ansc 3060 - oral health and dental disease

Why is dentistry, oral health important??

Oral health impacts general health!

Periodontal disease is the most common disease in pets

According to the American Veterinary Dental Society (AVDS)

80% of dogs

70% of cats have periodontal disease by the age of three!

Quality of life issue

Canine and feline mouths VERY similar to ours

Periodontal disease, oral pathology HURTS

Bad breath may be(likely) due to Periodontal Disease

Chronic inflammation and pain is a shame, and as animal advocates, we never want to be to blame!

what is the most neglected pet health needs

Preventive dental care

Sequelae of Periodontal disesase

Halitosis

Furcation lesions

No teeth

Fractured jaw

Fistulas

Cardiac, kidney,

and liver

problems

Oral health and dental disease TRUTHS

- pets still eat when they have advanced mouth disease

- Not just a "dental" anymore - dirty teeth aren't the biggest problem

- whole mouth imaging is vital to complete an exam

- ANESTHESIA necessary to fully access a mouth

- ANTIBIOTICS ARE WORTHLESS IN TREATING PERIODONTAL DISEASE

what is a COHAT

comprehensive oral health assessment and treatment

Oral Health/Dental Disease anatomy

±Teeth

±Tongue and gums

±Salivary glands

°Parotid, mandibular,

sublingual, and zygomatic

±Bones

bones

- maxilla

- mandible (2)

The shape of an animal's skull affects...

the positioning of the teeth

Brachycephalic:

short, wide muzzle

Pekingese, Pugs, and Persians

Mesaticephalic:

medium length and width

Golden Retrievers, terriers, most cats, and ferrets

Dolichocephalic:

long, narrow

Doberman Pinschers, Greyhounds, or Oriental cats

teeth (eating, grooming, defense)

Mammals - 2 types of teeth

- brachydont

- hypsodont

Brachydont /low-crowned teeth-

man, carnivores - dogs and cats, pigs

crown above the gingiva

constricted neck at the gum line

a root embedded in the jawbone

Hypsodont/high-crowned teeth

continue to erupt throughout life

horses, ruminants

Most of the body is below the gum line

Teeth

Incisors: cutting and nibbling food

Canine teeth: holding and tearing food

Premolars: cutting, holding, and shearing food

Molars: grinding food

diphyodont

2 sets of teeth: deciduous, permanent

Dental formulae-How many permanent teeth do dogs and cats have?

dogs: 42 permanent

cats: 30 permanent

pulp

center, core of tooth

Function: blood supply, nerves, connect to apex

cells in the pulp, called "odontoblasts" form dentin

enamel

hardest tissue in the mammalian body

formed before tooth eruption

hard, but brittle and subject to chipping

covers dentin

dentin

majority of the tooth , surrounds pulp

Function: >50% tooth is root

Alveolar bone:

forms the jaw and the sockets which the roots of the teeth

Periodontal ligament

helps to hold the tooth in the socket

attaches to the cementum of the tooth and the alveolar bone

Cementum:

hard, calcified tissue that covers the dentin of the root

gingiva

gum tissue

Tooth eruption

Kittens and puppies - diphyodonts

deciduous teeth begin to erupt at about...

3-4 weeks of age

Permanent teeth begin to emerge at about...

3-4 months of age

By_____of age usually all of the permanent teeth have emerged

24 weeks

Incisors

6 incisors in the maxilla and 6 mandible -dog and cat

°Incisors used for shearing and grooming

Canines

lower canine should intersect the upper lateral incisor and upper canine

Occlusion-SHORT MUZZLE (BRACHYCEPHALIC BREEDS)

underbite

LONG MUZZLE (DOLICOCHOCEPHALIC BREEDS)

overbite

how do bacteria in the mouth act

Bacteria adhere to the enamel, synthesizing molecules, esp. carbohydrates

how does plaque form

Carbohydrate molecules are sticky, attracting more bacteria,eventually forming plaque

how does tartar form

Calcium carbonate deposits on the plaque which hardens, forming tartar

what bacteria causes trouble

It is this bacteria below the gumline that is causing all the trouble-what we don't see

Pathogenesis of Periodontal disease

1. Bacteria in the mouth forms plaque that sticks to the surface of the teeth

2. Minerals in the saliva harden the plaque into dental calculus (tartar), - firmly attached to the teeth

3. The real problem = plaque and spread under the gingiva

Many animals don't have significant tartar but DO have...

significant perio

plaque under gingiva

Bacteria secrete toxins = tissue damage - weakens periodontal ligament

Immune system mounts a major response - remember the classic signs of inflammation and PAIN!!

Stages of Periodontal disease- 1

gingivitis

sensitive gum tissue, redness or

bleeding of gums

Treatment now can reverse the changes

Stages of Periodontal disease- 2

The underlying gum is more inflamed and is pulled further away from the tooth.

Stages of Periodontal disease- 3

Tartar buildup continues

Gingiva is pulled further away from the tooth

The bacteria under the gumline is weakening the periodontal ligament and weakening the jaw bone

Stages of Periodontal disease- 4

ulcerated gums (blue arrow)

pus along the gum line

severe tartar

pain

+/-Sepsis, internal organ damage

Prevention and Treatment

Discuss importance of oral health at puppy/kitten visit

- Address specific Breed/conformation problems

REGULAR exams, COHATS

Preventative care at home helps! (brushing, diet

Diagnostic Imaging

DENTAL radiographs - skull films WORTHLESS (except for TMJ fx)

CT

Dental Exam and Charting

Anesthesia necessary for an accurate dental exam/treatment

- records of teeth before

- diagnostic records

- formulate a treatment plan

Pain Management-a multi-modal approach

requires extended periods of anesthesia

Pre-anesthetic evaluation: exam, bloodwork

Pre-anesthetic injections

Continuous-rate infusion (CRI)

Safe and very effective

Regional nerve blocks

Oral pain medications

Diagnosing and treating dental disease

Anesthesia

Radiographs give us a much clearer picture-can't tell how bad dental disease is just by looking!

Chart all findings

Dental radiographs-high definition digital films best

Basic Prophy

Ultrasonic scaling

remove calculus, reducing anesthesia time

Hand scaling to finish below the gum line

Polishing to smooth the enamel surface

Complete oral exam to detect chipped teeth, oral cancer, gum recession and pockets.

Application of OraVet, a plaque retardant.

Before & After dental photos

Diagnosis and treatment cont.

Root planning

Flushing the gums

Polishing

Fluoride treatment

Clinical signs of dental disease

Subtle to extreme

Halitosis

+/- facial swellings

Most pets continue to eat....why??

Painful muzzle

Prevention of dental disease

Exam every 6-12 months, pets with history of periodontal disease should be checked every 3 months

BRUSH, BRUSH, BRUSH!!

Extractions

Dental radiographs

VERY important for the evaluation of teeth before, during and after extraction to avoid patient injury!!!

Nonsurgical

Surgical

Surgical extraction involves initial gumincisions

Extractions steps

1. The tooth root is lefted out of the alveolus(tooth socket) with an extraction forcepts

2. A high speed drill mounted with adiamond bur is used to smooth alveolaredges

3. The gingival flap is contoured and "released"to provide a tension free closure

4. Post operative dental radiographs are taken to ensure there are no toothremnants left

Neoplasia

growths in the oral cavity can be benign or malignant

malignant growths

- 50% of oral tumors in dogs are malignant-malignant melanomas common

- 90% of oral tumors in cats malignant-squamous cell carcinomas common in cats

epulis

A benign gum growth that occurs usually in older dogs is called an epulis

Feline Stomatitis

a common, painful problem in many cats

red and inflammed gingiva that spreads from areas adjacent to teeth to areas more distant (back of the throat or the oropharynx)

the gums (gingiva) enlarge and block off areas of the oropharynx

Cats with stomatitis often have...

halitosis

Feline stomatitis cause/treatment

Caused by immune reaction, FeLV, FIV

Disease can only be controlled, not cured

No antibiotics, no steroids!!

only treatment -partial or full mouth extractions

Tooth Trauma

enamel and dentin can be missing

pulp exposure with and without bleeding

a dark discolored tooth

a loose tooth or facial swelling over the root of a damaged tooth

Any portion of the root or crown can be broken or damaged

avulsion

An injury in which soft tissue is torn completely loose or is hanging as a flap.

Fractured teeth

The most common teeth that are broken

canine teeth in the dog and the cat

the upper fourth premolar (large tooth on the top in the back) in dogs

After the tooth is fractured:

bacteria from the mouth will gain access to the pulp (root canal) and infect the tooth

tooth eventually dies and becomes a bacterial haven

Bacteria infect the bone in that area

the blood vessels in the area will pick up the bacteria and spread it to other areas of the body (the liver and kidneys and possibly to the heart valves)

Fractured teeth- Treatment

If only the dentin is exposed and not the pulp

Restoration can be performed

Severely damaged teeth may need to be extracted

Root canals can be performed on any tooth that qualifies

Endodontics

treatment of nonvital , vital and dying teeth

what are the most routine endonotic treatments

Root canal therapy and vital pulpotomy

- Root canal therapy is superior to extraction in almost all cases

- Root canal therapy of functional teeth is much less painful than extractions

- Extractions that involve bone loss may require eight to 12 weeks to heal-no functional tooth left

Root Canal Therapy

the treatment of the internal aspect of the tooth called the root canal

- An initial endodonticfile is used to evaluate the root canal

- Endodontic files are used to removeinfected pulp

- Irrigants are used to cleanse and to disinfect the root canal system

root canal filling

The roots were filled with a sealer cementand gutta percha (rubber-like material)used in human endodontics (AH plus)

Prosthodontics

fabrication and installation of bridges and crowns for the retention of dental function and to protect the dentition

Orthodontics involves...

the treatment of malocclusions or abnormal bites