Periodontal Disease - Part II

Linda J. DeBowes DVM, MS
Diplomate ACVIM (Internal Medicine), AVDC
Seattle, Washington 

 

Equipment

  • Scaling
    • Ultrasonic scalers
      • Heat generation
      • Significant amounts of heat at their tips
      • Water is used as a coolant
      • Supragingival
      • Perio tips – subgingival
    • Sonic scalers 
      • Do not generate heat
      • Slower – clinical significance ??
      • Supra and subgingival
    • High speed handpiece with Roto pro burs
      • NOT RECOMMENDED

 

  • Polishing
    • Low speed hand piece
    • Prophy angle
    • Generates heat!
    • Polish carefully to avoid trauma

Instruments

  • Periodontal probe
    • Blunt end
    • Graded markings  
    • Measure periodontal pocket depth
  • Explorer
    • Sharp point
    • Assess furcation bone loss
    • Assess subgingival irregularities
    • Calculus
    • Resorptive lesions

Hand instruments – scaling, root planing

  • Scaler
    • Sharp point
    • Scaling
    • Supragingival only
    • Do Not Use - subgingival
  • Curette
    • Rounded toe - tip
      • Scaling
        • - Subgingival
        • - Supragingival
      • Root planing
    • Universal – blade perpendicular to shank 
    • Graceys - Offset blade (70 degrees) with one working edge
      • After–five
        • - Longer shank
        • - Root planing
        • - Deep pockets
      • Mini-five
        • - Shorter blade
        • - Subgingival
        • - Narrow pockets

When to recommend a basic dental cleaning

  • Gingivitis
    • Unresponsive to daily tooth brushing
    • Subgingival plaque, calculus
  • Calculus accumulation
  • Periodontitis
    • Gingival recession
    • Furcation exposure
    • Mobile teeth

Basic goals of treating periodontal disease

Remove all plaque and calculus

  • above the gum line (supragingival)
  • most importantly below the gum line (subgingival)
  • If subgingival plaque and calculus remain
    • Continued inflammatory response
    • Increased attachment loss

Improve the health of the periodontal tissues

Prevent or slow disease progression

  • Gingivitis
    • Inflammation is completely reversible
  • Periodontitis
    • Attachment loss – permanent
    • Soft tissue attachment
    • Advanced procedures
    • Guided tissue regeneration (GTR)

When Treating periodontal disease 

General anesthesia  required
  • For complete dental evaluation and periodontal treatment.
  • Cuffed endotracheal tube
    • To protect patient’s airway
  • Appropriate fluid support
  • Monitoring during anesthesia

Bacteria being aerosolized

  • The attending personnel should wear protective face mask and eyewear
  • Do not do dental procedures in surgery suite

Basic Dental Cleaning

Chlorhexidine rinse may decrease
  • Aerosolized bacteria
  • Magnitude of bacteremia
Gross calculus removal
  • Calculus forceps or extraction forceps
  • Large pieces of calculus
  • Do not injure tissues (gingiva or tooth)
Scale teeth
  • Removes calculus (& plaque)
  • Primarily with power scaling
    • Do not use tip of instrument against tooth
    • Tips vary in working edges         
  • Hand instruments
    • Difficult to reach areas

Polishing

  • always done after the teeth have been scaled
  • smooths the tooth surface to decrease plaque accumulation
  • fine to medium grit prophy paste
  • polishing action can generate a significant amount of heat
  • rinse well to remove all paste
Pro-V-Seal prophy barrier sealant
  • designed to help  prevent bacteria from adhering to teeth
  • professional product for use by the veterinarian
  • take-home kit for the owners to use on a weekly basis at home

Deep periodontal pockets

  • Closed root planing
  • Open root planing
  • Local antimicrobial treatment     

Antimicrobials Use in Patients with Periodontal Disease  

Treatment of periodontal disease
  • Chlorhexidine – topical
  • Local antibiotic delivery systems
  • Systemic antimicrobials
    • Good anaerobic spectrum needed
    • Clindamycin
    • Amoxicillin and clavulanic acid
    • Metronidazole

Prevention of distant site infections
  • Bacteremia occurs during all dental manipulations
  • At risk patients
  • Therapeutic antibiotic levels at time of procedure

When to recommend extraction – considerations

  • Extent of attachment loss
  • Owners commitment to continued dental care
  • Jeopardizing health of adjacent teeth
  • Endodontic health
  • Owner’s preferences

Basic Extraction Techniques – Simple Extractions

PATIENCE!!

Cut gingival attachment to tooth

Section tooth if multi-rooted

Severing periodontal ligament (PDL)

  • Scalpel blade
  • Luxators

Stretching and tearing of PDL

  • Dental elevators
  • Apply tension/stretch on PDL and HOLD!!
  • PDL fibers have to tear
Extraction forceps

Suturing