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

• Recent references from PubMed and VetMedResource.