Dental disease

what can we advise owners to prevent plaque build up?

1. brush teeth = gold standard

2. dental diet

3. regular dental cleaning/polishing

4. chewing toys

5. reduce treats

how does osteoclast formation occur?

• cytokines trigger stem cells to be attracted to the gingiva → differentiation into osteoclasts

why is osteoclastogenesis is important in periodontal disease?

• causes bone resorption and this weakens teeth → increased chances of damage and ideal environment for infection

what are the stages of periodontal disease?

0-4

what is stage 0 periodontal disease?

• healthy periodontal tissue, no issues present, no disease

what is stage 1 periodontal disease?

• gingivitis only and no attachment loss

what is stage 2 periodontal disease?

• gingivitis is present with ,25% alveolar attachment loss

• may be early radiographic signs of periodontitis and attachment loss

what is stage 3 periodontal disease?

• gingivitis + 20-50% alveolar attachment loss

• increased probing depth or radiographic determination of the loss of attachment

• stage 2 furcation involvement in multirooted teeth

what is stage 4 periodontal disease?

• gingivitis + >50% attachment loss

  • measured by increased probing depth/radiographic evidence or stage 3 furcation involvement

what is gingivitis generally caused by?

• dental plaque accumulation - indicates poor oral hygiene - not for certain that there’s assosicated disease

what are two types of periodontitis?

1. active - loss of attachment + gingivitis

2. quiescent - loss of attachment but no inflammation/severe inflammation

key clinical signs of periodontal disease?

1. halitosis

2. plaque and calculus

3. gingivitis

4. gingival recession

5. periodontal pocketing

6. bone loss

7. furcation exposure

8. mobile teeth and loss of teeth

Compare the right radiograph to the left

• right radiograph = alveolar bone resorption

  • due to periodontal disease

what is FORL?

• feline odontoclastic resorptive lesions

what is the aetiology of FORL?

1. loss of outer, protective blast-cell layer of root

2. persistant stimulus → root absorption-repair pattern

what are potential causes of FORL

1. inflammation due to periodontal disease

2. abfraction - microfracture due to mechanical loading causing bacterial resorption

3. commercial pet food

4. vit D levels

what is the pathophysiology of FORL?

1. abnormal teeth remodelling by odontoclasts starting in cementum

2. type 1 lesions affecting cervical region, type 2 affecting apical root

3. cementum and dentine resorbed → enamel resorption and lacunae develop int he crown

4. weakened teeth → increased fracture risk

what are the 3 types of lesion in FORL?

1. inflammatory - apple core lesions radiographically

2. replacement resorption → periodontal ligament loss → ‘ghost roots’ on radiograph

3. type 1 and 2 lesions simultaneously

what areas are most commonly affected by FORL?

1. notably lower third premolars

2. canines

3. upper fourth premolars

4. sites of poor hygiene and inflammation

with FORL, is only one side of the mouth affected?

• no, it’s bilaterally symmetrical

how do we diagnose FORL?

1. oral examination

2. radiography

what are our differentials for FORL?

1. periodontal disease

2. dental cavities

3. gingival hyperplasia

4. traumatic fracture

How do we treat FORL?

• extraction of all teeth with any stages present

• coronal amputation for advanced stage 2/3 with ghost roots radiographically

what do we need to do post op for FORL?

1. post op check at 1 and 3 weeks

2. routine dental and oral checks every 3 months