Periodontal Disease

Question 1

Periodontal disease is the _____ _____ infection seen in the veterinary world

Answer 1

Most common

Question 2

What is the difference between plaque and tartar

Answer 2

Plaque: soft, sticky layer of bacteria adhered to the tooth (brownish yellow in color) easy to cut through

Tartar: (AKA calculus) is the hardened plaque combined with calcium from saliva, cannot brush it away it need professional cleaning

Question 3

Define periodontal disease

Answer 3

Inflammation and infection of the tissues surrounding the tooth collectively called the peridontium (not the tooth itself)

Question 4

What is periodontal disease characterized as

Answer 4

Movement of the gingival margin towards the apex (gingival recession) Exposing more crown and root

Migration of the attached gingiva

Loss of the periodontal ligament leading to loss of the bone surrounding the tooth

Question 5

What is the different between marginal and attached gingiva

Answer 5

Marginal: loose, immediate around the tooth, this is what gets probed

Attached: higher up, cannot be lifted normally

Question 6

Why is periodontal disease a problem

Answer 6

It is painful

Bacteria from infected tissues can enter the blood stream

Organs such as the lungs, kidneys and liver are most susceptible to infections from the mouth

Question 7

Why is periodontal disease considered multi factorial?

Answer 7

Because there can be many causes or predisposing factors contributing to the disease

Question 8

What are some predisposing factors to periodontal disease

Answer 8

Age
Species 
Breed 
Genetics 
Chewing behaviour
Grooming habits 
Patient health status 
Frequency of professional care 
Diet 
Orthodontic occlusion 
Home care 
Bacterial flora of the oral cavity

Question 9

If dogs chew a lot more they are more likely to have cleaner teeth but more prone to

Answer 9

Fractures

Question 10

What skull type is most prone to periodontal disease

Answer 10

Brachycephalic

Question 11

What type of diet is better in preventing periodontal disease

Answer 11

Dry diets

Question 12

What is acquired pellicle

Answer 12

A glycoprotein component of saliva that attaches to the tooth surface

This helps bacteria attach to the tooth surface

Question 13

How long does it take acquired pellicle to form

Answer 13

20 minutes

Question 14

Approx ___ hours after pellicle formation, bacteria starts to colonize the tooth surface, this bacteria layer is known as ___

Answer 14

6-8 hours

Plaque

Question 15

Bacteria attached to the tooth absorbs calcium from the saliva and becomes calcified, this is known as

Answer 15

Tartar or calculus

Question 16

Healthy gingival flora is made of mostly

Answer 16

Gram positive aerobic bacteria

Question 17

Describe how the gram positive aerobic bacteria create an anaerobic environment

Answer 17

It metabolizes the oxygen, the lack of oxygen allows anaerobic bacteria to colonize the tooth

Question 18

As periodontal disease progresses, gram ___ bacteria colonizes the tooth, as it continues to progress further _____ begin to colonize

Answer 18

Negative

Spirochetes

Question 19

Oral bacteria are arranged on the tooth in a ____, describe this

Answer 19

Biofilm

An aggregate of bacterial colonies protected by the polysaccharide complex

Question 20

It is the disruption of the biofilm that is important in the control of

Answer 20

Periodontal disease

Question 21

Plaque can be found in what 4 different areas around the tooth?

Answer 21

Free floating in the pocket

Attached to the tooth supra and subgingivally

Attached to the gingiva subgingivally

Question 22

As the bacteria infiltrates and colonizes the sulcus or pocket and invade the gingival tissue, the patients body will try and fight the infection, how does it do this?

Answer 22

WBCs produce antibodies and send chemical signals into the system to stimulate other cells to come and attach the bacteria

The bacteria often contain endotoxins (lipopolysaccharides or LPS) and enzymes that are toxic to the gingival tissues

Question 23

Describe what happens as the inflammation continues and the gingiva loosens from the tooth resulting in the formation of a pocket between the tooth and gingiva, what happens if it is not treated?

Answer 23

As the pocket grows deeper into the periodontium you start to lose tissue and bony support

If the patient is not treated the disease progresses and deeper pockets form with increased bone and tissue loss resulting gingival recession and furcation exposure

Question 24

What is a furcation? Where is it found?

Answer 24

The area where the roots join the crown in multi rooted teeth only

Question 25

How is furcation exposure classified

Answer 25

Classified by depth Class 1: exposure less than 1 mm Class 2: greater than 1mm exposed but not fully through Class 3: complete furcation exposure, probe can pass through the furcation completely

Question 26

As bone loss proceeds, the tooth may become

Answer 26

Mobile

Question 27

If bone loss is extensive and attachment is lost, the tooth may

Answer 27

Fall out

Question 28

What is the most common presenting complaints of clients seen in periodontal disease

Answer 28

Halitosis (bad breath)

Question 29

What are some other signs of periodontal disease

Answer 29

``` Not eating well Drooling Blood in saliva Pawing at the mouth Swelling in the face ```

Question 30

What is seen in oral exams in patients with periodontal disease

Answer 30

Red inflamed gingiva, which may bleed easily when probed due to fragile capillaries in the tissues An accumulation of plaque and calculus is evident (the amount doesn’t always correspond to the degree of periodontal disease present)

Question 31

What is the general evaluation of periodontal disease based on

Answer 31

Plaque Calculus Inflammation Topography (surface features including gum recession and furcation exposure)

Question 32

A thorough evaluation of periodontal disease can only be done under anesthesia with

Answer 32

Periodontal probing Intraoral radiographs

Question 33

Describe the classification system of periodontal disease

Answer 33

Stages 1-4 (0= not occurring) Based on the patients worst tooth to establish overall stage of disease Each tooth much be evaluated and charted for effective treatment (don’t just look for the worst tooth)

Question 34

describe healthy gingival (PD0)

Answer 34

Knife-like margin Coral pink or pigmented color Smooth topography and flow tooth to tooth Gingival tissue is firm Close observation: you see blood vessels at the gingival margin known as defined stippling (tiny capillaries)

Question 35

As periodontal disease progresses the topography of the gingiva becomes

Answer 35

Irregular and the even flow from tooth to tooth is lost

Question 36

What is the normal sulcus depth for dog and cats?

Answer 36

Dogs: 2-3mm Cats: 0.5-1mm

Question 37

Describe what stage 1 of periodontal disease looks like (PD1)

Answer 37

Early gingivitis (gingival inflammation with no evidence of bone loss) Redness (inflammation) of gingiva at the crest Defined stippling more difficult to visualize No noticeable changes seen on X-ray Reversible with treatment May appear 2-4 days after plaque accumulation in previously healthy gingiva Localized to the gingival sulcus

Question 38

Describe what stage 2 periodontal disease looks like (PD2)

Answer 38

Early periodontitis Reversible with dental scaling and prophylaxis as well as home care Increased inflammation including edema and development of subgingival plaque Increased amount of supragingival plaque and calculus Gingival topography starting to become irregular Less than 25% bone loss on x ray

Question 39

Describe what stage 3 periodontal disease looks like (PD3)

Answer 39

Moderate periodontitis Irreversible damage to the bone and gingiva (can stop it but cannot reverse it) Gingiva bleeds on gentle probing 25-50% bone loss on X-rays Severity often not visible on awake exam Often includes: gingival recession, moderate periodontal pockets, furcation exposure and tooth mobility grade 1

Question 40

Describe what stage 4 periodontal disease looks like (PD4)

Answer 40

Advanced periodontitis Irreversible damage to bone and gingiva Gingiva bleeds with gentle probing Deep periodontal pockets Over 50% of bone loss seen on X-ray Often includes: severe gingival recession, grade 3 furcation exposure, mobile teeth, severe inflammation, purulent discharge

Question 41

How do you use the periodontal probe when assessing periodontal disease

Answer 41

Probing depth: measurement from gingival margin to pocket base Attachment level (loss): measurement from cementoenamel junction (CEJ) to base of pocket in cases of gingival recession