Gingivitis

Introduction | Causes & Prevention | Symptoms & Signs | Diagnosis & Test | Treatment Options

Gingivitis

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Introduction

Dental disease is one of the most common veterinary problems in companion animals. Gingivitis, which is a general term for inflammation and infection of the gums (which medically are called "gingiva"), is the first phase of dental, or periodontal, disease. "Periodontal" means surrounding or pertaining to the teeth. According to some authorities, approximately 80% of domestic dogs will develop some degree of dental disease by the time they are 3 or 4 years old. Gingivitis tends to worsen with age, primarily due to the build-up of bacteria from poor or inconsistent dental care. Most owners of pet dogs are not conscientious about keeping their dog's teeth clean and well cared-for. Many veterinary clinics offer dental treatments for dogs (and for cats) that are quite similar to the cleanings that people get from their dental caretakers. Keeping your dog's gums and teeth healthy and clean is important to prevent infections and other oral ailments.

Causes & Prevention

Causes of Gingivitis in Dogs
Gingivitis usually starts from an accumulation of food particles in the crevices and other spaces between a dog's teeth and its gums. This nesting of food provides a platform for overgrowth of the diverse bacterial population that is part of the normal flora inside of a dog's mouth. Over time, without a proper diet and routine dental care, the host-parasite balance can become disrupted, causing the bacteria that normally live in small numbers inside of a dog's mouth to proliferate. These bacteria aggregate between the teeth and gums, causing inflammation, irritation, infection and bleeding. As the bacteria reproduce and multiply, they stick to the smooth surfaces of the teeth and form plaque, which in turn thickens, mineralizes and becomes calculus (also called tartar). Calculus can develop anywhere on the teeth, but in dogs it is most commonly seen on the cheek-side surfaces of the upper molars and premolars.

The edges of healthy gums fit snugly around the teeth, in both people and dogs. However, as gingivitis progresses, the plaque and calculus become hardened and rough, pushing the gums away from the teeth. The resulting pockets that develop along the gum line trap food particles and become sites for further bacterial proliferation. The infected gums bleed and can be quite painful for the animal. Left untreated, inflammation of the gums (gingivitis) will progress to periodontitis, which is inflammation and infection of the deeper structures that support the teeth. In extremely advanced cases, affected teeth can completely lose their attachment to the jaw bone. When this happens, the dog will no longer have the use of those teeth.

Prevention of Gingivitis
Fortunately, gingival disease is almost always preventable by regular in-home and veterinary dental care. Owners should start taking care of their dogs' teeth shortly after the permanent teeth have erupted – which should happen by about 8 or 9 months of age. A number of products are commercially available to help owners with canine oral hygiene. These include brushes, pastes, washes, rinses, bones and other chewing products that help to physically reduce plaque and calculus build-up. Special dental diets are also commercially available to help mechanically keep a dog's teeth clean. Dogs that are prone to periodontal disease should be fed a palatable, high-quality dry kibble as the mainstay of their diet. Soft or wet food diets can promote dental disease, whereas hard dry kibble tends to keep teeth cleaner and in better shape.

Special Notes
Interestingly, dogs that live in underdeveloped countries or communities seem to be less likely to develop severe dental disease than those dogs that live in highly developed areas. This probably is because the diet of dogs in underdeveloped communities is more variable, and their teeth and gums may experience more rigorous grinding and chewing action depending on what they find to eat.

Symptoms & Signs

Effects of Gingivitis on Dogs
Gingivitis is the first stage of a process that, if not addressed, will progress to a more serious condition called periodontitis. Owners should take their dogs' dental care very seriously. Untreated dental disease can ultimately lead to life-threatening disease as a result of the proliferation of bacteria and the spread of bacteria throughout a dog's blood stream. Dogs with gingivitis will have sore mouths. Their gums will hurt, and they may even bleed now and then. They may be reluctant to chew on bones or rawhides, and they may also be reluctant to eat their normal amount of food.

Symptoms of Gingivitis in Dogs
In the early stages of gingivitis, dogs may show mild signs of inflammation of their gums. As the disease progresses, the symptoms will progress as well. Dogs with gingivitis typically will show one or more of the following clinical signs, depending upon the stage and severity of their disease:

Bad breath (halitosis; this is one of the hallmarks of dental disease in dogs)
Swollen gums (edematous gingiva)
Red gums (erythemic gingiva)
Bleeding gums (gingiva bleed easily with light pressure)
Ulcerated gums
Plaque build-up ("stained teeth")
Calculus build-up ("tartar")
Irregular gingival (gum line) surfaces
Pus oozing from the gum line upon contact
Pain
Difficulty chewing
Reluctance to eat (despite obvious hunger)
Excessive salivation (drooling; ptyalism)
Loose teeth
As gingivitis worsens, the dog's gums may visibly appear to recede. Unfortunately, affected dogs often resist close inspection of their oral cavities, because this condition can be extremely painful. It can be quite challenging for a veterinarian to get a good look at the mouth of a dog with gingivitis.

Dogs at Increased Risk
Miniature Poodles and Toy Poodles, and other small breeds, are predisposed to dental disease, including gingivitis. Brachycephalic breeds – those with broad skulls and short, flat faces (such as Pugs, Boxers, Boston Terriers, Bulldogs, Pekingese, King Charles Cavalier Spaniels, etc.) are also at increased risk of developing gingivitis. These dogs tend to develop dental disease due to the extreme crowding of teeth in their tiny or abnormally formed jaws, which reduces the effectiveness of natural cleaning mechanisms. Poor nutrition can also contribute to gingivitis. Dogs that chew on bones, are given crunchy dog biscuits and are primarily fed a high-quality hard dry kibble seem less prone to developing periodontal disease than dogs that are fed primarily a soft or moist diet. Dogs with diabetes mellitus have an increased risk of gingivitis, because that disease affects their metabolism and promotes the accumulation of pathogenic bacteria in the oral cavity.

Diagnosis & Tests

Initial Evaluation
Gingivitis in dogs is not especially difficult for a veterinarian to diagnose. It usually can be identified by a thorough oral examination, as long as the patient cooperates. In most cases, gingivitis is found during a routine annual wellness examination. If the patient is particularly resistant to having its mouth looked at, sedation may be necessary. It is very important to maintain good oral health in our companion dogs. Bacteria that proliferate in the mouth can spread through the blood and infect many other organs in the dog's body. Because the mouth is such a ripe receptacle for the input of infectious organisms, owners of dogs should pay particular attention to the health of their dog's mouth and teeth.

Diagnostic Procedures
The initial database for a dog presenting with bad breath and other symptoms suggesting oral disease includes a complete history, a thorough physical examination and a complete examination of the teeth, gums and oral cavity. Most veterinarians will also take a blood sample to run a complete blood count and a serum biochemistry profile. A urine sample will usually be taken and analyzed as well. These initial diagnostic tests will provide valuable information about the dog's internal organs and overall health. They should be conducted before sedation or general anesthesia is used to permit more advanced examination.

Once a dog is sedated or anesthetized, the veterinarian can examine the gums and teeth in much greater - and much less painful - detail. She can probe between the gums (gingiva) and teeth to identify any abnormal pockets and plaque or tartar accumulation. Gentle pressure by a finger against each tooth can reveal any looseness or even complete detachment of the tooth from the jaw and may also disclose bleeding and/or oozing of pus from surrounding gingival tissue. If the gingivitis is very advanced, dental radiographs (X-rays) can be taken to assess the health of the underlying tooth structures and supporting bone. Dental films can be particularly valuable, because many signs of advanced oral disease are hidden below the visible gum line and cannot be seen on a routine physical examination. Gingival biopsies can also be taken and submitted to a veterinary pathology laboratory for microscopic evaluation.

Special Notes
Accumulation of plaque and calculus occurs naturally to some extent in all domestic dogs. However, gingivitis is almost always preventable. Owners should discuss routine in-home dental care regimens that are appropriate for their particular dogs with their veterinarian. Good oral hygiene will not only prevent or greatly reduce the risk of gingivitis and more serious periodontal disease, but it will also make the dog's breath much more pleasant. It is not difficult to brush a companion dog's teeth. There are a number of different brushes and devices, and dog-friendly tooth pastes, that can be used for routine dental care of our domestic dogs. The tooth pastes that we people use should not be used for our dogs. There are plenty of canine-friendly tooth pastes to choose from.

Treatment Options

Goals of Treating Gingivitis
In most cases, dogs with gingivitis will need to be placed under general anesthesia or be heavily sedated before they can have a complete dental examination and treatment. The goals of treating gingivitis are to remove any accumulations of plaque and calculus along the gum line, relieve the pain caused by inflammation and infection of the gums and prevent further progression of the disease. Gingivitis is a very uncomfortable condition. Dogs suffering from this disorder may lose their appetite or desire to eat and can drop weight. They also commonly develop bad breath.

Treatment Options
Dogs with moderate to severe gingivitis typically will be heavily sedated or put under general anesthesia before their treatment begins. This is important not only for their own comfort, but also to allow the attending veterinarian or skilled technician to clean above and below the gum line, scale, probe and polish all of the teeth and assess the nature and extent of gum inflammation and infection. Specialized ultrasonic dental instruments similar to those used by human dentists are increasingly available to veterinary practitioners. Dental procedures for dogs will effectively remove all but the deepest accumulations of plaque and calculus. Antibiotic gels may be applied to the gums topically after the teeth are cleaned, to help soothe and restore health to the sore, inflamed gums. Dental procedures in dogs often dislodge bacteria from around the teeth; these bacteria then enter the dog's blood stream and can cause infections in remote organs. Sometimes, treatment with a broad spectrum antibiotic after dental work is advisable to reduce the risk of those infections.

A number of surgical techniques, including gingival flaps, bone replacement and bone augmentation, are available to help a dog retain teeth that have been loosened by deep pockets caused by gingivitis. Infected, diseased gum tissue can be removed by a surgical procedure called a "gingivectomy." After any veterinary dental treatment, owners should maintain a regular oral hygiene regimen for their dogs. This should include brushing with toothpastes or gels specifically formulated for veterinary use, and washing or flushing the dog's mouth with oral canine products. Fluoride and chlorhexidine are among the most effective topical products for reducing plaque formation and bacterial build-up, although they should not necessarily be used at the same time. Brushing and rinsing should be done daily or at least twice a week to obtain the best results. A veterinarian is the best person to recommend specific products.

Oral antibiotics may be prescribed for a week or two before and after dental procedures, to reduce the risk of systemic infection. This is quite important, because the teeth-cleaning process almost always disrupts and dislodges large numbers of bacteria, which then get into the dog's blood stream through its inflamed and bleeding gums. Sustained-release veterinary products that are applied to the dog's gums to help healing and reduce pain are also available. Vaccines are being developed to provide protection against the primary bacteria that commonly proliferate in the mouths of dogs with gingivitis.

Dietary management is another important part of preventing and treating gingivitis in dogs. Hard dry kibble leaves fewer food particles on the enamel surface of teeth than does soft food, and it also helps to mechanically clean the teeth. There are a number of prescription kibbles specifically formulated to support oral hygiene; these are commercially available through veterinarians and from specialty pet supply stores. Chewing on bones, rawhides, crunchy dog biscuits and specialized dental treats can also help keep a dog's teeth clean and reduce the risk of gingivitis. Some authorities recommend providing bones, rawhides and other chew treats only under strict supervision, so that someone is present to retrieve the item if it unexpectedly gets stuck in the dog's throat.

Prognosis
The prognosis for dogs with gingivitis is highly variable, depending upon the stage of the disease and the dog's immune status, among other things. The prognosis is good to excellent if the disease is caught early – before it has progressed to periodontitis – and if the owner is conscientious about regular preventative dental care. If gingivitis is not properly diagnosed and effectively treated, the bacteria that proliferate in dental plaque and gum pockets can enter the bloodstream and migrate to remote locations. This can be extremely dangerous and potentially fatal.

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