STAGES OF DENTAL DISEASE

Dental disease doesn't just appear out of nowhere. There's a recognized progression that leads from healthy teeth all the way to serious dental disease.

PRE-PLAQUE PHASE

Before plaque can appear on teeth, it needs something to attach to. This something is called the dental (or acquired) pellicle. The dental pellicle is a sticky material formed from salivary glycoproteins, substances present in normal saliva . These glycoproteins attach tightly to the teeth and provide an ideal surface for bacteria. Bacteria present in the mouth attach to the dental pellicle and set the stage for the next step in dental disease.

PLAQUE FORMATION

The next stage is the formation of plaque. Plaque can be defined as "a soft, granular amorphous deposit containing a milieu of bacteria." Put more simply, plaque is a (relatively) soft, sticky substance that builds up on teeth and can contain many different types of bacteria.

PLAQUE EVOLUTION

The longer plaque stays around, the more of a problem it becomes. For people, daily brushing and flossing is important to keep plaque buildup under control. Unfortunately, pets don't brush their teeth (unless we do it for them), so plaque can stay in place and begin to change. Over time, plaque collects several different substances:

Organic materials

• epithelial (skin) cells
• white blood cells
• macrophages (a type of inflammatory cell)
• carbohydrates
• fats
• polysaccharides (sugars)
• proteins

Inorganic materials

• calcium
• phosphorus

Bacteria

• gram positive cocci - the type of bacteria that appears early; a good example of this type is Staphylococcus, which is a normal skin bacteria
• gram negative rods - the type of bacteria to appear later; a good example of this type is E. coli, which is well known for causing serious (sometimes fatal) infections
• spirochetes - these also appear later, and are similar to bacteria that can be found inside of the intestines

TARTAR FORMATION

As plaque accumulates all of these materials, it begins to harden, or mineralize. Mineralized plaque is called tartar, or calculus. Tartar is too strong and firmly attached to be removed by brushing. There are 2 types of tartar:

• supragingival ("above the gum") - this is the tartar you see, which is brownish-tan or yellow, brittle, and easier to remove (sometimes it "cracks," or snaps off)
• subgingival ("below the gum") - this is the tartar you don't see, which is hidden under the gum; it's black and very strongly attached to the tooth; if it's not removed (usually with an ultrasonic scaler), it can lead to tooth loss

GINGIVITIS

Gingivitis is irritation of the gum tissue, which can result in red and swollen gums, pain, and bleeding. It's often a direct result of tartar buildup, which causes distortion of the normal gum tissue, food retention, and further plaque and tartar buildup. Bacteria also plays a part. Fortunately, gingivitis can usually be reversed by cleaning the teeth to remove the tartar.

PERIODONTITIS

Periodontitis, or periodontal disease, is the final stage of dental disease. It's a result of the inflammation associated with gingivitis spreading to the rest of the tooth and surrounding bone. The changes of periodontitis are permanent, and lead directly to tooth loss.

BACTERIAL INFECTIONS

The bacteria that are present as a result of dental disease can easily enter the bloodstream and make its way to internal organs. Some direct effects of bacteria originating from dental disease include:

• Heart disease
• Kidney problems
• Liver problems
• Lung and respiratory problems

These infections and complications tend to be more common with advanced dental disease, but can potentially occur at any stage.

The next page will show some examples of dental disease:

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