Periodontal disease and stomatitis

Question 1

How common is periodontal disease in SA?

Answer 1

Very - affects to some extent at least 70% of all cats and dogs >3 years of age. Preventable in most cases. Can progress significantly before the owner notices the first signs.

Question 2

What causes periodontal disease? 2 categories + examples

Answer 2

Multifactorial - primary and secondary factors

PRIMARY - plaque-bacteria and their toxic products

SECONDARY - lack of oral hygiene, calculus deposits, nutrition lacking in EFAs and anti-oxidants, genetics, stress, systemic illness (DM), (humans - smoking, drugs etc)

Question 3

What is plaque? Where?

Answer 3

a biofilm, therefore a mucoid matter on teeth.

found on teeth especially near and under the gingival margin

Question 4

What is calculus?

Answer 4

=mineralised plaque (common term = tartar)

Question 5

Does calculus cause perio-disease?

Answer 5

Not per se but it offers a porous surface for easier plaque adhesion

Question 6

True/False: you will (almost) always find periodontal disease where there is calculus, but periodontal disease can be present without calculus as long as there is plaque.

Answer 6

True

Question 7

What are the components of the periodontium? 3

Answer 7

gingiva, periodontal ligament and alveolar bone

Question 8

what are the different stages of periodontal disease?

Answer 8

stage 0-4

Question 9

Describe the different stages of periodontal disease.

Answer 9

0 = healthy gingiva
1 = gingivitis, no evidence of attachment loss
2 = mild periodontosis with 50% attachment loss

Question 10

Describe stage 1 periodontal disease: gingivitis

Answer 10

Hyperaemia, oedema and tendency of gingiva to bleed
Gingivitis is plaque-induced (mixed frlow of predominantly gram+ and a few gram- bacteria)
Reversible with consistent regular (daily) plaque removal
Gingivitis is always the first stage of periodontal disease (but doesn’t lead to perio-disease in all patients)

Question 11

Pathogenesis - why can disease progress form gingivitis to grade 2-4?

Answer 11

plaque in the subgingival sulcus favours disease progression - with decreasng O2 saturation in plaque there is a shift of bacteria type (gram + to gram - obligate anaerobes).

Question 12

Why does the epitheliuen that lines the gingival sulcus faciliatate the microbial invasion of periodontal tissues?

Answer 12

the epithelium here is not keratinised

Question 13

What happens in the irreversible stages?

Answer 13

tissue destruction (caused by gram - bacteria - obligate anaerobes e.g. Porphyromonas spp, Fusobacterium, Prevotella, Spirochaetes. Destruction caused by the tissue’s immune response.

Question 14

Are there systemic risks of periodontal disease?

Answer 14

Yes - association betwen severity of periodontal disease and the prevalence of cardiac lesions as diagnosed with ECG in dogs and also systemic inflammatory parameters and also the following: myocardial disease, renal disease (glomerular and interstitial) and hepatitis.

Question 15

How to diagnose periodontal disease?

Answer 15

Full diagnostics under general anaesthesia - complete dental charting and dental radiography (essential e.g. so you don’t miss a fractured jaw!)

Question 16

why are dental radiographs useful? 3

Answer 16

• determine the % of attachment loss for staging.
• determine the pattern: vertical or horizontal bone loss?
• determine whether to expect difficulty during extraction

Question 17

What does dental charting involve? 5

Answer 17

• missing teeth - note these down!
• test all teeth for mobility
• measure gingival recession
• check the furcations
• use dental mirror to view the lingual/palatal aspects

Question 18

How much motility is there in the different stages of periodontal disease?

Answer 18

stage 1 = up to 0.5mm lateral excursions when tip of crown is ‘flicked’ with probe tip
stage 2 = >0.5mm, 1mm

n.b. mobility stage 2 is normal for mandibular incisors

Question 19

Define furcation defect

Answer 19

bone loss, usually a result of periodontal disease, this affects the back of a root trunk of a tooth where 2 or more roots meet (bifurcation or trifurcation)

Question 20

Desvribe the furcatons you’d check during dental charting.

Answer 20

stage 1 = tip of probe ‘finds’ the furcation
2 = the probe goes partially under the tooth
3 = probe goes fully under tooth and re-emerges on the other side.

Question 21

What should you do when you have a furcation exposure grade 3?

Answer 21

test the furcation integrity from the lingual and also the palatal aspects ( a fully intact gingival margin doesn’t rule out furcation exposure)

Question 22

What are the broad treatment options for periodontal disease?

Answer 22

• extractions
• scaling and polishing
• prevention with adequate oral home care
• advanced treatment (flap surgery etc).

Question 23

What is a complication of periodontal disease?

Answer 23

Oronasal fistula - nasal discharge, sneezing after eating or drinking

Question 24

How can you prevent an ONF?

Answer 24

Always probe the pocket depth on the palatial aspect on the canine tooth as well. Suspect ONF if canine tooth has severe periodontal disease. Repair of ONF should always be recommended

Question 25

Which breeds have a risk of jaw fracture secondary to periodontal disease?

Answer 25

Toy breeds - they have a relatively big teeth in a very small and thin mandible. If bone resorption occurs there may be very few millimetres of bone left on the ventral mandible. Always take rafiographs before extracting on a small breed mandible.

Question 26

Define stomatitis

Answer 26

Inflammation of the oral mucosa extending beyond the mucogingival junction. It is usually bilateral and fairly symmetrical. If asymmetrical consider other Ddx such as neoplasia so take biopsies.

Question 27

What is caudal extent in cats?

Answer 27

The severe inflammation of the caudal vestibular mucosa and of the palate-glossal folds.

Question 28

Common name for ulcerative stomatitis in dogs

Answer 28

Contact ulcers or kissing lesions

Question 29

Treatment - stomatitis

Answer 29

Early referral recommended, warn of no low cost options, welfare if already in pain and can't eat, extensive extraction required, also immediate pain relief, plaque control, consider corticosteroids as last resort instead of PTS but not accepted best standard of care.

Question 30

How can you prevent an ONF?

Answer 30

always probe the pocket depth p