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ALWAYS LOOK FOR THE POSITIVE “When it is dark enough, you can see the stars.” -Persian proverb Diseases of Digestive System Chapter 2 ORAL DISEASES Oral Diseases: Periodontal Disease Gingivitis: earliest sign of Periodontal Disease Reversible inflammation of the soft tissues of the gums Cause: accumulation of tartar on teeth Tartar is conducive to bacterial growth Enzymes produced by bacteria damage tooth attachment and cause inflammation Gingival hyperplasia could develop secondary to gingivits Oral Diseases: Periodontal Disease Periodontal means “around the tooth” Periodontal Disease is plaque-induced inflammation of gums Food particles & bacteria collect around gum line and form plaque (tartar) Minerals in saliva collect in plaque and harden to form calculus which adheres to teeth 3-5 days to harden Causes bad breath Protects the bacterial environment Progressive, results in eventual tooth loss Oral Diseases: Periodontal Disease Periodontitis: irreversible condition resulting from untreated gingivitis Receding gums Alveolar bone resorption Loss of teeth alveolar bone Oral Diseases: Periodontal Disease Periodontitis Separation of teeth from gums to form pockets Bacteria and inflammation destroy the periodontal ligament Pockets are abnormal if the depth exceeds: 3mm in the dog 1mm in the cat Other consequences Bacteria enter blood stream Can cause micro-abscesses in liver, kidneys Cause endocarditis on heart valves Periodontal Pockets Oral Diseases: Periodontal Disease Mild tartar more tartar severe tartar >50% bone loss Mild gingivitis more gingivitis gum receding tooth is loose No bone loss min bone loss moderate bone loss should be pulle Oral Diseases: Periodontal Disease Iatrogenic mandibular fracture resulting from excessive force extraction of a lower molar tooth Oral Diseases: Periodontal Disease Signs of periodontal disease Halitosis Reluctance to chew hard food Pawing at mouth personality changes Sneezing, nasal discharge Increased salivation Facial swelling, tooth loss Dx Complete oral exam Presence of tartar (plaque) on teeth Measurement of periodontal pockets Oral Diseases: Periodontal Disease Treatment: Dental Prophylaxis ◦ Dental scaling with ultrasonic scaler With hand scaler ◦ Root planning ◦ Gingival curettage ◦ Lavage ◦ Polishing to smooth the tooth surface and prevent tartar buildup ◦ Flouride treatment 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 at home by owner Oral Diseases: Periodontal Disease Client info Good oral hygiene is necessary for all pets Brush teeth daily Schedule routine dental cleanings at veterinary office Treat gingivitis early before irreversible lesions occur Extractions are sometimes necessary to clear up infections beneath the gum line 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&p laynext_from=PL&playnext=1&index=5 Oral Diseases: Trauma Many Causes: Falls, fights, burns, blunt trauma (HBC) “High-rise syndrome” in cats Fractured hard palate, mandible Tongue injury Cats playing with needles & thread Electrical, chemical burns Gunshot wounds, fish hooks Bones lodged in teeth Fx mandible—cat; HBC Oral Diseases: Trauma Signs History or signs of head trauma Increased salivation Inability to close mouth due to: Pain Fracture/dislocation Foreign body (FB) Reluctance to eat Presence of foreign object Dx PE of oral cavity X-ray to r/o embedded FB Oral Diseases: Trauma Treatment Depends on type of trauma Control bleeding Provide supportive care IV fluids pain relief Ensure adequate airway Repair/extract damaged teeth Client info 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 Diseases: Neoplasia Relatively common in cats and dogs - malignant melanoma and squamous cell carcinoma most common Signs Depend on location and size of growth Abnormal food prehension Increased salivation Tooth loss Oral pain Dx Histology of mass X-rays to r/o metastasis Biopsy of regional lymph node to r/o metastasis Oral Diseases: Neoplasia Squamous cell carcinoma (Upper R 3rd incisor) Bone loss around lesion 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 Diseases: Neoplasia Treatment Surgical excision Partial removal of mandible/maxilla if bone is involved Radiation therapy Chemotherapy Client info Prognosis for malignant tumors is guarded to poor even with aggressive therapy Benign lesions have good Prognosis Animals (esp.cats) with bone removed may need nutritional support (feeding tube) Oral Diseases: Salivary Mucocele Accumulation of excessive amounts of saliva in SQ tissue Most common lesion of salivary glands in dogs; rarely seen in cats 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 Treatment ◦ Aspirate fluid ◦ Surgical drainage ◦ Remove salivary gland; insert Penrose drain x7d Client info ◦ Without removal of gland, excess fluid will continue to accumulate ◦ Some cases may resolve spontaneously Removal of mandibular salivary gland Lip-Fold Dermatitis Often seen in breed with pendulous upper lips Constant moisture in the folds from saliva causes bacterial growth Food, hair, moisture cause irritation, erythema, and fetid odor Signs/Diagnosis Halitosis Collection of debris in lower lip fold Lip-Fold Dermatitis Treatment ◦ Dental cleaning ◦ Clip hair ◦ Clean out folds ◦ Diaper rash cream applied topically ◦ Surgery is permanent treatment Client info ◦ ◦ ◦ ◦ Keep lip folds dry 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 WHAT SETS YOU APART? “I am not afraid to die on a treadmill. I will not be outworked. If we get on a treadmill together, one of two things will happen; You’re going to get off first or I’m going to DIE. It’s really that simple.” -Will Smith ESOPHAGEAL DISEASES Esophageal Diseases: Gastroesophageal Reflux Esophagitis is an inflammation of the esophageal wall caused by Mucosal irritants Gastroesophageal reflux- the most common cause of esophagitis Reflux of gastric contents into the esophagus leads to inflammation and abnormal function of the lower esophageal sphincter Esophageal Diseases: Gastroesophageal Reflux Clinical Signs ◦ Anorexia ◦ Dysphagia ◦ Excessive salivation ◦ Regurgitation Severity of clinical signs depends on: ◦ The type of material ingested ◦ The length of contact with the mucosal surface ◦ The integrity of the esophageal mucosal barrier Esophageal Diseases: Gastroesophageal Reflux Diagnosis: Endoscopy and/or fluoroscopy Esophageal Diseases: Gastroesophageal Reflux Treatment of Irritating Substances ◦ Do not induce vomiting ◦ Administer activated charcoal ◦ Prevent further ingestion ◦ mucosal protectants - sucralfate Treatment for Gastroesophageal reflux ◦ Dietary changes –high protein, low fat ◦ mucosal protectants – sucralfate, H2 blockers ◦ Anti-emetics - Metoclopramide Esophageal Diseases: Gastroesophageal Reflux Client Info Prevent access to irritating substances Avoid excessively hot food Always follow oral medications with water to prevent the tablet or capsule from sticking to the esophagus causing irritation Esophageal Disease: Obstruction Esophageal obstruction Ingestion of nondigestible objects Degree of damage depends on size, shape, time in esophagus Surgical removal is least desirable → stricture formation Signs Exaggerated swallowing movements Increased salivation restlessness Retching Anorexia Hx of chewing on foreign objects Esophageal Diseases: Obstruction Esophageal endoscopy Esophageal Obstruction Diagnosis Endoscopy Radiography 6 month old St. Bernard Esophageal Obstruction Esophageal Obstruction 8 yr male cat Esophageal Obstruction 7 mo old Pug