Difference between revisions of "Periodontal Disease"

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==Typical Signalment==
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== Introduction<br> ==
*Pure bred cats are particularly susceptible and include:
+
 
 +
Periodontal disease is essentially an inflammatory response by the supporting structures of the teeth known as the periodontium. These structures include the gingiva, periodontal ligaments, cementum and alveolar bone.
 +
 
 +
It is the most common dental disease in dogs and cats and the major cause of tooth loss in both species. There are numerous factors that contribute to the formation of the disease but the primary agent is dental plaque. Plaque accumulates at the gingival margin, partly due to insufficient oral hygiene.
 +
 
 +
Initially the bacterial flora tend to be non-motile aerobes or facultative anaerobes. However, as the supply of oxygen is reduced by supragingival plaque accumulation and pocket formation, the bacterial flora become more motile and anaerobic. Important bacterial flora responsible include Porphyromonas gingivalis, Bacteroides asaccharolyticus, Fusobacterium nucleatum, Actinomyces viscosus and Actinomyces odontolyticus.
 +
 
 +
Gingivitis and periodontitis are the two main forms of the disease. Gingivitis is the early form of the disease and often but not always progresses to periodontitis.
 +
 
 +
'''Gingivitis''' - Reversible inflammation of the marginal gingival tissues that does not affect the periodontal ligament or the alveolar bone.
 +
 
 +
'''Periodontitis''' - Inflammation and irreversible destruction of the tooth's supporting structures that includes the gingiva, periodontal ligament, alveolar bone and root cementum. It usually occurs after years of plaque accumulation and gingivitis. The epithelial attachments of the tooth regress apically and there is absorption of the associated alveolar bone, resulting in permanent loss of tooth support. <br>
 +
 
 +
<br>
 +
 
 +
== Signalment<br> ==
 +
 
 +
Pure bred cats are particularly susceptible and include:  
  
 
<gallery>
 
<gallery>
Line 7: Line 24:
 
Image:Tabby-point.JPEG|''Siamese''<br> Kamée 2009, WikiMedia Commons
 
Image:Tabby-point.JPEG|''Siamese''<br> Kamée 2009, WikiMedia Commons
 
Image:Mainecoon.png|''Maine Coon''<br> Harald Wehner 2006, WikiMedia Commons
 
Image:Mainecoon.png|''Maine Coon''<br> Harald Wehner 2006, WikiMedia Commons
</gallery>
+
</gallery>  
 +
 
 +
Affects majority of cats over two years of age.
  
* Affects majority of cats over two years of age.
+
Certain breeds of dogs are thought to be susceptible to an aggressive form of the disease and include:  
*Certain breeds of dogs are thought to be susceptible to an aggressive form of the disease and include:
 
  
 
<gallery>
 
<gallery>
 
Image:Greyhound.jpg|''Greyhound'' <p> ToB 2005, WikiMedia Commons
 
Image:Greyhound.jpg|''Greyhound'' <p> ToB 2005, WikiMedia Commons
 
Image:Maltese.jpg|''Maltese'' <p> sannse 2003, WikiMedia Commons
 
Image:Maltese.jpg|''Maltese'' <p> sannse 2003, WikiMedia Commons
</gallery>
+
</gallery>  
 +
 
 +
Small breed dogs are more prone to tooth crowding, predisposing the animal to the initiation and rapid progression of the disease
  
*Small breed dogs are more prone to tooth crowding, predisposing the animal to the initiation and rapid progression of the disease
+
<br>
  
==Description==  
+
== Clinical Signs<br> ==
Periodontal disease is essentially an inflammatory response by the supporting structures of the teeth known as the periodontium. These structures include:
 
*[[Gingiva Introduction|gingiva]]
 
*[[Periodontal ligament - Anatomy & Physiology|periodontal ligaments]]
 
*cementum
 
*[[Alveolar Bone|alveolar bone]]
 
  
It is the most common dental disease in dogs and cats and the major cause of tooth loss in both species. There are numerous factors that contribute to the formation of the disease but the primary agent is dental plaque. Plaque accumulates at the gingival margin, partly due to insufficient oral hygiene.  
+
Clinical signs include fetid breathe odour (halitosis), excessive salivation, blood in saliva, dysphagia,&nbsp;pain on mastication and&nbsp;difficulty eating. There may also be&nbsp;loose teeth. The animal may be lethargic and show signs of&nbsp;weight loss and poor grooming.  
  
Initially the bacterial flora tend to be non-motile aerobes or facultative anaerobes. However, as the supply of oxygen is reduced by supragingival plaque accumulation and pocket formation, the bacterial flora become more motile and anaerobic.
 
Important bacterial flora responsible include:
 
*''Porphyromonas gingivalis''
 
*''[[Bacteroides]]'' ''asaccharolyticus''
 
*''Fusobacterium nucleatum''
 
*''[[:Category:Actinomyces|Actinomyces]]'' ''viscosus''
 
*''[[:Category:Actinomyces|Actinomyces]]'' ''odontolyticus''
 
  
'''Gingivitis''' and '''periodontitis''' are the two main forms of the disease. Gingivitis is the early form of the disease and often but not always progresses to periodontitis.
 
  
*'''Gingivitis''' - Reversible inflammation of the marginal gingival tissues that does not affect the periodontal ligament or the alveolar bone.
+
== Diagnosis ==
  
*'''Periodontitis''' - Inflammation and irreversible destruction of the tooth's supporting structures that includes the gingiva, [[Periodontal ligament - Anatomy & Physiology|periodontal ligament]], [[Alveolar Bone|alveolar bone]] and root cementum. It usually occurs after years of plaque accumulation and gingivitis. The epithelial attachments of the tooth regress apically and there is absorption of the associated [[Alveolar Bone|alveolar bone]], resulting in permanent loss of tooth support.
+
Clinical signs are indicative of oral disease.  
  
==Diagnosis==
+
An oral examination should be performed.&nbsp;This is the most important part of the diagnostic procedure and should include inspection of extraoral structures (looking for swelling, atrophy or assymmetry), such as&nbsp;face,&nbsp;lips, muscles of mastication,&nbsp;temporomandibular joints,&nbsp;salivary glands,&nbsp;lymph nodes,&nbsp;maxillae and mandibles. Intraoral structures such as the&nbsp;dentition, gingiva,&nbsp;mucosa, tongue,&nbsp;tonsils and dental occlusion should also be thoroughly examined. On visual inspection of the intraoral structures, an animal with periodontitis may demonstrate&nbsp;oral mucosal ulceration, inflammed and bleeding gingiva,&nbsp;loss of normal gingival contour,&nbsp;purulent discharge from the periodontal pocket, gingival recession,&nbsp;loose teeth and presence of variable quantities of plaque and calculus on the tooth surface.
  
===Clinical Signs===
+
A thorough periodontal examination of dogs should always be performed under general anaesthesia. The examination under general anaesthesia in cats allows a more detailed evaluation of the oral cavity.&nbsp;The periodontal examination is performed using a periodontal probe which is gently run under the gingival margin of each tooth. An evaluation is made of the&nbsp;amount of plaque and calculus present on the tooth surface, the&nbsp;degree of gingivitis and the presence of [[Gingival Hyperplasia|gingival hyperplasia]] or recession. The degree of attachment loss and boney resorption at the furcation is also investigated as well as the&nbsp;mobility of individual teeth.
*fetid breathe odour (Halitosis)
 
*excessive salivation
 
*blood in saliva
 
*dysphagia
 
*pain on mastication
 
*difficulty eating
 
*loose teeth
 
*lethargy
 
*weight loss
 
*poor grooming
 
  
===Oral Examination===
+
The disease can then be staged:  
This is the most important part of the diagnostic procedure and should include inspection of the following:
 
*Extraoral structures (looking for swelling, atrophy or assymmetry)
 
**face
 
**lips
 
**muscles of mastication
 
**temporomandibular joints
 
**salivary glands
 
**lymph nodes
 
**maxillae
 
**mandibles
 
*Intraoral structures
 
**dentition
 
**gingiva
 
**mucosa
 
**tongue
 
**tonsils
 
**occlusion
 
  
On visual inspection of the intraoral structures, an animal with periodontitis may demonstrate the following:
+
*'''Stage 0 - Normal and healthy periodontium'''
*oral mucosal ulceration
+
*'''Stage 1 - Periodontal disease/Gingivitis''' (0% attachment loss, Pocket depth &lt;0.5mm)
*inflammed and bleeding gingiva
+
*'''Stage 2 - Early periodontal disease''' (&lt;25% attachment loss, Pocket depth &lt;1.0mm)
*loss of normal gingival contour
+
*'''Stage 3 - Moderate periodontal disease''' (25-50% attachment loss, Pocket depth &lt;2.0mm)
*purulent discharge from periodontal pocket
+
*'''Stage 4 - Severe periodontal disease''' (&gt;50% attachment loss, Pocket depth &gt;2.0mm)
*gingival recession
 
*loose teeth
 
*variable quantities of plaque and calculus on the tooth surface
 
  
===Periodontal Examination===
+
Oral radiography can be used to assess periodontal disease. Cases of periodontitis will show generalised horizontal and vertical alveolar bone loss in focal areas. Radiographic signs of periodontal disease include&nbsp;resorption/rounding of the alveolar margin,&nbsp;widening of the periodontal space, loss of the lamina dura (cortical bone of the alveolus) and [[Alveolar Bone|alveolar bone]] destruction.
  
A thorough periodontal examination of dogs should always be performed under general anaesthesia. The examination under general anaesthesia in cats allows a more detailed evaluation of the oral cavity.
 
  
The periodontal examination is performed using a periodontal probe which is gently run under the gingival margin of each tooth. An evaluation is made of the following:
 
*amount of plaque and calculus present on the tooth surface
 
*degree of gingivitis
 
*presence of [[Gingival Hyperplasia|gingival hyperplasia]] or recession
 
*degree of attachment loss
 
*boney resorption at the furcation
 
*mobility of individual teeth
 
  
The disease can then be staged:
+
== Treatment ==
  
*'''Stage 0 - Normal and healthy periodontium'''
+
'''Gingivitis'''  
*'''Stage 1 - Periodontal disease/Gingivitis''' (0% attachment loss, Pocket depth <0.5mm)
 
*'''Stage 2 - Early periodontal disease''' (<25% attachment loss, Pocket depth <1.0mm)
 
*'''Stage 3 - Moderate periodontal disease''' (25-50% attachment loss, Pocket depth <2.0mm)
 
*'''Stage 4 - Severe periodontal disease''' (>50% attachment loss, Pocket depth >2.0mm)
 
  
 +
Educate the owner of the disease process and also educate them on good daily dental home care such as tooth brushing and diet.
  
===Diagnostic Imaging===
+
Perform a dental scale and polish and ensure the owner is aware that regular examinations to assess the condition of the teeth will be required from now on.
Oral radiography can be used to assess periodontal disease. Cases of periodontitis will show generalised horizontal and vertical alveolar bone loss in focal areas.
 
  
Radiographic signs of periodontal disease:
+
'''Periodontitis'''
*resorption/rounding of the alveolar margin
 
*widening of the periodontal space
 
*loss of the lamina dura (cortical bone of the alveolus)
 
*[[Alveolar Bone|alveolar bone]] destruction
 
  
==Treatment==
+
Educate the owner of the disease process and also educate them on good daily dental home care such as tooth brushing and diet.
'''Gingivitis''':
 
*Educate the owner of the disease process
 
*Educate the onwer in good daily dental home care such as tooth brushing and diet
 
*Dental scale and polish
 
*Regular examinations to assess the condition
 
  
'''Periodontitis''':
+
Perform a dental Scale and polish and root surface debridement. Teeth with severe peridontitis will need to be extracted and periodontal surgery may be necessary.
*Educate the owner of the disease process
 
*Educate the owner in good daily dental home care
 
*Dental Scale and polish
 
*Root surface debridement
 
*Extraction of teeth with severe periodontitis
 
*Periodontal surgery may be necessary
 
*Regular examinations to assess the condition
 
  
 +
Regular examinations to assess the condition of the teeth are vital and the owner needs to be made aware of this.
  
==References==
+
<br>
 +
 
 +
== References ==
  
 
*Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''
 
*Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''
  
*Merck & Co (2008) '''The Merck Veterinary Manual'''
+
*Merck &amp; Co (2008) '''The Merck Veterinary Manual'''
 
 
  
[[Category:Teeth_-_Inflammatory_Pathology]][[Category:Oral_Cavity_and_Gingiva_-_Pathology]]
+
[[Category:Teeth_-_Inflammatory_Pathology]] [[Category:Oral_Cavity_and_Gingiva_-_Pathology]] [[Category:To_Do_-_Review]] [[Category:Oral_Diseases_-_Cat]] [[Category:Oral_Diseases_-_Dog]]
[[Category:To_Do_-_Clinical]]
 
[[Category:Oral Diseases - Cat]][[Category:Oral Diseases - Dog]]
 

Revision as of 15:22, 22 March 2011

Introduction

Periodontal disease is essentially an inflammatory response by the supporting structures of the teeth known as the periodontium. These structures include the gingiva, periodontal ligaments, cementum and alveolar bone.

It is the most common dental disease in dogs and cats and the major cause of tooth loss in both species. There are numerous factors that contribute to the formation of the disease but the primary agent is dental plaque. Plaque accumulates at the gingival margin, partly due to insufficient oral hygiene.

Initially the bacterial flora tend to be non-motile aerobes or facultative anaerobes. However, as the supply of oxygen is reduced by supragingival plaque accumulation and pocket formation, the bacterial flora become more motile and anaerobic. Important bacterial flora responsible include Porphyromonas gingivalis, Bacteroides asaccharolyticus, Fusobacterium nucleatum, Actinomyces viscosus and Actinomyces odontolyticus.

Gingivitis and periodontitis are the two main forms of the disease. Gingivitis is the early form of the disease and often but not always progresses to periodontitis.

Gingivitis - Reversible inflammation of the marginal gingival tissues that does not affect the periodontal ligament or the alveolar bone.

Periodontitis - Inflammation and irreversible destruction of the tooth's supporting structures that includes the gingiva, periodontal ligament, alveolar bone and root cementum. It usually occurs after years of plaque accumulation and gingivitis. The epithelial attachments of the tooth regress apically and there is absorption of the associated alveolar bone, resulting in permanent loss of tooth support.


Signalment

Pure bred cats are particularly susceptible and include:

Affects majority of cats over two years of age.

Certain breeds of dogs are thought to be susceptible to an aggressive form of the disease and include:

Small breed dogs are more prone to tooth crowding, predisposing the animal to the initiation and rapid progression of the disease


Clinical Signs

Clinical signs include fetid breathe odour (halitosis), excessive salivation, blood in saliva, dysphagia, pain on mastication and difficulty eating. There may also be loose teeth. The animal may be lethargic and show signs of weight loss and poor grooming.


Diagnosis

Clinical signs are indicative of oral disease.

An oral examination should be performed. This is the most important part of the diagnostic procedure and should include inspection of extraoral structures (looking for swelling, atrophy or assymmetry), such as face, lips, muscles of mastication, temporomandibular joints, salivary glands, lymph nodes, maxillae and mandibles. Intraoral structures such as the dentition, gingiva, mucosa, tongue, tonsils and dental occlusion should also be thoroughly examined. On visual inspection of the intraoral structures, an animal with periodontitis may demonstrate oral mucosal ulceration, inflammed and bleeding gingiva, loss of normal gingival contour, purulent discharge from the periodontal pocket, gingival recession, loose teeth and presence of variable quantities of plaque and calculus on the tooth surface.

A thorough periodontal examination of dogs should always be performed under general anaesthesia. The examination under general anaesthesia in cats allows a more detailed evaluation of the oral cavity. The periodontal examination is performed using a periodontal probe which is gently run under the gingival margin of each tooth. An evaluation is made of the amount of plaque and calculus present on the tooth surface, the degree of gingivitis and the presence of gingival hyperplasia or recession. The degree of attachment loss and boney resorption at the furcation is also investigated as well as the mobility of individual teeth.

The disease can then be staged:

  • Stage 0 - Normal and healthy periodontium
  • Stage 1 - Periodontal disease/Gingivitis (0% attachment loss, Pocket depth <0.5mm)
  • Stage 2 - Early periodontal disease (<25% attachment loss, Pocket depth <1.0mm)
  • Stage 3 - Moderate periodontal disease (25-50% attachment loss, Pocket depth <2.0mm)
  • Stage 4 - Severe periodontal disease (>50% attachment loss, Pocket depth >2.0mm)

Oral radiography can be used to assess periodontal disease. Cases of periodontitis will show generalised horizontal and vertical alveolar bone loss in focal areas. Radiographic signs of periodontal disease include resorption/rounding of the alveolar margin, widening of the periodontal space, loss of the lamina dura (cortical bone of the alveolus) and alveolar bone destruction.


Treatment

Gingivitis

Educate the owner of the disease process and also educate them on good daily dental home care such as tooth brushing and diet.

Perform a dental scale and polish and ensure the owner is aware that regular examinations to assess the condition of the teeth will be required from now on.

Periodontitis

Educate the owner of the disease process and also educate them on good daily dental home care such as tooth brushing and diet.

Perform a dental Scale and polish and root surface debridement. Teeth with severe peridontitis will need to be extracted and periodontal surgery may be necessary.

Regular examinations to assess the condition of the teeth are vital and the owner needs to be made aware of this.


References

  • Tutt, C., Deeprose, J. and Crossley, D. (2007) BSAVA Manual of Canine and Feline Dentistry (3rd Edition) BSAVA
  • Merck & Co (2008) The Merck Veterinary Manual