Yuck, he has dog breath. How often have you heard that expression? Dogs and cats can both suffer the effects of halitosis, such as exclusion from their human partners, but what is concerning is the underlying process creating the stinky breath. Periodontal disease is the most common medical issue in dogs, with a worldwide prevalence around 85 percent. This means that most likely the dog sitting by your side has a disease that you could be preventing!
Periodontal disease is the process in which plaque induces the inflammation and subsequent destruction of periodontal tissues. These tissues are the ones that support the structure and health of the tooth itself. They include the gingiva (gums), periodontal ligament (the tissue that holds the tooth into the socket), the bone that surrounds the tooth and the tissue that surrounds the root of the tooth (the cementum). Any one or combination of these tissues can be affected by the processes of periodontal disease. This is a progressive process and advances in stages.
As noted above, these processes all begin with the accumulation of plaque on the surface of the tooth. This plaque forms first as a layer of sticky material created from a combination of saliva and food. Over the next 24 hours, the plaque matures, and bacteria become bound in a matrix of other compounds. This mature plaque becomes bound to the tooth until mechanically removed by scraping it off. Once the plaque matures, a thick, hard material called calculus, also known as tartar, forms over the tooth. Once this happens, a new bacterial population invades the tissues and the first stage of periodontitis progresses, becoming evident as gingivitis, which can be seen as a red line at the base of the tooth where it meets the gum line. At this point, the process accelerates with the release of toxins and enzymes that will start to degrade the connective tissue that supports the tooth, including the periodontal ligament, which is responsible for keeping the tooth in the sulcus. This can be seen as a very swollen, red area at the base of the tooth. Progression continues with the bone surrounding the tooth being lost to the degradation processes with consequent tooth loss as the final stage. The beginning of the last stage is noted by mobility of the affected tooth. This process can lead to signs of oral disease, which the owner can note fairly easily, including halitosis, increased salivation, difficulty eating and oral pain.
In addition to the loss of teeth due to advanced periodontal disease, there are other processes that can affect the whole animal, not just the oral tissues. Once the connective tissue is compromised, the bloodstream can be accessed by the organisms that are causing the periodontal disease. This bathes the bloodstream with a constant stream of bacteria, the toxins that are produced by these bacteria and breakdown products of the cells affected by the periodontal processes. This constant influx of pathogenic organisms and products can lead to systemic disease in the affected animal. Associations have been found between periodontal disease and changes in the kidney, the lining cells of the chambers of the heart, heart valves and liver. There is good evidence that periodontal disease increases the risk for heart diseases.
The effects of periodontal disease on the pet can be quite devastating, but it can be very easily prevented and managed.
Home care is the first line of defense against the effects of periodontal disease. The best and most effective treatment is tooth-brushing with a specially designed brush for dogs and cats or a pediatric soft-bristle brush. Brushing your pet may be a challenge and is best demonstrated by your veterinarian or veterinary technician. Brushing once every day can be very effective at removing the plaque from the surface of the tooth and removing the preliminary step in the progression of disease. If once a day isn’t possible, then good results can also be obtained by brushing every other day.
There are also effective passive ways to provide oral home care that are complimentary to brushing. These include dental prescription diets and chews. Cartilaginous products such as rawhides can provide mechanical cleaning and effectively floss between teeth if used on a regular basis. Be sure to use a product that has been approved by the Veterinary Oral Health Council.
The second step is regular visits to your veterinarian to assess your pet’s oral cavity. These visits should happen at least every six months as disease can progress in a significantly short period of time. You should also evaluate your pet’s mouth every time you brush for signs of disease, such as redness of the gums, bad breath and loose teeth. If any signs of disease are present, your veterinarian will recommend that a complete cleaning of the teeth be performed. This can in some cases reverse the disease, or at least stem it from progressing further. This procedure must be performed under general anesthesia, as the procedure requires the full cooperation of the pet to be performed properly. The dental cleaning takes several steps, including full-mouth dental X-rays, charting of each individual tooth for evidence of disease, a deep scaling of the plaque and calculus off of the tooth and the pocket between the tooth and gums and, finally, polishing the tooth to return to a smooth surface.
But the most important step lies in your bond with your pet. You can keep your pets healthy and free from dental disease by observing them, taking care to brush their teeth on a regular basis and taking them for regular dental exams!
Dr. Stephen C. Meister, VMD, MRCVS, is an associate veterinarian at Society Hill Veterinary Hospital. For more information, visit www.societyhillvets.com or call 215-627-5955.