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 25-28 September, 2018 | Singapore
sulfur compounds (VSCs). One of these is hydrogen sulfide, which creates the “rotten egg smell”. VSCs are proinflammatory and actually contribute to periodontal inflammation and attachment loss. Therefore, not only are the VSCs produced by periodontal disease, they also directly increase the level of periodontal disease. Consequently, control of halitosis should be part of the treatment for periodontal disease.
Gingivitis is typically associated with calculus on the involved dentition, but is primarily elicited by PLAQUE and thus can be seen in the absence of calculus. Alternatively, widespread supragingival calculus may be present with little to no gingivitis. It is critical to remember that calculus itself is essentially non-pathogenic. Therefore, the degree of gingival inflammation should be used to judge the need for professional therapy.
As gingivitis progresses to periodontitis, the oral inflammatory changes intensify. The hallmark clinical feature of established periodontitis is attachment loss.
In other words, the periodontal attachment to the tooth migrates apically. As periodontitis progresses, alveolar bone is also lost. On oral exam, there are two different presentations of attachment loss. In some cases, the apical migration results in gingival recession while the sulcal depth remains the same. Consequently, tooth roots become exposed and the disease process may be identified on conscious exam. In other cases, the gingiva remains at the same height while the area of attachment moves apically, thus creating a periodontal pocket. This form is typically diagnosed only under general anesthesia with a periodontal probe. It is important to note that both presentations of attachment loss can occur in the same patient, as well as the same tooth. As attachment loss progresses, alveolar bone loss continues, until tooth exfoliation in most cases. After tooth exfoliation occurs, the area generally returns to an uninfected state, but the bone loss is permanent.
Severe local consequences:
The most common severe local consequence of periodontal disease is an oral-nasal fistula (ONF). ONFs are typically seen in older, small breed dogs; however they can occur in any breed as well as felines. ONFs
are created by the progression of periodontal disease up the palatal surface of the maxillary canines however; any maxillary tooth is a candidate. This results in a communication between the oral and nasal cavities, creating an infection (sinusitis). Clinical signs include chronic nasal discharge, sneezing, and occasionally anorexia and halitosis. Definitive diagnosis of an oronasal fistula often requires general anesthesia. The diagnosis is made by introducing a periodontal probe into the periodontal space on the palatal surface of the tooth. Interestingly, this condition can occur even when the remainder of the patient’s periodontal tissues are relatively healthy (including other surfaces of the affected
tooth). Appropriate treatment of an ONF requires extraction of the tooth and closure of the defect with
a mucogingival flap. However, if a deep periodontal pocket is discovered prior to development of a fistula, periodontal surgery with guided tissue regeneration can be performed to save the tooth.
Another potential severe consequence of periodontal disease can be seen in multi-rooted teeth, and is called a class II perio-endo abscess. This occurs when the periodontal loss progresses apically and gains access
to the endodontic system through the apical blood supply, thereby causing endodontic disease via bacterial contamination. The endodontic infection subsequently spreads though the tooth via the common pulp chamber and causes periapical infection on the other roots.
This condition is also most common in older small and toy breed dogs; however, this author has personally treated a case in a Labrador Retriever. The most common site for a class II perio-endo lesion to occur in small animal patients is the distal root of the mandibular first molars.
The third potential local consequence of severe periodontal disease is a pathologic fracture. These fractures typically occur in the mandible (especially the area of the canines and first molars), due to chronic periodontal loss, which weakens the bone in affected areas. This condition is again, most commonly seen in small breed dogs, mostly because their teeth (especially the mandibular first molar) are larger in proportion to their jaws as in comparison to large breed dogs. Pathologic fractures occur most commonly as a result of mild trauma, or during dental extraction procedures. Although this is typically considered a disease of older patients, this author has personally treated three cases in dogs less than three years of age.
Pathologic fractures carry a guarded prognosis for several reasons including: lack of remaining bone, low oxygen tension in the area, and difficulty in rigidly fixating the caudal mandible. There are numerous options for fixation, but the use of wires, pins or plates is generally required. Regardless of the method of fixation, the periodontally diseased root (s) MUST be extracted.
Awareness of the risk of pathologic fractures can help the practitioner to avoid problems in at risk patients during dental procedures. If one root of an affected multi-rooted tooth is periodontally healthy, there is an even greater chance of mandibular fracture due to the increased force needed to extract the healthy root. An alternate form of treatment for these cases is to section the tooth, extract the periodontally diseased root, and perform root canal therapy on the periodontally healthy root. In cases where periodontitis involving a mandibular canine or first molar is identified during a routine prophy, it is best to inform the owners of the possibility of a jaw

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