ALWAYS LOOK FOR THE POSTIVE

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ALWAYS LOOK FOR THE POSTIVE

• When it is dark enough, you can see the stars.
• -Persian proverb

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Diseases of Digestive System

• Chapter 2

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Oral Diseases Periodontal Disease

• Periodontal Disease is plaque-induced
  inflammation of gums
• Progressive
• Includes gingivitis, gingival hyperplasia,
  peridontitis with vertical bone destruction, and
  peridontitis with horizontal bone destruction
• The end result is loss of tooth
• Periodontal means around the tooth
• Etiology
• Food particles, bacteria collect around gum line
  and form plaque (tartar)
• Causes gingivits
• Minerals in saliva collect in plaque and harden
  to form calculus which adheres to teeth
• 3-5 d to harden
• Causes bad breath
• Protects the bacterial environment

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Oral Diseases Gingivitis

• Gingivitisearliest signs of Periodontal Disease
• Involves only the soft tissues of the gums
• Reversible inflammation of gums
• Gingival hyperplasia (may also be breed- or
  drug-related)
• Causeaccumulation of tartar on teeth
• Tartar is conducive to bacterial growth
• Enzymes produced by bacteria damage tooth
  attachment and cause inflammation

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Oral Diseases Periodontal Disease

• Without intervention, gingivitis progresses to
• Periodontitisirreversible condition
• Loss of gingival root attachment (receding gums)
• Alveolar bone resorption
• Loss of teeth

alveolar bone
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Oral Diseases Periodontal Disease

• Periodontitisirreversible condition
• Alveolar bone resorption
• Gingivitisreversible earliest signs of
  Periodontal Disease

Mild tartar more tartar severe tartar
gt50 bone loss Mild gingivitis more
gingivitis gum receding tooth is
loose No bone loss min bone loss
moderate bone loss should be pulled
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Oral Diseases Periodontal Disease

• Calculus builds up under gums
• Separates teeth from gums to form pockets,
  which encourages more bacteria to accumulate and
  grow
• Bacteria secrete toxins/enzymes that cause
  detachment of tooth from bony socket
• WBCs invade area and release their enzymes to
  destroy bacteria
• These enzymes also cause detachment of tooth from
  bone
• Pockets get deeper and deeper
• Weakens bone
• Can cause pathologic fractures
• Other sequellae
• Bacteria enter blood stream
• Can cause micro-abscesses in liver, kidneys
• Cause endocarditis on heart valves

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Oral Diseases Periodontal Disease
Iatrogenic mandibular fracture resulting from
excessive force extraction of a lower molar tooth
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Oral Diseases Periodontal Disease

• Signs
• Halitosis
• Reluctance to chew hard food
• Pawing at mouth
• Oral pain personality changes
• Sneezing nasal discharge
• Increased salivation
• Facial swelling tooth loss
• Dx
• Complete oral exam
• Presence of tartar (plaque) on teeth

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Oral Diseases Periodontal Disease

• Rx
• Dental scaling
• with ultrasonic scaler
• Root scaling/planing (below gum line)
• with thin ultrasonic tip curette
• Gingival curettage
• with curette against inner surface of gums
  (gingival pockets diseased soft tissue inner
  surface)
• rationale is to convert chronically inflamed
  ulcerated lesions into a clean surgical wound to
  promote healing
• Polishing to smooth the tooth surface and prevent
  tartar buildup
• Irrigation to remove diseased tissue and plaque

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Oral Diseases Periodontal disease
DOXIROBE GEL controls infection and promotes
rebuilding of periodontal structures
contains Doxycycline, an antibiotic
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Oral Diseases Periodontal Disease
Plaque prevention gel
Applied once a week
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Oral Diseases Periodontal Disease

• Client info
• Good oral hygiene is necessary for all pets
• Brush teeth daily
• Routine dental cleanings performed at
  veterinarians
• Treat gingivitis early before irreversible
  lesions occur
• Extractions are sometimes necessary to clear up
  infections
• Hard, crunchy food may promote better dental
  health by removing tartar before it calcifies
• Once it calcifies, tartar must be removed
  professionally

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next1index5
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Oral Trauma

• Causes (many)
• Falls, fights (bites), burns, blunt trauma (HBC)
• High-rise syndrome in cats
• Fractured hard palate, mandible
• Tongue injury from biting own tongue, dog fight,
  eat from tin can in garbage, FB(Foreign body)
• Cats playing with needles, thread strangulate
  tongue
• Electrical, chemical burns
• Gunshot wounds, fish hooks
• Bones lodged in teeth

Fx mandiblecat HBC
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Oral Trauma

• Signs
• History or signs of head trauma
• Increased salivation
• Inability to close mouth due to
• Pain
• Fracture/dislocation
• FB
• Reluctance to eat (same reasons)
• Presence of foreign object
• Dx
• PE of oral cavity
• X-ray to r/o embedded FB

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Oral Trauma

• Rx
• Depends on type of trauma
• Control bleeding
• Provide supportive care
• IV fluids
• pain relief
• Insure adequate airway
• Repair/extract damaged teeth
• Client info
• Like kids, if animals can get into trouble, they
  will
• Discourage chewing on electric cords
• Dont leave caustic/toxic chemicals out
• Keep pets in fenced yard or on leash when outside
• Animals still eat well without entire tongue

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Oral Neoplasia

• Relatively common in cats and dogs malignant
  melanoma and squamous cell carcinoma most common
• Signs
• Depend on location and size of growth
• More common in males
• Abnormal food prehension
• Increased salivation
• Tooth loss
• Oral pain
• Dx
• Histology of mass
• X-rays to r/o metastasis
• Biopsy of LN to r/o metastasis

Squamous cell carcinoma (Upper R 3rd
incisor) Bone loss around lesion Rostral
maxillectomy was curative
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Oral Diseases Oral Neoplasia
A gingival (buccal mucosa) melanoma involving a
dog's caudal mandible and temporomandibular
joint region.
Above An invasive feline oral squamous cell
carcinoma (courtesy of Jon Slattery)
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Oral Neoplasia

• Rx
• Surgical excision
• Partial removal of mandible/maxilla if bone is
  involved
• Radiation therapy
• Chemotherapy
• Client info
• Px for malignant tumors is guarded even with
  aggressive therapy
• Benign lesions have good Px
• Animals (esp cats) with bone removed may need
  nutritional support (feeding tube)

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Oral Diseases
http//veterinarydentistry.posterous.com/
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Salivary Mucocele

• Accumulation of excessive amounts of saliva in SQ
  tissue
• Most common lesion of salivary glands in dogs
  rarely seen in cats (following trauma)
• Cause is unknown (tight collar, choke chain??)
• Signs
• Slowly enlarging, nonpainful, fluid-filled
  swelling on neck or under tongue
• Reluctance to eat
• Difficult swallowing
• Blood-tinged saliva
• Respiratory distress

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Salivary Mucocele

• Dx
• Clinical signs
• Paracentesis shows thick, blood-tinged fluid
• Rx
• Aspirate fluid
• Surgical drainage
• Remove salivary gland insert Penrose drain x 7 d
• Client info
• Cause is unknown trauma may be involved
• Without removal of gland, excess fluid will
  continue to accumulate
• Some cases may resolve spontaneously

Removal of mandibular salivary gl
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Lip-Fold Dermatitis

• Often seen in breed with pendulous upper lips
  (spaniels, setters, St. Bernard, bulldogs,
  bassets)
• Constant moisture in the folds from saliva causes
  bacterial growth
• Food, hair, moisture cause irritation, erythema,
  and fetid odor
• Signs
• Halitosis
• Collection of debris in lower lip fold
• Dx
• Clinical signs
• Rx
• Dental cleaning
• Clip hair
• Clean out folds (food)
• Diaper rash cream
• Sx is permanent Rx

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Lip-Fold Dermatitis

• Client info
• Keep lip folds dry (for the rest of animals
  life!!)
• Flush/clean lip folds
• with 2.5 benzoyl peroxide shampoo
• chlorhexidine
• malaseb pledgets (chlorhexidine miconazole)
• Drying agents like corn starch several times a
  day
• Good dental hygiene will help prevent it

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START A CHART
ORAL MOA CS DX TX PROGNOSIS
Periodental disease Gingivitis Periodental Halitosis
Trauma Falling, HBC
Neoplasia
Salivary mucocele
Lip fold dermatitis