Treating Periodontal Disease

Fractures of the enamel of the tooth are quite common in the dog and less common in the cat. Years ago we thought if a tooth fractured and the pulp chamber (center canal of the tooth containing the nerve and vessel) was not entered, there was not any real problem. We now understand that tooth is painful. The exposed dentin under the enamel has microscopic canals that transfer heat, cold and pressure right into the pulp chamber. Bacteria are also able to travel through the microscopic canals into the pulp chamber. Fifty percent of these fractured teeth will eventually abscess unless treated. Applying a bonded sealant will decrease to chance of abscessing to five percent. Bonding the teeth will also stop the pain in that tooth.

The process of bonding a tooth involves contouring the rough edges of the tooth with multiple grades of sanding discs, chemically etching the tooth enabling the acrylic bonding agent to grasp the tooth structure tightly. Applying the bonding agent and curing it with a special ultraviolet light. This will leave the tooth with a smooth surface which will also decrease the ease with which plaque will build up on the tooth.

The gum tissue is usually attached firmly to the side of the tooth except for the few millimeters of the leading edge. If this attachment to the tooth is “broken down” by bacterial infections under the gum line the bone that holds the tooth firmly in place is next in line for the bacteria to attack. If we can intercept this process by injecting a slow release antibiotic (Doxirobe) gel, we can sometimes stop the progressive bacterial infection and get the gum tissue to re-attach to the tooth. This gel inhibits tissue destruction, fights infection and helps prevent plaque from filling up the gum pocket.

Pictured here is the antibiotic being injected into the deep gum pocket next to the root of a tooth at risk.

If the gum tissue is healthy and attached to the tooth we do not have to provide periodontal care. If plaque invades the gum pockets around the tooth it will cause loss of the attachment and the bacteria will continue to make deeper and deeper pockets around the tooth. If we can clean off this plaque under the gum lines and smooth the tooth surface there is a chance to save the tooth if it is still solid in the bone. In some instances the gum tissue has receded because the underlying bone has been destroyed by the inflammatory process and we create sliding gum flaps to cover the exposed tooth root and hope the gum tissue reattaches to the cleaned tooth root. Our goal with periodontal work is to save the teeth and keep our pets out of pain and free from infection.

Dogs have more malocclusion problems than cats. One of the most common problems in dogs is retained baby teeth. There should never be both the baby tooth and the permanent tooth in the same tooth space at the same time. We will extract the baby tooth to allow the permanent tooth to be in the right location.

If during the growing stages of a pet, teeth are pressing on the roof of the mouth or against an opposing tooth, we will extract the offending tooth to allow for the proper jaw growth and prevent unnecessary pain. Sometimes we will refer the pet to a veterinary dentist for advanced procedures.

If there is bone loss around a tooth or we extract a tooth leaving a large cavity space, we may fill the space with a synthetic bone matrix. This material encourages new bone to form in the place we fill. This is a wonderful option if we are trying to restore as much normal anatomy as possible.

Teeth that are fractured and have the pulp chambers (nerve and blood vessel chamber) exposed or teeth that are “dead” will never heal by themselves. They either need to be extracted or have a root canal performed to prevent the tooth from abscessing and to eliminate ongoing pain. If finances allow, all major teeth (fang teeth and biggest molar teeth) in the above two categories would have root canals performed on them. Not uncommonly we choose, with the owner, to extract these teeth. We will present the benefits, fees and prognosis with each treatment to allow owners to make the best decisions for their situations.

Root canal treatment involves cleaning out the pulp chamber (removing the blood vessel, nerve and any debris), filling the chamber with a special material to prevent any future bacterial infection, and finally, sealing the chamber with a special material to close the chamber again. This is a specialized procedure and a veterinary dentist will perform this treatment.

All diseased, broken, and/or fractured teeth that are not going to be saved with periodontal work or root canals should be extracted to prevent further pain or infection. Teeth that have lost more than 50% of their supporting bone or, in cat’s teeth, are affected by resorptive lesions, should be extracted.

After we x-ray a tooth to determine the extent of the pathology we develop an extraction plan. Appropriate local nerve blocks are injected near the teeth (like Novocain we might receive in the dentist’s office). Most commonly we will surgically create a gum flap to expose the bone supporting the tooth. Multi-rooted teeth are sectioned with a high speed hand drill. Bone surrounding much of the root is removed with the dental drill with special burs. Various types of root elevators and luxators (special hand tools) are then used to break down the ligament that attaches the tooth to the bone (periodontal ligament). The roots of the teeth are removed, the rough edges of the bone smoothed with dental burs, the socket flushed out, and the gum flap closed over the empty socket with absorbable sutures. Cats and dogs seem to do very well after their teeth extractions. Clients frequently report improvement in their activity and/or behavior after diseased or fractured teeth are extracted.