Periodontal Disease Dentistry 2

Aetiology/Pathogenesis
1. Basic mechanisms
  1. Supra gingival and sub gingival plaque accumulates
  2. Bacteria - facultative anaerobes and aerobes
  3. O2 levels drop and anaerobes colonise
  4. Peridontal pockets form due to tissue destructive actions of toxins
2. What is plaque
  1. 75% inorganic 25% organic
  2. Of which Ca and P make up inorganic
  3. MIneralised plaque is calculus - buccal aspect
  4. Calculus is plaque retentive and bacteria friendly
3. Bacteria
  1. Bacteroides
  2. Peptostreptococcus
  3. Fusobacterium
  4. Lots more poss
4. Progression
  1. INflamed gingival margin
  2. Neutrophil rich fluid in gingival sulcus
  3. Bacteria colonise
  4. Cellular infiltrate develops
  5. Junctional epithelium breakdown
  6. Tissue destruction at peridontal ligament and alveolar bone crest
  7. Pocked deepens and widens
  8. Debris accumulate
  9. Progressive bone resorption
  10. Tooth mobility and loss
Grading
1. Normal
  Annotations:
  - 0
2. Gingivitis
  Annotations:
  - 1
3. Early periodontal disease
  Annotations:
  - 25% attachment loss 2
4. Modrate peridontal disease
  Annotations:
  - <50% attachment loss 3
5. Severe Peridontal Disease
  Annotations:
  - >50% attachment loss 4
Diagnosis
1. Radiography
  1. Lowered alveolar bone margin
  2. Bone loss below furcation and root exposure
2. Signs of stage 4 Gum recession, root exposure, appositional ulcer.
3. Signs of stage 3: Tooth mobility, vertical bone loss, furcation has dropped right down, gingival recession too with pockets, visible furcation point in multi root teeth, Root exposure
4. Signs of stage 2: Attachment loss - periodontal probe and x rays usually <25% Fairly subtle x ray signs - should have a slight peaking of the bone in the interdental space.
5. Signs of stage1: gingivitis only - slightly inflamed and oedematous surrounding one or more teeth
6. Sulchus
  1. No more than 4mm deep
  2. No more than 1mm in cats
7. Probing
  1. Supra bony pocket - soft tissue only
  2. Infra bony pocket - expands into alveolar crest
  3. Pseudo pocket - gingival hyperplasia
  4. Receeding gums and horizontal bone loss
8. Measure degree of gingival recession from enamel junction to free margin - may be normal (hide bone loss)
Routine
1. Throat pack in place and slightly head down
2. Rinse oral cavity in 0.12% Chlorohexadine
3. Remove gross supra gingival calculus with calculus forceps and hand scaler
4. Perform subgingival scaling with sub gingival curette
5. Polish all teeth include below gum margin with prophy paste
6. Remove all debris from mouth and clean and reinsert throat pack
7. Rinse again and assess to extract
  1. Probing and x rays
  2. Ask client first-be realistic
Caries
1. Dogs generally protected due to dietary habits
  1. Less fermentable carb
  2. Higher pH
  3. Variations in oral bacteria
2. Often affects first molar of lowar jaw
3. Acid produced by bacteria actin on food residues acts on the mineralization
4. Gray pit or cavity on occlusal surface
5. Dragging felt when probed due to softened dentine,
6. Restoration of tooth after removal of diseasesd part
7. Commonest treatment used is extraction

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Periodontal Disease Dentistry 2

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	Created by Charlotte Stephe about 9 years ago