PerioPearl for Veterinarians: Periodontal Disease in Pets and Oral Health Impacts on Total Body Health

Periodontal disease (PD) is the most common disease affecting pets, with a reported prevalence of at least 80% in dogs and 70% in cats over 3 years of age. PD is an inflammatory condition caused by the host's immune response to subgingival plaque bacteria. The earliest stage of PD is gingivitis, which is a reversible condition, but as it progresses further damage occurs to the periodontium (alveolar bone, cementum, periodontal ligament and gingiva). Bone and tissue damage results from the bacteria and their metabolic products as well as the inflammatory mediators produced by the host.  Without intervention, PD progresses and can result in sequelae including loss of tooth attachment, alveolar bone resorption, tooth loss, tooth root abscessation, mandibular fracture, and pain. The degree of plaque accumulation, the type of bacteria present, and the host’s immune response are factors in the pathogenesis of PD. (1,2,3,4)

Unfortunately, the impact of PD on a pet's health extends beyond the periodontium and can result in systemic effects.  Chronic PD induces increased vascular permeability allowing bacteria (mostly gram-negative anaerobes) and their toxic byproducts to migrate from periodontal tissues into the blood and lymph vessels and seed into distal organs. Moreover, PD provides a reservoir of inflammatory mediators and cytokines that migrate to and harm these organs (4,5,6).

It has been demonstrated that a cause-and-effect relationship exists between periodontal infection and organ damage (7,8). Human and animal studies have identified multiple organ systems that can be negatively impacted by PD including cardiovascular (myocardiosis, endocarditis, hypertension, atherosclerosis), renal, hepatic, joints (arthritis), pancreatic (pancreatitis, insulin resistance), pulmonary (pneumonia, COPD), and reproductive (infertility, low birth weight) (7,9,10,11).

Bacteremia associated with chronic PD is particularly harmful to the liver and kidneys as in the process of filtering the blood bacteria can populate these organs. In response, immune complexes form and further stimulate the production of bioactive mediators that cause organ damage (6). The inflammation associated with advanced PD also plays a major role in the adverse systemic effects associated with it. Elevated blood glucose levels during active PD are thought to be to be a result of low-level insulin resistance triggered by proinflammatory cytokines (7). Cardiac arrhythmias have also been linked to PD in a study that demonstrated that inflammatory changes in the atrial myocardium caused by periodontitis led to disturbances in the structural and electrophysiologic properties of the atrium and facilitated atrial fibrillation (12).

Multiple studies have confirmed that there is a direct correlation between the severity of PD and the level of internal pathology. Histopathologic research on dogs has demonstrated a relationship between the extent of PD and kidney disease (both glomerular and interstitial), liver parenchymal disease, fibrosed mitral heart valves and diseased myocardium (papillary muscle) (6,13). Another study on dogs demonstrated that for every square centimeter of PD burden in dogs there was a 1.4-times higher likelihood of greater changes being present in the left atrio-ventricular valves, 1.2 times higher likelihood for greater liver pathology, and 1.4 times higher likelihood for greater kidney pathology (9).

The risk of endocarditis was found to be six times higher for dogs with stage three PD (25% to 50% clinical attachment loss) compared to those with no PD (8). A study conducted on cats revealed that there are systemic markers associated with the severity of dental disease, and that these markers change with dental treatment, demonstrating that dental disease in cats has adverse systemic consequences (14). Treatment of periodontal infection was shown to result in a decrease in the acute-phase protein concentration, which supports the hypothesis that a cause-and-effect relationship exists between periodontal infection and distant organ changes (7).

Systemic damage associated with PD can be irreversible, so prevention is crucial. Regular dental care, including timely and effective management of PD, is crucial for pets’ overall longevity and well-being. There are two components to dental care: home care and veterinary dental care.

Home care is a struggle for many pet parents, so it is crucial to work with them and determine what approach is most likely to be successful. Daily brushing with a pet specific enzymatic toothpaste is the gold standard, but other alternatives include dental wipes, oral rinses, medicated dental chews, dental diets or water additives. Water additives in the past have not been very beneficial, but a new hyaluronic acid product called PerioPearls will be on the market soon and is highly effective. PerioPearls consists of a soluble tablet that is added to the water daily to improve the condition of the periodontium.

Professional veterinary dental care is key to the prevention of PD. Routine anesthetized oral examination, diagnosis and treatment of PD. The use of PerioVive, a hyaluronic acid gel, following dental procedures can double the rate and quality of oral tissue regeneration and repair and can dramatically decrease the progression of periodontal disease and associated organ damage.

References

1. Hendy E, Behery AE, Gomaa M, Abd El Raouf M, Ezzeldein SA. Overview of Periodontal Disease in Dogs and Cats. Journal of Veterinary Dentistry. 2026;0(0). doi:10.1177/08987564261424349

2. Lobprise, Heidi B., and Johnathon R. Dodd, editors. Wiggs’s Veterinary Dentistry : Principles and Practice. Second edition., Wiley Blackwell, 2019.

3. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005 Nov 19;366(9499):1809-20

4. Jiménez-Beato G, Machuca-Portillo G. Heart and periodontal diseases: does evidence exist of association? Med Oral Patol Oral Cir Bucal. 2005 May-Jul;10(3):215-20. English, Spanish. PMID: 15876964.

5. Scannapieco FA. Systemic effects of periodontal disease. Dent Clin North Am 2005; 49: 533–550.

6. DeBowes L J, Mosier D, Logan L, Harvey C E, Lowry S and Richardson D C (1996).

   Association of periodontal disease and histologic lesions in multiple organs from 45 dogs, J Vet Dent 13: 57-60.

7. Niedzielska I, Janic T, Cierpka S, et al. The effect of chronic periodontitis on the development of atherosclerosis: review of the literature. Med Sci Monit 2008; 14:103–106.

8. Glickman L T, Glickman N W, Moore G E, Goldstein G S and Lewis H B (2009). Evaluation of the risk of endocarditis and other cardiovascular events on the basis of severity of periodontal disease in dogs, J Am Vet Med Assoc 234 (4): 486-494.

9. Pavlica Z, Petelin M, Juntes P, Eržen D, Crossley DA, Skalerič U. Periodontal Disease Burden and Pathological Changes in Organs of Dogs. Journal of Veterinary Dentistry. 2008;25(2):97-105. doi:10.1177/089875640802500210

10. Harvey C. The Relationship Between Periodontal Infection and Systemic and Distant Organ Disease in Dogs. Vet Clin North Am Small Anim Pract. 2022 Jan;52(1):121-137. doi: 10.1016/j.cvsm.2021.09.004. PMID: 34838247.

11. Johnson, N. Periodontal Disease: Systemic Consequences in Wider Focus. Vet Times The website for the veterinary profession. 2011. https://www.vettimes.co.uk  

12. Yu G, Yu Y, Li YN, et al. Effect of periodontitis on susceptibility to atrial fibrillation in an animal model. J Electrocardiol. 2010 Jul-Aug;43(4):359-66. Epub 2009 Dec 29.

13. Rawlinson JE, Goldstein RE, Reiter AM, Attwater DZ, Harvey CE. 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 Mar 1;238(5):601-9. doi: 10.2460/javma.238.5.601. PMID: 21355802.

14. Cave NJ, Bridges JP, Thomas DG. Systemic effects of periodontal disease in cats. Vet Q. 2012;32(3-4):131-144.