Periodontal Disease Pathogenesis

Lecture 3

What are the 4 components of the peridontium, which are the tissues that surround the tooth and hold it in place?

gingiva

periodontal ligament

cementum

alveolar bone

What is the most common disease of dogs and cats presented to small animal practitioners?

periodontal disease

What is the most common cause of oral infection and tooth loss?

periodontal disease

Is periodontal disease reversible?

No, once established it can only be managed and is chronically progressive

Describe healthy gingiva.

sharp, thin, and noninflamed margins

coral-pink if non-pigmented

firm and stippled

Describe the appearance of plague induced gingivitis.

marginal gingivitis with rounded edges

gingival margin — erythematous

may bleed upon probing

What colonizes on tooth surfaces within 24-36 hours after cleaning/brushing?

Bacterial plaque

_____ is an organic, transparent, adhesive biofilm consisting of glycoproteins, bacteria, and extracellular polysaccarhides.

Plaque

If not removed within a few days, plaque initiates what at the gingival margin?

inflammatory response

Normal oral flora is composed of primarily _____, _____ bacteria.

aerobic, gram positive

The accumulation of ______ and the subgingival location creates an anaerobic environment, causing an increase in anaerobic, gram negative, and spirochete bacteria.

dental calculus

Gingivitis is diagnosed when the inflammation is limited to the ____.

gingiva

Gingival inflammatory response to plaque consists of ____, _____, and _____.

vasculitis, edema, collagen loss

Advanced gingivitis leads to the potential development of _____.

periodontitis

True or False: Not all animals with gingivitis will ultimately develop periodontitis.

True

What are inflammatory factors (host’s immune response) in progression of gingivitis to periodontitis?

subgingival plaque bacteria

lipopolysaccharide from gram negative bacteria induce inflammatory mediator cytokines

activated neutrophils release proteolytic enzymes and reactive oxygen species

What is the generalized assessment of periodontal health evaluating gingivitis, plaque, and dental calculus?

gingivitis index

Evaluate gingivitis:

• no inflammation

• healthy

none

Evaluate gingivitis:

• mild inflammation and color change

• no bleeding on probing

GI1

Evaluate gingivitis:

• moderate inflammation

• bleeding on probing

GI2

Evaluate gingivitis:

• severe inflammation

• spontaneous bleeding on probing

GI3

List risk factors for periodontitis.

age (older)

breed (toy, brachycephalic, dolichocephalic)

persistent deciduous teeth

malocclusions

genetic predisposition

host’s immune response

non-abrasive diet

chewing habits

periodontal trauma

oral foreign bodies

Why are toy breeds at risk for periodontitis?

tooth crowding

Why are brachycephalic breeds at risk for periodontitis?

rotated and crowding of teeth

Why are dolichocephalic breeds at risk for periodontitis?

dry mouth

In periodontitis, the inflammatory factors associated with the ____ and ____ cause the destruction of the tissues surrounding the tooth.

anaerobic bacteria

host’s immune response

List clinical features of periodontal disease.

gingivitis

halitosis (bad breath)

gingival enlargement

gingival recession

periodontal pockets

abscessation

facial swelling

draining fistulae

oronasal fistula

osteomyelitis

osteolysis

mandibular fractures

systemic organ lesions from baceremia

opthalmic manifestations

oral pain

tooth mobility

What is shown in this image?

gingival recession associated with periodontal disease

What is shown in this image?

oronasal fistula associated with periodontitis of maxillary canine tooth

Definitive diagnosis of periodontal disease stage requires ____, ____, and ____.

general anesthesia

dental radiography

periodontal probing

Does the degree of severity of periodontal disease relate to an individual tooth or the entire mouth?

individual tooth - a patient may have teeth that have different stages of periodontal disease

How should you write diagnosis of periodontal disease in the medical record from your physical exam?

“suspect grade of dental disease”

What refers to the destruction of the periodontium due to periodontitis?

attachment loss

The amount of attachment loss for a tooth is determined with _____, _____, and ____.

periodontal probing

measurement of gingival recession (if present)

radiographs

What is the distance (in mm) from the free gingival margin to the most apical point that the probe reaches when gently inserted into the gingival sulcus or pocket?

probing depth

What is defined, based on radiographs, as the distance from the alveolar margin to the cementoenamel junction relative to the length of the tooth?

attachment loss

What is shown in this image?

tooth root furcation

Furcation Index:

• probe extends less than halfway under the crown in any direction of a multi-rooted tooth with attachment loss

Stage 1 (F1)

Furcation Index:

• probe extends greater than galfway under the crown of a multi-rooted tooth with attachment loss but not through and through

Stage 2 (F2)

Furcation Index:

• probe extends under the crown of a multi-rooted tooth, through and through from one side of the furcation out the other

Stage 3 (F3)

Stages of Periodontal Disease:

• clinically normal

• gingival inflammation or periodontitis not clinically evident

Normal (PD 0)

Stages of Periodontal Disease:

• gingivitis only without attachment loss

• height and architecture of alveolar margin is normal

• radiographic findings are normal

Stage 1 (PD 1)

Stages of Periodontal Disease:

• early periodontitis or, at most, there is stage 1 furcation index

• early radiographic signs of periodontitis

• loss of periodontal attachment is less than 25%

Stage 2 (PD 2)

Stages of Periodontal Disease:

• moderate periodontitis

• 25-50% of attachment loss

• stage 2 furcation involvement

Stage 3 (PD 3)

Stages of Periodontal Disease:

• advanced periodontal disease

• greater than 50% attachment loss

• stage 3 furcation

Stage 4 (PD 4)

What is the stage of periodontal disease shown in this image?

Normal (PD 0)

What is the stage of periodontal disease shown in this image?

Stage 1 (PD 1)

What is the stage of periodontal disease shown in this image?

Stage 2 (PD 2)

What is the stage of periodontal disease shown in this image?

Stage 3 (PD 3)

What is the stage of periodontal disease shown in this image?

Stage 4 (PD 4)

Calculate attachment loss based on the image.

11/15 = 0.733

Attachment loss = 73%