Professional Documents
Culture Documents
20
Periodontal Disease
Etiology and Pathogenesis
OVERCROWDING
dolicephalic dogs. Usually the smaller dogs tend to have teeth too
big for their dental arches, resulting in overlapping of tooth crowns
or 90 degree rotation. In brachycephalic skulls, the third, second,
and sometimes the first maxillary premolars are rotated (Fig. 1).
These deviations from normal predispose the teeth to food entrap-
ment, which then contributes to plaque and calculus formation . In
pet dogs with nonmotivated owners, extraction of affected teeth will
solve the problem; however, aggressive periodontal therapy and
home care will maintain these teeth in those dogs with motivated
owners. Breeders of small-breed dogs must be counseled on the
problems of tooth size in dental arches and taught what to look for.
In general, it is much easier to change skeleton size rather than
tooth size. Thus, breeders may have to rethink their long-range
breeding goals . Brachycephalic animals will be plagued with tooth
rotation and crowding as long as the skull type exists. The preceding
information applies to the feline species as well.
MOUTH BREATHING
DIET
BEHAVIOR
DEVELOPMENTAL DEFECTS
PATHOPHYSIOLOGY
exposed tooth root and increased tooth mobility can be seen (Fig.
6). Periodontal pockets, if present, can be diagnosed with a probe.
Ulcerations of the buccal mucosa are often seen opposite sites of
calculus accumulation. Radiographically, there will be an increased
erosion of the alveolar process with a loss of bone height. Areas with
the largest accumulation of hyperplastic tissue are correlated with
increased pocket depth. As the disease progresses, the animal may
show signs of difficulty in eating, anorexia, severe halitosis, pawing
at the mouth, or bleeding from the mouth. An animal with a low-
grade infection may present with episodes of hepatitis, kidney
disease, or gastrointestinal disease from the periodic bacteremia that
can occur during eating.
Periodontal disease can present in several forms. It is important
to recognize and understand what is happening with each of these
forms in order to apply the proper treatment. Periodontal disease
may present as gingival recession with exposure of root surface. This
recession can be so severe that the teeth will nearly be exfoliated,
but there will be no pocket formation. The small periodontal pocket
CEJ------
Figure 7. Diagrammatic rep-
resentation of gingival recession ------------------P
without pocket formation. The gin-
giva (G) has retracted beyond the
cementoenamel junction (CEJ).
Plaque (P) covers the crown and
exposed root surface and fills the
shallow periodontal pocket (PP).
Pocket epithelium (PE) covers the ICT--------
infiltrated connective tissue (ICT).
AB = alveolar bone. PL = peri-
odontal ligament fibers.
PL----
(Fig. 12). If these resorptive lesions are found early, the tooth can
be preserved by doing a restorative procedure to fill the defect.
TREATMENT PLANNING
sive dental deposits. Group III animals are often older, and a
thorough work-up before dental procedures are started should be
done to evalute function of the heart, liver, and kidneys. These cases
will require more than one visit if severely affected teeth are to be
preserved. The time required to complete the treatment will be
greater, as will the cost to the client. Tooth mobility should be
evaluated first. Any teeth that are readily moved should be noted
and extracted. The remaining teeth should be treated as in Group
II cases. The teeth should again be checked for mobility, and any
questionable teeth removed if the owner is not willing to have
further periodontal surgical procedures done. Extraction of mobile
or hopelessly involved teeth is necessary because these teeth will
act as foreign bodies, and removal allows the remaining dentition to
respond better to periodontal treatment. Tooth mobility should be
checked in all patients with clinical signs of periodontitis. A tooth in
which less than one third of the root structure is surrounded by
healthy alveolar bone is hopeless and should be extracted. Teeth
that are critical to the dog's function that have deep pockets, root
exposure, or bony defects can be preserved with additional peri-
odontal surgical techniques, adequate home care, and frequent
follow-up visits. Two to three weeks should be given before re-
evaluation for periodontal surgery to allow the gingival tissues to
respond to the initial treatment.
Scaling, polishing, root planing, and subgingival curettage are
all necessary steps in the treatment of more severe cases of peri-
odontal disease to remove the local initiating factors of the inflam-
matory process. When the gingival tissues have returned to a more
healthy state, the success of periodontal surgery will be greater.
When cases are presented with more severe periodontal disease
and the client wishes to do what is necessary to preserve the teeth,
several other procedures may be necessary to remove deep pockets
and slow down the disease process. These procedures are gingivec-
tomy, gingivoplasty, and gingival flaps. The prognosis for these teeth
is guarded, but with these additional surgical procedures, conscien-
tious home care, and more frequent visits for dental proplylaxis, the
teeth can function for some time.
TREATMENT PROCEDURES
MEDICAL THERAPY
Table 1. Aerobic Culture and Sensitivity Tests from 97 Canine Oral Cavities
ANTIBIOTIC SENSITIVITY
NO.
CULTURES %TOTAL No. Times %
ORGANISM PRESENT CULTURES* Drug Tested Effect
SUMMARY
Table 2
COMPOUND INDICATIONS DOSAGE ROUTE
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PERIODONTAL DISEASE 833
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