Basic and Advanced Periodontal Treatment

Introduction

Periodontal disease is inflammation and infection of the periodontium (gingiva, periodontal ligament, alveolar bone and cementum) due to plaque bacteria and the host’s response to the bacterial insult. Gingivitis is reversible, affecting gingiva only. As inflammation continues, the gingiva detaches from the tooth, creating a periodontal pocket, and a shift occurs in the gingival flora from a gram-positive aerobic to a gram-negative anaerobic spectrum. Periodontitis is the more severe form of periodontal disease, affecting all periodontal tissues and resulting in attachment loss, gingival recession, periodontal pocket formation and alveolar bone loss. Bone loss is usually irreversible, causing the tooth to become mobile and ultimately to exfoliate. Periodontal disease affects 70-80% of cats and dogs over two years of age. Its systemic effects are well documented in humans (heart disease and stroke, diabetes, respiratory disease, and increased risk of premature delivery and low birth weight infants). Few studies have as yet been performed in companion animals.

Examination

Periodontal examination is performed under general anesthesia and includes (1) probing of the gingival sulcus of all teeth with a periodontal probe; and (2) imaging of all teeth with dental radiographic film and a dental x-ray unit. The teeth are evaluated for the presence of plaque, calculus (mineralized plaque), gingivitis, gingival recession, sulcus (or pocket) probing depth, attachment loss, and mobility. Gingival enlargement may lead to the formation of so-called pseudopockets, which is commonly seen in brachycephalic dogs.

Treatment Options

The goal of periodontal therapy is elimination of supraand subgingival plaque and reduction of periodontal pockets. Medicinal therapy includes the use of topical rinsing solutions (e.g., dilute chlorhexidine) or systemic antimicrobials (e.g., amoxicillin/clavulanic acid, clindamycin, spiramycin/metronidazole, doxycycline). Because of potential side effects and/or the possibility of bacterial resistance, systemic antimicrobials should only be used in selected cases to serve as an adjunct to local treatment. Mechanical/instrumental therapy can be categorized in two different concepts: (a) closed treatment (scaling, closed root planing, and polishing); and (b) open treatment. Closed treatment is indicated, when pocket depths do not exceed 4-5 mm, and consists of debriding the tooth and root surfaces of plaque and calculus as well as root planing and gingival curettage without reflecting a soft tissue flap. Open treatment is indicated when pocket depths exceed 5-6 mm and is performed following reflection of a gingival or mucoperiosteal flap. [...]