Exam Flashcards
Define gingivitis
Inflammation of gingiva
Is the earliest stage of disease in the oral cavity which can lead to periodontitis
Define periodontitis
Inflammation of the underlying tissue and periodontum
Gingiva is the :
First line of defence protecting underlying bone and supporting tissue
What does gingiva provide?
The main mechanical barrier to infection
Where is ginigival sulcus secreted?
Through the sulcular walls to flush out debris from the sulcus
What kind of properties does the gingival sulcus have?
Anti-microbial
What does saliva contain? Why?
Calcium and fluoride to help maintain the integrity of the enamel
What is saliva? What does it do?
Bactericidal, aids in the healing of oral mucosa
What is the enamel bulge?
The area where the tooth bulges out at the gingival margin
What does the shape of enamel bulge and how it meets in the gingival, do?
Work to keep the sulcus free of debris
What does normal occlusion do?
Helps remove plaque before it hardens to calculus
Post dental prophylaxis plaque formation : (bacteria)
No bacteria present
Deposit of acellular film called ? made up of saliva ?
Acquired pellicle
Glycoproteins
Plaque a few minutes after post dental prophylaxis : (bacteria)
Gram positive cocci and rods (aerobic)
What happens to the acquired pellicle when bacteria attaches? (few mins after dental prophylaxis)
Plaque starts to form
Plaque formation 6hrs after dental prophylaxis : (bacteria)
Gram negative cocci and rods (aerobic)
Plaque formation 24-48hrs after dental prophylaxis : (bacteria)
Anaerobic motile rods and spirochetes
Organic substances pertaining to 24hrs post dental prophylaxis
Exfoliated epithelial cells
Leukocytes
Macrophages
Protein
Lipid
Inorganic substances pertaining to 24hrs post dental prophylaxis (c & p)
Calcium and phosphorus, due to saliva pH of 7.4
7 factors affecting the occurrence of periodontal disease
Food debris
Varies
Missing/maloccluded teeth
Mouth breathing/rock chewing
Systemic diseases
Nutrition
Breed
Food debris with periodontal disease
creates a great environment for plaque (hard food rather than soft food)
Caries, with periodontal disease
Where the enamel has been destroyed or worn, so provides a great place for bacteria and plaque
Missing or maloccluded teeth with periodontal disease can…
increase the amount of retained food
Mouth breathing/rock chewing with periodontal disease
Dehydrated oral cavity renders plaque together tougher and stickier
Systemic diseases with periodontal disease
Can decrease an animals defences
Increasing invasion of bacteria
Nurtrition with periodontal disease
Malnutrition can weaken defences
Types of food can affect occurrence
Breeds pertaining to periodontal disease
Certain breeds are more prone to occlusion problems due to the shape of their mouth
How does plaque lead to periodontal disease?
Once the plaque is mature and extended into the gingival sulcus, the environment easily grows anaerobic bacteria
How is plaque leading to periodontal disease, prevented?
By preventing plaque from maturing and growing into the sulcus
What is periodontitis?
Inflammation or disease that affects the deeper structures
What is periodontal index?
A measure of the amount of periodontal attachment loss
List the 6 stages of periodontal disease (gingivitis)
Healthy (GI0)
Marginal gingivitis (GI1)
Moderate gingivitis (GI2)
Severe gingivitis or early periodontitis (GI3)
Moderate periodontitis
Severe periodontitis
Healthy gingivitis
GI0
Firm and resilient gingiva
Minimal sulcus depth
Marginal gingivitis
GI1
Gingival inflammation
No increase in sulcus depth
Mild odour
Increased crevicular fluid
Vasculitis of vessels at junctional epithelium
Leukocytes into epithelium on sulcus
Becomes more permeable
Moderate gingivitis
GI2
Increase inflammation with edema
Gingiva bleeds when probed
Gingiva becomes friable and encroaches on the crown
Increased sulcus depth due to increased gingival size
Severe gingivitis or early periodontitis
GI3
Severe inflammation
Periodontal ligament inflamed
Deeper pocket formation
Some epithelial loss
Bleeding
Periodontitis present
Moderate periodontitis
Formation of deep pockets
Bone and epithelial attachment loss
+/- gingival hyperplasia or gingival recession
Increased vasculitis with destruction of periodontal ligament
Severe periodontitis
Advanced breakdown of periodontal structures
Significant gingival recession
Tooth mobility
Severe pocket
More than 50% bone loss
What do you record when charting?
Pocket depth
Gingival recession
Attachment loss
Where do you measure attachment loss?
From the cemento-enamel junction to the bottom of the pocket
How to measure gingival recession
An estimate from the CEJ to the current free gingival
Then add 1-2mm to account for normal gum line
How to measure pocket depth
Measured from the current free gingival margin to the bottom of the pocket
Numbers when grading periodontitis
PD0
PD1
PD2
PD3
PD4
PD0
Healthy gingiva and deeper periodontal structure
PD1
Gingivitis only, with no attachment loss
PD2
Less than 25% attachment loss
PD3
25-50% attachment loss
PD4
Greater than 50% attachment loss
Numbers when grading mobility
M0
M1
M2
M3
M0
No tooth mobility
M1
Slight tooth mobility
M2
Moderate tooth mobility
M3
Severe tooth mobility
Numbers when grading furcation
F1
F2
F3
F1
Furcation exposed
F2
Furcation undermined
F3
Furcation open through to the other side
Things to address pre-prophylaxis
Age and general health
Head exam
Inside the oral cavity
Why do we assess patients age and general heath before a prophylaxis?
Most patients are older, so may present with other medical problems
Pre-screen to assess organ function
Assessing for abnormalities on a head exam pre prophylaxis
Midline of face
Position
Eye appearance
Sinus area
Facial bones
Biting plane
Temporimandibular joint
Lips
Assessing inside the oral cavity pre prophylaxis
Buccal/labial mucosa
Soft and hard palate
Tongue and sublingual
Saliva
Breath
Throat and tonsils
Foreign bodies
Plaque and calculus
What do you give pre-prophylaxis in order to help combat the floor of bacteria into the blood stream?
Antibiotics
What to treat for when gingivitis is present pre prophylaxis (bacteria)
Aerobic staph/strep
What to treat for when periodontitis is present pre prophylaxis (bacteria)
Anaerobic and aerobic
When to treat mild gingivitis pre prophylaxis
1hr before prophylaxis
When to treat severe gingivitis pre prophylaxis
1 day before
When to treat severe periodontitis pre prophylaxis
7-10 days before
Patient safety when performing a prophylaxis
Cuffed ET tube
Gauze packing
Adjustable table for drainage
Eye covers for patient
Technician safety when performing a prophylaxis
Chlorhex rinse
Goggles, face mask, and gloves
Proper and safe use of machines and equipment
Equipment required when performing a prophylaxis
Scaling tools
Anesthetic
Steps to performing a dental prophylaxis
Charting of plaque and calculus
Chlorhex rinse to decrease contaminants
Plaque and calculus supra-gingival
scaling
Sub-gingival scaling with a curet
Explore with explorer and chart abnormalities
Polish (sub and supra-gingival areas)
Sub-gingival irrigation (Chlorhex)
Fluoride treatment
Charting
Why do we utilize radiography in dentistry?
Most serious pathology in the oral cavity stems from the gingiva which cannot be seen without a radiograph
Pertaining to clients, why is it good to take radiographs in dentistry?
For legal reasons, good to show below the gum line as it will aid in explaining why a tooth needs to be extracted, etc
What will be determined when taking dental radiographs on a young animal?
The presence of adult tooth buds
Pertaining to periodontal disease, why is it good to take dental radiographs?
Can show the extent of bone loss
Can also indicate periodontal disease
Why do we take dental radiographs in patients with missing teeth?
To see if they are coming in or they are permanently missing
Dental radiographs prior to a tooth extraction will determine
If it needs to be extracted
Dental radiographs while doing a tooth extraction
To indicate the type of root you are working with
Dental radiographs after a tooth extraction
To check for anything retained
Why do we take dental radiographs of the mandible and maxilla?
To assess for fractures
Checking for body density
Why do we take dental radiographs of chipped or broke teeth?
To help determine the extent of the fracture
What do we do post-prophylaxis?
Monitor the oral cavity
Monitor the animal
Give post-op meds
Why do we do oral post prophylaxis checks?
To make sure there are no complications and that healing is happening if there were extractions
Why do we monitor the animal post prophylaxis?
To make sure there are no complications and to make sure the patient is eating properly
What are some post prophylaxis medications that are given?
Antibiotics if there was extensive periodontal disease
Chlorhex rinse for 2-3 to help healing
What is the most common species for resorptive lesions?
Cats
Where do resorptive lesions occurs?
Most begin at the neck of the tooth at the CEJ
What teeth are most commonly seen with resorptive lesions?
Premolars and molars, but can be seen on canines and incisors
What surface of the tooth are resorptive lesions most commonly found?
Buccal and labial surface
What are resorptive lesions?
Bacterial destruction within the tooth
Resorptive lesions start at the CEJ where the cementum and dentin are softer, and what?
They are constantly in contact with the subgingival plaque bacteria
What are resorptive lesions filled with?
Odontoclasts, which absorbs dentin and enamel
Name the 6 factors thought to cause resorptive lesions
Periodontal disease
Diet
Viral cause
Regurgitation of hairballs
Genetics
Gingivitis/stomatitis
What is the number 1 indicator of resorptive lesions?
Periodontal disease
What do people think diet can do with resorptive lesions?
Some think it can increase acidifiers
What do some think phosphate in diet has to do with the cause of resorptive lesions?
May have to do with the decrease in phosphate in diets, which decreases the remineralization of the teeth
Viral causes pertaining to resorptive lesions
Can decrease the immunological response
Many cats with resorptive lessons are found to be what positive?
FIV and FeLV
Why can hairballs cause resorptive lesions?
Can increase the amount of stomach acids in the mouth
What purebred cat breeds are more prone resorptive lesions?
Persians
Siamese
Russian blue
What could over breeding cats do in terms of resorptive lesions?
Can decrease immune systems
What would resorptive lesions associated with gingivitis/stomatitis be due to?
Inflammatory resorption
What is LPS?
Lymphocytic plasmacytic stomatitis
Signs/history of LPS in cats
Halitosis
Increased saliva
Dysphagia
Inappetence
Weight loss
Tests to run with LPS
FeLV
FIV
Name the classes of lesions
Class 1
Class 2
Class 3
Class 4
Class 5
Class 1 lesions
Early lesion, only unblocking enamel or cementum, will feel like a roughened area
How are class 1 lesions found?
Usually found by subgingival exploration
Class 2 lesions
Significant lesions, deeper with increased tooth destruction
Where do class 2 lesions reach?
Dentin, but not pulp chamber
Class 3 lesions
Deep in the pulp chamber, but not much crown loss
Where do class 3 lesions reach?
Through the dentin, into the pulp chamber, and will bleed on probing
What may class 3 lesions be covered by?
A pulpal polyp
Class 4 lesion
Extensive lesions with considerable loss of tooth structure
Could be missing a large portion of the crown
Could be discoloured and very easily shattered
Class 5 lesion
Passive destruction with separation of root and crown
What kind of crown might you see with a class 5 lesion?
A floating crown with almost no root OR just the root remaining under very inflamed gingiva
Treatment of class 1 lesion
Smoothing lesion and applying a fluoride treatment
Must have all edges smooth before adding fluoride
How long does a fluoride treatment for class 1 lesions last?
6-12 months plus home care
What is the treatment for class 2 lesions?
Restoration with glass ionomers or extraction of the tooth
Must be dry and polished to a smooth surface
Treatment for class 3 and 4 lesions
Extraction of the tooth, removing the whole root
Treatment of class 5 lesions
Floating crowns are extracted and roots are extracted if gingival irritation is present
How can class 5 treatment of lesions be a problem?
Can become a problem if a cyst forms around the root
3 ways to prevent lesions
Home care when young
Regular dental exams and prophylaxis
Feed appropriate diets
Home care lesion prevention
Brushing teeth with a fluoride toothpaste
What will regular dental exams/prophylaxis prevent for lesions?
Increase the chance of finding the lesions in the early stages of
Which kind of food stays on the teeth more than the other?
Moist food stays on the teeth more than dry
What will happen when you decrease the amount of retained food stuck in the teeth?
Will decrease the plaque accumulation
