Transcript always look for the postive

ALWAYS LOOK FOR THE POSTIVE
“When it is dark enough, you
can see the stars.”
-Persian proverb
Diseases of Digestive System
Chapter 2
Oral Diseases: Periodontal Disease
• Periodontal Disease is plaque-induced inflammation of gums
– Progressive
– Includes gingivitis, gingival hyperplasia, peridontitis with vertical bone
destruction, and peridontitis with horizontal bone destruction
– The end result is loss of tooth
• Periodontal means “around the tooth”
– Etiology
• Food particles, bacteria collect around gum line and form plaque (tartar)
– Causes gingivits
• Minerals in saliva collect in plaque and harden to form calculus which adheres to
teeth
– 3-5 d to harden
– Causes bad breath
– Protects the bacterial environment
Oral Diseases: Gingivitis
• Gingivitis—earliest signs of Periodontal Disease
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Involves only the soft tissues of the gums
Reversible inflammation of gums
Gingival hyperplasia (may also be breed- or drug-related)
Cause—accumulation of tartar on teeth
• Tartar is conducive to bacterial growth
• Enzymes produced by bacteria damage tooth attachment and cause
inflammation
Oral Diseases: Periodontal Disease
Without intervention, gingivitis progresses to:
• Periodontitis—irreversible condition:
– Loss of gingival root attachment (receding gums)
– Alveolar bone resorption
– Loss of teeth
alveolar bone
Oral Diseases: Periodontal Disease
• Periodontitis—irreversible condition:
– Alveolar bone resorption
• Gingivitis—reversible; earliest signs of Periodontal Disease
Mild tartar
Mild gingivitis
No bone loss
more tartar
more gingivitis
min bone loss
severe tartar
>50% bone loss
gum receding tooth is loose
moderate bone loss should be pulled
Oral Diseases: Periodontal Disease
• Calculus builds up under gums
– Separates teeth from gums to form ‘pockets’, which encourages more
bacteria to accumulate and grow
• Bacteria secrete toxins/enzymes that cause detachment of tooth from
bony socket
• WBC’s invade area and release their enzymes to destroy bacteria
– These enzymes also cause detachment of tooth from bone
• Pockets get deeper and deeper
– Weakens bone
– Can cause pathologic fractures
• Other sequellae
– Bacteria enter blood stream
• Can cause micro-abscesses in liver, kidneys
• Cause endocarditis on heart valves
Oral Diseases: Periodontal Disease
Iatrogenic mandibular fracture resulting from excessive force extraction of a lower
molar tooth
Oral Diseases: Periodontal Disease
• Signs
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Halitosis
Reluctance to chew hard food
Pawing at mouth
Oral pain; personality changes
Sneezing; nasal discharge
Increased salivation
Facial swelling; tooth loss
• Dx
– Complete oral exam
– Presence of tartar (plaque) on teeth
Oral Diseases: Periodontal Disease
• Rx
– Dental scaling
• with ultrasonic scaler
– Root scaling/planing (below gum line)
• with thin ultrasonic tip; curette
– Gingival curettage
• with curette against inner surface of gums
(gingival pocket’s diseased soft tissue inner
surface)
– rationale is to convert chronically inflamed
ulcerated lesions into a clean surgical wound to
promote healing
– Polishing to smooth the tooth surface and prevent
tartar buildup
– Irrigation to remove diseased tissue and plaque
Oral Diseases: Periodontal disease
DOXIROBE GEL controls infection and promotes rebuilding of periodontal structures
*contains Doxycycline, an antibiotic
Oral Diseases: Periodontal Disease
Plaque prevention gel
Applied once a week
Oral Diseases: Periodontal Disease
• Client info
– Good oral hygiene is necessary for all pets
• Brush teeth daily
• Routine dental cleanings performed at veterinarian’s
• Treat gingivitis early before irreversible lesions occur
– Extractions are sometimes necessary to clear up infections
– Hard, crunchy food may promote better dental health by
removing tartar before it calcifies
• Once it calcifies, tartar must be removed professionally
http://www.youtube.com/watch?v=qnbJZWycdg&feature=PlayList&p=480B67A7E8907594&playnext_from
=PL&playnext=1&index=5
Oral Trauma
• Causes (many)
– Falls, fights (bites), burns, blunt trauma (HBC)
– “High-rise syndrome” in cats
• Fractured hard palate, mandible
– Tongue injury from biting own tongue, dog fight, eat
from tin can in garbage, FB
– Cats playing with needles, thread; strangulate
tongue
– Electrical, chemical burns
– Gunshot wounds, fish hooks
– Bones lodged in teeth
(Foreign body)
Fx mandible—cat; HBC
Oral Trauma
• Signs
– History or signs of head trauma
– Increased salivation
– Inability to close mouth; due to:
• Pain
• Fracture/dislocation
• FB
– Reluctance to eat (same reasons)
– Presence of foreign object
• Dx
– PE of oral cavity
– X-ray to r/o embedded FB
Oral Trauma
• Rx
– Depends on type of trauma
– Control bleeding
– Provide supportive care
• IV fluids
• pain relief
– Insure adequate airway
– Repair/extract damaged teeth
• Client info
– Like kids, if animals can get into trouble, they will
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Discourage chewing on electric cords
Don’t leave caustic/toxic chemicals out
Keep pets in fenced yard or on leash when outside
Animals still eat well without entire tongue
Oral Neoplasia
Relatively common in cats and dogs; malignant melanoma and squamous
cell carcinoma most common
• Signs
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Depend on location and size of growth
More common in males
Squamous cell
carcinoma (Upper
Abnormal food prehension
R 3rd incisor)
Increased salivation
Bone loss around
Tooth loss
lesion
Oral pain
• Dx
– Histology of mass
– X-rays to r/o metastasis
– Biopsy of LN to r/o metastasis
Rostral
maxillectomy was
curative
Oral Diseases: Oral Neoplasia
A gingival (buccal mucosa) melanoma
involving a dog's caudal mandible
and temporomandibular joint region.
Above: An invasive feline oral
squamous cell carcinoma
(courtesy of Jon Slattery)
Oral Neoplasia
• Rx
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Surgical excision
Partial removal of mandible/maxilla if bone is involved
Radiation therapy
Chemotherapy
• Client info
– Px for malignant tumors is guarded even with aggressive
therapy
– Benign lesions have good Px
– Animals (esp cats) with bone removed may need nutritional
support (feeding tube)
Oral Diseases
http://veterinarydentistry.posterous.com/
Salivary Mucocele
Accumulation of excessive amounts of saliva in SQ tissue
Most common lesion of salivary glands in dogs; rarely seen in cats (following
trauma)
Cause is unknown (tight collar, choke chain??)
• Signs
– Slowly enlarging, nonpainful, fluid-filled swelling on neck or
under tongue
– Reluctance to eat
– Difficult swallowing
– Blood-tinged saliva
– Respiratory distress
Salivary Mucocele
• Dx
– Clinical signs
– Paracentesis shows thick, blood-tinged fluid
• Rx
– Aspirate fluid
– Surgical drainage
– Remove salivary gland; insert Penrose drain x 7 d
• Client info
– Cause is unknown; trauma may be involved
– Without removal of gland, excess fluid will continue to
accumulate
– Some cases may resolve spontaneously
Removal of
mandibular
salivary gl
Lip-Fold Dermatitis
Often seen in breed with pendulous upper lips (spaniels, setters, St. Bernard,
bulldogs, bassets)
Constant moisture in the folds from saliva causes bacterial growth
Food, hair, moisture cause irritation, erythema, and fetid odor
• Signs
– Halitosis
– Collection of debris in lower lip fold
• Dx
– Clinical signs
• Rx
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Dental cleaning
Clip hair
Clean out folds (food)
Diaper rash cream
Sx is permanent Rx
Lip-Fold Dermatitis
• Client info
– Keep lip folds dry (for the rest of animal’s life!!)
– Flush/clean lip folds
• with 2.5% benzoyl peroxide shampoo
• chlorhexidine
• malaseb pledgets (chlorhexidine + miconazole)
– Drying agents like corn starch several times a day
– Good dental hygiene will help prevent it
START A CHART
ORAL
MOA
CS
Periodental
disease
Gingivitis
Periodental
Halitosis
Trauma
Falling, HBC
Neoplasia
Salivary
mucocele
Lip fold
dermatitis
DX
TX
PROGNOSIS