periodontal disease - hawke ava ballina 2011 · 3 what exactly is periodontal disease? plaque is...

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PO Box 3001 Willoughby North 2068Phone: 0408 782 611

Email: [email protected]: www.sydneypetdentistry.com.au

Periodontal Disease

Dr Christine HawkeBSc(Vet)(Hons) BVSc(Hons) PhD

MACVSc (Veterinary Dentistry)

What’s the big deal about dental disease?

We know that 80-85% of dogs and

cats over three years have dental

disease that needs treatment

In the US, a recent study showed

that 15.5 million dogs and cats did

NOT get the treatment they needed

for existing dental disease

www.photobucket.com

Source: Path to High-Quality Care: Practical Tips for Improving Compliance (2003)American Animal Hospital Association


We are not talking about cosmetic cleaning or even

preventative care

We are talking about infection and pain

Dental disease affects the pet’s overall health and quality

of life, and even the bond between pets and their owners

*

www.mamagums.com

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Every animal deserves a healthy,

pain-free mouth

*

If dental disease is so common…..

Many owners are not aware or convinced of their pet’s need

for dental treatment

Dental disease is hidden inside the mouth

Animals don’t always show what we consider to be

‘classic’ signs of pain or discomfort

Pets rely on US to help their owners understand what care

they need and why

…why aren’t we treating more of it?

Max the poodle’s annual check-up

Is this healthy and pain-free?

Why might Max’s owner have not noticed that Max has a problem?

Furcation exposure

GingivalRecession

Root exposure

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What exactly is periodontal disease?

PLAQUE IS THE PRIMARY CAUSE

Plaque initially forms on supragingival surfaces and then extends

below the gumline. Conditions become more anaerobic as plaque,

calculus and gingival swelling occlude the gingival sulcus.

What exactly is periodontal disease?

Loss of attachment is due to

both bacterial products and

the host’s immune response

The final outcome depends

on the interactions between

the host and the pathogen

(varies between individuals,

and within individuals over

time)

SYSTEMIC FACTORS that alter the host’s immune

response OR cause lesions that affect the integrity of the

oral cavity against infection

LOCAL FACTORS that favour plaque retention OR

interfere with its mechanical removal

Natural cleaning mechanisms include chewing, tongue

movements and saliva flow

What secondary factors are involved?

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SYSTEMIC FACTORS

Breed and genetics

Age

General health status

Nutritional status

Stress

Immunodeficiency

Hypersensitivity

Endocrine disease

Renal disease

Infectious agents

Autoimmune disease


LOCAL FACTORS

Calculus

Crowding and rotation

Malformations

Persistent deciduous teeth

Trauma

Oral disease eg neoplasia, hyperplasia

Chewing behaviour

Saliva flow


Back to Max.... Periodontal disease has both local and systemic effects

Would bone loss go untreated in other parts of the body?

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Systemic effects of periodontal disease

Bacteria penetrate via the

damaged gingival epithelium

and enter the bloodstream

Chronic antigenic stimulation

induces proinflammatory

mediator release

What was done for Max?

Max had a general anaesthetic, and his teeth were scaled

and polished

Seventeen teeth were beyond salvage and were extracted.

He ate well that night in hospital!

On recheck a week later, Max’s owner was surprised by how

much brighter he was (‘I thought he was just getting old!’).

1. Remove plaque, calculus and debris from tooth surfaces and

periodontal pockets

Remove the source of infection and inflammation

Allow healing to occur

Produce a smooth surface (decrease plaque reattachment)

2. Remove or treat any damaged or diseased teeth

3. Produce an environment that promotes self-cleaning and aids

home care

Our treatment goals:

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When does an animal need treatment?

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GINGIVITISIS REVERSIBLE

PERIODONTITISIS NOT REVERSIBLE

1. Periodontal disease cannot be treated by the use

antimicrobials alone. We need to physically remove the

plaque and bacteria.

2. Removing supragingival plaque does NOT affect the

subgingival plaque

3. Once calculus forms, you cannot get teeth clean again by

brushing alone.

Three important points about treatment

1. Gross removal of calculus (as required)

2. Oral and dental examination periodontal probing and charting

3. Dental radiographs (as required)

4. Develop treatment plan

5. Periodontal debridement (supra + sub-gingival scaling)

6. Polishing using prophy paste

7. Irrigation to remove debris

8. Surgical procedures (as required)

9. Home care advice

10. Recheck and review

Step by step guide to dental treatment

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Staff safety

Avoid injury and infection

Protective eyewear, mask and gloves

Rinse animal’s mouth with chlorhexidine prior to

scaling and polishing

Examination, probing and charting

Check the oral cavity for any abnormalities such as lumps,

ulcers etc

Check the teeth

Any extra or missing teeth – count them!

MAXILLAMAXILLA 3.1.4.23.1.4.2

MANDIBLEMANDIBLE 3.1.4.33.1.4.3

TOTAL = 42TOTAL = 42

Dental formula - dog

www.link.vet.ed.ac.uk/clive/cal/Dentistry/Website/index.htm

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MAXILLAMAXILLA 3.1.3.13.1.3.1

MANDIBLEMANDIBLE 3.1.2.13.1.2.1

TOTAL = 30TOTAL = 30

Dental formula - cat

www.link.vet.ed.ac.uk/clive/cal/Dentistry/Website/index.htm


Check the oral cavity for any abnormalities such as lumps,

ulcers etc

Check the teeth

Any extra or missing teeth – count them!

Tooth position (eg malocclusions, rotation, crowding)

Tooth structural changes (fractures, resorptive lesions etc)

Periodontal disease indices include:

Plaque and calculus indices

Gingivitis and mobility indices

Furcation exposure

Probing depths


Furcation index:

F1 up to 1/3 of width of tooth

F2 more than 1/3 of width of tooth

F3 ‘through and through’

www.dentalvet.com

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Normal probing depth for dogs is up to ~3mm

For cats it is up to ~0.5-1mm

Also note where the gingival margin sits

www.dentalvet.com

Recording your findings

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23 5

4

4

#

II

22

22

#

II

missing

fractured

furcation (F2)

to extract

extracted









9. Home care advice



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Should it stay or should it go?

1. Prognosis for each tooth (is it worth trying to save?)


Periodontal disease index for each tooth can be determined

based on severity of attachment loss:

PD0 normal periodontium

PD1 gingivitis only

PD2 <25% attachment loss

PD3 25-50% attachment loss

PD4 >50% attachment loss


1. Prognosis for each tooth (is it worth trying to save?)

2. Importance of each tooth (dentition as a whole)

- Strategic functional units are the canines and carnassials

3. Overall health status of the animal (are repeated

anaesthetics going to be a problem?)

4. Owner and patient compliance for home care

- Are they willing and able?

- Is it likely to be effective anyway (eg furcation cleaning)?

5. Skill levels of practitioner (is referral an option?)

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9. Home care advice



Periodontal debridement

Scaling needs to be done above AND

below the gumline

When using an ultrasonic scaler, take

care not to overheat the tooth (10 sec/ tooth)

Hand scalers can be used for areas that are hard to access

Hand curettes are used to clean subgingival pockets

Open root planing - in cases where

pockets are deep eg >5mm may

do apical repositioning flap

Polishing and irrigation

Polishing removes microscopic deposits and leaves a

smooth surface

Always have prophy paste in the cup

Flare the edges to polish under the gumline

Irrigate to remove debris

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9. Home care advice



Antibiotic use in periodontal disease

Prophylactic antibiotic therapy should be considered in:

Geriatric, immunocompromised or debilitated patients

Patients with pre-existing heart disease

Patients with surgical prostheses

Patients where combining dentistry with elective surgery

Therapeutic use of antibiotics is appropriate where

extractions are performed, there are significant periodontal

pockets, or where gross oral infections are present

QUESTIONS?

periodontal disease - hawke ava ballina 2011 · 3 what exactly is periodontal disease? plaque is...

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