Immunohistochemical evaluation of suspected oral malignant melanoma in cats.

Oral malignant melanoma (OMM) is considered the third most common oral malignant neoplasm in cats, but its variable morphology and frequent lack of melanin pigment make it a diagnostic challenge. Twenty-two cases of cats with malignant oral neoplasms that were diagnosed as OMM or listed OMM as a suspected differential diagnosis on the biopsy report were examined using an immunohistochemistry (IHC) panel for S100, melan-A, PNL2, laminin, CD34, and pan-cytokeratin. Although OMM was suspected (n = 14) or previously diagnosed (n = 8), only 2 cases were immunohistochemically confirmed as OMM. Seven cases were classified as soft tissue sarcoma based on positive expression of CD34 or laminin, and one was classified as carcinoma based on positive expression of pan-cytokeratin. The majority of cases (n = 12) were categorized as unclassified malignant neoplasms because they did not express melan-A, PNL2, laminin, CD34, or pan-cytokeratin; however, a proportion of these did express S100 (n = 7). Long-term prognosis of all 22 cats was poor, with a median survival time of 87 days (range = 2-249 days). Cases with longer survival times (>100 days) were treated with surgery, radiation therapy, or a combination. For feline oral malignant neoplasms thought to be OMM, routine use of IHC is required for an accurate diagnosis.

Management and Outcome of Maxillofacial Trauma in a 9-Week-Old Dog.

This case report describes diagnosis, treatment, and outcome of maxillofacial trauma in a 9-week-old shih tzu. In addition to an open left mandibular body fracture and a right condylar process fracture, there were several relatively stable and minimally displaced right maxillary fractures. The torn soft tissues associated with the left mandibular body fracture were sutured closed, and a tape muzzle was placed. Due to sufficient fracture healing at the 2-week recheck examination, the tape muzzle was removed. The 6-week reexamination confirmed continued healing and recovery. Anesthesia was performed at the 5.5-month reexamination when the dog was 8 months old, revealing the presence of persistent deciduous teeth, linguoverted, malformed, and partially erupted permanent teeth, and asymmetric skeletal malocclusion (in addition to the breed-specific mandibular mesioclusion). Persistent deciduous teeth and linguoverted and malformed permanent teeth were extracted to allow for normal opening and closing of the mouth without traumatic occlusion. Long-term follow-up is recommended in juvenile dogs with maxillofacial injuries in order to prevent, recognize, and treat dental complications resulting from the trauma.

Assessment of Temporary Crown Extensions to Correct Linguoverted Mandibular Canine Teeth in 72 Client-Owned Dogs (2012-2016).

A search of the medical and dental records at Evidensia Lørenskog Dyreklinikk, in Lørenskog, Norway, was conducted to identify dogs that received temporary crown extensions (TCEs) to correct linguoverted mandibular canine (LMC) teeth over a 54-month investigation period (2012-2016). Criteria for inclusion into the study were the presence of complete medical and dental records, pre- and postoperative clinical photographs and intraoral radiographs of the affected canine teeth, adequate information pertaining to the procedures performed, and at least 1 follow-up >3 months after appliance removal. Seventy-two dogs with LMC teeth were treated with TCE. Thirty-nine breeds were represented in this study. Mean age at the time of appliance installation was 6.4 (range, 4.7-13.4 months [median, 5.9 months] months). Fifty-three (73.6%) dogs presented with class I malocclusion, 14 (19.5%) dogs with class II malocclusion, and 5 (6.9%) dogs with class III malocclusion. Twenty-five (34.7%) dogs were considered to have mild, 32 (44.4%) dogs to have moderate, and 15 (20.8%) dogs to have severe mandibular canine malocclusion. The TCE was combined with other treatment modalities (active orthodontics, extraction of nonstrategic teeth, gingivectomy, and inclined bite plane and ball therapy) to correct mandibular canine tooth malocclusions in 19 (26.4%) dogs. Fractured or detached crown extensions were seen in 9 (12.5%) dogs. Soft tissue ulceration or inflammation was seen in 7 (9.7%) dogs. The mandibular canine teeth occlusion resolved completely with self-retaining, functional, nontraumatic occlusion in 56 (77.8%) dogs. Fifteen dogs (20.8%) resolved with functional, nontraumatic occlusion, but the mandibular canine teeth were too short to be perfectly self-retained, thus left with 1- to 2-mm crown extensions for permanent retention. In 1 (1.4%) dog, both mandibular canine teeth relapsed almost back to original position. The results show that TCE is a viable treatment option to correct LMC teeth in young dogs.

Morphologic and Morphometric Description of the Temporomandibular Joint in the Domestic Dog Using Computed Tomography.

The temporomandibular joint (TMJ) in the domestic dog is a synovial joint with 2 articular surfaces, the mandibular fossa of the squamous portion of the temporal bone and the articular head of the condylar process of the mandible. Although different diagnostic imaging techniques have been used to study the TMJ in dogs, morphologic and morphometric studies based on computed tomography (CT) are scarce. The purpose of the present study was to describe the morphologic and morphometric features of the TMJ in domestic dogs using CT. Width and depth of the mandibular fossa and 2 different angles between the mandibular fossa and the condylar process were measured in 96 TMJs of 48 dogs of different breeds (Labrador retriever, German shepherd, cocker spaniel, boxer, English bulldog, pug, shih tzu, and Cavalier King Charles spaniel). Temporomandibular joint conformation differed between breeds. Mid- and small-sized dogs had mandibular fossae that were more shallow, less developed retroarticular processes, and irregularly shaped condylar processes. The TMJs were more congruent in large dogs, presenting with deeper mandibular fossae, prominent retroarticular processes, and more uniform condylar processes. The measurements proposed in this study demonstrated 3 different morphologic conformations for the TMJ in the dogs of this study.

Protein tyrosine phosphatase 1B is a key regulator of IFNAR1 endocytosis and a target for antiviral therapies.

Type 1 interferons (IFN1) elicit antiviral defenses by activating the cognate receptor composed of IFN-α/ß receptor chain 1 (IFNAR1) and IFNAR2. Down-regulation of this receptor occurs through IFN1-stimulated IFNAR1 ubiquitination, which exposes a Y466-based linear endocytic motif within IFNAR1 to recruitment of the adaptin protein-2 complex (AP2) and ensuing receptor endocytosis. Paradoxically, IFN1-induced Janus kinase-mediated phosphorylation of Y466 is expected to decrease its affinity for AP2 and to inhibit the endocytic rate. To explain how IFN1 promotes Y466 phosphorylation yet stimulates IFNAR1 internalization, we proposed that the activity of a protein tyrosine phosphatase (PTP) is required to enable both events by dephosphorylating Y466. An RNAi-based screen identified PTP1B as a specific regulator of IFNAR1 endocytosis stimulated by IFN1, but not by ligand-independent inducers of IFNAR1 ubiquitination. PTP1B is a promising target for treatment of obesity and diabetes; numerous research programs are aimed at identification and characterization of clinically relevant inhibitors of PTP1B. PTP1B is capable of binding and dephosphorylating IFNAR1. Genetic or pharmacologic modulation of PTP1B activity regulated IFN1 signaling in a manner dependent on the integrity of Y466 within IFNAR1 in human cells. These effects were less evident in mouse cells whose IFNAR1 lacks an analogous motif. PTP1B inhibitors robustly augmented the antiviral effects of IFN1 against vesicular stomatitis and hepatitis C viruses in human cells and proved beneficial in feline stomatitis patients. The clinical significance of these findings in the context of using PTP1B inhibitors to increase the therapeutic efficacy of IFN against viral infections is discussed.

Assessment of 68 Prosthodontic Crowns in 41 Pet and Working Dogs (2000-2012).

A search of the medical and dental records at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania was conducted to identify dogs that received full or partial prosthodontic crowns over a 13-year period (2000-2012). Forty-one dogs with a total of 68 prosthodontic crowns were identified. Further criteria for acceptance into the study included presence of complete medical records containing adequate information pertaining to the procedures performed, and current follow-up either by telephone, electronic mail, or via in-person examination. Treatment was considered to be successful when the prosthodontic crown was in place and there was no further structural injury to the tooth upon making contact with the client or at the time of death of the dog confirmed by the client. The mean number of days the prosthodontic crowns remained in place without further injury to the tooth was 1,598 (range, 161-4, 464 days [median, 1,414 days], standard deviation 1,093 days). Bond failure between the cement and the tooth or the cement and the prosthodontic crown occurred in 3 cases (4.4%). Fracture of the prosthodontically treated tooth occurred in an additional 7 cases (10.3%). Treatment was classified as successful in 58 cases (85.3%). The results suggest that prosthodontic crown therapy is a successful, practical, and durable treatment option for protection of previously injured teeth in pet and working dogs.

Computed tomographic characteristics of odontogenic neoplasms in dogs.

Odontogenic neoplasms are locally invasive oral tumors in dogs. The purpose of this retrospective study was to describe CT characteristics for varying histopathologic types of canine odontogenic neoplasms. A board-certified veterinary radiologist who was unaware of histologic findings reviewed and scored imaging studies. A total of 29 dogs were included in the study. Twenty-three of these dogs had concurrent dental radiographs. The most common CT characteristics for all tumor types were a direct association with or in the region of multiple teeth in 96.4% (27/28), contrast enhancement in 96.3% (26/27), alveolar bone lysis in 93.1% (27/29), and mass-associated tooth displacement in 85.2% (23/27). Mass-associated cyst-like structures were identified in 53.6% (15/28) and were only present in tumors containing odontogenic epithelium. Canine acanthomatous ameloblastomas (n = 15) appeared as extra-osseous (10/15) or intra-osseous (5/15) masses. Intra-osseous canine acanthomatous ameloblastomas were more likely to have mass-associated cyst-like structures and were subjectively more aggressive when compared with extra-osseous canine acanthomatous ameloblastomas. Amyloid-producing odontogenic tumors (n = 3) had subjectively uniform CT imaging characteristics and consisted of round soft tissue and mineral attenuating masses with multiple associated cyst-like structures. Fibromatous epulides of periodontal ligament origin (n = 4) were contrast enhancing extra-osseous masses that were rarely referred for CT examinations and 25% (1/4) were not visible with CT. Other odontogenic tumors were less represented or had more variable CT imaging characteristics. Mass-associated tooth destruction was appreciated more often with dental radiographs and extra-oral tumor extension was identified more often with CT.

Assessment of apical periodontitis in dogs and humans: a review.

Veterinary dentists commonly encounter apical periodontitis in dogs. An overview of the disease is presented, concentrating on pathogenesis and mechanisms of healing. Assessment modalities are reviewed and interpretations of treatment success and failure are discussed. The limitations of readily available diagnostic equipment are illustrated. The benefits of identifying the causative agent and resultant pathosis should not be overlooked. Well-designed clinical studies evaluating various methods of long-term follow-up for apical periodontitis in dogs are needed.

Use of a barrier membrane to repair congenital hard palate defects and to close oronasal fistulae remaining after cleft palate repair: seven dogs (2019-2022).

OBJECTIVE: To describe the use of a barrier membrane in dogs for repair of congenital hard palate defects and closure of oronasal fistulae (ONF) remaining after previous cleft palate (CFP) repair. ANIMALS: 7 client-owned dogs. METHODS: The hard palate defect was closed with medially positioned flaps (Von Langenbeck technique) or pedicle flaps (2-flap palatoplasty) and a membrane composed of autologous auricular cartilage from the pinna or allogenous fascia lata underlying the mucoperiosteal flaps. RESULTS: All palate defects were considered to have a high risk of dehiscence based on their type and size and the characteristics of the surrounding tissue. The barrier membrane was used in 5 dogs for repair of congenital hard palate defects and in 2 dogs for closure of ONF remaining after previous CFP repair. Resolution of clinical signs occurred in all cases. Complete success (ie, complete closure of the palate defect and absence of clinical signs) was achieved in 5 dogs (4 with congenital hard palate defects and 1 with an ONF remaining after previous CFP repair). The persistent ONF in 1 dog with functional success (incomplete closure, but no clinical signs) was smaller than prior to surgery. CLINICAL RELEVANCE: Barrier membranes underlying mucoperiosteal flaps may constitute an alternative technique in dogs for repair of congenital hard palate defects and closure of ONF remaining after previous CFP repair.

Polyamine inhibitors for treatment of feline oral squamous cell carcinoma: a proof-of-concept study.

This study assessed proof-of-concept for use of polyamine inhibitor 2-diluoromethylornithine (DFMO) as a treatment for oral squamous cell carcinoma (SCC) in client-owned cats. Polyamine levels in tumor tissue and normal oral mucosa were quantified before and after treatment. DFMO was administered orally to 14 client-owned cats with histologically confirmed oral SCC. Patients were monitored for gastrointestinal, dermatologic, auditory, hematological, and biochemical abnormalities. Total polyamine levels in tumor tissue decreased after treatment, as did the specific polyamine putrescine in both tumor tissue and normal mucosa. Ototoxicity was observed in 5 of 6 cats receiving pre- and post-treatment brainstem auditory evoked potential tests. Subclinical thrombocytopenia was observed in 6 of 14 cats. One cat showed mild post-anesthetic tremors that resolved without treatment. Oral administration of DFMO at doses used in this study resulted in significantly decreased tumor polyamine levels without life-threatening clinical or hematological toxicities. Further studies are warranted to explore pathophysiology of polyamine biochemistry and use of polyamine inhibitors in treatment of cats with oral SCC.

Surgical treatment for cleft palate in dogs yields excellent outcomes despite high rates of oronasal fistula formation: a narrative review.

Cleft palate is the most common congenital orofacial defect in dogs. Although this topic has been extensively studied in experimental dogs, current literature on clinical patients is limited to case reports and small case series studies with many individual opinions based on experience. This narrative review summarizes the literature of the last 10 years with application to clinical practice, focusing on the preparation of the patient until surgery, options for surgical management, and perioperative complications. Surgical treatment must be performed to obtain separation between the nasal/nasopharyngeal and oral/oropharyngeal passages. This will allow the dog to have independent function and reduce clinical signs associated with food, water, and other foreign material entering the respiratory tract. Surgical treatment has good to excellent outcomes when the procedure is carefully planned and appropriately executed despite the high rates of postoperative oronasal fistula reported.

Etiology, clinical presentation, and outcome of temporomandibular joint luxation in cats: 21 cases (2000-2018).

This study was performed to report etiology, clinical presentation, treatment, and outcome of temporomandibular joint (TMJ) luxation in 21 cats (2000-2018). TMJ luxation was diagnosed by either dental radiography or computed tomography (CT). Causes for TMJ luxation included altercation with a dog (38%), hit-by-car (19%), unknown (19%), fall (19%), and ran into inanimate object (5%). The most common complication was development of permanent malocclusion (24%), followed by reduced vertical mandibular range of motion (5%). Reduction of TMJ luxation was successful in 94.7% of the cases. Reduction of the TMJ luxation was significantly associated with time from injury to treatment. No other significant associations were observed between cause of injury, type of TMJ stabilization, and outcome. TMJ luxation in cats carries an excellent prognosis with early joint reduction and supportive care. Concurrent dental trauma and maxillofacial injuries are common, and all patients with head trauma must be stabilized and evaluated with a thorough examination.

Morphometry and Morphology of the Articular Surfaces of the Medial Region of the Temporomandibular Joint in the Felis Catus (Domestic cat) - A Cone Beam Computed Tomography Study.

The articular surfaces of the temporomandibular joint (TMJ) in the cat consist of the articular head of the condylar process of the ramus of the mandible and the mandibular fossa of the petrous part of the temporal bone. Anatomic conformation of the TMJ articular surfaces can vary; however, this has not been studied in the cat. Thus, the aim of this study was to characterize the conformation of the medial region of the TMJ in mesocephalic adult cats as well as to determine the articular relationship by measurement of the degree of coverage of the mandibular fossa over the articular head. This was accomplished by assessing 60 TMJs from 30 mesocephalic adult cats by means of cone-beam computed tomography (CBCT). The width and depth of the mandibular fossa, and the degree of coverage of the mandibular fossa were evaluated using parasagittal reconstructions of the medial aspect of the TMJ by two observers. No statistically significant difference was observed during the intra and interobserver evaluation of the mandibular fossa width and depth and the degree of coverage of the mandibular fossa over the articular head. P-values for the studied variables were greater than 0.05. The resulting measurements demonstrated a concave mandibular fossa with a prominent retroarticular process and a poorly developed articular eminence; a well-defined rounded articular surface, and a high degree of coverage (171°) of the mandibular fossa over the articular head. In conclusion, the articular surfaces at the medial aspect of the TMJ displayed elevated geometric similarity, with an articular head of the condylar process deeply seated in the mandibular fossa.

Orofacial manifestations of high-rise syndrome in cats: a retrospective study of 84 cases.

Medical records of cats with high-rise trauma were reviewed to document the prevalence and clinical manifestations of orofacial injury. Cats were presented over a 10-year period from January 2000 to December 2009. Signalment, weight, number of stories fallen, and survival data were recorded in 84 cats and physical examination findings were obtained from 83 cats. Fourteen of these cats were examined by veterinarians of the Dentistry and Oral Surgery Service. Mean age was 37-months. Mean distance fallen was 2.65 stories, and in the majority of cases the substrate the cat fell on was not recorded Overall, survival was 94.0% when including euthanasia as a cause of death and 98.8% when excluding euthanized patients. Orofacial findings included bilateral epistaxis, hard palate fracture +/- tear of palatal soft tissue, palatal soft tissue bruising, mandibular fracture, mandibular symphyseal separation, tongue injury, facial soft tissue injury, dental trauma, and other oral soft tissue injury. Sixty-six percent of cats suffered some degree of orofacial injury. The population was analyzed for the prevalence of each type of injury. An oronasal fistula was seen in one cat as a complication of an untreated hard palate fracture. Possible etiology of the injuries and treatment options are discussed.

Dental Abnormalities in Immature Dogs with a History of Mandibular Fractures.

This study was performed to report the dental abnormalities encountered in immature dogs with a history of mandibular fracture. Dogs were included in the study if mandibular fractures were diagnosed by means of oral examination and diagnostic imaging, they were treated with non-invasive or minimally invasive methods, and there was a follow-up examination of at least 90 days after the initial presentation with the last follow-up visit occurring at 6 months of age or older. Eleven dogs met the inclusion criteria. Dental abnormalities occurred exclusively in those dogs that had sustained fracture of the mandibular body or fracture at the transition of mandibular body and mandibular ramus. A high number of developing permanent teeth located in or near the mandibular fracture were affected (73.5%). The most common dental abnormalities were failure of eruption or partial eruption (29.0%), resorption (22.6%), abnormal shape (19.4%), and enamel hypoplasia (16.1%). The majority of deciduous teeth (64.3%) in or near the mandibular fracture exfoliated uneventfully. Ten out of 11 dogs needed a surgical procedure to treat dental abnormalities after mandibular fracture healing. The development of the tooth germs located in or near a mandibular fracture is frequently affected. Radiographic evaluation of the area of trauma is recommended until eruption and full development of the teeth are completed.

Etiology, Clinical Presentation, and Outcome of Mandibular Fractures in Immature Dogs Treated with non-Invasive or Minimally Invasive Techniques.

This study was performed to report etiology, clinical presentation, and outcome of mandibular fractures in immature dogs treated with non-invasive or minimally invasive techniques. Immature dogs diagnosed with mandibular fractures from 2001 to 2016 were included in this study. Diagnosis of the mandibular fracture was achieved by oral examination and diagnostic imaging in the anesthetized dog. Twenty-nine immature dogs with 54 mandibular fractures were selected. Within the mandibular body, the regions of the developing permanent canine and first molar teeth were most commonly involved (46.4% and 35.0%, respectively). Within the mandibular ramus, 53.8% of the fractures were located in its ventral half, and 38.5% in the condylar process. Muzzling was applied in 72.4% of the dogs. All dogs had clinical healing with resolution of signs of pain and recovery of mandibular function. Mean time for clinical healing was 21 ± 9 days. Age of the dog and duration of muzzling were significantly associated with the time needed for clinical healing. In immature dogs, fractures of the mandibular body occur most commonly in the regions of the developing permanent canine and first molar teeth, while fractures of the mandibular ramus are most commonly found in its ventral half and the condylar process. Non-invasive or minimally invasive management of mandibular fractures in immature dogs carries a good prognosis regarding clinical healing and recovery of mandibular function. Dogs should be monitored for the development of dental abnormalities and/or skeletal malocclusion until permanent teeth have erupted and jaw growth is completed.

Oral and Maxillofacial Tumor Management - From Biopsy to Surgical Removal.

The main objective of oral and maxillofacial (OMF) tumor resection is to get local control of the disease. Many OMF tumors can be cured with wide or radical surgery, whereas others might only achieve temporary local control of the disease by removing infection and the source of pain, thereby improving the quality of life of the patient while keeping masticatory function. The standard of care on managing OMF tumors includes the diagnosis and identification of the local and distant extension of the disease to establish an appropriate treatment plan tailored for each patient. In this article, we provide a practical review of the current information related to staging, biopsy, and main surgical techniques for OMF tumor removal.

Surgical Treatment and Outcome of Acquired Midline Palate Defects in Cats.

Acquired midline palate defects (PDE) affect the hard palate and/or soft palate, and result from trauma, commonly falling from a height or being hit by a motor vehicle. Additional life-threating injuries and costs associated with the treatment may delay the surgical treatment. This retrospective study describes signalment, cause, and extent of the PDE, and treatment in 25 cats. In addition, the outcome of the surgical repair is described in 19 (76%) cats. All defects were repaired within 5 days of the injury. Twenty (80%) cats were 4 years of age or younger. The most common rostral extent of the PDE was to the level of the third premolar tooth (n = 8; 32%), incisor teeth (n = 7; 28%), and fourth premolar tooth (n = 5; 20%). The soft palate laceration was present in all cases. Surgical therapy was successful in all cases with follow-up. The most common techniques used for the closure of the hard palate defect were bilateral pedicle flaps with lateral releasing incisions (n = 8; 32%), direct apposition of the oral mucosa (n = 7; 28%), bilateral pedicle flaps with lateral releasing incisions and interquadrant splinting (n = 5; 20%), and unilateral pedicle flap with one lateral releasing incision (n = 4; 16%). A tension-free closure by direct apposition of the edges was possible for the soft palate laceration. No oronasal fistulae were identified at follow-up. The only complication was malocclusion. The interquadrant splinting was most often used for PDE extending to the rostral portion of the hard palate (p < 0.05). The cats that suffered postoperative malocclusion were significantly more likely to have sustained temporomandibular joint injury, underwent CT scan, or had a feeding tube placed before discharge. The results of this retrospective study indicate that the early treatment (within 5 days) of the acquired longitudinal defects in the midline of the hard and soft palates is highly successful.

Caudal and middle segmental mandibulectomies for the treatment of unilateral temporomandibular joint ankylosis in cats.

Case series summary: Three cats affected by unilateral temporomandibular joint ankylosis underwent segmental mandibulectomy, while one cat with bilateral ankylosis underwent right temporomandibular joint gap arthroplasty and left segmental mandibulectomy. Minimal intraoperative complications were linked to the segmental mandibulectomies in the cases reported. All cats recovered their ability to open the mouth, and the vertical range of motion was unaltered during the postoperative period. Mandibular drift and dental malocclusion were the main postoperative complications related to the segmental mandibulectomies. Relevance and novel information: Surgical excision of ankylotic tissue at the temporomandibular joint region may be technically challenging and associated with severe iatrogenic trauma of surrounding tissues. The results of this case series suggest that middle or caudal segmental mandibulectomy is a safe, feasible and effective surgical procedure to treat unilateral temporomandibular ankylosis in cats and could be considered as an alternative surgical technique to surgical excision of ankylotic tissue at the temporomandibular joint.

Association of periodontal disease with systemic health indices in dogs and the systemic response to treatment of periodontal disease.

OBJECTIVE: To determine whether severity of periodontal disease (PD) was associated with systemic health indices in dogs and whether treatment of PD altered systemic health indices. DESIGN: Prospective cohort study. ANIMALS: 38 dogs. PROCEDURES: Healthy dogs with clinical signs of PD were included in the study. Physical examination, serum biochemical analysis, a CBC, urine evaluation, measurement of serum C-reactive protein (CRP) concentration, and a microalbuminuria test were performed prior to treatment of PD. All tooth roots were scored for gingivitis and attachment loss, and appropriate treatment of PD was performed. Laboratory data were obtained 4 weeks after treatment. The Spearman rank correlation and Wilcoxon signed rank test were used for statistical analysis. RESULTS: Analyses of the correlation of several variables with attachment loss or gingivitis or of differences before and after treatment revealed significant results for several variables. After applying Bonferroni corrections for family-wise error rate, significant rank correlations were found between attachment loss and platelet number (r = 0.54), creatinine concentration (r = -0.49), and the within-dog difference in CRP concentrations before and after treatment (r = 0.40). The BUN concentration was significantly higher after treatment than before treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Increasing severity of attachment loss was associated with changes in systemic inflammatory variables and renal indices. A decrease in CRP concentration after treatment was correlated with the severity of PD. The BUN concentration increased significantly after treatment of PD. There is a need for continued research into the systemic impact of PD.