Gingiva/Periodontal disease

Question 1

How does healthy gingiva appear?

Answer 1

This gingiva has a normal junctional epithelium and very little gingival crevicular fluid. Very few polymorphonuclear leucocytes are encountered.

Question 2

How does gingiva with early gingivitis appear?

Answer 2

In this state, junction epithelium is not affected and very little gingival crevicular fluid is
produced. Early vasculitis increases the exudation of serum proteins and migrating
polymorphonuclear leucocytes, mostly T-cells and occasional plasma cells.
Immunoglobulins and some complement might be detected. Only collagen destruction
occurs in the infiltrated connective tissues and there are early sporadic changes within
fibroblasts

Question 3

What is the Molecular Pathogenesis of periodontal disease?

Answer 3

Stage 1 - Reactions to Plaque
Stage 2 - Macrophage and serum Protein System Activation.
Stage 3 - Upregulation and detachment of junctional epithelium
Stage 4 - Attachment Loss
*Vascular changes in inflammation
*Destruction of Connective Tissue
*Destruction of Bone

Question 4

How is diabetes mellitus a risk factor for gingivitis/periodontal disease?

Answer 4

Uncontrolled diabetes mellitus causes defective function of the MTNs, reduce antibody
production and also increases MMP production by macrophages. This explains the
increased risk of these patients to periodontal disease. Diabetes mellitus also affects
micro-vasculature and in this way reduce the resistance of the oral mucosal to periodontal
disease.

Question 5

Environmental risk factors for periodontal disease?

Answer 5

*Smoking
*Mouth Breathing
(The protective mechanisms of saliva is reduced in people with mouth breathing.)
*Xerostomia. (Dry Mouth)
Salivary glycoprotein and mucins protects the mucosal surfaces. Saliva flow has a
cleansing and lubricating function and many of the ingredients of saliva (e.g. enzymes like
lysozyme, catalase, lactoperoxidase as well as the immunoglobulins) create an
antibacterial effect. The prolonged use of certain drugs (e.g. antihistamines) could reduce
saliva production. Any condition that directly affects saliva production or other systemic
conditions that cause this (e.g. diabetes mellitus) could therefore affect resistance to
periodontal disease.
*Nutrition.
*Irritants.
* Trauma
* Enamel defects

Question 6

What are signs of oral pain?

Answer 6

Bleeding from the mouth: Common presenting signs of periodontal disease in
dogs and cats are bleeding from the mouth, or
* Drooling
* Facial swelling
* Decreased grooming or poor coat quality
* Changing eating habits e.g., selective eating of soft food, dropping food.
* Changed position of the head during eating, exaggerated or changed jaw
movement during or after eating,
* Signs of rhinitis e.g., sneezing nasal discharge could indicate periodontitis at the
maxillary teeth.
* Head shyness or the reluctance to have the face and mouth manipulated could be a
sign of previous or current oral pain or discomfort.

Question 7

What is an oronasal fistula?

Answer 7

An oral nasal fistula is a permanent, epithelialised communication between the oral and
nasal cavities. These patients often present with signs of rhinitis: sneezing, nasal
discharge and epistaxis. These symptoms could be triggered by periodical periodontitis or
tooth associated infection or abscessation at the apices of many maxillary teeth in close
proximity to the nasal cavity or nasal diverticulum.

Question 8

At an initial assessment of oral health what questions should be asked?

Answer 8

• Any signs of oral pain
• Do they eat normally? Any recent changes to the diet?
• Any recent changes in body weight especially unexplained weight loss?
• Changes in grooming behaviour or play?
• What is the current oral care protocol?
• How strictly are these plans implemented?
• Are there any changes in the tolerance of these procedures?

Question 9

Before lifting the lip on a dental exam what should be assessed?

Answer 9

visual examination
Palpate the masticatory muscles.
Palpate all accessible bony structures.
Retropropulsion of the eyes
Palpate superficial lymph nodes

Question 10

During complete examination the following should be closely examined and
recorded:

Answer 10

• Calculus and Plaque indices
• Gingivitis
• Tooth mobility
• Any signs of attachment loss e.g. furcation exposure, gingival recession.
• Periodontal probing depths
• Gingival enlargement
• Periodontal disease index
• Any swelling or oral masses
• Coronal damage e.g. crown fractures, tooth wear, intrinsic or extrinsic staining.
• Supragingival resorptive lesions
• All visibly absent teeth.

Question 11

The following suggestion is a logical way to effectively proceed after the initial examination
and charting:

Answer 11

• Disinfect the oral cavity with chlorhexidine solution
• Reform necessary regional anaesthesia
• Remove heavy accumulations of calculus
• Ultrasonic scaling
• Subgingival debridement of all periodontal pockets
• Periodontal surgery or otherwise plans on referral
• Biopsies of masses and swellings
• Dental extractions and closure of extraction sites.
• Endodontic treatment or notes on planned referral
• Post-operative radiographs polishing
• irrigation of periodontal pockets or sulcus.
• Application of any adjunctive/barrier treatments (SANOS®)