how do I stage periodontal disease in dogs and what treatment is indicated at each stage?

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Periodontal disease (PD) in dogs is staged 0–4 per tooth, based on the degree of attachment loss measured by periodontal probing and intraoral radiography under general anesthesia. A complete and accurate diagnosis cannot be made on the awake patient — anesthesia is required for periodontal probing and intraoral radiography to determine the true extent of pathology.14 Staging is defined by attachment loss at each individual tooth, and a single patient may have teeth at different stages simultaneously.2 Stage 0 (PD0) is clinically normal with no gingival inflammation and no attachment loss.2 Stage 1 (PD1) is gingivitis only, with no attachment loss and normal alveolar bone height and architecture.2 Stage 2 (PD2) is early periodontitis with less than 25% attachment loss, or at most furcation involvement grade 1 in multi-rooted teeth, with early radiographic signs of bone loss.2 Stage 3 (PD3) is moderate periodontitis with 25–50% attachment loss, or furcation involvement grade 2 in multi-rooted teeth.2 Stage 4 (PD4) is advanced periodontitis with greater than 50% attachment loss, or furcation involvement grade 3 in multi-rooted teeth.2 Treatment at each stage is directly tied to the degree of attachment loss. PD1 is managed with dental scaling, polishing, irrigation, and initiation of home dental care.1 PD2 requires all PD1 care plus locally applied antimicrobials and/or subgingival scaling when pocketing is present.1 PD3 is treated with closed or open root planing, with or without locally applied antimicrobials, or advanced periodontal treatment such as guided tissue regeneration — but periodontal surgery at this stage is only successful when the client commits to consistent daily home oral hygiene; extraction is indicated if that commitment cannot be made.1 PD4 requires either extraction or periodontal surgery including osseous resective or additive procedures followed by consistently performed home care, and prognosis at this stage is guarded.1 Activated platelet-ri