Could Periodontal Disease be a Silent Killer?

Periodontal disease (PD) is one of the most prevalent infectious diseases in both humans and animals and can affect overall health as well as quality of life. PD results in damage to the healthy tissues in the mouth (gingiva/gum tissue) and (alveolar bone/the jaw bone). It results in tissue damage from inflammatory mediators of the immune system and often leads to loss of tooth attachment with gingival recession and/or periodontal pocket formation.

Bacterial plaque associated periodontal disease is the most common chronic infection in humans, cats and dogs. In humans, there is an association between PD and heart disease (myocardial infarction and stroke) as well as other systemic organs. In dogs it has also been associated with changes in internal organs (we assume this is similar in cats; however there are more scientific studies on periodontal disease in the dog).

Studies show that PD not only influences the survival of teeth, but it can also have a significant adverse impact on systemic health, and that it may be responsible for major morbidity and mortality risk among susceptible animal populations.

In animals, kidney disease (particularly glomerulonephritis) is considered a potential consequence of chronic low-grade bacteremia associated with PD. Pyelonephritis and interstitial nephritis may also result from bacteremia or sepsis related to oral infection. In extreme cases of PD, where a disease process sufficiently injures the glomeruli and/or interstitium, chronic renal failure may result.

Heart disease: Bacterial endocarditis, in animals may result from bacteremia associated with dental manipulations or severe PD. In these studies using dogs, the same bacteria found in lesions on the diseased mitral valves of the heart were the same bacteria that were found in the mouth. Endocardiosis and myocardial fibrosis occur with increased frequency in aging dogs and it has been suggested that geriatric dogs with PD have a higher incidence and greater severity of cardiac disease compared to those with healthy teeth.

Lung disease: Chronic bronchitis, chronic obstructive pulmonary disease (COPD), fibrosis and emphysema are often present in dogs with PD. Periodontal disease may be an initiating, contributing, or exacerbating factor for these conditions.

Liver disease: Bacteremia associated with PD is a suspected cause of some liver disorders, including hepatitis is animals.

Not only can PD have systemic effects (as listed above), but there can also be pathology and disease that cause problems in the mouth itself. One main issue can be oral discomfort/pain with having root exposure of teeth with gum recession. Some of these teeth can also have loss of the integrity of their supporting structures such as the periodontal ligament and surrounding bone, causing these teeth to become loose and mobile (these teeth are not comfortable when trying to chew (eat) or play with toys, etc).

Since PD can lead to alveolar bone loss (loss of the jaw bone), it can place a pet at an increased risk for a jaw fracture to occur. This is unfortunately, more common than one would think. The PD weakens the jaw and it does not take much force to then suffer from a jaw fracture.

Most animals hide their oral pain from us. It is their instinct- if they were to show weakness or pain in the wild, then they would be preyed upon. It is up to us to pick up on any changes in their behavior and/or eating habits and to have them thoroughly examined on a routine basis.

Periodontal disease does have a strong genetic component and is seen more commonly in smaller breed dogs than in larger breeds. It is recommended that all pets have a routine dental cleaning and thorough evaluation on an annual basis. Proper oral evaluation includes: Blood work, anesthesia, a dental cleaning, thorough intraoral exam while under anesthesia (dental charting) and evaluation of dental x-rays taken while under general anesthesia. If a simple examination of just looking in the mouth on an awake patient is performed- pathology is going to be missed. Often times there are areas of oral disease that are missed if a thorough intraoral exam using a dental probe and explorer are not used and if dental x-rays are not evaluated.

Preventative methods, such as thorough daily tooth brushing, appropriate periodontal diagnosis, and the treatment of established disease contributes to the longevity of the dentition and may also lower the prevalence of a range of important systemic conditions.

References:

1. Debowes LJ, Mosier D, et al. Association of periodontal disease and histologic lesions in multiple organs from 45 dogs. J Vet Dent 1996; 12: 57-60

2. Rawlinson, JE, Goldstein, RE, et al. Association of periodontal disease with systemic health indices in dogs and the systemic response to treatment of periodontal disease. J Am Vet Med Assoc 2011; 238: 601-609

3. Pavlica A, Petelin M, Juntes P, Erzen D, Crossley DA, Skaleric U. Periodontal disease burden and pathological changes in organs of dogs. J Vet Dent 2008; 25: 97-105

4. Strom BL, Abrutyn E, Berlin JA, Kinman JL, et al. Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med 1998; 129:761-769