Periodontal disease in dogs is extremely common. According to the Cornell University College of Veterinary Medicine, up to 90% of dogs over the age of 3 years already have periodontal disease. Not only is this disease painful for your pup, but it will also result in losing teeth over time. It also can lead to damage to other parts of the body.
But what exactly is periodontal disease, and what can we do about it?
What Is Periodontal Disease in Dogs?
Periodontal disease is a complicated process involving everything in the mouth, from saliva to bacteria to the jawbone. Below, we will discuss the process, the stages of the disease, and the treatment options.
Letting periodontal disease go without treatment results in chronic pain, which may not resolve with treatment of the affected teeth. Treating sooner rather than later will help minimize the risk of chronic pain, tooth loss, and systemic disease.
While reading, remember that it is always easier, less expensive, and less painful for your pup to prevent disease or treat it early than to fix it late in the disease process. We can’t completely prevent disease, but routine home care and regular check-ups with your veterinarian can go a long way toward preventing severe disease and tooth loss over time.
Basics of Periodontal Disease
The first thing you need to know to understand periodontal disease is some basic dental anatomy.
Dog Teeth
The teeth are attached to the jaw by the periodontal ligament, which is only 1-2 millimeters long. The gingiva, or gums, cover the outside of the bone and a small part of the teeth, protecting the periodontal ligament and bone from injury and infection.
Difference Between Dental Disease and Periodontal Disease
Your veterinarian can evaluate dental disease while your pup is awake and is probably already checking on it during their wellness visits. Periodontal disease affects tissues that are not visible to the naked eye and so requires tools such as a periodontal probe, which measures the space between the teeth, gums, and jawbone, and dental X-rays to evaluate.
Affects the Bones in the Jaw
Once the bone is damaged, your pup is at a much higher risk of breaking their jaw than they should be. A fracture is most likely to occur when chewing on hard objects such as antlers or hooves, but it can also happen with much gentler activities such as playing with rope toys or even eating their regular food.
Increase the Risk of Damage to Other Organs
Chronic inflammation due to periodontal disease has been shown to have numerous effects on the body, but there is also a risk of bacteria finding their way into the bloodstream. From there, they can access all sorts of places in the body and cause damage to organs such as the heart, lungs, liver, and kidneys.
Stage One Periodontal Disease
Stage one periodontal disease in dogs is as healthy as they get; there is no stage zero. At stage one, there is plaque on the teeth, possibly some tartar buildup, and mild gingivitis, but the periodontal ligament and bones are still healthy.
Plaque
Plaque is a sticky film that forms on the surfaces in the mouth, most noticeably on the teeth. It forms when the bacteria in the mouth produce biofilm, a mixture of proteins and mucous that help protect the bacteria from the environment and immune system. Plaque may not be readily visible.
Tartar
As plaque interacts with the minerals in saliva, mainly calcium, it turns into tartar, which is also called calculus. Tartar is hard and varies in color from white to yellow to brown. It requires much more effort to remove from the surface of the teeth than plaque does.
Gingivitis
The medical term for your dog’s gums is gingiva, so gingivitis describes inflammation of the gums. This inflammation occurs due to irritation and infection of the gums from the bacteria in the mouth, usually associated with biofilm buildup. In the early stages, gums will appear a brighter pink than usual and may be slightly puffy. As gingivitis progresses, the gums will turn bright red, be visibly swollen, and will bleed easily from everyday activities such as eating and drinking.
Stage Two Periodontal Disease
In stage two periodontal disease in dogs, plaque, tartar, and gingivitis are worse than in stage one. The gingivitis has begun to affect the periodontal ligament, but less than 25% of the attachment between the teeth and the jawbone has been lost. At this point, the teeth are beginning to be painful.
Periodontal Ligament Damage
As gingivitis worsens, the bacteria in the mouth can reach the periodontal ligament. Since this ligament is supposed to be protected, it does not have great defenses against bacterial invasion. In addition, the ligament is trapped between two very hard tissues.
When inflammation occurs, tissue usually swells away from hard surfaces. However, the periodontal ligament has no room for this, so the pressure created causes pain. This pressure on the ligament and bone results in the death of these tissues. When the ligament dies, the tooth loses its attachment to the bone.
Stage Three Periodontal Disease
In stage three periodontal disease in dogs, 25-50% of the periodontal ligament attachment has been lost. Your dog’s teeth will be painful by stage three. Your veterinarian may recognize signs of gingival recession on examination of your dog’s mouth, and some teeth may be visibly loose.
At this stage, the true severity of periodontal disease is difficult to evaluate on an awake examination. The teeth are often so covered in tartar that only the tips can be seen, and it is impossible to evaluate the area where they meet the gums without first cleaning them.
Gingival Recession
Gingival recession is the medical term for when the gums begin to pull back from their normal position in the mouth. It is a sign that the bone underneath the gums has died, in addition to losing the periodontal ligament. The gums only attach to the tooth a few millimeters above where the bone ends, so bone loss also results in the gums disappearing.
Stage Four Periodontal Disease
At this stage, your pup’s teeth are loose, painful, and may fall out due to everyday activities such as eating. They may even struggle to eat due to the pain. There is greater than 50% loss of the periodontal ligament in addition to all the signs from stages one through three.
What Causes Periodontal Disease in Dogs?
All dogs will have some periodontal disease throughout their lifetime, so the real question is why it is worse in some dogs than others. Periodontal disease in dogs is a complex interaction of several factors. Let’s talk about a few of them.
Genetics
Genetics is the number one factor determining how severe your pup’s periodontal disease will be. Which types of bacteria survive in your dog’s mouth depends on things like the pH and mineral content of their saliva and the effectiveness of their immune system. These characteristics are mostly determined by their genes, with a small environmental influence.
In addition, some breeds seem particularly predisposed to severe dental disease. Greyhounds, Miniature Schnauzers, Yorkshire Terriers, and Dachshunds are all well-known by veterinarians to have bad teeth and need earlier and more frequent care.
Conformation
Conformation is a technical term referring to how your dog is shaped. Regarding dental disease, small-breed dogs and flat-faced dogs are more likely to have severe disease. This is because they have less room for teeth in their mouths than they should. The teeth crowded together in these small mouths create more and better places for bacteria to hide. Bacteria creating homes for themselves is the start of periodontal disease.
Diet
The type of food you provide your dog may have a significant effect on their oral health. Dry food with large kibble that needs to be chewed before it can be swallowed will physically remove plaque from the surface of the teeth in a way that moist food does not. Some kibbles are specially formulated with coatings that enhance this effect or contain ingredients that bind calcium in the saliva, which helps slow plaque turning into tartar. Ask your veterinarian about the best food option for your pup’s oral health.
Lack of Home Care
We will discuss the various options for home care later when discussing the prevention of periodontal disease. For now, recognize that not performing routine dental care at home is an extremely common cause of periodontal disease in dogs.
General Health
Certain systemic diseases can increase the risk of periodontal disease. Anything that causes suppression of the immune system, such as adrenal gland disease or diseases of the immune system, may cause periodontal disease to worsen more quickly than it would otherwise. Other diseases that affect the health of the tissues lining the mouth, such as kidney disease, may allow bacteria to take hold faster than usual.
Age
Just like in humans, periodontal disease in dogs worsens as they age. This is because tissue health generally decreases, and older pets’ immune systems weaken. As mentioned above, certain diseases that are more common in older pets can also increase the risk of periodontal disease as your pup gets older.
Signs of Periodontal Disease in Dogs
There are a lot of different signs of periodontal disease in dogs. Which ones you notice depend on not only the stage of the disease but also the specific problems your dog has and how you interact with them. For example, you will notice bad breath sooner if your dog loves kissing your face. You may need to get in the habit of purposefully looking at your dog’s mouth and teeth to be sure you notice the early signs of periodontal disease. Here are some things to look for:
- Gums that are bright pink or red
- Gums that look puffy or rough instead of smooth and shiny
- Bad breath (also called halitosis)
- Teeth that appear dull or rough (this could be either tooth damage or plaque)
- White, yellow, or brown areas on teeth (usually worst along the gums)
- White or pale green pus along the gum line
- Holes in the gums
- Roots of the teeth showing
- Bleeding gums
- Dropping food
- Chewing food with head turned to the side
- Not chewing on toys like they used to
- Loose or missing teeth
- Teeth that are connected to each other by tartar
- Hair or fur stuck in the gums or between teeth
- Drooling or excessive lip-licking
- Pawing at the mouth or rubbing their face on the floor or other surfaces
How to Treat Periodontal Disease in Dogs
Periodontal disease in dogs always requires the help of a veterinarian. Just as humans go to the dentist regularly, even when taking care of their teeth every day at home, dogs need the help of a veterinarian to maintain their oral health properly.
Some people may offer services they call teeth cleanings, but these are not the same as a cleaning performed by a veterinarian. These services may be brushing your dog’s teeth or even performing what are sometimes called anesthesia-free dental cleanings. Still, they cannot properly evaluate and treat periodontal disease without anesthesia.
Veterinary Care
Veterinary treatment of periodontal disease in dogs starts with what is commonly called a dental cleaning. You may also hear this called a dental prophy, dental prophylaxis, or a COHAT. COHAT stands for Complete Oral Health Assessment And Treatment. Below, we will go over the parts of this procedure.
What is included in these procedures can vary, so discuss what you can expect for your pup with your veterinarian. Like most things, the more severe the disease, the more expensive the treatment. A COHAT for a dog with stage one disease will be much less expensive than one with stage three, which requires more advanced procedures and numerous extractions.
Anesthesia
While humans often have dental work performed while they are awake, this is not possible in veterinary medicine. We cannot explain what we are doing to our dogs and expect them to understand at a level where they would not close their mouths while we are working. They must be asleep to evaluate the insides of the teeth and reach the teeth at the back of the mouth. This is done most safely with full anesthesia so that we can prevent inhalation of the water or products used during a COHAT.
Tooth Scaling
Scaling of the teeth in dogs is the same procedure performed on humans by their dentist, using almost exactly the same equipment. Plaque and tartar are removed from the surface of the teeth using hand scalers and ultrasonic scalers, allowing the teeth to be evaluated and treated without obstruction.
Tooth Polishing
After scaling, your veterinarian will polish the teeth. Again, this is exactly the same as what human dentists do. All surfaces of the teeth are polished to remove microscopic scratches that occur during scaling. If left alone, these scratches would provide extra places for bacteria to grab hold and start the dental disease process again, even faster than before.
Examination
Your veterinarian will examine your dog’s teeth and identify noticeably loose teeth, gingivitis or gingival recession, and signs of abscesses, such as bulges or holes in the gums. They will also check for masses and other signs of disease in the mouth.
Periodontal Probing
Human dentists also perform periodontal probing, though most people aren’t aware of it. A periodontal probe measures the pocket between the teeth and the gums. The pocket’s normal size varies with the dog’s size and teeth, but larger-than-normal pockets indicate periodontal disease at stage two or above.
Dental Radiographs
Dental radiographs are recommended but are not considered standard of care in all locations, so talk to your veterinarian about whether they offer these and when they perform them. Radiographs allow your veterinarian to look at the tooth and the bone underneath the gumline, which cannot be done any other way. They are used to further characterize periodontal disease, identify abscesses, locate other types of disease in the bone, and determine which teeth need to be extracted.
Extractions
Unfortunately, extraction of the affected tooth is usually the recommended treatment for periodontal disease at stages three and above. These teeth are loose and painful and are unlikely to heal without intense care. Teeth at stage two are often left in the mouth with the hope that some of the bone will regrow. However, without appropriate home care, they will likely need to be extracted in another year or two.
Subgingival Scaling or Root Planing
These are slightly more advanced dentistry procedures that your veterinarian may or may not perform. They involve removing tartar from the affected tooth’s root and may require surgery to expose the root to complete the procedure.
Advanced Dentistry
Advanced dentistry techniques include root canals, bone grafts, and orthodontics. These will generally require a referral to a board-certified veterinary dentist.
Home Care
Regardless of your pup’s periodontal disease stage, they will require home care following their veterinary care. Just as humans brush their teeth daily and still need professional cleanings, home care will help minimize your dog’s periodontal disease but won’t completely stop it from happening. We will discuss the various options for home care in the next section, but always follow your veterinarian’s specific recommendations after dental procedures.
How to Prevent Periodontal Disease in Dogs
As mentioned above, there is no way to completely prevent periodontal disease in dogs. It also cannot be treated solely with home care. However, there are many things you can do to help minimize periodontal disease in dogs. Using products approved by the Veterinary Oral Health Council, or VOHC, will have the most beneficial effects. Taking care of your dog’s teeth will help keep them healthy, happy, and pain-free throughout their life. Let’s talk about the most common options!
Teeth Brushing
Brushing daily using VOHC-approved toothpaste is the number one way to maintain your dog’s oral health. Brushing helps remove plaque before it hardens, and many toothpastes contain enzymes that help eat away at plaque even after you finish brushing.
When you first start brushing your dog’s teeth, they probably won’t enjoy it. Be gentle in handling their mouth, and consider using a finger brush so you can feel what you’re doing. A small, soft toothbrush designed for dog teeth is fine, but you’re more likely to accidentally push too hard with it than when using your finger.
You may notice your pup’s gums bleeding when you first start brushing. As long as the bleeding is mild and stops quickly, don’t let this stop you. Unhealthy gums will bleed, but leaving them alone to continue being unhealthy won’t solve the problem. If you are worried about the amount of bleeding, talk to your veterinarian right away.
Start with very short sessions where you wipe some toothpaste on their teeth and let them walk away. Giving a treat afterward might help with training, but it also might remove the toothpaste before the enzymes can work. Instead, use toothpaste in a flavor that your dog likes. Beef or chicken-flavored toothpaste sounds terrible to me, but your dog will probably love it!
Tooth Wipes
If your dog won’t tolerate brushing their teeth, consider using wipes instead. These often have the same ingredients as toothpaste, but it may be easier to take a quick swipe instead of scrubbing away.
Diet
As mentioned above, certain diets are better for oral health than others. Kibble is generally better than moist food, but the real advantages come from feeding a specially formulated dental diet. Talk to your veterinarian about the best options for your pup.
Toys
There is a wide variety of toys that advertise dental health benefits. Some remove plaque as your dog chews on them, and others claim to floss your dog’s teeth using rope toys. While nothing is wrong with these toys, they won’t be very beneficial if they are your pup’s only dental care at home.
Home Checks
Making sure your pup is used to having their mouth handled will help with brushing their teeth and looking at their mouth. Routine checks at home will help you know what is normal for your pup and also help you find early signs of periodontal disease.
When to See a Vet For Gum Disease
It is always best to treat periodontal disease early to avoid chronic pain, tooth loss, and to limit the risk of systemic disease. Because periodontal disease is often worse under the gum line than it initially appears, discussing dental care with your veterinarian at every well visit and as soon as you notice signs of gum disease at home is recommended. In particular, have your pup seen by your veterinarian if you notice:
- Persistent bad breath
- Visible tartar on the teeth
- Gums that are bright pink, red, swollen, or appear to have a rough texture
- Bleeding gums, blood in food or water bowls, or blood on toys after chewing
- Difficulty eating or rubbing their face
Final Thoughts on Periodontal Disease
While periodontal disease is incredibly common, it is also a disease with numerous treatment options. Preventing advanced periodontal disease is key to keeping your pup happy, healthy, and pain-free throughout life. You can do this with routine home and veterinary care, performing home checks on your dog’s oral health, and working with your veterinarian as soon as you notice signs of disease.
FAQs
What does gum disease look like in dogs?
Gum disease can be as mild as slightly puffy, bright pink gums or as severe as visibly loose teeth with blood and pus coming from holes in the gums. There are many stages in between these extremes.
How can I treat periodontal disease in dogs at home?
Treating periodontal disease always requires working with your veterinarian. To minimize the veterinary care your dog will need, you can brush their teeth daily, provide dental treats, feed a dental diet, and check on their teeth yourself to know when problems arise.
What is the cost of periodontal disease treatment in dogs?
The cost of treating periodontal disease varies greatly. Dogs with stage one disease who only need a professional cleaning and good home care will cost much less than those with stage three or four, who will need numerous extractions and possibly advanced dental procedures. Schedule an appointment with your veterinarian to get an estimate for your pup’s care.
How do I prevent periodontal disease in my dog?
While periodontal disease is not entirely preventable, routine home care such as brushing and regular veterinary dental cleanings to stay ahead of the disease will significantly decrease the risk of advanced periodontal disease throughout your dog’s life.
Why do my dog’s gums bleed while brushing?
Bleeding gums when you brush your dog’s teeth is a sign of early periodontal disease. When the gums are unhealthy, they bleed more easily, which may be the first visible sign of gum disease in your dog. Continue brushing and consult with your veterinarian to determine what additional steps you should take.
