Jvd 2007 (#1)

Front 1

Tenative diagnosis in this case was chronic alveolar osteitis of 204 and 304

Back 1

Tx options included: extraction, root planing, osseous resection, osteoplasty, bone replacement, or a combination of these treatments

Front 2

Periodontal Attachment Loss (PAL) is a more accurate measurement of periodontal destruction compared with periodontal probing depth b/c it measures from the base of the gingival sulcus/periodontal pocket to a fixed point on the tooth crown (CEJ)

Back 2

Focal periodontal disease stage 3 was present at 204 and 304 as evidenced by tooth extrusion (supereruption) with 25-50% bony support loss.
Periodontal pockets of 1-2mm were measured and 204 and 304 had chronic alveolar osteitis (buccal bone expansion) characterized by a pronounced, bulbous shape

Front 3

These areas of chronic alveolar osteitis were recontoured with a high-speed handpiece and water-cooled tapered diamond bur to reestablish the proper physiologic relationship b/w the bone and root

Back 3

Gentle digital compression was applied to the resutured gingval flap in the area of the recontoured alveolar osteitis for several minutes to encourge readaptation of the mucogingival tissues to bone & control hemorrhage

Front 4

Periodontal disease may be the most common disease in the cat

Back 4

Reported in 60% of client owned cats > 3 yrs of age; and up to 85% in cats > 6 yrs of age

Front 5

Periodontal disease includes inflammation of the periodontium (gingiva, PDL, cementum, and alveolar bone) resulting in recessive alteration of the periodontium, with or without active disease

Back 5

Perio dz begins as gingivitis and may advance to periodontitis

Front 6

Periodontitis is distinguished from gingivitis by clinically detectable attachment loss. It is characterized by active destruction of the PDL and alveolar bone with pocket formation, recession or both

Back 6

True

Front 7

In cats, chronic periodontal disease can be uniquely expressed as canine tooth extrusion (supereruption)

Back 7

Feline chronic alveolar osteitis is another distinguishing clinical finding of the canine teeth in cats (characterized by bulging alveolar bone around one or more canine teeth)

Front 8

Untreated perio dz may result in chronic rhinitis and ophthalmic manifestations

Back 8

Perio dz can also progress to endodontic dz if alveolar bone loss advances to the root apex or lateral canals, resulting in pulpitis and pulp necrosis

Front 9

In dogs, there is evidence that periodontal dz may affect systemic health based on a + correlation b/w the severity of perio dz and histopathologic changes in the kidney, myocardium, and liver

Back 9

Studies suggest an association b/w human periodontal disease and certain systemic disorders such as diabetes mellitus, pneumonia, heart disease, and preterm birth

Front 10

Perio dz is initiated primarily by the accumulation of bacterial plaque on the teeth and periodontium

Back 10

Bacteria induce tissue destrcution through direct action and indirectly by activating host defense cells, which in turn produce and release mediators that stimulate the effectors of connective tissue breakdown

Front 11

Genetic makeup appears to be the most important determinant in the development of perio dz (in dogs,cats,humans)

Back 11

Other factors--such as: diet, chewing habits, age, home care, and general oral health status play a role as well

Front 12

What are the goals of Periodontal tx?

Back 12

1. Reestablishment of normal anatomic/physiologic form and function (pocket reduction & elimination of soft/bony lesions)
2. Eradication or arrest of the perio lesion, with correction or cure of the deformity created by it
3. Alteration in the mouth of the predisposing factors that lead to periodontal disease

Front 13

In a recent study 53% (78 of 147) cats displayed expansion of the buccal bone radiographically at one or more canine teeth

Back 13

Buccal bone expansion at the canine teeth represents a condition of osteitis

Front 14

The closest comparable findings in humans to the buccal bone expansion are:

Back 14

small or large nodular, ridge, or spike-like outgrowth projections of bone described as exostoses

Front 15

Closed root planing is considered appropriate for what sized pocket depths in cats?

Back 15

1-2mm and lacking bony abnormalities

Front 16

Osseous surgery has been described as additive or subtractive. What does this mean?

Back 16

1. Additive osseous surgery is the restoration of the alveolar ridge to its original level, as in guided tissue regeneration. It produces the ideal outcome of periodontal therapy, regeneration of lost bone, and reestablishment of the perio ligament and gingiva at a more coronal height
2. Subtractive or resective osseous surgery restores the form of the alveolar bone to the position present at the time of surgery or to a level slightly more apical.

Front 17

What is osteoplasty?

Back 17

reshaping of bone without removal of tooth-supporting bone

Front 18

What is ostectomy?

Back 18

removal of tooth-supporting bone

*there is often overlap b/w osteoplasty and ostectomy during osseous resective surgery*
The goal is to remove the least amount of bone required to produce a satisfactory form

Front 19

Osseous surgery also results in pocket reduction that can enhance oral hygiene and periodic professional maintenance

Back 19

True

Front 20

For successful outcome to perio tx, surgical therapy must be followed with appropriate postoperative management, as well as suitable long-term home care maintenance

Back 20

Inadequate control of pain may result in delayed wound healing, increased risk of infection, reduced food and water intake, and change from normal behavior patterns

Front 21

NSAIDs may help control the connective tissue destruction that occurs in perio dz.

Back 21

Plaque bacteria induce tissue destruction indirectly by activating host defense cells, which subsequently produce and release mediators that stimulate the effectors of connective tissue breakdown

Front 22

A wide array of molecules are produced including the cytokines (IL-1 and TNF-alpha), prostaglandins (PGE2), and hydrolytic enzymes
Gingival fibroblasts produce the bone-resorbing cytokine IL-6

Back 22

cyclooxygenase-2 inhibition, provided by carprofen, may be useful in helping to control fibroblast production of IL-6 in patients with severe perio dz

Front 23

Human clinical trials and animal model studies support the theory that inhibition of local arachidonic acid metabolites with NSAIDS slows perio dz progression

Back 23

True

Front 24

Recent study in cats--treatment with clindamycin, spiramycin-metronidazole, or doxycycline produced a substantial reduction in the # of Phorphyromonas spp. and resulted in substantial clinical improvement

Back 24

True

Front 25

After plaque has formed, its biofilm characteristics resist most passive control methods, but bruhsing will mechanically disrupt plaque accumulation

Back 25

Chlorhexidine is a diguanidohexane that is considered the optimal oral antiseptic
It can help reduce anaerobic subgingival microflora in humans when used as an oral rinse

Front 26

Zinc ascorbate used as an oral antiseptic has been shown to decrease development and progression of gingivitis in cats

Back 26

A diet formulated for dental dz--that promotes prolonged tooth surface contact helps remove plaque

Front 27

An alternative perio dz management technique includes the feeding of diets or treats containing polyphosphates

Back 27

Polyphosphates chelate salivary calcium, thereby preventing plaque from mineralizing into calculus

Front 28

Successful tx and control of perio dz requires a multidimensional approach

Back 28

True