Periodontal disease Flashcards
Define periodontitis
Plaque-induced inflammation: Gingivitis and periodontitis.
Define Periodontal disease
An inflammatory and destructive condition affecting the support tissues of the teeth
What is plaque?
Biofilm: aggregation of bacteria + debris + inflammatory cells
What is the role of a biofilm?
To protect bacteria from Antibacterials
Describe how plaque forms
‘Pellicle’: Acellular film of salivary glycoproteins/ polypeptides and lipids, lays down on enamel
- Forms quickly (within 6 hours), bacteria adhere
- Mineralises in as quickly as 24-48 hours, bacteria start to absorb calcium from saliva
What is calculus?
Mineralise plaque
Where is calculus most commonly located?
- Supra-gingival calculus: crown.
* Sub-gingival calculus: gingival sulcus
Define gingivitis
Inflammation of the soft tissues of the gingiva secondary to plaque accumulation.
What is marginal gingivitis?
Free edge of the gingiva affected
What causes the inflammatory reaction on the gingiva?
Gingival sulcus colonised by anaerobic bacteria.
- > Inflammation: bacterial enzymes, endotoxins released and host immune system reacts.
- Reversible
What is periodontitis? Where does it develop?
- Inflammation and destruction of periodontal ligament and alveolar bone- attachment loss of the tooth.
- Develops in the sub-gingival extension= Periodontal pocket.
- IRREVERSIBLE
What is the aetiological cause of periodontal disease?
Plaque
Which factors influence the likeliness of developing periodontal disease?
- Breed: Brachycephalics, Greyhounds, Schnauzers, Maltese, Abysinnian and Somali Cats. MALOCCLUSION.
- Immune status: Immuno-compromised can mean more severe disease - FIV
- Developmental Defects: retention of deciduous teeth.
- Diet: Soft food reduces mechanical abrasion of the teeth.
Describe the steps in the disease process of periodontal disease and how it develops
- Plaque formation
- Deepening of the sulcus: secondary to the junctional epithelium becoming inflamed.
- Proliferation of the subgingival plaque and increased anaerobic microflora.
- Toxins lead to tissue damage: Bacteria + cytotoxins and endotoxins lead to tissue destruction.
- Continued attachment loss: calculus helps plaque to overgrow - increased PD.
- Tooth loss: Junctional epithelium separates from tooth - periodontal pocket - osteoclastic resorption - loss alveolar bone - tooth mobility.
Describe stage 0 in clinical periodontal disease
Normal Healthy Periodontium:
- Non-inflamed pink colour.
- Radiographs: No abnormalities
Describe stage 1 in clinical periodontal disease
No attachment loss
- Plaque and calculus deposit on tooth
- Marginal gingivitis
- Gingivitis only secondary to plaque.
- Reversible
Describe stage 2 in clinical periodontal disease
Up to 25% attachment loss as the sulcus deepens
- Plaque and calculus extend down the root
- Bone recedes
- Pocket forms
Describe stage 3 in clinical periodontal disease
Attachment loss 25-50% - gingival recession
- Plaque and calculus extends further down root
- Deepening pocket
- More extensive bone reduction
Describe stage 4 in clinical periodontal disease
Over 50%
- Extensive plaque and calculus
- Severe inflammation
- Pocket deepening
- Severe bone and gum loss
What are some clinical signs of periodontal disease?
- Halitosis (bad breath)
- Salivation (ptyalism) + blood-tinged saliva
- Variable amounts plaque +/- calculus
- Inflamed/ bleeding gingiva
- Purulent discharge from periodontal pocket
- Loss of gingival contour
- Furcation exposure
- Tooth mobility
- Dysphagia/pain when eating
How can periodontal disease be diagnosed?
- Gingivitis index
- Attachment loss
- Radiography
What is the primary goal in treating periodontal disease?
Suppress inflammation and stop progression of disease
How is treating periodontal disease initially approached?
- General health assessment: Rule out any contributory factors worsening the clinical signs
- Full mouth periodontal probing and charting: Ability to check progression of disease.
- Formulate treatment plan: Owner compliance for postoperative home management.
What are the steps/methods of treating periodontal disease?
- Reduce the bacterial load
- Supragingival scaling
- Subgingival debridement
- Polishing
- Sulcular lavage
- Extractions
- Periodontal Surgery
How can the bacterial load in the mouth be reduced initially?
Flushing with chlorhexidine - reduce potential bacteraemia
Antibiotic prophylaxis pre-dental procedure.
When should extractions take place in a dental procedure?
Extractions should be done after scale and polish (CLEAN SURGICAL SITE)
Describe the whole order of dental treatments
- Record calculus deposits
- Remove gross calculus deposits
- Definitive oral examination with charting
- Radiographs as required
- Supragingival scaling and subgingival scaling (up to 2mm depth)
- Check the teeth for residual calculus and remove as found
- Polish
- Tooth extractions
- Subgingival lavage
What is the single most effective home management method for teeth?
Tooth brushing
What are some considerations for home tooth brushing?
- Location: Gum line and gingival sulcus.
- Selecting tooth brush:
• Soft brushes: deform easy and do not remove plaque well
• Hard Brushes: Painful
• Medium Brushes: PERFECT! - Toothpaste: Fish/poultry flavoured
What is the correct technique for tooth brushing dogs teeth?
- Close the mouth to avoid dog chewing the tooth brush.
- Brush around the gum line.
- From caudal to rostral teeth.
- Finger brush
What is the correct technique for tooth brushing cats teeth?
- Softer/Puppy brush is more gentle for the feline gingival tissues.
- Brush around the gum line.
- From caudal to rostral teeth.
What advice should be given to owners if they seen bleeding when brushing?
- Tooth brushing can create bleeding if there is gingivitis.
- Will improve when plaque decreases and resolves gingivitis.
- DO NOT STOP!!!!
What is a chemical anti-plaque agent?
Chlorhexidine
• Good broad spectrum antibacterial action with no side effects.
• More effective when used together with mechanical cleaning.
• It has 2/3rd of anti-plaque effect compared to tooth brushing.
• Good for oral lesions that are healing.
