Lecture 5 Canine and feline infectious, inflammatory and immune mediated oral conditions Flashcards
What is periodontal dz?
plaque induced disease of the tooth’s supporting structures (periodontitis, gingivitis)
Who is dental disease most frequiently diagnosed in?
all age groups of dogs and cats but increased severity with increased age and decreased weight
increased severity on buccal surfaces of teeth and caudal oral cavity
What diseases is periodontal disease associated with?
- local: sialoadentitis, cellulitis, osteomyelitis, tracheitis, bronchitis, oral nasal fistulas
- systemic: heart, renal, lung, hepatic dz (associations)
What are the supporting structures of the teeth that make up periodontal anatomy?
ON EXAM
- cementum
- periodontal ligament
- alveolar bone
- gingiva
Attached gingiva is important for what?
health of the tooth
what are the components of gingival region
- free gingiva
- attached gingiva
- cementoenamel junction
- mucogingival junction
alveolar mucosa
How do you do a periodontal evaluation?
- examine gingival sulcus with periodontal probe
dog 1-3mm
cat
What is loss of attachement?
periodontal ligament between alveolar bone and cementum is no longer present
What is loss of attachement made up of (components)
gingival recession + periodontal pocket
To evaluate periodontal region, you have to do what?
radiographs!
What does periodontal disease depend on/susceptibility?
- plaque, calculus
- oral microflora
- breed and species speciic
- gen health
- chewing habits
- saliva
- diet
- local irritants
- home care
What is plaque made up of?
bacteria, salivary glycoproteins, extracelular polysaccharides
undisturbed plaque
organic and inorganic components (food, salivary glycoproteins, bacterial by-products)
How do you grade plaque?
- 1/3 surface of tooth
- 2/3 surface of tooth
- > 2/3 surface of tooth
What bacteria are present in a healthy mouth?
primarily gram + non motile cocci (aerobes and facultative anaerbes)
What bacteria are present with periodontal dz?
primarily anaerobic gram = motile, filamentous
What is the effect of bacteria in th emouth?
bacteria and their byproducts stimulate immune system and cause cytokine production and inflammatory mediators
What is calculus (tartar)
mineralized plaque
2-4 weeks to form
What are the features of supragingival calculus?
- local irritant
- protects subgingival plaque
- maintains anaerobic environment (closes up the sulcus)
What are the features of subgingival calculus?
prevents healing of gingiva
How do you grade calculus (tartar)
- 1/3 surface of tooth
- 2/3 surface of tooth
- > 2/3 surface of tooth
What breeds can be predisposed to periodontal dz?
- small breed
- bulldog, boxer
- sighthounds, maltese, mini schauzer
- abyssinian, somali cats
Why does tooth crowding, rotationa nd or malocclusions predispose dogs to periodontal dz?
teeth do not get the same kind of natural cleaning with chewing and also extra places for food to accumulate
What are 3 systemic diseases that can lead to periodontal disease?
- diabetes
- renal disease
- hepatic disease
What are 5 situations where an animal may be immunosuppressed and thus predisposed to periodontal disease?
- FeLV/FIV
- cushings
- steroid administrartion
- age
- stress
What are bad chewing behaviors?
- bones, sticks, rawhide bones, hooves, hard plastic bones, large ice cubes
- tennis balls or abrasive toy–endodontic dz
- hair chewing
Radiation therapy–salivary gland in radiation field causes what?
xerostomia
Open mouth breathing dogs are more prone to what?
xerostomia and periodontal disease
Cyclosporine can cause what?
xerostomia
What are the features of diets that can affect mouth health and periodontal dz (not seen that often)
- texture–dental diet vs reg
- pH–irritation at lower pH
- carbohydrates–increased sugars
- vitamins-decreased vit C, D, Se
- minerals-decreased Ca, P
What are local irritants that and can cause periodontal dz?
- malocclusions, crowding, bruxism–indirect trauma–structural sress to roots and tissues of teeth–>PD or direct trauma
- foreign body –fibers–rope bones, socks, hair
Why is home care important for PD?
within minutes of cleaning ther eis a thin pellicle or biofilm of salivary glycoprotein covers the tooth, within hours bacteria are incorporated–>plaque development
What is the WCVM gold standard of home care?
- daily brushing–sulcular method, horizontal plane, 45 degree angle towards the tooth
a.. soft bristle human
b. replace brush once a month
c. buccal/labial aspect (inside if possible esp weiner dogs)
(NOT human toothpaste) - oral hygiene rinse–antimicrobial
- oral hygiene gel-zinc, tuarine
- dental diet-mechanical
What are clinical signs of periodontal disease?
- halitosis
- red, edematous, painful gingiva
- gingival bleeding while chewing or during probing
- plaque and calculus
- gingival recession
- tooth mobility
- dysphagia and dropping food
- abrnomal mastication pattern
- pawing at or rubbing mouth
- unwilling to play with toys
- ptyalism
- discharge from nasal and/or oral cavity
What are the 4 stages of periodontal disease?
- stage 1: gingivitis only without loss of attachment (no attachement loss, reversible with home care, recheck)
- stage 2: early periodontitis (
What is the treatment of stage 2 periodontal disease?
- oral hygiene/prophylaxis
2. periodontal surgery–root planing (subgingival scaling)/gingival curettage for PP
What are the features of stage 3 periodontal disease?
moderate periodontitis
25-50% loss of periodontal attachment
F2
M2-3
What is the treatment for stage 3 periodontal disease?
- oral hygiene, prophylaxis
- periodontal surgery (open rooth planing for PP >5mm, gingivectomy)
- recheck 2wk, 3mo
- home care (good to guarded px)
- extraction
WHat are the features of stage 2 periodontal disease?
- early periodontitits
- peridonitis
3.
What are the features of grade 3 periodontal disease?
moderate periodontitis
25-50% loss of perodontal attachment
F2
M2-3
What are the treatments for grade 3 periodontal disease?
remove all the material below the gumline!!!
oral hygiene/prophylaxis
periodontal surgery–open rooth planing for PP >5mm
gingivectomy
recheck at 2wks nd 3 months
home care (good to guarded)
extraction–if owner not willing to maintain cleaning at home!
What is stage 4 periodontal disease?
advanced periodontitis
>50% loss of periodontal attachment
F3
M3
What is the treatment for stage 4 periodontal disease?
- oral hygiene/prophylaxis
- periodontal surgery (open rooth planing for PP >5mm)
guided tissue regeneration
gingivectomy
recheck 2 wks and 3 months
home care–guarded to poor prognosis
extraction
What are complications of perioodontal disease
tooth loss oral nasal/antral fistulal perio-endo lesions chronic ulcerative paradental stomatitis (CUPS)/lymphoytic plasmacytic stomatitis (LPS) tooth resorptionn
What is treatment for oral nasal fistulas?
extraction
single or double mucoperiosteal flap (debride scar tissue)
antibiotics
How can periodontal disease lead to endodontic disease?
via access via lateral/accessory canals
via the apex
How do you diagnse perio-endo lesions?
by x-ray
How do you treat perio-endo lesions?
rooth canal and periodontal treatment
extraction
What is CUPS/LPS?
severe ulceration often involving tissues CONTACTING TEETH
PAINFUL, can be cyclic
teeth may be relatively normal
What is the etiology of CUPS/LPS
immune response
What are clinical signs of CUPS/LPS
not eating, head shy, drooling, smells bad
What is the treatment for CUPS/LPS?
extraction of teeth >PD2
meticulous home care! twice a day!
not being cured, it is long term treatment
antibiotics, pain control and glucocorticoids
Why should all cats with CUPS/LPS be FIV, FeLV tested?
Not because changes treatment but may affect what client willing to pay. (are they predisposed?)
How does tooth resorption occur?
Inflammation causes activation of odontoclasts = tooth destruction
How prevalent is tooth resorption?
6/10 cats have evidence of tooth resorption
What are the types of tooth resorption?
type 1 the peridodontal ligament is intact (dark line on x ray)
type 2 the periodontal ligament is not intact?
How do you diagnose tooth resporption?
exam and x rays
What is treatment of tooth resorption?
extraction! even if a small lesion. painful if above the gum line
crown amputation and intentional rooth retention–can do crown amputation only if it is type 2 and there is no intact periodontal ligament–cannot see where tooth rooth ends and bone begins. That is not appropriate for type 1. Then you would do a gum flap
don’t seem to be painful below the gumline
