Periodontal disease - HAWKE AVA Ballina 2011 · 3 What exactly is periodontal disease? PLAQUE IS...
Transcript of 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
What’s the big deal about dental disease?
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
*
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What’s the big deal about dental disease?
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
What secondary factors are involved?
LOCAL FACTORS
Calculus
Crowding and rotation
Malformations
Persistent deciduous teeth
Trauma
Oral disease eg neoplasia, hyperplasia
Chewing behaviour
Saliva flow
What secondary factors are involved?
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
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!
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
Examination, probing and charting
Furcation index:
F1 up to 1/3 of width of tooth
F2 more than 1/3 of width of tooth
F3 ‘through and through’
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Examination, probing and charting
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
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Recording your findings
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23 5
4
4
#
II
22
22
#
II
missing
fractured
furcation (F2)
to extract
extracted
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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Should it stay or should it go?
1. Prognosis for each tooth (is it worth trying to save?)
Should it stay or should it go?
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
Should it stay or should it go?
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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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
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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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
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?