Veterinary Periodontology E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 751

Veröffentlichungsjahr: 2012

Beschreibung

Veterinary Periodontology is a comprehensive yet user-friendly reference on periodontal disease in dogs and cats, encompassing etiology, pathogenesis, and clinical features. Emphasizing clinical management of this common dental disease, this book covers basic as well as advanced treatments, offering practical instruction on therapeutic procedures. Veterinary Periodontology builds on existing human-based knowledge to provide veterinary-specific information on the periodontal disease process, therapies, patient management, and instrumentation. The book presents detailed information in an accessible format, including numerous step-by-step procedures for use in the clinic. Full-color images aid in comprehension. Veterinary Periodontology is beneficial for anyone who practices veterinary dentistry, including specialists, general practitioners, students, and technicians.

Leseprobe

Contents

Contributors

Reviewers

Preface

SECTION 1 Understanding the disease process

1 The structure and function of the periodontium

Periodontium

Odontogenesis and the periodontium

Gingiva

Periodontal ligament

Cementum

Alveolar bone

Conclusion

Acknowledgment

2 Etiology and pathogenesis of periodontal disease

Introduction

Plaque

Calculus

Other predisposing factors

Periodontal disease theories

3 Bacteriology of periodontal disease

SECTION 2 The progression of disease

4 Gingivitis

Introduction

5 Periodontitis

Introduction

Clinical signs

Patterns of bone loss

Staging periodontal disease

Other clinical signs of diagnostic and/or prognostic importance in periodontal disease

Other clinical signs

Treatment

6 Local and regional consequences of periodontal disease

Introduction

Conclusion

7 Systemic manifestations of periodontal disease

Introduction

Prevalence of periodontal disease

Pathogenesis of systemic effects

Affected organs/systems

Other deleterious effects

Conclusion

8 Unusual forms of periodontal disease

Periodontal abscesses

Feline caudal stomatitis (previously called gingivostomatitis)

Feline juvenile (puberty) gingivitis/periodontitis

SECTION 3 Initial therapy of periodontal disease

9 Dental radiology for periodontal disease

The value of periodontal radiography

Radiographic appearance of normal periodontal anatomy

Radiography in periodontal disease and other pathologic conditions

The appearance of the periodontium in specific conditions

Clinical applications of periodontal radiography

10 The complete dental cleaning

Introduction

Procedure

11 Advanced non-surgical therapy

Introduction

Options for therapy

Hand scaling/root planing

Scaling/root planing

Mechanical (ultrasonic) therapy

Combined therapy using both hand and mechanical methods

12 Local antibiotic usage

13 Home plaque control

Introduction

Homecare discussion/instructions

Types of homecare

Conclusions

14 Antibiotics in periodontal disease

Introduction

Antibiotics used for periodontal disease (Box 14.1)

Appropriate antibiotic selection

Indications for antibiotic therapy in periodontal disease

Local delivery of antibiotics

Potential alternative uses of antibiotics

SECTION 4 Periodontal surgical techniques

15 Gingival surgery

Introduction

Gingival curettage

Gingivectomy

Conclusions

16 Periodontal flap surgery

Introduction

Indications

Results of pocket therapy

Surgical preparation

Specific flap types

Suture patterns for periodontal surgery

Postoperative care

17 Treatment of the exposed root surface

Introduction

Root scaling/planing

Bone treatment (osteoplasty)

Root conditioning (biomodification of the root surface)

18 Osseous surgery and guided tissue regeneration

Introduction

Alveolar bone architecture

Patterns of bone loss

Preoperative diagnostics

Treatment planning and case selection

Prognosis for therapy

Resective osseous surgery

Regenerative periodontal surgery

Response to treatment

Techniques for GTR

Determination of new attachment

Periodontal splinting

19 Furcation involvement and treatment

Introduction

Etiology

Diagnosis and classification

Local anatomic factors

Treatment

Class I defects

Class II and III defects

Hemisection

Tooth resection with partial extraction

Prognosis

SECTION 5 Related topics

20 Host modulation therapies

Introduction

Drug therapies

Conclusion

21 Patient management for periodontal therapy

Patient safety concerns

Pain considerations

Feline and brachycephalic anatomical differences

Postoperative care

Pain evaluation and scoring

SECTION 6 Periodontal instrumentation

22 Periodontal hand instruments

Instruments for diagnosis

Scalers (Figure 22.4)

Curettes

Chisels (Figure 22.11)

Files (Figure 22.12)

Quetin furcation curettes

Diamond-coated files

Knives (Figure 22.13)

23 Mechanical scalers

Ultrasonic scalers

Sonic scalers (Figure 23.6)

Tips (Figure 23.7)

Rotary scalers

Conclusions

24 Other power equipment used in periodontology

Hand-pieces

Dental burs

Instruments for polishing

Appendix 1 AVDC-Approved abbreviations

Appendix 2 Dental charts

Appendix 3 Sharpening

Appendix 4 Resources

Appendix 5 Plaque and calculus indices

Index

This edition first published 2013 © 2013 by John Wiley & Sons, Inc.

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Library of Congress Cataloging-in-Publication Data

Niemiec, Brook A. Veterinary periodontology / Brook A. Niemiec. p. ; cm. Includes bibliographical references and index.

ISBN 978-0-8138-1652-4 (hardback : alk. paper)

1. Veterinary dentistry. 2. Periodontics. 3. Periodontal disease. I. Title. [DNLM: 1. Periodontal Diseases–veterinary. SF 867] SF867.N54 2012 636.089′7–dc23

2012015385

A catalogue record for this book is available from the British Library.

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Contributors

Brett Beckman,DVM, FAVD, DAVDC, DAAPMFlorida Veterinary Dentistry, Punta Gorda, FLAtlanta Veterinary Dentistry, Sandy Springs, GAAffiliated Veterinary Specialists, Orlando, FLRobert Furman, BVMS, MRCVSChief ResidentSouthern California Veterinary Dental SpecialtiesIrvine, CAJerzy Gawor, DVM, PhD, FAVDKlinika Weterynaryjna Arka, Kraków, PolandColin E. Harvey, BVSc, FRCVS, DACVS, DAVDCProfessor of Surgery and DentistryDepartment of Clinical Studies, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphia, PAJames E. Hinrichs, DDS, MSDiplomate, American Board of PeriodontologyProfessor and Director of Advanced Education in PeriodontologyUniversity of MinnesotaMinneapolis, MNR. Michael Peak, DVM, DAVDCChief of DentistryTampa Bay Veterinary SpecialistsThe Pet Dentist of Tampa Bay, Inc.www.thepetdentist.comKevin Stepaniuk, BSc, DVM, FAVD, DAVDCVeterinary Clinical SciencesCollege of Veterinary MedicineUniversity of MinnesotaSt. Paul, MNPaul Theuns, DVMGoudenregenstraat 293353 VA PapendrechtNetherlands

Reviewers

Ruth E. Bartel, DAVDC

Daniel T. Carmichael, DAVDC

Johnathon R. Dodd, DAVDC

Jerzy Gawor, FAVD

Barron P. Hall, DAVDC

Christopher J. Snyder, DAVDC

Jason W. Soukup, DAVDC

Tammy L. White, DAVDC

Preface

Veterinary dentistry has been practiced for centuries, but only really developed into proper performance on small animal patients since the 1980s. Thanks to veterinary dental pioneers such as Emily, Mulligan, Williams, Grove, and Ross, this field has since become a recognized specialty with a growing reputation. Although we are still called “doggy dentists” and often work in obscurity, we are indeed coming into our own.

More and more clients are seeking options for the “best care” for their “four-legged children.” This includes proper dental treatment, especially as trends are turning toward smaller breeds, which are typically even more prone to periodontal disease. Furthermore, with trends of increasing life spans for our small animal patients, dental disease is becoming more severe and problematic. Moreover, the significant local and particularly systemic disease is a growing concern as a consequence of unchecked periodontal disease. These trends have resulted in a collectively marked increase in the number of clients interested in proper periodontal therapy and all options available for maintaining teeth and health (dental and overall).

Throughout the growth in our field, we have leaned heavily on the human side of dentistry for our information and treatment modalities. While this has certainly been invaluable, we have learned that dogs and cats are not small humans. Although the basic tenets of periodontal disease and treatment are the same between our patients and their human counterparts, there are significant differences in the anatomy and physiology as well as common disease states. I have made every attempt to point out these differences within this text. On occasion, this is based on unpublished “experience” of mine and that of my colleagues, which is noted for the reader when necessary. I believe these comments and sections are an important advantage to the reader and are therefore some of the most important aspects of this book.

This text is of value to anyone who has interest in veterinary dentistry, overall veterinary practice, and even human dentistry. Clients and front office staff will benefit from the chapters on local and systemic disease, so they can understand the disease process. In addition, the chapters on basic periodontal care (prophylaxis, non-surgical treatment, and homecare) will help them to understand what happens in the dental operatory of general practices. Technicians, students, and inexperienced veterinarians will enjoy these sections as well as those on pathogenesis and progression of disease, radiology, antimicrobial therapy, pain management, and equipment. Experienced practitioners will also benefit from all those chapters, but they may use the surgical section to start exploring more advanced procedures as well. I expect this text to be especially valuable for those practitioners pursuing dentistry certificates, as it provides all the current research and techniques in one book with easy-to-follow, high-quality step-by-step graphics. Finally, seasoned specialists can utilize this book to review the research and potentially glean information from some of the newer techniques from either the author’s experience or from my foray deep into the literature.

It is critical to note that although many of the procedures in this text seem straightforward, hands-on train­ing is essential to proper therapy. This includes tech­niques that are seemingly basic such as dental radiology, peri­odontal probing, and scaling (both hand and ultrasonic techniques). (Please see appendix 4, “Resources,” for a list of courses.)

Above all, however, my main goal in writing this book is to improve periodontal care in general veterinary practices. In my time of almost 20 years in practice, the quality of veterinary dentistry within our specialty and within high-end general practices has improved exponentially. However, the quality of dental care within the average veterinary practice is still very poor. In my estimation, the number of general practices that perform complete subgingival scaling, ever use a periodontal probe, provide dental radiographs, or have a DVM perform an oral examination is less than 10%. As such, the vast majority of veterinary dental care is significantly substandard.

It is my hope that this text will inspire veterinarians to continue advancing their knowledge and skills regarding periodontal disease and therapy, thereby resulting in superior care for all veterinary patients. As a final note, I have also learned a great deal during the writing of this text, which has improved my patient care and greatly benefited my practice.

Best regards,Brook A. Niemiec, DVMDiplomate, American Veterinary Dental CollegeFellow, Academy of Veterinary Dentistry

SECTION 1

Understanding the disease process

1

The structure and function of the periodontium

Kevin Stepaniuk and James E. Hinrichs

Periodontium

The supporting apparatus of the tooth is known as the periodontium. The gingiva, periodontal ligament (PDL), cementum, and alveolar bone are the tissues of the periodontium (Figure 1.1). This unique collection of tissues has a functional role in the oral cavity beyond anchoring the tooth in the bone. Understanding the structural, functional, biochemical, immunological, and molecular aspects of the periodontium is necessary to understand the pathophysiology of periodontal disease, periodontal treatments, periodontal regeneration, and periodontal repair. The hard tissues (cementum and bone) and the soft tissues (PDL and gingiva) of the periodontium play active rolls in the local inflammatory and immune response by synthesizing and releasing cytokines, growth factors, and enzymes. This fascinating interrelation of tissues, along with the normal apoptosis of the cells of the periodontium, provides the backdrop for the continued battle between periodontal health and disease.

Odontogenesis and the periodontium

Odontogenesis is the embryological events in tooth development. Complete tooth development is described elsewhere.1 However, the development of the tooth is not isolated from development of the periodontal tissues. During enamel development an outer enamel epithelium (OEE), inner enamel epithelium (IEE), and stellate reticulum are present. Adjacent to the enamel epithelium are the ectomesenchymal cells that form the dental follicle and papilla. The dental follicle gives rise to the cementum, PDL, and some alveolar bone.2 This ectomesenchymal embryonic tissue forming the dental papilla and follicle is derived from neuroectoderm.2

Figure 1.1 Histological image of the periodontium depicting dentin (D), cementum (C), periodontal ligament (PDL), alveolar bone (AB), apposition of buccal alveolar bone (AAB) associated with insertion of dental alveolar fiber, coronal crest of alveolar bone (CAB), medullary alveolar bone (MAB), arteriole (A), gingival connective tissue (GCT), stratified epithelium of gingiva (SEG), and oral mucosa (OM).

The tooth root forms after the crown has developed, but before it is completely mineralized. The OEE and IEE, without the stellate reticulum, develop into Hertwig’s epithelial root sheath (HERS). HERS proliferates into the underlying connective tissue to form the root. The dental papilla is stimulated to form odontoblasts, which ­produce dentin. At this stage, the root sheath breaks up and cementoblasts are formed from the adjacent ectomesenchymal tissue. This inductive, interactive ectodermal-ectomesenchymal pattern of tooth and periodontium development is conserved in most higher vertebrate species.3 HERS cells can remain trapped in the periodontal ligament and are known as the epithelial rests of Malassez (ERMS) (Figures 1.2 and 1.3). These cells, if stimulated later in life, may become cysts or possibly odontogenic tumors.4,5 However, it is debated whether the ERMS are sources of odontogenic tumors.

The enamel epithelium proliferates into a thick reduced enamel epithelium that fuses with the oral ­epithelium.6 The gingiva forms as the crown of the tooth penetrates into the oral epithelium and erupts into the oral cavity. A dentogingival junction is created and the junctional epithelium is established.

Repair and/or regeneration of the periodontium share many of the same events that occur during development of these unique tissues. A complete understanding of these chemical messengers and cell origins may provide a basis for periodontal repair and regeneration. However, the complete biochemical and molecular changes and the origins of cells, particularly cementoblasts, are not fully understood. It may be argued that periodontal tissue cannot be regenerated (restored to normal architecture), rather it is repaired.2 For example, there is little evidence to support that acellular (primary) cementum reforms. Instead, when repair occurs, cellular cementum is deposited; this is argued to not be a true odontogenic tissue.2 In many regeneration studies, the newly formed cementum is cellular with low numbers of fibers resulting in a new attachment may be weaker than the normal acellular extrinsic fiber cementum.7 Similarly, repair as opposed to complete regeneration of a PDL occurs following damage.8

Figure 1.2 Epithelial rests of Malassez: dentin (D), cementum (C), periodontal ligament (PDL) with rests of Malassez (RM), and incremental apposition lines in alveolar bone (AB).

Figure 1.3 Connective tissue with an arteriole (A) with epithelial rests of Malassez (RM) displayed as a mosaic pattern.

Gingiva

The oral mucosa is classified into specialized mucosa (dorsum of tongue), the non-keratinized alveolar mucosa and the keratinized masticatory mucosa. The masticatory mucosa includes the hard palate mucosa and the gingiva. The gingiva is demarcated from the alveolar mucosa by the mucogingival junction (Figure 1.4).

General histology of the gingiva

A stratified squamous epithelium and deeper connective tissue (collagen fibers and ground substance) are the components of the gingiva. Gingival connective tissue consists of collagen fibers (type I and III collagen), fibroblasts, nerves, blood vessels, lymphatics, macrophages, eosinophils, neutrophils, T and B lymphocytes, and plasma cells.1,9,10 This connective tissue is called lamina propria with a superficial papillary layer and deeper reticular layer. There are some variations in the lamina propria in relation to the type of gingiva. In the attached gingiva, the lamina propria has a papillary layer interdigitating with of the epithelium and a reticular layer adjacent to the periosteum of the alveolar bone.