Periodontal Disease Flashcards
What is the most common oral disease and #1 cause of tooth loss ?
Periodontal disease
Can you treat periodontal disease?
NO ! You can only prevent it!
Periodontitis is a site specific disease, which commonly waxes and wanes and is painful (even if patient appears asymptomatic).
Memorize that
Periodontal dz can cause what kind of dzs? Name three
Chronic nephritis
Hepatopathies
Endocarditis
Which feline viral disease exacerbates periodontal disease?
Calicivirus
What is an acquired pellicle ?
It is a thin layer of salivary proteins on the surface of the tooth to which bacteria attaches - forms very quickly
What is calculus ?
Mineralized plaque containing bacteria which release endotoxins that cause gingivitis
What is plaque ?
It is a combination of bacteria, food, debris, oral epithelial cells and mucin
What type of bacteria inhabit plaqie
Bacteria - initially gram positive, aerobic and non-motile cocci
later gram negative, motile and anaerobic rods and spirochetes
GINGIVITIS is REVERSIBLE
FACT
PERIODONTITIS is IRREVERSIBLE but CONTROLLABLE
FACT
- causes gingival recession
- destruction of the periodontal ligament
- bone loss
- mobility
What are the 4 criterias to determine the stage of periodontal disease?
- gingival appearance
- sulcular depth
- percentage of bone loss
- tooth mobility
What is the minimal sulcular depth in dogs ?
1-3mm
What is the minimal sulcular depth in cats ?
0-1mm
Describe Stage I - Gingivitis
- erythema
- gums bleed when probed
- loss of stipling
- normal sulcus depth
- REVERSIBLE with proper treatment and home care
Describe Stage II - Early periodontitis
- Minor pockets
- Normal to hyperplastic gingiva
- Minimal bone loss
- Usually no mobility
- PERIODONTITIS - can be controlled but NOT completely reversed
Describe Stage III - Moderate Periodontitis
- gingival hyperplasia +/- recession
- moderate - deep pocket formation
- 25-50% bone loss
- slight to moderate mobility
Describe a Stage IV - Advanced Periodontitis
- HORIZONTAL and VERTICAL bone loss
- PERIAPICAL LUCENCY
- Deep pocket depth
- Furcation is exposed and there is >50% tooth loss
- Advanced tooth mobility
What is the objective of treating periodontal disease?
- remove the biofilm
- minimize attachment loss and pocket depth
- Maintain adequate attached gingiva (2-3mm)
What is the #1 preventative method for decreasing periodontal dz?
Surface Active Agents Mechanical Abrasion
Always check with the owner to see if they would be willing to clean the dog’s teeth at home, if they cannot, then its better to extract the teeth.
-
Dental diets and dental hygiene help prevent accumulation of plaque and tartar BUT have NOT been shown to be an effective treatment for periodontitis.
FACT
Name me the 4 systemic antibiotics that are used for periodontal diisease
- Clindamycin
- Clavamox
- Metronidazole
- Doxycycline
Name me a local antibiotic therapy
Doxirobe gel - only used for dogs (3-6 weeks)
Clindoral (Dogs and Cats - last 7-10 days)
What type of scaler should you use ?
Ultrasonic scaler
What type of scaler should you NOT use/ NOT recommended ?
Sonic
What should be in your basic dental pack (4 items)
- scaler
- currette
- explorer/probe
- dental mirror
Which two instruments in your basic dental pack has to be frequently sharpened ?
Scalers and currettes.
Describe how you would; use a scaler on a tooth?
- Never use the sharp tip below the gingival margin
and work away from the sulcus (towards the crown)
Describe how you would; use a scaler on a tooth?
- Never use the sharp tip below the gingival margin
and work away from the sulcus (towards the crown) - Used for HEAVY / THICK SUPRAGINGIVAL calculus deposits
How many cutting surface does a currette have?
1
What is a currette used for?
It is used for supra or subgingival calculus removal and root cleaning.
More delicate than a scaler p
What is the difference between a probe and an explorer?
Probe is used to measure sulcus depth
Explorer is used to assess access into the pulp cavity and assess for caries lesions
Which power scale type can cause Iatrogenic damage?
Rotosonic
- no longer used
What is the greatest disadvantage of the magnetostrictive metal stack
It generates more heat and therefore, a water spray is important.
It is also a heavier hand piece.
What are the steps of complete dental cleaning
- Disinfect
- Examine / RADIOGRAPH
- Gross calculus removal
- Subgingival calculus removal
- Missed plaque detection
- POLISH
- Irrigate and flush out sulcus
- Periodontal probe - Rad and then flush again
- 1/2 sealants
How do you disinfect the oral cavity?
power spray using a 0.12% Chlorhexidine from the 3 way syringe
- helps reduce odor
What are the Stages of the Calculus Index
0 = no supragingival calculus 1 = covers 1/3 of the crown (mild) 2 = calculus covers 2/3rd of the crown (moderate) 3= calculus covers all the crown (severe)
What are the Stages of the Gingivitis index
0 = no inflammation
1 = mild inflammation, slight edema
2 = moderate inflammation, edema and bleeding on probing
3 =severe inflammation
How do you GROSSLY REMOVE CALCULUS using a hand scale ?
Always use the SIDE of the scaler and NOT use it below the gingival margin
WHICH is a CRITICAL STEP for COMPLETE DENTAL CLEANING
Subgingival calculus removal
- use both hand currette and ultrasonic scaler
- Remember heat generated by the ultrasonic scalers can damage teeth
What do you use to detect missed calculus ?
- Disclosing Solution
- Air from the 3 way syringe
- faster less messy and YOU CAN SEE the INSIDE POCKETS
- residual calculus will appear chalky and white
Dental POLISH is an ESSENTIAL STEP. T/F
True
What is the function of Sulcus irrigation?
Flush polish out of the sulcus and leave it clean
When probing, where are deep pockets typically found in small dogs?
Palatal surface of maxillary canines
- pockets commonly enter the nasal cavity
- check the nostrils - blood is present - presence of oronasal fistula
What is the function of PERIODONTAL Index
= Measures the amount of OVERALL tissue loss
- recession measurement + pocket depth = amount of attachment loss
What are the stages of the periodontal index ?
0 = normal gingiva 1 = gingivitis only with no attachment loss 2 = less than 25% 3 = 25-50% attachment loss 4 = 50% attachment loss, at this level, undoubtedly, there is some pathologic tooth mobility and it is imminent that the tooth will be lost
What are the Stages of furcation exposure ?
0 = no furcation involvement 1 = incipient - probe can enter to a depth of 1mm only 2 = probe can enter > 1mm - bone loss 3 = through and through - probe passes horizontally through the furcation
What is pathologic mobility?
Movement in excess of physiologic mobility = pathologic mobility
What are the stages of MOBILITY?
0 = normal 1 = Mild (0.5-1mm) 2 = Moderate (1-2mm) 3 = Severe (>2mm)
What is a barrier sealant for ?
- applied after cleaning is completed
- retard plaque formation
