Periodontal Disease Flashcards
T/F: periodontal disease is the number one cause of tooth loss
True
What is the etiology of peridontal disease?
Acquired pellicle - thin layer of salivary proteins on the surface of the tooth to which bacteria attach
Plaque is a combination of bacteria, food, debris, oral epithelial cells, and mucin
Periodontal pockets
Calculus - mineralized plaque containing bacteria which release endotoxins causing gingivitis
Gingivitis - inflammatory process of gums
Periodontitis - inflammation and destruction of junctional epithelium and epithelial attachment at base of the gingival sulcus exposing periodontium
What diseases can exacerbate periodontal disease?
Neutrophil dysfuntion Diabetes mellitus Hyperadrenocortisim Autoimmune disease Feline viral disease (calicivirus) Xerostomia (dry mouth)
Periodontal disease as been implicated in the formation of what conditions?
Chronic nephritis
Hepatopathies
Endocarditis
—> due to chronic bacteria in circulation
T/F: periodontitis is reversible
False
Gingivitis is reversible
Periodontitis is irreversible —>gingival recession and destruction of periodontal ligament
Clinical signs of periodontal disease
Halitosis Accumulation of plaque and tartar Inflamed or bleeding gingiva Loose teeth Decreased appetite Oral discomfort
Stages of periodontal disease is based on what criteria?
Gingival appearance Sulcus (pocket) depth Attachment loss Furcation exposure Tooth mobility
The recession measurement PLUS ____________ equals the attachment loss in peridontal disease
Pocket depth
What is a pseudopocket?
Area of gingival hyperplasia increases probing depth but there is no loss of attachment from gingival hyperplasia
What what is thee periodontal index of a tooth with attachment loss of 10mm with a normal attachment of 50mm?
10/50 x 100 = 20%
This is a stage 2 tooth
What stage of furcation exposure will the probe enter greater than 1mm but not pass all the way through
Stage 2
At stage 3, the probe can pass horizontally through furcation
T/F: some degree of mobility to a tooth is normal
True
Physiologic mobility —> movment of tooth within the periodontal ligament space
What are the stages of tooth mobility??
Stage 0 = normal physiologic mobility (under 0.2mm)
Stage 1= mild pathologic mobility (0.2-0.5mm)
Stage 2= moderate (0.5-1mm)
Stage 3= >1mm or any axial movement
What is the normal sulcus depth in cats and dogs?
Dog 1-3mm
Cat 0-1mm
How would you stage this tooth?
Gingival tissue is firm and pink
Defined stippling
Normal sulcus depth
Stage 0- normal
How would you stage this tooth? Erythema Gingival swelling (loss of sharp margins) Gingiva bleed when probed Loss of stifling Normal sulcus depth
Stage 1 - gingivitis (reversible with proper home treatment)
How would you stage this tooth? Gingiva bleed when probed Normal -hyperplastic gingiva Minor pockets/gingival recession <25% attachment loss
Stage II - early periodontitis
Can be controlled but not completely reversed
How would you stage these teeth?
Gingival hyperplasia +/- recession (horizontal bone loss)
20-25% attachment loss - moderate deep pocket formation
Furcation exposure
Stage III- moderate periodontitis
How would you stage these teeth?
Gingival recession with horizontal bone loss and deep pockets with vertical bone loss
> 50% attachment loss
- furcation exposure
- advanced tooth mobility
Stage IV- advanced periodontitis
In a cat you have vertical pocket formation with granulation tissue and ostetitis. What is this called?
Feline buccal bone expansion
How do you treat periodontal disease?
Prevent new lesions and prevent further destruction (remove biofilm, minimize attachment loss and pocket depth, maintain adequate attached gingiva)
Home care - daily tooth brushing
Through dental cleaning - possible extractions or periodontal surge
Antibiotics ( required brushing to break up biofilm)
What systemic antibiotic therapy can be used to help control periodontal disease
Clindamycin
Clavamox
Metronidazole
Doxycycline
What local products are there for antibiotic therapy with periodontal disease?
Chlorhex spray, gel or rice
Doxirobe gel (dogs) Clindoral (dog and cat)
T/F: Oral speculum are necessary for cleaning in all patients
False
Hypodermic needle casing or syringe barrel preferred
Avoid mouth gags in cats —> opening mouth fully can compress maxillary artery causing ischemic injury
What tools are part of a basic dental cleaning pack?
One scaler
One curette
One explorer/probed combo
One dental mirror (retractor)
What tool is this?
Pointed tip with two cutting surfaces
How should it be used??
Scaler
Work away from sulcus
NEVER use sharp tip below the gingival margin
What tool is this?
Rounded tip and back with flat face
Only one cutting edge
How is it used?
Curette
Used for Supra- or subgingival calculus removal and root cleaning
More delicate than scaler — use scaler for heavy/thick supragingival calculus deposits
What tool is used for measuring sulcus depth?/
Periodontal probe
What tool is used to assess access into pulp cavity and assess or caries lesions
Periodontal explorer
What is the difference between ultrasonic a piezoelectric scalers?
Ultrasonic — all sides of tip are active and has rotational tip movement —> good for cleaning
Piezoelectric - lateral surfaces of the tip are active with tip movement is linear parallel to tooth —> good for scaling perio and endo procedures
A bur block contains what instruments?
A three way syringe —> water, air, and ‘power’ spray
Low speed hand piece
High speed hand piece
What are the steps to a complete dental cleaning
Disinfect the oral cavity
Examine, chart, rads
Gross calculus removal
Subgingival calculus removal
Missed plaque detection
Polish
Irrigate sulcus
Periodontal probing and rads
Sealants
Homecare
Follow up
How is the oral cavity disinfected?
Power spray mouth with 0.12% chlorhexidine from 3 way syringe
If calculus covers 2/3rds of the crown, how is this graded?
2
Moderate
What is considered grade 1 in the gingivitis index?
Mild inflmmation, slight edema
What is a grade 2 on the gingivitis index?
Moderate inflammation, edema, bleeding on probing
How is gross calculus removed?
Hand scaling — use side of scaler (should not be used below gingival margin)
Or
Ultrasonic scaling
How is subgingival calculus removed?
Both hand curette and ultrasonic scaler
— careful.. head generated from ultrasonic scaler can damage teeth, use lots of water and keep tip moving
How can you detect missed calculus ?
Disclosing solution
Air —> residual calculus appears white and chalky
How much pressure do you apply when polishing the teeth?
Enough to flare of the prophy cup and get under the gingival margin into sulcus
If too much—> heat generates
What diagnostics do you do after cleaning?
Periodontal probing — measure sulcus depth
- check for pockets, attachment loss, gingival recession or hyperplasia, tooth mobility
Exporting — differentiate pulp exposure from tertiary dentin in teeth with attrition/abrasion to confirm caries lesions
Radiographs
You would probe at leas ______ spots or sides of a tooth to measure sulcus depth
4
Or go continuously around
Why are we concerned about deep pockets, especially on the palatal surface?
Commonly enter the nasal cavity —-> oronasal fistula
When are barrier sealants applied?
After cleaning when periodontal disease is present
Esp if home care is questionable
Retard plaque formation
