Gingivitis and Swollen Gums in Dogs

Gingivitis in Dogs

Gingivitis is a reversible inflammation of the gums and is considered the earliest stage of periodontal disease. In the early phases of gingivitis, some plaque is present and there is mild redness of the gums, but the gingival surfaces are smooth.

The gingival sulcus (gum pocket) is the narrow space between the inner wall of the gum and the tooth. As gingivitis develops, the bacteria present in these pockets changes for the worse, and the accumulation of more bacteria, which release toxins, destroy gums.

In advanced gingivitis, there is plaque and calculus under the gums, moderate-to-severe redness of the gums, and the gum surfaces are irregular. Dental calculus is calcium phosphate and carbonate mixed with organic matter, while plaque is a collection of food, debris, bacteria, dead skin cells, and mucous that forms within 24 hours on clean tooth surfaces. The gum responds to plaque with an inflammation of blood vessels, swelling, and collagen loss.

More than 80 percent of pets aged three years or more have gingivitis. It develops earlier in life in toy breeds, and in general, affects dogs earlier in life than it does cats.

Symptoms and Types

• Red or swollen gums, especially on the side of the gum facing the inner cheeks

• Bad breath (halitosis)

• Variable amounts of plaque and calculus

Causes

Plaque accumulation is one of the main causes leading to gingivitis in dogs. Predisposing factors include:

• Old age

• Crowded teeth

• Soft food

• Open-mouth breathing

• Bad chewing habits

• Lack of oral health care

• Uremia and diabetes mellitus

• Autoimmune diseases

Diagnosis

Your veterinarian will perform a thorough physical exam on your dog, taking into account the background history of symptoms and possible conditions that might have led to this condition. You will need to give a thorough history of your dog's health and the onset of symptoms, such as when the bad breath began, what your dog typically eats, whether your dog has had trouble eating/chewing, and whether your dog has had any previous health conditions. The routine you have been using to keep your dog's teeth clean, if you have been using one, should be shared with your veterinarian as well, including the products you use.

Part of the physical exam involves closely examining your dog's mouth to identify the condition. Your veterinarian will then make an appointment with you to bring your dog in for a dental exam. During the dental exam, your dog will be anesthetized. Your veterinarian will check the depth of the gum pockets, the amount of plaque and bacteria on the surface of the teeth, and will pull any teeth that are rotten or that are too crowded. All of the plaque and calculus will be removed using a scaling process that is done with special dental equipment, and if necessary, root planning. The tooth surfaces will be polished and the teeth will be reexamined after cleaning.

Treatment

If teeth are overcrowded or baby teeth are present in an adult dog, your veterinarian may remove some teeth. Special dental tools will be used to remove all plaque and calculus, to polish the teeth, and rinse them. Your vet will then teach you how to clean your pet’s teeth, and appointments for follow-up examinations should be scheduled.

Living and Management

You can help maintain your dog’s oral health care by brushing or rubbing (with a special finger pad) its teeth once a day or at least twice a week with veterinary toothpaste. Your veterinarian may also give you a veterinary antibacterial solution to squirt on your pet’s teeth to decrease plaque build-up. Rawhide chew strips and specialized food recommended to you by your veterinarian can reduce tartar and improve the dog's oral health as well.

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Periodontal Disease and Treatment: Dental Scaling

According to the American Veterinary Dental Society (AVDS), Periodontal disease is the most common clinical disease seen in adult dogs and cats. At three years or older, dogs and cats begin to exhibit signs of periodontal disease. It is completely preventable and reversible in many cases, however, the more severe cases can only prevent further damage with the appropriate tailor-made treatments. In order to effectively prevent, treat, or slow down the destructive effects of periodontal disease, veterinarians need to ensure they are performing the most crucial step of dental scaling: subgingival curettage.

The impact of periodontal disease

Periodontal disease refers to gingival inflammation induced by the bacteria found in plaque and encompasses both gingivitis and periodontitis. Gingivitis refers to inflammation that extends only to the gingiva and not the surrounding periodontal structures. If treated, gingivitis is reversible. If untreated, it may lead to periodontitis as plaque migrates and calculus accumulates under the gingival margin. The proportion of anaerobic bacteria increases in subgingival plaque and triggers an inflammatory response that then destroys surrounding tissues, such as periodontal ligaments and alveolar bone. Destruction of these supportive tissues is permanent.

Periodontitis can have both local and systemic ramifications. Local manifestations include oral pain, periodontal abscesses, oronasal fistulas, osteomyelitis, and pathologic fractures. [include photos] Systemically, periodontal disease can lead to morphologic changes in the kidneys, heart, and liver.

Treatment of periodontal disease

The treatment for periodontal disease is a professional dental cleaning under general anesthesia and home care maintenance. Together, these methods help to remove plaque that triggers the inflammation responsible for damaging tissue.

Homecare

To remove superficial plaque, home care such as teeth brushing and antiseptic applications are great routine practices.

Vet care

Professional cleanings done by your vet removes mineralized plaque in the form of tartar and calculus from both below and above the gum line. The treatment of gingivitis is aimed at restoring the health of the gingiva and preventing the onset of periodontitis. Treatment of patients with periodontitis aims to prevent localized disease progression and the spread of disease to other teeth.

Periodontal probing

Before a dental cleaning, your vet will perform an oral exam. During this exam, a periodontal probe is used to measure the subgingival pockets. The probe is rounded with a blunt tip that has graduated markings that are gradually inserted at each point in the gingival sulcus. Patients with gingivitis have normal periodontal sulcus depths. However, patients with periodontitis have deeper probing depths than what is typical. The pathogenic periodontal pockets are a result after inflammation progressively destroys the periodontal ligament and causes the epithelial attachment to migrate toward the root’s apex. Vertical alveolar bone loss can also increase periodontal pocket depth.

Subgingival curettage

An integral step to the treatment of periodontal disease is the removal of plaque and calculus above and below the gingival margin. Once the subgingival surface remains free of plaque and debris, the sulcular epithelium can reattach to the tooth root. A failure to remove subgingival calculus will prevent reattachment and allow periodontitis to progress.

According to the American Veterinary Dental Society:

“The most critical part of a dental scaling procedure is scaling the tooth surfaces that are within the gingival pocket … where periodontal disease is active.”

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