Veterinary dental nursing procedures

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Veterinary dental nursing procedures

• THE PERIODONTIUM

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The Periodontium
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Periodontium

• (tissue) next to the tooth
• Comprises
• Gingiva
• Periodontal ligament
• Tooth socket (alveolar) bone

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Periodontitis

• Inflammation of the periodontium

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The Gingiva
Oral mucosa
Gingival mucosa
Muco-Gingival Junction
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Periodontium
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Attached Gingiva
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Muco-Gingival Junction
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Free Gingiva
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Gingival pocket (sulcus)
Dog 0.5-3mm
Cat 0.5-1mm
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Junctional epithelium
attachment epithelium
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Cemento-Enamel Junction
Visible as a line which demarcates the shiny
enamel of the crown and the dull cementum of the
root.
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Periodontium in Detail
Tooth
Enamel
Gingiva
Cemento-Enamel Junction
Muco-gingival junction
Cementum
Periodontal Ligament
Alveolar bone
Oral Mucosa
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Free Attached Gingiva

• Free gingiva defines a pocket
• Gingival Sulcus
• Attached gingiva indicative of tooth health

Free
Attached
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Normal Gingiva

• Gingiva has thick epithelium
• Tough
• Some elasticity

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Normal Gingiva
enamel

• Normal gingiva is attached for several mm to
  enamel at base of crown

attachment
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Normal Gingiva
enamel

• Has a small pocket
• 0.5-3 mm (dogs)
• 0.5-1 mm (cats)

0.5-3mm
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Signs of Gingivitis

• Inflamed gingiva, variable
• Redness
• Swelling/Thickening
• Bleeding (when touched)
• Pocket depth (usually increased)

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Gingival Hyperplasia

• Pocket depth increased but no loss of attachment
• Boxer dogs
• Not so serious

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Healthy Periodontium
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Healthy Periodontium
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Plaque

• A white, furry film
• comprised of
• Dental pellicle
• Salivary protein derivatives, lipids
• Food debris
• Cellular debris (mouth cells)
• Bacteria
• Collects where least abrasion
• between teeth and around base of teeth
• Can form within 6 hours

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Plaque Bacteria

• Plaque Bacterial Culture

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Plaque revealed with dye
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Plaque worsens with

• Time
• Oral sugars
• Low O2

Sugars
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Factors promoting plaque

• Diet canned gt dried gt dental dry gt raw bones etc
• Dental abnormalities
• Crowding
• Malocclusion
• Rotation
• Supernumerary
• Retained temporary teeth
• Fractured teeth
• Enamel defects
• Position of salivary glands ducts (saliva)
• Lack of chewing
• Hair in mouth
• Mouth breathing (drying effect)
• Systemic illnesses
• Diabetes mellitus
• Renal failure
• Hypothyroidism
• Chronic viral infections
• Certain auto-immune diseases

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Calculus (Tartar)

• Deep layers of plaque mineralise to form calculus
  
• Can begin to form within 24-48 hrs
• Calculus provides protection for more plaque to
  form

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Stopped
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Gingivitis

• Is usually a result of plaque/calculus
• Inflammation of the gums

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Gingivitis (marginal)
No attachment loss
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Gingivitis (marginal)
No attachment loss
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Periodontitis

• Is an extension of gingivitis
• Inflammation of the periodontium
• Results in various degrees of attachment loss
• Crown attachment (epithelial attach.)
• Root attachment (periodontal ligament attach.)

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Stomatitis

• Is an extension of periodontitis
• Inflammation of the mouth
• Many other mouth structures also involved
• Gums
• Tooth sockets
• Lips
• Tongue
• Tonsils

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Gingivitis,Periodontitis,Stomatitis
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Local effects of Periodontitis

• Pain
• Bleeding gums
• Tooth loss

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Local effects of Periodontitis
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Systemic effects of Periodontitis

• Absorption of bacteria
• Free Bacteria
• Bacteraemia, Endotoxaemia
• Bacteria-Antibody complexes may damage
• Heart valves endocarditis
• Liver
• Kidneys glomerulonephritis
• Lungs
• Brain meningitis

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Mild Attachment Loss
1-2 mm loss
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Mild Attachment Loss
1-2 mm loss
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Moderate Attachment Loss
3-6 mm loss
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Moderate Attachment Loss
3-6 mm loss
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Severe Attachment Loss
gt6 mm loss
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Severe Attachment Loss
gt6 mm loss
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Severe Attachment Loss
gt6 mm loss
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Gingival Attachment Loss 1

• Pocket depth may be increased
• Loss of attachment to
• crown
• root (/- )

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Gingival Attachment Loss 1
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Gingival Attachment Loss 2

• Pocket may not be greatly increased
• if concurrent recession of gingiva bone

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Gingival Attachment Loss 2
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Reattachment

• If severe attachment loss
• Remove tooth
• If not severe attachment loss, perform procedures
  to encourage reattachment
• Tooth smoothing (odontoplasty)
• Enamel smoothing
• Root planing
• Gingivectomy, Gingival flaps (apical, sliding)

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Reattachment Tissues Available
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Reattachment Scenarios

• Gingival Epithelium
• If gingival epithelium attaches most quickly a
  long junctional epithelium results. This is not
  desirable, as it is very weak.
• Gingival Connective Tissue
• When gingival connective tissue connects first,
  root resorption often occurs.
• Alveolar Bone
• If alveolar bone cells arrive first, either root
  resorption or ankylosis with result.
• Periodontal Ligament
• When periodontal ligament connects most quickly,
  new attachment can occur. This option is the most
  desirable.

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The End