Natural progression of disease

6 Natural progression of disease








ORAL EXAMINATION – UNDER GENERAL ANAESTHETIC


See the front page of the dental record for details of findings (Fig. 6.1a) and the back page of the dental record for details of the treatment performed (Fig. 6.1b).



In summary, examination under general anaesthesia confirmed the moderate generalized gingivitis (Fig. 6.2a, b). There was no evidence of periodontitis, i.e. no gingival recession and no increased periodontal probing depth at any site (Fig. 6.3). There was moderate accumulation of calculus, especially on the buccal aspect of the upper fourth premolar and first molar bilaterally (Fig. 6.2a).







THEORY REFRESHER


Periodontal disease is a collective term for a number of plaque-induced inflammatory lesions that affect the periodontium.


In gingivitis, the plaque-induced inflammation is limited to the soft tissue of the gingiva. Sulcus depths are normal (i.e. periodontal probing depths are 1–3 mm in the dog and 0.5–1 mm in the cat). As periodontitis occurs, the inflammatory destruction of the coronal part of the periodontal ligament allows apical migration of the epithelial attachment and the formation of a pathological periodontal pocket (i.e. periodontal probing depths increase). If the inflammatory disease is permitted to progress, the crestal portion of the alveolar process begins to resorb. Alveolar bone destruction type and extent are diagnosed radiographically. The resorption may proceed apically on a horizontal level. Horizontal bone destruction is often accompanied by gingival recession, so periodontal pockets may not form. If there is no gingival recession, the periodontal pocket is supraalveolar, i.e. above the level of the alveolar margin. The pattern of bone destruction may also proceed in a vertical direction along the root to form angular bony defects. The periodontal pocket is now intra- or subalveolar, i.e. below the level of the crestal bone.


Diagnosis of periodontal disease relies on clinical examination of the periodontium in the anaesthetized animal. In addition, radiography is mandatory if there is evidence of periodontitis on clinical examination. It is essential to differentiate between gingivitis and periodontitis in order to institute appropriate treatment. In individuals with gingivitis, the aim is to restore the tissues to clinical health; in individuals with established periodontitis, the aim of therapy is to prevent progression of disease.


The following parameters need to be assessed and recorded for each tooth in all patients:




Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Natural progression of disease
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