Periodontal treatment

The treatment of periodontal diseases always starts with basic periodontal therapy (professional dental cleaning) that includes supra- and subgingival scaling using power and/or hand instruments, and selective polishing to remove all dental deposits.

The patient is anaesthetised and placed on a dental table in a bag that supports the body, and a heating blanket or other device to support the body temperature should be used. Care must be taken to maintain the patient’s airway and to support the head and neck region. The patient may be placed in lateral or dorsal recumbency. Detailed oral examination and dental radiographs are performed. A pharyngeal gauze pack is used in addition to suction and a cuffed endotracheal tube to prevent any aspiration of materials from the oral cavity. Before any treatment, the oral cavity should be rinsed with an antiseptic solution (chlorhexidine). Antiseptic solutions should have an immediate and lasting bactericidal action, thereby reducing the risk of surgical wound infection and bacteremia (entrance of the bacteria into the bloodstream). Pre-procedural rinsing also reduces the level of aerosolized bacteria. Antibiotics are used in selected rare patients only. Regional nerve blocks are performed if any advanced procedures other than professional dental cleaning are planned.

Basic periodontal therapy is performed prior to any surgical procedures to enable a more accurate assessment of the tooth structure and provide a cleaner environment for surgery. Basic periodontal therapy may be performed with power and/or hand instruments. A variety of power scalers is available with tips for supra- and subgingival use and adapted for periodontal debridement or designed specifically for periodontal debridement.

Hand instruments used for manual scaling in veterinary dentistry include scalers and curettes. Scalers are designed for the removal of supragingival calculus. Periodontal curettes are finer and rounded instruments to be primarily used for subgingival scaling, root planing, and gingival curettage. Mastering the technique of using hand instruments requires specific training.

A plaque-disclosing agent can be used following basic periodontal therapy to help reveal areas of plaque and calculus remnants. Residual plaque can be removed by polishing, while any residual calculus will require further scaling. It is a common practice to make the dental surfaces as smooth as possible after scaling. However, the long-term beneficial effect of polishing would appear to be minimal. Furthermore, some loss of the tooth structure occurs during polishing.

In cases of advanced disease, basic periodontal therapy/professional dental cleaning is followed by periodontal debridement, root planing, periodontal surgery, guided tissue regeneration and extractions as indicated.

In general, teeth affected by PD 1 will return to health with basic periodontal therapy/professional dental cleaning, while teeth affected by PD 4 will need extraction. Teeth affected with PD 2 and PD 3 may be treated and kept for a while, providing daily oral home care is established, but the disease will generally progress.

Finishing the treatments in one cycle in animals is attempted, but severe cases may need two or more procedures a few weeks apart. Depending on the extent of periodontal diseases and procedures patients are also treated systemically with analgesics (e.g., NSAIDS, opioids) in addition to local nerve blocks, and in rare selected cases with systemic antibiotics. While the use of antibiotics should be limited to carefully selected cases, antiseptics should be used in every patient prior and after periodontal therapy and oral surgery.

If you have noted any problems with your animal, please consult your veterinarian.

Selected references
1. Gorrel CE, Hale FA (2012). Principles of periodontal surgery. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 161-166.
2. Holcombe LJ, Patel N, Colyer A, Deusch O, O’Flynn C, Harris S (2014). Early canine plaque biofilms: characterization of key bacterial interactions involved in initial colonization of enamel. PLoS One 9(12):e113744.
3. Marshall MD, Wallis CV, Milella L, Colyer A, Tweedie AD, Harris S (2014). A longitudinal assessment of periodontal disease in 52 Miniature Schnauzers. BMC Vet Res, doi: 10.1186/1746-6148-10-166.
4. Sarkiala-Kessel EM (2012). Use of antibiotics and antiseptics. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 15-21.
5. Terpak CH, Verstraete FJM (2012). Instrumentation, patient positioning and aseptic technique. In: Verstraete FJM, Lommer M, eds. Oral and maxillofacial surgery in dogs and cats. Saunders Elsevier, Edinburgh: 55-68.
6. Verstraete FJM (2011). Small animal dentistry syllabus VSR413 – winter 2011. Davis: Department of surgical and radiological sciences, School of veterinary medicine, University of California-Davis.
7. Wolf HF, Rateitschak EM, Rateitschak KH, Hassel TM (2005). Color atlas of Dental Medicine: Periodontology. 3rd ed. Stuttgart: Thieme.