Flashcards in Periodontal disease and stomatitis Deck (30):
How common is periodontal disease in SA?
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.
What causes periodontal disease? 2 categories + examples
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)
What is plaque? Where?
a biofilm, therefore a mucoid matter on teeth.
found on teeth especially near and under the gingival margin
What is calculus?
=mineralised plaque (common term = tartar)
Does calculus cause perio-disease?
Not per se but it offers a porous surface for easier plaque adhesion
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.
What are the components of the periodontium? 3
gingiva, periodontal ligament and alveolar bone
what are the different stages of periodontal disease?
Describe the different stages of periodontal disease.
0 = healthy gingiva
1 = gingivitis, no evidence of attachment loss
2 = mild periodontosis with 50% attachment loss
Describe stage 1 periodontal disease: gingivitis
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)
Pathogenesis - why can disease progress form gingivitis to grade 2-4?
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).
Why does the epitheliuen that lines the gingival sulcus faciliatate the microbial invasion of periodontal tissues?
the epithelium here is not keratinised
What happens in the irreversible stages?
tissue destruction (caused by gram - bacteria - obligate anaerobes e.g. Porphyromonas spp, Fusobacterium, Prevotella, Spirochaetes. Destruction caused by the tissue's immune response.
Are there systemic risks of periodontal disease?
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.
How to diagnose periodontal disease?
Full diagnostics under general anaesthesia - complete dental charting and dental radiography (essential e.g. so you don't miss a fractured jaw!)
why are dental radiographs useful? 3
-determine the % of attachment loss for staging.
-determine the pattern: vertical or horizontal bone loss?
-determine whether to expect difficulty during extraction
What does dental charting involve? 5
-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
How much motility is there in the different stages of periodontal disease?
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
Define furcation defect
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)
Desvribe the furcatons you'd check during dental charting.
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.
What should you do when you have a furcation exposure grade 3?
test the furcation integrity from the lingual and also the palatal aspects ( a fully intact gingival margin doesn't rule out furcation exposure)
What are the broad treatment options for periodontal disease?
-scaling and polishing
-prevention with adequate oral home care
-advanced treatment (flap surgery etc).
What is a complication of periodontal disease?
Oronasal fistula - nasal discharge, sneezing after eating or drinking
How can you prevent an ONF?
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
Which breeds have a risk of jaw fracture secondary to periodontal disease?
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.
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.
What is caudal extent in cats?
The severe inflammation of the caudal vestibular mucosa and of the palate-glossal folds.
Common name for ulcerative stomatitis in dogs
Contact ulcers or kissing lesions
Treatment - stomatitis
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.