Canis ISSN: 2398-2942

Periodontal pockets

Contributor(s): MarkThompson, Matthew Oxford

Introduction

  • Cause: sequela to gingivitis/periodontitis Periodontal disease.
  • Loss of attachment of supporting structures of the tooth.
  • Normal sulcus depth in dogs is 1-3 mm.
  • Active plaque is the cause of periodontal disease.
  • Plaque is a biofilm of salivary proteins and oral bacteria which adheres to the exposed tooth surface. Plaque is a very stable environment, which can be affected only very minimally by chemicals such as disinfectants and antibiotics. Plaque elimination requires mechanical removal.
  • If plaque persists for a prolonged period it can become calcified to form calculus. Calculus is a largely inert material, however it has two factors that promote the progression of periodontal disease. It increases surface area, which is rough and aids plaque deposition. It accumulates around the gingival margin, reducing oxygen tension here and promotes the proliferation of anaerobic bacteria. It is these that are presumed to be responsible for the progression from gingivitis to periodonitis .
  • Periodontal pockets, along with gingival recession, are an important presenting sign of periodontitis Periodontitis.
  • Treatment: periodontal surgery Periodontal surgery: overview, gingivectomy Gingivectomy or gingivoplasty or tooth extraction Dental extraction.

Pathogenesis

Etiology

Pathophysiology

  • Sequela to untreated gingivitis/periodontitis Periodontal disease.
  • As calculus forms, the oxygen tension within the gingival sulcus changes, promoting the proliferation of anaerobic organisms. It is this switch that leads to the progression of periodontal disease. Inflammatory mediators released in response to the anaerobes promote osteolysis which will cause alveolar bone loss. This may lead to gingival recession or periodontal pocket formation or a combination of both. As the epithelial attachment recedes apically, alveolar bone loss exposes the root surface and the cementum layer. Cementum is rough which promotes in turn greater plaque and calculus deposition as subgingival accumulations. This then further promotes alveolar bone loss in spiralling progression. This is periodontitis, and it is irreversible. It can however be managed and its progression prevented with good professional therapy followed by good home care.
  • Gingival hyperplasia Gingival enlargement  is an alternative response to periodontal disease.
  • If the full thickness of alveolar bone is destroyed bone loss proceeds horizontally from the alveolar crest. In this case, the epithelial attachment usually remains coronal to remaining alveolar bone, forming a suprabony pocket. With horizontal bone loss the gingival margin often recedes with the epithelial attachment which results in periodontitis without pocket formation, known as gingival recession.
  • If a partial thickness of alveolar bone is destroyed, especially along the root surface, this is called vertical bone loss. In this case, the epithelial attachment often recedes apically beyond the crest of the remaining alveolar bone, forming an infrabony pocket. This is a periodontal pocket and owing to the reduced oxygen tension in the pocket, will rapidly progress to deep pocket formation, often exuding pus. Periodontal pockets are harder to manage than gingival recession.
  • The tooth will become mobile when >50% periodontium destroyed. This will weaken the remaining periodontal ligament even more, and most significantly, the periodontal disease will now become significantly more painful for the patient. As the tooth moves within the alveolus, there is stimulation of nerves within the periodontal ligament and at the apex of the tooth supplying the pulp.
  • Pocket may extend to apices of teeth. If the bone loss is present around the root apex it will allow bacterial access to the pulp via the apex. Bacterial infection of the pulp will rapidly lead to pulp necrosis, which may result in periapical pathology developing around the other root apices of the same tooth .
  • Oronasal fistulas Oronasal fistula occur most commonly with deep pockets associated with palatal pocket formation around the maxillary canine tooth.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers


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