Lecture 6: Periodontal disease

Question 1

Periodontal disease is

Answer 1

Periodontal disease is an inflammation and infection of the tissues surrounding the tooth, collectively called the periodontium

Question 2

Periodontal Disease is characterized by

Answer 2

Movement of the gingival margin towards the apex (gingival recession)
Exposing more crown and root
Migration of the attached gingiva
Loss of the periodontal ligament
Leading to loss of bone surrounding the tooth

Question 3

Why is periodontal disease a problem?

Answer 3

Painful
Bacteria from infected tissues enter the blood stream
Organs such as lungs, kidneys, and liver are most susceptible to infection

Question 4

Factors that can predispose to Periodontal disease: (multifactorial)

Answer 4

Age
Species
Breed
Genetics
Chewing Behavior
Diet
Grooming habits
Orthodontic occlusion
Patient health status
Home Care
Frequency of professional care
Bacterial flora of the oral cavity

Question 5

Etiology of Periodontal Disease

Answer 5

A glycoprotein component of saliva called acquired pellicle, attaches to the tooth surface
The pellicle helps bacteria attach to the tooth surface
Approximately 6 – 8 hours after pellicle formation, bacteria start to colonize the tooth surface
This bacteria layer is known as plaque
Bacteria attached to the tooth absorbs calcium from saliva and becomes calcified
This is known as tartar or calculus

Question 6

When does pelicile start to form and when does bacteria start to colonize

Answer 6

Takes 20 minutes to form
Approximately 6 – 8 hours after pellicle formation, bacteria start to colonize the tooth surface

Question 7

Types of bacteria in periodontal disease

Answer 7

The healthy gingival flora is made up of mostly gram-positive aerobic bacteria
The aerobic bacteria metabolize the oxygen creating an anaerobic environment
Allows anaerobic bacteria to begin to colonize the tooth
As periodontal disease progresses, gram-negative bacteria begin to colonize the tooth surface
As the condition progresses further, spirochetes begin to colonize

Question 8

Bacterial biofilm of periodontal disease

Answer 8

Oral bacteria are arranged on the tooth in a biofilm
An aggregate of bacterial colonies protected by the polysaccharide complex
It is the disruption of this biofilm that is important in the control of periodontal disease

Question 9

Location of plaque

Answer 9

Free floating in the pocket
Attached to the tooth
Supragingival
Subgingival
Attached to the gingiva
Subgingival

Question 10

What is the patients response to periodontal disease

Answer 10

As the bacteria infiltrate and colonize the sulcus or pocket and invade the gingival tissue, the patient attempts to fight the infection
White blood cells produce antibodies and send chemical signals into the system to stimulate other cells to come in and attack the bacteria
The bacteria often contain endotoxins (lipopolysaccharides or LPS) and enzymes that are toxic to the gingival tissues

Question 11

Pathogenesis of periodontal disease is

Answer 11

As the inflammation continues, the gingiva loosens from the tooth resulting in the formation of a pocket between the tooth and gingiva
As the pocket grows deeper into the periodontium, you start to lose tissue and bony support
If the patient is not treated the disease progresses and deeper pockets form with increased bone and tissue loss resulting in:
gingival recession
furcation exposure
Furcation = the area where the roots join the crown in multi-rooted teeth
Gingival recession and furcation exposure

Question 12

Furcation exposure is classified as

Answer 12

Classified by depth:
Class 1- Exposure less than 1 mm
Class 2-Greater than 1 mm exposed but not fully through
Class 3- Complete furcation exposure, probe can pass through furcation
As bone loss proceeds, the tooth may become mobile
Finally, if the loss of attachment is sufficient, the tooth may fall out

Question 13

Clinical signs noticeable by owner of periodontal disease

Answer 13

Most commonly, clients report halitosis (bad breath)
Other signs
Not eating well
Drooling
Blood in saliva
Pawing at the mouth
Swelling on the face

Question 14

What would the oral exam show with periodontal disease

Answer 14

Red, inflamed gingiva, which may bleed easily when probed
Due to fragile capillaries in the tissue
An accumulation of plaque and calculus is evident
Note: the amount of plaque and calculus doesn’t always correspond to degree of periodontal disease present

Question 15

Periodontal disease is classified by what factors

Answer 15

A general evaluation of periodontal stage can be performed on an awake cooperative patient
Based on factors such as:
Plaque
Calculus
Inflammation
Topography (surface features, includes gum recession and the amount of furcation/root exposed)

Question 16

How would you preform a proper dental exam for periodontal disease

Answer 16

A thorough evaluation can only be performed with the patient under general anesthesia, and includes in addition to factors noted above:
Periodontal probing
Intraoral radiographs* (this is required to achieve an accurate result)

Question 17

How to classify periodontal disase

Answer 17

Stages 1 – 4
Patient’s worst tooth is used to establish overall stage of disease
ie: patient is said to have stage 4 periodontal disease if even only one tooth is at this stage and the rest of the teeth in the mouth are healthy
Each tooth must be evaluated and charted for effective treatment. You just don’t look for the worst tooth and grade it only!

Question 18

PD0 looks like

Answer 18

Has a knife-like margin
Coral pink or pigmented color
Smooth topography (surface of gingiva as it flows from tooth to tooth)
Generally, as periodontal disease progresses the topography becomes irregular and the even flow from tooth to tooth is lost
Gingival tissue is firm
Close observation reveals presence of blood vessels at the gingival margin known as defined stippling

Question 19

What is the normal sulcus depth

Answer 19

Sulcus depth should be 2 to 3 mm in dogs and 0.5 to 1 mm in the cat

Question 20

PD1 looks like

Answer 20

Early Gingivitis - Gingival inflammation, no evidence of bone loss
Redness (inflammation) of gingiva at the crest
Defined stippling more difficult to visualize
No noticeable changes seen radiographically*
Reversible with treatment
May appear 2-4 days after plaque accumulation in previously healthy gingiva
Localized to gingival sulcus

Question 21

PD2 looks like

Answer 21

Early Periodontitis
Reversible with dental scaling and prophylaxis as well as home care
Increased inflammation
Including edema
Development of subgingival plaque
Increased amount of supragingival plaque and calculus
Gingival topography starting to become irregular
Less than 25% bone loss on x-rays

Question 22

PD3 looks like

Answer 22

Moderate Periodontitis
Irreversible damage to bone and gingiva
Gingiva bleeds with gentle probing
25-50% bone loss on x-rays
Severity often not visible on awake exam

Question 23

PD3 often includes

Answer 23

Often includes:
Gingival recession
Moderate periodontal pockets
Furcation exposure
Tooth mobility (grade 1)

Question 24

PD4 looks like

Answer 24

Advanced Periodontitis
Irreversible damage to bone and gingiva
Gingiva bleeds with gentle probing
>50% bone loss on x-rays
Deep periodontal pockets

Question 25

PD4 often includes

Answer 25

Severe gingival recession
Grade 3 Furcation exposure
Mobile teeth
Severe inflammation
Purulent discharge

Question 26

Where to measure periodontal depth

Answer 26

Attachment level (loss) measurement
Measure the cementoenamel junction (CEJ) to base of pocket in cases of gingival recession

Question 27

How to get appropriate probing depth

Answer 27

Probing depth
Measurement from gingival margin to pocket base