ISSN 2398-2942      

Periodontal surgery: overview

icanis
Contributor(s):

Mark Thompson


Periodontal surgery

Pre-operative concerns

Pre-operative work-up and systemic disease concerns

  • Main cause of periodontitis Periodontal disease is a disruption of equilibrium between the bacteria in the subgingival plaque and calculus, and the host's immune system at the dentogingival junction.
  • Endocrine diseases, metabolic disease, debilitating disease, corticosteroid therapy, nutritional deficiency and immune-mediated disease all predispose to periodontitis.
  • Careful history taken with regard to pre-existing diseases, physical examination and diagnostic tests therefore important - complete blood count, biochemical panel and urine analysis indicated.

Anesthesia

  • Inhalation anesthesia recommended - cuffed endotracheal tube mandatory Endotracheal intubation.
  • Careful monitoring required.

Antibiotics and oral antiseptics

  • Periodontal treatment and tooth extraction results in bacteremia and so should not be performed in conjunction with other surgical techniques.
  • Bacteremia associated with routine periodontal treatment clears up within 20 minutes - antibiotic prophylaxis should only be necessary in geriatric or debilitated animals, or if severe stomatitis present or if combined with tooth extractions.
  • Choice and dosage of antibiotic controversial - recommendations range from 5 day course of clindamycin Clindamycin PO pre-operatively to IV administration of broad-spectrum antibiotic such as ampicillin at time of premedication or induction.
  • Good practice to flush mouth with antiseptic solution (chlorhexidine Chlorhexidine ) prior to periodontal treatment - use correct concentration; 0.2% considered safe, although more dilute solution may be indicated (0.05%) if oral mucosa exposed throughout procedure.

Patient positioning

  • Lateral recumbency preferred by many veterinary surgeons - important to place towel/sandbag under neck to tilt head downwards to ensure drainage of saliva, etc.
  • Dorsal recumbency useful alternative as exposure to buccal and lingual surfaces of teeth good without needing to turn patient over halfway through procedure.
  • Main hazard of dorsal recumbency is fluid aspiration - again, towel/sandbag under neck and lower head end of table.
  • Use pharyngeal pack and cuffed endotracheal tube.
  • Dorsal recumbency indicated for surgical extraction of caudal maxillary teeth.
  • Take care to prevent patient becoming too wet during procedure.

Workplace

  • Keep instruments sterilized - use full aseptic technique for extractions.
  • Operator ideally in seated position with forearms resting on table.

Personal protection

  • Operator should wear mask and eyewear to prevent contact with bacteria-laden fluid particles - goggles indicated if dental drill used.
  • Surgical mask recommended.
    Only effective for up to 8 hours.
  • Disposable latex gloves should be worn.

Further Reading

Publications

Refereed papers

Related Images

Can’t find what you’re looking for?

We have an ever growing content library on Vetlexicon so if you ever find we haven't covered something that you need please fill in the form below and let us know!

 
 
 
 

To show you are not a Bot please can you enter the number showing adjacent to this field

 Security code