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Y3 MOD Dentistry > Periodontal disease > Flashcards

Periodontal disease Flashcards

1
Q

Define periodontitis

A

Plaque-induced inflammation: Gingivitis and periodontitis.

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2
Q

Define Periodontal disease

A

An inflammatory and destructive condition affecting the support tissues of the teeth

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3
Q

What is plaque?

A

Biofilm: aggregation of bacteria + debris + inflammatory cells

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4
Q

What is the role of a biofilm?

A

To protect bacteria from Antibacterials

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5
Q

Describe how plaque forms

A

‘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
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6
Q

What is calculus?

A

Mineralise plaque

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7
Q

Where is calculus most commonly located?

A
  • Supra-gingival calculus: crown.

* Sub-gingival calculus: gingival sulcus

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8
Q

Define gingivitis

A

Inflammation of the soft tissues of the gingiva secondary to plaque accumulation.

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9
Q

What is marginal gingivitis?

A

Free edge of the gingiva affected

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10
Q

What causes the inflammatory reaction on the gingiva?

A

Gingival sulcus colonised by anaerobic bacteria.

  • > Inflammation: bacterial enzymes, endotoxins released and host immune system reacts.
  • Reversible
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11
Q

What is periodontitis? Where does it develop?

A
  • Inflammation and destruction of periodontal ligament and alveolar bone- attachment loss of the tooth.
  • Develops in the sub-gingival extension= Periodontal pocket.
  • IRREVERSIBLE
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12
Q

What is the aetiological cause of periodontal disease?

A

Plaque

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13
Q

Which factors influence the likeliness of developing periodontal disease?

A
  • 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.
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14
Q

Describe the steps in the disease process of periodontal disease and how it develops

A
  1. Plaque formation
  2. Deepening of the sulcus: secondary to the junctional epithelium becoming inflamed.
  3. Proliferation of the subgingival plaque and increased anaerobic microflora.
  4. Toxins lead to tissue damage: Bacteria + cytotoxins and endotoxins lead to tissue destruction.
  5. Continued attachment loss: calculus helps plaque to overgrow - increased PD.
  6. Tooth loss: Junctional epithelium separates from tooth - periodontal pocket - osteoclastic resorption - loss alveolar bone - tooth mobility.
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15
Q

Describe stage 0 in clinical periodontal disease

A

Normal Healthy Periodontium:

  • Non-inflamed pink colour.
  • Radiographs: No abnormalities
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16
Q

Describe stage 1 in clinical periodontal disease

A

No attachment loss

  • Plaque and calculus deposit on tooth
  • Marginal gingivitis
  • Gingivitis only secondary to plaque.
  • Reversible
17
Q

Describe stage 2 in clinical periodontal disease

A

Up to 25% attachment loss as the sulcus deepens

  • Plaque and calculus extend down the root
  • Bone recedes
  • Pocket forms
18
Q

Describe stage 3 in clinical periodontal disease

A

Attachment loss 25-50% - gingival recession

  • Plaque and calculus extends further down root
  • Deepening pocket
  • More extensive bone reduction
19
Q

Describe stage 4 in clinical periodontal disease

A

Over 50%

  • Extensive plaque and calculus
  • Severe inflammation
  • Pocket deepening
  • Severe bone and gum loss
20
Q

What are some clinical signs of periodontal disease?

A
  • 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
21
Q

How can periodontal disease be diagnosed?

A
  • Gingivitis index
  • Attachment loss
  • Radiography
22
Q

What is the primary goal in treating periodontal disease?

A

Suppress inflammation and stop progression of disease

23
Q

How is treating periodontal disease initially approached?

A
  • 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.
24
Q

What are the steps/methods of treating periodontal disease?

A
  • Reduce the bacterial load
  • Supragingival scaling
  • Subgingival debridement
  • Polishing
  • Sulcular lavage
  • Extractions
  • Periodontal Surgery
25
Q

How can the bacterial load in the mouth be reduced initially?

A

Flushing with chlorhexidine - reduce potential bacteraemia

Antibiotic prophylaxis pre-dental procedure.

26
Q

When should extractions take place in a dental procedure?

A

Extractions should be done after scale and polish (CLEAN SURGICAL SITE)

27
Q

Describe the whole order of dental treatments

A
  • 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
28
Q

What is the single most effective home management method for teeth?

A

Tooth brushing

29
Q

What are some considerations for home tooth brushing?

A
  • 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
30
Q

What is the correct technique for tooth brushing dogs teeth?

A
  • Close the mouth to avoid dog chewing the tooth brush.
  • Brush around the gum line.
  • From caudal to rostral teeth.
  • Finger brush
31
Q

What is the correct technique for tooth brushing cats teeth?

A
  • Softer/Puppy brush is more gentle for the feline gingival tissues.
  • Brush around the gum line.
  • From caudal to rostral teeth.
32
Q

What advice should be given to owners if they seen bleeding when brushing?

A
  • Tooth brushing can create bleeding if there is gingivitis.
  • Will improve when plaque decreases and resolves gingivitis.
  • DO NOT STOP!!!!
33
Q

What is a chemical anti-plaque agent?

A

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.

Y3 MOD Dentistry (11 decks)

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