Many factors contribute to this problem including diet, age, genetics, conformation, and general overall health. As a rule, animals that eat soft food tend to have more periodontal disease problems than animals that eat the hard type of food. Older animals have more problems than younger animals. Some animals seem to be predisposed to periodontal disease, especially in pure breed dogs and cats. Animals with crowded teeth and especially small breed dogs have more problems with periodontal disease than large breed dogs or those dogs with lots of room between their teeth. Animals with other problems, such as diabetic animals, may have more periodontal disease problems than animals that are otherwise healthy.

	Canine		Feline
					Stage I Gingivitis Margin of attached gingiva (gum) is inflamed and swollen. Plaque covering teeth. Radiographically, there is no change from healthy periodontium. Stage 1 can appears two to four days after plaque accumulation in previously healthy gingiva.  The condition is reversible with treatment.
					Stage II Early Periodontitis Entire attached gum is inflamed and swollen. Mouth is painful and odor begins to be noticeable. Stage 2 is similar to the early stage in that it is still reversible; there is an increase in inflammation including edema and subgingival plaque development. Amounts of supragingival plaque and calculus are increased. Radiographically, there is little noticeable change. Professional treatment and home dental care can prevent this from becoming irreversible.
					Stage III Moderate Periodontitis Cherry red and bleeding attached gum is being destroyed by infection and calculus (tartar). Sore mouth affects eating and behavior. Bad breath is present.  In Stage 3, there is a moderate loss of attachment or moderate pocket formation with 10–30% loss of bone support.  The gingiva will bleed upon gentle probing at this stage. Radiographically, subgingival calculus may be visualized and a rounding of the alveolar crestal bone at the cervical portion of the tooth can be seen upon careful examination.  May be irreversible.
					Stage IV Advanced Periodontitis Chronic bacterial infection is destroying the gum, tooth and bone. Bacteria may be spreading throughout the entire body via the bloodstream and may damage the kidneys, liver and heart.

 The clinical signs of periodontal disease includes red gums, foul mouth odor, difficulty chewing (from oral pain), moderate to heavy dental calculus (tarter), and tooth loss. In small breed dogs advanced periodontal disease will cause the jaw to break because of bone loss from the disease. Besides the obvious oral problems periodontal disease may contribute to other health problems such as heart disease and kidney disease.

The best treatment for periodontal disease is prevention. Companion animals with crowded teeth should have them removed early in life. Proper diets should be fed that includes hard "biscuits" and is nutritionally balanced. Clearly bones or other extremely hard objects should not be given to dogs or cats otherwise there is a great risk of breaking teeth. Oral maintenance (tooth brushing) should be started early in life BEFORE periodontal disease has a chance to start. And finally, companion animals should have their first dental prophylaxis (teeth cleaning) by three years of age. The more advanced the periodontal disease the greater the risk of complications and tooth loss. Just like with people, these problems can be prevented.

Therapy of periodontal disease
Periodontal care includes supragingival and subgingival scaling, application of local medication, bone graft implants, periodontal flap surgery, extraction and home care.

Stage 1 gingivitis care includes thorough supra and subgingival teeth cleaning and polishing, followed by daily brushing. Gingivitis will usually resolve within weeks of the oral hygiene visit.

Stage 2 early periodontal disease, where minimal to moderate pockets are diagnosed, can be treated similarly to stage 1 disease +/- root planing, +/- local administration of an antibiotic (LAA).

Doxirobeª Gel (Pfizer) contains a flowable biodegradable solution of 8.5% doxycycline hyclate, which is applied subgingivally to cleaned periodontal pockets greater than 3 mm in dogs older than 1 year.

         
Image 1: Drawing of periodontal pocket before antibiotic insertion.


Image 2: Local antibiotic administered.

Upon contact with the gingival crevicular fluid or water, the doxycycline polymer hardens within the periodontal pocket. The application allows sustained release of antibiotic for several weeks at the site of injection. The gel gradually biodegrades to carbon dioxide and water. The antibiotic is not a substitute for scrupulous pocket debridement and other periodontal procedures (Images 1 and 2.)

Doxirobe allows direct treatment of localized periodontal disease.

• Is bacteriostatic against Porphyromonas gingivalis, Prevoltella intermedia, Camphylobacter rectus, and Fusobacterium nucleatum, which are associated with periodontal disease.
• Inhibits collagenase enzymes, which are destructive to the periodontal attachment apparatus.
• Directly binds to dentin and cementum for prolonged release.
• Decreases edema and inflammation, and promotes growth of junctional epithelium resulting in decreased pocket depth.
• Helps rejuvenate tissues of the periodontium (LAA does not regenerate lost tissue).