Managing stage I and II periodontal disease (Proceedings)
Prevention and treatment of periodontal disease can only be accomplished through regular professional care under general anesthesia. Multiple steps are involved in this process and the veterinary/technician team plays a vital role in ensuring quality control, efficiency and completeness. The following discussion details the essential steps that the quality dentistry service can utilize to ensure proper periodontal prevention and therapy for their patients with an emphasis on stage I and stage II periodontal disease. Stage III and stage IV will be discussed in separate proceedings and lectures.
The following classification of periodontal disease stages from the website of the American Veterinary Dental College
Periodontal Disease Classification
The degree of severity of periodontal disease relates to a single tooth; a patient may have teeth that have different stages of periodontal disease.
• Normal (PD 0): Clinically normal – no gingival inflammation or periodontitis clinically evident.
• Stage 1 (PD 1): Gingivitis only without attachment loss. The height and architecture of the alveolar margin are normal.
• Stage 2 (PD 2): Early periodontitis – less than 25% of attachment loss or at most, there is a stage 1 furcation involvement in multirooted teeth. There are early radiologic signs of periodontitis. The loss of periodontal attachment is less than 25% as measured either by probing of the clinical attachment level, or radiographic determination of the distance of the alveolar margin from the cemento-enamel junction relative to the length of the root.
• Stage 3 (PD 3): Moderate periodontitis – 25-50% of attachment loss as measured either by probing of the clinical attachment level, radiographic determination of the distance of the alveolar margin from the cemento-enamel junction relative to the length of the root, or there is a stage 2 furcation involvement in multirooted teeth.
• Stage 4 (PD 4): Advanced periodontitis – more than 50% of attachment loss as measured either by probing of the clinical attachment level, or radiographic determination of the distance of the alveolar margin from the cemento-enamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth.
Client Communication Before and During the Prophylaxis
Proper phophylaxis is the basis of the approach to preventing stage I teeth from progressing to stage II. Unfortunately we never know what stage of periodontal disease we will be faced with until we have the patient under anesthesia and have utilized probing and radiography to define the extent of disease. Normal gingival does not guarantee normal subgingival tissue. Multiple stages are likely to occur in each individual patient. Premolars may be normal with no gingivitis, tartar or attachment loss while incisors may be mobile and require extraction. Expect this variability and relay it to the client.
Pictures and radiographs of past patients serve a vital role in the communication process. When clients can see what the anticipated disease looks like prior to the actual procedure compliance is much easier to facilitate. Take time to educate clients prior to the procedure. Unexpected findings are much easier to explain while the patient is under anesthesia if the client has seen prior examples of patients with periodontal disease.
As just described a complete oral evaluation under anesthesia many times reveals additional pathology requiring dental radiography and/or further treatment. Therefore it is imperative that owners are available by phone during the procedure so that any abnormalities can be relayed to the owner and permission granted to approach these problems during the same anesthetic episode. It is common to find periodontal pockets that require treatment surrounding what appears to be a normal tooth.
Minimize Patient and Operator Exposure During Prophylaxis
Aerosolization is unavoidable with the use of mechanical scalers during dental prophylaxis exposing both the staff and the patient to oral bacteria. Chlorhexidine solution may be used as a rinse prior to cleaning to decrease this factor and possibly diminish the degree of bacteremia. Protective glasses, gowns and face masks reduce exposure as well and should be worn by the operator. Finally proper insufflation of the endotracheal tube prevents aspiration of microbes by the patient.