of periodontal disease up the palatal surface of
the maxillary canines (however, any maxillary tooth
is a candidate). This results in a communication between the oral and nasal cavities, creating an infection (sinusitis). Clinical signs include chronic nasal discharge, sneezing, and occasionally anorexia and halitosis. De nitive diagnosis of an oronasal  stula often requires general anesthesia. Appropriate treatment of an ONF requires extraction of the tooth and closure of the defect with a mucogingival  ap.
Another potential local consequence of severe periodontal disease results from in ammation close to the orbit potentially leading to blindness. The proximity of the apices of the maxillary fourth premolars/ rst molars, place the delicate optic tissues in jeopardy. In addition, the apices of the maxillary canines lie in this area and can create similar issues, especially in brachycephalic breeds.
The other local consequence is described in recent studies which have linked chronic periodontal disease to oral cancer. The association in this case is likely due to the chronic in ammatory state that exists with periodontitis.
Severe systemic manifestations:
Systemic rami cations of periodontal disease are also well documented. The in ammation of the gingiva and periodontal tissues which allows the body’s defenses to attack the invaders also allows these bacteria to gain access to the body. Recent animal studies suggest
the possibility that these bacteria negatively affect the kidneys and liver, leading to decrease in function of these vital organs over time. Furthermore, it has also been suggested that these bacteria can become attached to previously damaged heart valves (IE valvular dysplasias) and cause endocarditis, which in turn can result in intermittent infections, and potentially thromboembolic disease.28 Other studies have linked oral bacteremias to cerebral and myocardial infarctions and other histological changes. Additional human studies have linked periodontal disease to an increased incidence of chronic respiratory disease (COPD) as well as pneumonia. There are many studies that strongly link periodontal disease
to an increase in insulin resistance, resulting in poor control of diabetes mellitus as well as increased severity of diabetic complications (wound healing, microvascular disease). Additionally, it has been shown that diabetes is also a risk factor for periodontal disease. Periodontal
disease and diabetes are currently viewed as having a bidirectional interrelationship where one worsens the other.
While some of these studies are not de nitive, we know that periodontal disease is an infectious process and that affected patients must deal with these bacteria
on a daily basis, which in turn can lead to a state of chronic disease. Therefore, we must learn to view periodontal disease as not just a dental problem
that causes bad breath and tooth loss, but as an
initiator of more severe systemic consequences. As
one author states, “Periodontal disease is clearly an important and potentially life threatening condition, often underestimated by health professionals and the general public”. Only by thinking in these terms can we fully appreciate the scope of the disease process and discuss the problem with clients so that they can appreciate the depth of the problems their pets face. This information will signi cantly increase client compliance with homecare and dental prophylaxis, as well as advanced dental procedures.
Periodontal therapy: Introduction:
The basis of periodontal therapy is still bacterial plaque control. Therefore, treatment of periodontal disease is generally a two to four step procedure depending on the stage of the disease. These steps include a thorough dental prophylaxis, periodontal surgery, homecare, and extraction.
The cornerstone of periodontal therapy is a thorough dental prophylaxis. This MUST be performed under general anesthesia, and should include the following steps:
Step 1: Pre surgical exam and consultation: This
is an often neglected step of a professional dental prophylaxis. The veterinarian should perform a
complete as possible physical and oral exam. The physical exam combined with pre-operative testing
is important to screen for health issues and ensure anesthetic safety. The oral examination should identify obvious pathology as well as allow for a preliminary assessment of periodontal status. The veterinarian can then discuss the various disease processes and the available treatment options in person with the use of visual aids. This will greatly increase client understanding and compliance. Furthermore, based on the physical  ndings, the practitioner can create a more accurate estimate both of procedure time and  nancial costs to the client. This small investment of time will improve the experience of everyone involved (veterinarian, technician, receptionist, client, and patient).
Step 2: Supragingival scaling. This step can be performed via mechanical or hand scaling. The

   610   611   612   613   614