WSAVA Nov 2021 Proceedings - Flipbook - Page 44
13–1 5 NOVEMBER, 202 1
0019
PERIODONTAL DISEASE AND THERAPY
C. Wickramasinghe1,2
Colombo ,/Sri Lanka, 2Colombo/Sri Lanka
1
Periodontium consists of alveolar bone, periodontal ligament, cementum
and gingiva [2]. It surrounds and supports the tooth. Alveolar bone is the
socket part of the mandible and maxilla in which the teeth are embedded.
Cementum is a hard tissue that covers the root of the teeth. Periodontal
ligament lies in between these two. The space between the tooth and
gingiva is gingival sulcus, of which the normal depth is less than 3 mm for
dogs and less than 1 mm for cats.
Qualifications:
Periodontal disease
Wickramasinghe Arachchige Don Chandika Hiroshan Wickramasinghe
Periodontal disease is the inflammation of the structures of the periodontium. This is characterized by inflammation, apical migration of epithelial
attachment and bone loss [1]. This is an infectious disease caused by
plaque bacteria and the resulting inflammatory response caused by
cytokines etc. Periodontal disease is progressive [3] if not treated, and
essentially irreversible [3],[4] if guided tissue regeneration techniquehs are
not used. [2]
BVSc, MSc, MSLCVS
chandika17@yahoo.com
PERIODONTAL DISEASE AND THERAPY
Pet Vet Animal Hospital, 155, Kirula Road, Colombo 05, Sri Lanka.
Chandika Wickramasinghe, BVSc, MSc, MSLCVS
Chandika17@yahoo.com
Introduction
Historically, veterinary dental issues were considered an old or senior patient disease. However, oral issues are one of the most under diagnosed
conditions in pet animals. Chronic periodontitis is an extremely common
problem in dogs and cats [2]. The majority of animals over the age of
three years have a degree of periodontal disease that warrants treatment
[1]. By the age of 3 years, 90% of dogs and 70% cats suffer from some
sort of oral issues. Dental issues can be more prominent in small breed
and brachycephalic dogs due to crowding of teeth.
As the disease process advances, gingival sulcus depth increases, and
there will be permanent damages to the periodontal ligament, cementum
and alveolar bones, ultimately resulting in tooth loss, and even progressing to such advanced oral diseases like oronasal fistula, mandibular fractures etc. Bacterimia leads to disease processes in vital organs like liver,
heart, kidneys etc. Chronic pain is also an important factor affecting the
quality of life. Periodontal disease can also lead to endodontic disease
when periodontitis reaches the apex of the root of a tooth [5]. Indices
like gingivitis index, furcation index, probe depth, mobility index, plaque
index, calculus index etc. are useful in establishing the overall periodontal
disease grade of a patient.
Clinical Manifestations
Food particles get mixed with bacteria and salivary components to form
the plaque on teeth. These bacteria are one of the main causes of oral
health issues; particularly periodontal disease. Plaque gets stabilized,
usually within 3-5 days. Once stabilized, this is called tartar/cement and it
cannot be removed by regular brushing. That is why daily tooth-brushing is
of paramount importance to maintain the optimal oral health.
Clinical features of periodontal disease include gingivitis, gingival bleeding, halitosis, drooling, plaque and calculus, gingival recession, furcation
exposure etc. These can lead to behavioral manifestations like acting
withdrawn or aggressive, chewing differently, reluctance to play with
chew-toys, not allowing brushing teeth or toughing lips/teeth etc. due to
pain [4].
Periodontium: Anatomy
Diagnosis
Signalment and proper history/complaint will provide very useful information. Then, external orofacial examination and conscious oral cavity
examination needs to be performed. Finally, under anesthesia visual
examination, probing and dental radiographs have to be done. Diagnosis
must be established using a combination of oral examination under anesthesia and dental radiography [3].
Table 01: Grading of Periodontitis
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WSAVA GLOBAL COMMUNITY CONGRESS
Grade
Plaque and
Calculus
Radiologic
Changes
Other
I
Mild amount of
Plaque
Mild Redness
No Change
No Furcation/
Mobility, Established Gingivitis,
Reversible
II
Subgingival
Plaque
Redness and
Oedema
Upto 25% Support Early PeriodontiLoss
tis, Irreversible
Subgingival
Calculus
Redness, Oedema,
Gums bleed with
25 to 50% support
gentle probing,
loss
Gum recession or
hyperplasia
III
Gum Health
Established
Periodontitis,
Irreversible, Furcation II/III