Periodontal Disease Flashcards
define periodontal disease
- a bacterial infection that destroys the attachment fibers and supporting bones that hold the teeth in the mouth
- inflammation of the periodontum
-periodontal ligament, gingiva, cementum, and alveolar bone - the MOST common clinical condition occurring in adult dogs and cats!!
give clinical signs of periodontal disease
- halitosis
- oral pain
- discharge from nose or mouth
- sneezing
- facial swelling
describe predisposing factors to periodontal disease
- overcrowding of teeth, malocclusions, retained deciduous teeth
- brachycephalics: mouth breathing can dry the mouth
- allergies: overgrooming and hair acculumation
- fractured teeth/rough surface
- high risk breeds:
-dachshunds, chihuahuas, beagles, pugs, maltese, greyhounds, yorkies, poodles
describe bacteria and plaque
- plaque: sticky, bacteria-containing clear biofilm adhered to teeth
- bacteria in the biofilm are 1,000-5,000x more resistant to antibiotics versus free living bacteria
- resistance can be attributed to increase in SLIME LAYER, increased concentrations of antimicrobial enzymes (beta-lactamase), and communication between bacteria
describe mature plaque
- within 24 hours, if plaque is not disturbed, pathogenic bacteria have colonized the tooth
- after day 4 plaque does not grow but bacterial flora changes from gram + to gram -
- gingivitis: begins after changes int he bacterial flora occurs
-increase in overall numbers of bacteria
-increase in gram (-) motile rods
-increase in anaerobic species
describe indications for antibiotics in periodontal disease
use can be controversial and are not generally indicated for most routine dental prophylaxis
indications:
1. osteomyelitis
2. tooth root abscess or pyorrhea
3. ulcerative disease
4. patients with prosthetic devices: total hips, TPLO plates
5. systemically ill or immune compromised patients
6. patients having surgical procedures concurrent with dental procedures
7. severe oral infection requiring extensive extractions or periodontal surgery
common abx:
-amoxi-clav
-clindamycin: for bone infections!
-doxycycline
-metronidazole
-rarely use convenia
describe calculus/tartar
- calcified plaque
-70-90% inorganic calcium salts (hydroxyapatite MC)
-minerals from saliva and crevicular fluid - accumulates faster in large amounts on the buccal surface of maxillary teeth
-maxillary PM4 close to salivary duct - calculus is relatively non-pathogenic:
-primary effect is irritant
-associated plaque allows for continuation of periodontal disease
describe COHAT
comprehensive oral health assessment and treatment
- ANESTHETIZED complete oral exam, radiographs, and scaling/polishing +/- extractions
- adds depth and value to dental
-on dental chart: X is extraction 0 is missing - normal pocket depths (probing under gum line)
-cats: 0.5-1.0mm
-dogs: 1.0-3.0mm
-WILL BE ON EXAM
describe the gingivitis scoring index
(definitely know this!)
GI 0: normal gingiva
GI 1: mild inflammation, slight color change and edema, no bleeding on probing
GI 2: moderate inflammation, redness, edema, bleeding on probing
GI 3: severe inflammation, marked redness and edema, ulceration, spontaneous bleeding can occur, hypertrophy of gingival margin
*know that 0 is none and 3 is the worst; don’t memorize beyond this yet
-this system used when charting during COHAT
describe furcation involvement/exposure scoring
furcation: where the two roots meet right under the crown; should be encased in bone and not able to see
F0: no furcation exposure
F1: periodontal probe extends less than halfway under thw crown in any direction of a multi-rooted tooth with attachment loss
F2: exists when a periodontal probe extends greater than halfway under the crown of a multi rooted tooth with attachment loss but not through and through
F3: exists when a periodontal probe extends under the crown of a multi-rooted tooth, through and through from one side of the furcation out the other
describe tooth mobility index
subjective
M0: normal physiological mobility is up to 0.2mm
M1: mobility is increased in any direction other than axial over a distance of more than 0.2mm up to 0.5mm
M2: mobility is increased in any direction other than axial >0.5mm and up to 1.0mm
M3: mobility is increased in any direction other than axial over 1.0mm OR any axial movement
describe periodontal stages summary: WILL BE ON EXAM
stage 0: no pathology, healthy tissue
stage 1: gingivitis, no bone loss
-the ONLY reversible stage
-aveolar margins are normal
-gums bleed when probed
-gingiva inflamed and swollen
-plaque usually present
-treatment: prophylactic to remove plaque and routine homecare
stage 2: PD with <25% of bone attachment loss/erosion
-at most there is stage 1 furcation involvement in multi-rooted teeth
-gums bleed when probed
-no or limited mobility
-treatment: routine prophylactic cleaning to remove plaque and diligent homecare
stage 3/moderate: PD with 25-50% bone attachment loss
-stage 2 furcation may be seen
-increase in gingival sulcus/depth
-gingival hyperplasia and/or recession
-attachment loss usually significant
-treatment: depends on client compliance (extract versus root planing and routine diligent care)
stage 4/advanced: PD with >50% bone attachment loss
-destruction of surrounding bone, gingiva, tooth
-hematogenous spread of bacteria possible
-stage 3 furcation usually seen in multi-root teeth
-treatment: extraction, cannot save tooth
staging is a RADIOGRAPHIC DIAGNOSIS
describe attachment loss identification
- gingival recession: sulcus depth remains the same
-tooth roots exposed
-easy ID on conscious patient - gingiva remains at same height:
-area of attachment loss moves apically creating a periodontal pocket
-dx under gen anesth
-ID a pocket
describe bone loss with periodontal disease
2 common patterns
- horizontal bone loss:
-represents generalized periodontal disease - vertical/angular bone loss
-usually forms with crowding or an area with a nidus
-prognosis defined by the number of walls of bone remaining around pocket
describe nonsurgical therapy
- scaling: removal of plaque and calculus from the tooth surface (supra and sub gingival)
- root planing: removing embedded calculus along with cementum to leave a smooth root surface with a curette
-performed with more tooth-ward
-can damage the root if performed incorrectly
-cementum is irregular and requires greater force to remove deposits
-pocket depths greater than 5mm or those associated with other pathology require periodontal flap/open root planing
-gracie curette is ideal tool
describe local antibiotic use
- goal of surgical root planing is to promote gingival reattachment
- local abx use MAY help
- use only in >=4mm pockets
describe prevention
use only those accepted by the veterinary oral health council!!
