SA periodontal disease

Question 1

What is periodontitis?

Answer 1

Periodontal disease is an inflammatory and destructive condition affecting the support tissues of the teeth. It is initiated by plaque

Question 2

What is Plaque?

Answer 2

Plaque – Biofilm of bacteria in a matrix of salivary glycoproteins and external polysaccharides

Question 2

What is Calculus?

Answer 2

Calculus – Plaque which has become calcified by bacteria absorbing minerals from saliva

Question 3

What is pathophysiology of dental disease?

Answer 3

1. Plaque -
   -Protein and glycoproteins are deposited on enamel surface – pellicle
   -Pellicle allows adhesion of gram +ve bacteria
2. Calculus -
   -Plaque becomes mineralised through absorption of calcium from saliva (within days)
3. Gingivitis - REVERSIBLE
   -Calculus is rough and can irritate the gingiva causing inflammation
   -Rough, porous surface allows further plaque build up
   -Bacterial enzymes and endotoxins cause local inflammatory response
4. Periodontitis - IRREVERSIBLE
   -An anaerobic environment develops in gingival sulcus
   -Bacterial endotoxins and enzymes cause further inflammation of connective tissue
   -Gingival recession, destruction of periodontal ligament and alveolar bone
   -Attachment loss of tooth

Question 4

What cats/dogs have higher prevalence of periodontal disease?

Answer 4

*Higher prevalence in…
* small breed dogs + brachycephalics
*Breeds = greyhounds, schnauzers, maltese CATS = abysinnian + somali
*Malocclusion
*Developmental defects - retention of deciduous teeth
*Diet - soft food = reduced abrasion of teeth
*Immune status - immunocompromised = more severe

Question 5

With grading - what is stage 0?

Answer 5

Normal healthy periodontium
*Non-inflamed, pink colour
*Radiographs = no abnormalities

Question 6

What is the periodontal probe? How is it used?

Answer 6

*Tool to assess depth of gingival sulcus
*Normal depth 0-3mm dogs, 0-1mm cats
*Increased depth indicates periodontal disease
*‘Walk’ probe backwards along tooth
*Use horizontally to assess furcation

Question 7

What is Stage 1?

Answer 7

*Gingivitis without attachment loss
*Reversible
*No furcation exposure (multi rooted teeth)
*No bleeding of gingiva

Question 8

What is stage 2?

Answer 8

*Early periodontitis— deepened gingival sulcus, less than 25% of attachment loss
*Exposed root furcation may be present in multi – rooted teeth
*Gingival inflammation and bleeding

Question 9

What is stage 3?

Answer 9

*Moderate periodontitis— 25-50% attachment loss
*Probe can be placed greater than 1/3 way through furcation
*Gingival inflammation and bleeding

Question 10

What is stage 4?

Answer 10

*Severe periodontitis— Over 50% attachment loss
*Probe can be placed fully through furcation
*Gingival inflammation and bleeding

Question 11

How is periodontal disease diagnosed?

Answer 11

*Clinical signs
*Conscious examination.
*Anaesthetised examination – radiography, disease grading.

Question 12

What are the clinical signs of periodontal disease?

Answer 12

*Halitosis
*Salivation (ptyalism) + blood-tinged saliva
*Dentition -Visible plaque +/- calculus, furcation exposure, tooth mobility
*Gingiva -Inflamed/ bleeding, gingival recession
*Abscess formation, purulent discharge from periodontal pocket.
*Dysphagia/pain when eating, dogs- reluctance to play with tug toys

Question 13

How is periodontal disease treated?

Answer 13

*Perform an anaesthetised
*Scaling:
*Subgingival scaling – remove calculus below the gum line
*Flushing with chlorhexidine
*Polishing:
*Sulcular lavage:
*Extractions:

Question 14

What is included with examination of oral cavity?

Answer 14

*Oro pharynx during intubation
*Full mouth periodontal probing and charting
*Record missing teeth
*Full mouth radiography

Question 15

What is included in the scaling?

Answer 15

*Large calculus removed with forceps or calculus removers
*Ultrasonic scaling removes small calculus
*Subgingival scaling – remove calculus below the gum line

Question 16

Why would you flush with chlorohexidine?

Answer 16

Reduce bacterial load

Question 17

Why polish + how?

Answer 17

*Remove plaque and stains.
*USE LOW-SPEED: NO water cooling, avoid damage of teeth through heat generation. Check by polishing your nail, if not painful= perfect for teeth. Remember to polish in the gingival sulcus as well.

Question 18

Why sulcular lavage?

Answer 18

*Use air-water syringe gently to remove excess of paste and to dislodge debris from sulcus.

Question 19

When should you do extractions?
What are the 2 different types?

Answer 19

*Extractions should be done after scale and polish (CLEAN SURGICAL SITE).
*Closed vs open extractions

Question 20

In what order should you do dental treatments?

Answer 20

1. Record calculus deposits
2. Remove gross calculus deposits
3. Definitive oral examination with charting
4. Radiographs as required
5. Supragingival scaling and subgingival scaling (up to 2mm depth)
6. Check the teeth for residual calculus and remove as found
7. Polish
8. Chlorhexidine rinse
9. Tooth extractions
10. Subgingival lavage

Question 21

How can you control plaque control?

Answer 21

Brushing teeth

Question 22

How often should you brush teeth?

Answer 22

Every other day to prevent calculus formation

Question 23

What is a good chemical anti-plaque agent? Why is it good?

Answer 23

-Chlorhexidine:
*Good broad spectrum antibacterial action
*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.
*Available as liquid or toothpaste formulations