Importance of periodontal probing depth (PPD)

8 Importance of periodontal probing depth (PPD)




INITIAL PRESENTATION


Recurrent gingivitis and halitosis.



PATIENT DETAILS


An 8-year-old, neutered female, golden retriever.



CASE HISTORY


There were no oral or dental problems until around 8 months ago, when severe gingivitis localized to the upper canine teeth was noted. Three episodes of professional periodontal therapy (scaling and polishing and extraction of ‘some’ teeth) under general anaesthesia had been performed in the last 6 months and the dog had received a short course of antibiotics following each dental cleaning. The gingivae had appeared healthy for approximately 3 weeks after each cleaning and antibiotic course, and then the gingival inflammation had flared up again.


The dog was referred to us for management of recurrent gingivitis affecting the upper canine teeth. The owner did not feel that the oral inflammation was affecting the general well-being of the dog (i.e. interested in walks and eating well), but he did not appreciate the halitosis.



ORAL EXAMINATION – CONSCIOUS


The dog was relatively amenable to quick conscious oral examination, which revealed the following:


1. Missing teeth (presumably extracted)

2. Generalized moderate gingivitis

3. More severe gingivitis around upper canines

4. Gingival recession of the buccal aspect of 104 and 204

5. Gingival draining tracts of the buccal aspect of 204

6. Halitosis.


ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC


See the front page of the dental record (Fig. 8.1) for details of findings.


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Figure 8.1 Dental record. All clinical findings are reported on the front page of the dental record. Remember that periodontitis is a site-specific disease. PPD is recorded on the occlusal view of the tooth on the dental record so that you can easily identify the precise site of disease. Normal periodontal probing depth (PPD) is not noted on the dental record to avoid clutter. However, when gingival recession is present, then PPDs are always recorded, so that periodontal attachment loss (PAL) can be calculated (GR + PPD) and entered on the record at its precise site in green ink. PAL is a more accurate assessment of attachment loss.


In summary, examination under general anaesthesia identified the following:


1. Missing teeth (101, 102, 110, 202, 205, 210, 311 and 411)

2. Generalized mild to moderate gingivitis (Fig. 8.2a, b)

3. Severe gingivitis at upper canines (Fig. 8.3a, b)

4. Gingival recession of the buccal (Fig. 8.3a, b) and palatal aspects of 104 and 204

5. Gingival draining tracts buccally of 204 (Figs 8.2b and 8.3b)

6. Gingival recession of the buccal and lingual aspects of 304 and 404

7. Gingival recession and furcation involvement (grade III) of 206 (Figs 8.2b and 8.3b)

8. Gingival recession buccally over the distal root of 109 (Fig. 8.4) and 209

9. Increased periodontal probing depth of 104, 204, 109, 209, 304 and 404 (see dental record for precise location)

10. Uncomplicated crown fracture of 208 (Fig. 8.2b).

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Figure 8.2 Lateral photographs of the right (a) and left (b) upper jaw. Generalized mild to moderate gingivitis is evident.


(a) Note the gingival recession on the buccal aspect of 104 and over the distal root of 109.


(b) Note the gingival recession on the buccal aspect of 204 and 206. The gingival draining tracts located to the buccal aspect of 204 are obvious, as is the furcation involvement at 206. The crown fracture of 208 is also obvious.


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Figure 8.3 Lateral photographs centred on the right (a) and left (b) upper canine teeth.


(a) The gingiva of 104 is inflamed and there is a buccal gingival recession.


(b) The gingivae of 204 and 206 are inflamed and the gingival margin has receded apically. Three gingival drainage tracts are evident in the buccal gingiva of 204. The furcation of 206 is clearly involved in the disease process.


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Figure 8.4 Lateral photograph of the right caudal maxilla. The gingiva has receded to expose most of the buccal aspect of the distal root of 108. Note the location of the zygomatic and parotid papillae.



FURTHER INVESTIGATIONS


Radiographs were taken of 104, 204, 206, 109 and 209 to assess the extent and severity of the periodontitis. A baseline radiograph of 208 (UCF) was also taken to assess pulp and periapical status.



RADIOGRAPHIC FINDINGS


The radiographs of 104 and 204 confirmed the clinical diagnosis of periodontitis. There was resorption of the alveolar margin and widening of the periodontal space. The radiograph of 104 showed extensive bone loss extending beyond the apex (Fig. 8.5).


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Figure 8.5 Radiograph of 104. Note the extensive bone loss on the buccal aspect that extends beyond the apex.


The radiograph of 206 showed horizontal bone loss and obvious furcation involvement (Fig. 8.6), again confirming the clinical diagnosis of advanced periodontitis.


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Figure 8.6 Radiograph centred on 206. Marked horizontal bone loss and furcation involvement of 206 is evident.


The radiographs of 109 (Fig. 8.7a) and 209 (Fig. 8.7b) demonstrated marked periapical destruction at the palatal root.


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Figure 8.7 Radiographs centred on 109 (a) and 209 (b). Note the periapical bone destruction (of periodontal origin) around the palatal root of both teeth.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Importance of periodontal probing depth (PPD)
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