Systemic effects of periodontitis

9 Systemic effects of periodontitis




INITIAL PRESENTATION


Ten-month history of a progressively worsening cough.



PATIENT DETAILS


A 12-year-old, neutered male, Yorkshire terrier.



CASE HISTORY


The dog was being treated for septic pneumonia, with consolidation of the left cranial lung lobe likely to be secondary to his periodontal disease. He also had tracheitis and collapsing trachea. He was referred to us to manage the periodontal disease. No history of any previous oral or dental disease or treatment was available to us.



ORAL EXAMINATION – CONSCIOUS


The dog was amenable to conscious facial and oral examination, which revealed the following:


1. Missing teeth (presumably extracted, but some may have been congenitally absent); no teeth at all in the upper jaw, with lower incisors, canines and some premolars missing.

2. Oronasal communication at sites of 104, 108 and 204.

3. Severe accumulation of dental deposits in lower premolars and molars (suspect advanced periodontitis).

4. Marked rostral bone loss of both upper and lower jaw.

5. Separation of mandibular symphysis; the right and left mandibles were freely movable.

In addition, there was moderate ocular discharge, a right-sided nasal discharge and right mandibular lymph node enlargement.



ORAL EXAMINATION – UNDER GENERAL ANAESTHESIA


See the front page of the dental record (Fig. 9.1) for details of findings.


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Figure 9.1 Dental record. All clinical findings are reported on the front page of the dental record. 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. True attachment loss is the sum of the recession and probing depth. 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 the disease.


In summary, examination under general anaesthesia identified the following:


1. Missing teeth (all teeth in the upper jaw, all lower incisors, canines, 306, 310, 311, 405, 406, 410).

2. Advanced periodontitis in 305, 307, 308, 309, 407, 408, 409 and 411. The loss of attachment was manifested clinically as gingival recession and furcation exposure.

3. Marked bone loss in the rostral lower jaw with symphyseal separation; the right and left mandibles were freely movable (Fig. 9.2).

4. Oronasal communication at sites of 104, 108 (Fig. 9.3) and 204. Root remnants are present in oronasal communication at the site of 108.

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Figure 9.2 Extensive alveolar bone loss. The lower incisor and canine teeth were absent and there had been extensive bone loss. In fact, the bone loss had resulted in destruction and separation of the mandibular symphysis, and the left and right mandibles were freely movable.


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Figure 9.3 Occlusal photograph showing the oronasal communication (as a result of the severe periodontitis) at the sites of 104 and 108.



FURTHER INVESTIGATIONS



1. A series of full-mouth radiographs (14 films) was taken.

2. In lieu of the extreme rostral bone loss in both the upper and lower jaw, a biopsy (gingiva, underlying connective tissue and bone) was harvested from the rostral mandible and sent for histopathological examination.


RADIOGRAPHIC FINDINGS


The radiographs showed the following:


1. Severe loss of alveolar bone in the rostral upper (Fig. 9.4) and lower jaw (Fig. 9.5)

2. Root remnant of 108 (Fig. 9.4)

3. Advanced periodontitis in 305, 307, 308, 309, 407, 408, 409 and 411 (Figs 9.6 and 9.7).

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Figure 9.4 Radiograph of the upper jaw. The only remaining tooth is a root remnant of 108. Note the atrophy of the alveolar bone as a result of tooth loss.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Systemic effects of periodontitis

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