Changes

== Diagnosis ==

== Diagnosis ==

 

An [[Oral Examination - Introduction|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 asymmetry), 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.  

An [[Oral Examination - Introduction|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 asymmetry), 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.  

Periodontal disease is associated with loss of the attachment apparatus of the tooth. Clinically this is hard to detect and there is no correlation between the amount of calculus seen on the tooth and the degree of destruction. Loss of attachment usually involves the periodontal ligament, bone, root cementum and gingiva. Clinically, [[Dental Indices and Criteria#Tooth Mobility|mobile teeth]] may be evident and some teeth may have evidence of [[Dental Indices and Criteria#Gingival Recession|gingival recession]] and root exposure indicating that there is periodontal disease but for a full assessment, an examination has to be performed under [[Oral Examination Under General Anaesthesia|general anaesthesia]]. A [[Periodontal Probe|periodontal probe]] is used to assess the depth of the gingival sulcus and whether there is loss of bone or periodontal ligament. A [[Dental Indices and Criteria#Periodontal Probing Depth (PPD)|probing depth]] greater than 3mm in most dogs would be considered abnormal. This does vary based on the tooth and the size of the dog. Any depth over 0.5mm in cats would be considered abnormal. The periodontal probe is used to assess the degree of gingivitis, measure the pocket depth, check whether the tooth is mobile, whether there is bone loss between the roots ([[Dental Indices and Criteria#Furcation Involvement|furcation exposure]]) and measure the amount of gingival recession. The whole circumference of the tooth needs to be evaluated. <font color="red">(pics PD5, PD6)</font color>

Periodontal disease is associated with loss of the attachment apparatus of the tooth. Clinically this is hard to detect and there is no correlation between the amount of calculus seen on the tooth and the degree of destruction. Loss of attachment usually involves the periodontal ligament, bone, root cementum and gingiva. Clinically, [[Dental Indices and Criteria#Tooth Mobility|mobile teeth]] may be evident and some teeth may have evidence of [[Dental Indices and Criteria#Gingival Recession|gingival recession]] and root exposure indicating that there is periodontal disease but for a full assessment, an examination has to be performed under [[Oral Examination Under General Anaesthesia|general anaesthesia]]. A [[Periodontal Probe|periodontal probe]] is used to assess the depth of the gingival sulcus and whether there is loss of bone or periodontal ligament. A [[Dental Indices and Criteria#Periodontal Probing Depth (PPD)|probing depth]] greater than 3mm in most dogs would be considered abnormal. This does vary based on the tooth and the size of the dog. Any depth over 0.5mm in cats would be considered abnormal. The periodontal probe is used to assess the degree of gingivitis, measure the pocket depth, check whether the tooth is mobile, whether there is bone loss between the roots ([[Dental Indices and Criteria#Furcation Involvement|furcation exposure]]) and measure the amount of gingival recession. The whole circumference of the tooth needs to be evaluated. <font color="red">(pics PD6)</font color>

There are a number of methods that grade the severity of periodontal disease. It must be remembered though that different teeth in the mouth may be affected by different severities of the disease and even around each tooth, the degree of attachment loss may vary. Grading is based on the extent of attachment loss as this is indicative of periodontal destruction.  

There are a number of methods that grade the severity of periodontal disease. It must be remembered though that different teeth in the mouth may be affected by different severities of the disease and even around each tooth, the degree of attachment loss may vary. Grading is based on the extent of attachment loss as this is indicative of periodontal destruction.