Lecture 6: Periodontal Disease Management

What are the symptoms of periodontal disease?

• Reluctance to chew

• Head shyness

• Pawing at the face

• Dropping food when eating

• Sneezing/nasal discharge

• Exaggerated jaw motion when chewing

• Aversion to food or water - most patients will still eat with severe periodontal disease

What are the typical intraoral PE findings of periodontal disease?

• Halitosis

• Gingivitis

• Calculus

• Gingival recession/root exposure

• Missing teeth

• Mobile teeth

What are the typical extraoral PE findings of periodontal disease?

• submandibular swelling

• perioral swelling

• draining tracts

How is periodontal disease diagnosed?

• minimum database

• COHAT - requires anesthesia, requires imaging, requires probe exam

What are the 3 stages of the furcation index?

What are the 3 stages of tooth mobility index?

What are the 3 levels of the gingival index?

• Gingival index 1 - Inflammation and swelling of the gingiva with no bleeding during periodontal probing.

• Gingival index 2 - Inflammation and swelling of the gingiva with bleeding during periodontal probing.

• Gingival index 3 – Inflammation and swelling of the gingiva with spontaneous bleeding of the inflamed gingiva prior to periodontal probing.

What are the 4 stages of periodontal disease?

normal/PD0: 0% attachment loss, no gingivitis

stage 1: 0% attachment loss, gingivitis present

stage 2: <25% attachment loss, possible stage 1 furcation

stage 3: 25-50% attachment loss, possible stage 2 furcation

stage 4: > 50% attachment loss, possible stage 3 furcation

What are the first three instruments>

A. Marquis color-coded periodontal probe - calibrations in 3 mm sections (dog)

B. UNC-15 probe - markings at each mm and color coding at 5, 10, and 15 mm (cat or dog)

C. Uni. of Michigan “O” probe with Williams markings at 1, 2, 3, 5, 7, 8, 9, and 10mm (cat or dog)

How do you measure a periodontal pocket with a probe?

• Gently place the probe in between the gingiva and tooth

• Stop when you feel resistance at the end of the probe

• Record pocket depth

• Do NOT use too much force à if you do then you can damage the attached gingiva and cause pocketing!

What are the non-surgical treatment options for periodontal disease?

• Ultrasonic scaling and polishing

• Closed root planning

• With or without perioceutic application

• Homecare: Tooth brushing, Water additives, Diets, Chews

• Barrier/sealant application

• Can be performed in general practice

What are the surgical treatment options for periodontal disease?

• Defined as any procedure requiring a mucogingival flap

• Examples

  • Open root planning

  • Bone grafting

  • Guided Tissue Regeneration

  • Regenerative procedures with stem cells and grafts

  • Advanced mucogingival flap techniques to reduce pocketing

  • Surgical and non-surgical extractions

• Requires referral (except certain extractions)

What are perioceutics?

antimicrobial products available for dental applications - doxycycline or clindamycin gels → acts as physical barrier to pocket contamination, doxycycline in addition has anticollagenase activity

How is treatment planned for early-stage for advanced stage periodontal disease?

• Early-stage periodontal disease

  • PD0, PD1 – managed with annual COHATs and homecare\

  • PD2/F2 – closed root planning +/- perioceutic application

• Advanced stage periodontal disease

  • PD3 – open root planning +/- perioceutic application, GTR, extraction

  • PD4 – extraction

• Combined periodontal and endodontic lesions – extraction

• Periapical pathology - extraction

Why should a tooth not be scaled longer than 10 seconds?

ultrasonic scaler causes thermal damage to pulp when held against tooth for extended time?

What are the two types of ultrasonic scaling tips?

perio tip: thin, curved tip designed to reach deep into periodontal pockets and furcations, appropriate to use for subgingival cleaning

universal tip: thicker, straight tip that is used for moderate to heavy supragingival calculus removal

What is the most effective way to prevent periodontal disease?

daily tooth brushing

What is root planing?

deep dental cleaning: Run the curette along the surface of the tooth into the periodontal pocket, “hook” the granulation tissue and calculus, scrape upward along the tooth to remove debris

What are the steps of guided tissue regeneration?

• Ultrasonic scaling and polishing of tooth

• Regional nerve block: Bupivacaine

• Creation of mucogingval flap (15, 15c surgical blade)

• Open root planning for removal of calculus and granulation tissue from periodontal pocket

• Bone grafting material filled into boney defect: Synergy, Periomix

• Membrane placed, sutured into place 5-0 Monocryl: Doxirobe vs. Ossiflex membrane (Demineralized freeze-dried membrane allograft)

• Flap closure with 5-0 Monocryl

• dental rad recheck in 6 mo to monitor osseous integration

Why are antibiotics sometimes given prophylactically for dentals?

• Goal is to prevent metastatic bacteremia and to reduce infections associated with surgery. 

• COHATs have been documented to cause transient bacteremia that resolves within 24hrs of the procedure → Immune-competent patients resolve bacteremia on their own

• systemically administered antibiotics are needed for animals that are immune compromised, have underlying systemic disease, and/or have severe oral infections