Canine Oral Pathology Flashcards
How many teeth do dogs have
42
What is the dog’s dental formula
2 (I3/3, C1/1, P4/4, M2/3)
What might cause supernumerary teeth
Familial (seen in boxers and bulldogs)
can affect any tooth - most commonly 1st premolars and incisors
What breeds might commoly have supernumerary teeth
Boxers and bulldogs
What teeth are often supernumerary
1st premolars and incisors
Why might a dog have too few teeth
1) Hypodontia - not all dogs make all the teeth
2) Unerupted teeth - Always significant
T/F: unerupted teeth are always significant
True
For supernumerary teeth, you need to extract the tooth when ___________
the presence of of this tooth causes
1) Malocclusion
2) Increases the risk for periodontal disease
What should you consider for supernumerary teeth
-Always count the number of teeth
-More is usually bad
-Always evaluate radiographically
What are the two ways a dog might have too few teeth
1) Hypodontia/ Oligodontia / Anodontia: not all dogs make all the teeth
2) Unerupted teeth: always significant - need to rule out for the potential for odontogenic tumors and cysts
3) Made them, erupted them, lost them : from extraction, trauma, periodontal disease, resorption
conditions where dogs dont make the teeth
Hypodontia
Oligodontia
Anodontia
Why do you need to rule out teeth that didnt erupt
because of the potential for odontogenic tumors and cysts
What are ways that an animal might have made a tooth and had it erupt but then lost it
Extraction
Trauma
Periodontal disease
Resorption
What do you do if a dog has less than 42 teeth
1) Obtain a history
2) Obtain radiographs (most critical dx step)
-If tooth or tooth root present (bad)
-If no tooth or tooth root (yay)
when imbedded teeth go rogue
Dentigerous cysts
What tooth is dentigerous cyst most commonly associated with ______ *
Imbedded mandibular 1st premolar
What is the radiographic appearance of dentigerous cysts
expansule cystic lesion
How do you treat dentigerous cysts
Extraction and enucleation (critical to remove all the cystic lining)
after submit the lining for biopsy
Persistent deciduous tooth that is present after the permanent tooth has erupted
Retained
too few teeth, one or more imbedded in bone (usually a permanent tooth)
Imbedded tooth
What causes the expansion of dentigerous cysts
teeth that are embedded and the eruptive capsule spreads
Teeth are always a reason to recommend radiographs unless ____ *
you have radiographic evidence of complete extraction
T/F: imbedded teeth should always be extracted
True
Why might you be able to leave retained tooth roots in? *
1) No endodontic disease
2) No communication with the oral cavity
3) Less than 5mm in size
IF you leave them, document and tell the owner
What might cause developmental changes in tooth appearance *
Most commonly will be enamel hypo-mineralization
can be widespread or only affecting a single tooth
Causes:
-Local inflammation / trauma
-Infected deciduous tooth
-Iatrogenic
-Systemic inflammation
-Febrile event
-Distemper
-Systemic antimicrobials (Tetracycline, possibly enrofloxacin)
What breed does not form a normal synarthrosis in the mandible
Shih-Tzu
Why might persistent deciduous teeth be problematic
1) Malocclusion
2) Periodontal Disease (crowding, lack of circumferential gingival collar)
What is the most common retained deciduous tooth
Canine
What is a class 2 malocclusion
The mandibular teeth are distal to the maxillary teeth
“Overbite”
Mandibular brachygnathism
*You need to do something becayse it is painful
What is a class 3 malocclusion
Maxillary brachygnathism
where the mandibular teeth mesial to the maxillary teeth
Under bite
acceptable for some breeds, most comfortable and functional
What might occur as a result of a class 3 malocclusion
callous like tissue develops where mandibular teeth contact lio
outwards rotation of the incisors
developmental changes in tooth appearance will typically be due to
enamel hypomineralization
What virus can cause enamel hypoplasia
Distemper
What medications can cause enamel hypoplasia
Tetracycline, possibly enrofloxacin
Lack of the enamel exposes
Dentin, this can then lead to endodontic disease
CCUS stands for
canine chronic ulcerative stomatitis (CCUS)
What causes canine chronic ulcerative stomatitis (CCUS)
lymphocytic-plasmacytic inflammation of tissue contacting plaque retentive surfaces including the vestibular mucosa and lateral tongue margins
need to flip lip to see the buccal mucosa
kissing lesions - contact mucositis
What parts of the mouth are affected by canine chronic ulcerative stomatitis (CCUS)
Vestibular mucosa and lateral tongue margins
where the lips touch the teeth - dogs are allergic to the plaque
T/F: canine chronic ulcerative stomatitis (CCUS) is not painful
False it is very painful
What are the clinical signs of canine chronic ulcerative stomatitis (CCUS)
1) Very painful, severe halitosis
2) Kissing lesions
+/- weight loss, difficulty eating, masticatory muscle wasting, aggression
How do you treat canine chronic ulcerative stomatitis (CCUS)
1) Immaculate oral care (at home and professionally)
2) Analgesia
3) Immunosuppression / Immunomodulation
4) Extractions (usually lots, sometime all)
-Caudal teeth first most commonly
What are medical methods for canine chronic ulcerative stomatitis (CCUS) *
1) Doxycycline (sub-antimicrobial dose) 2mg/kg q24h
2) Immunomodulatory (Apoquel)
3) Immunosuppressive (Prednisone)
4) Pentoxyfilline
5) NSAIDs
6) Twice daily brushing
7) Professional cleanings at least every 6 months
What do you do surgically for canine chronic ulcerative stomatitis (CCUS)
Extractions!!
start this conversation early in the disease process
canine chronic ulcerative stomatitis (CCUS) has some features of PD, but often the management needs to be
more aggressive
What might cause ulcerative (reactive) lesions in the mouth
-Foreign body reaction
-Chemical exposures
-Electrical injury
-Osteonecrosis
What might cause proliferative (reactive) lesions
-Viral (papillomatosis)
-Gingival enlargement
-Focal fibrous hyperplasia
-Sublingual and buccal granuloma
What might cause patients to change their eating habits *
Ulcerative lesions (very painful)
unlike many dental problems, often the presenting complaint is not eating
When ulcerative lesions are severe they might
also expose bone
How might patients with ulcerative oral lesions present
oral pain, often severe
change in eating habits
acute onset drooling
interruption of the mucosal or gingival layer
ulcerative oral lesion
What can ulcerative lesions develop to if chronic
profound bone loss
How do you treat a reaction ulcer from oral foreign bodies
Surgical treatment (may be extensive)
How do you treat oral ulcerative lesions due to chemical exposures
Systemic treatment
Supportive care
Magic mouthwash
Often no surgical tx needed
may have chronic scarring
What are the ingredients of magic mouthwash
Sucralfate
Lidocaine
Diphenhydramine
What does electical cord injuries in the mouth look like
Red or blanched areas of tissue around the lips and gums
sores that arent bleeding
How do you treat electrical cord oral injuries
1) Stabilize, treat systemically first (pulmonary edema)
2) It may take up to six months to see full extent of damage (osteonecrosis)
3) Surgical treatment must be delayed
4) Magic mouthwash and analgesia for oral sores
Why do you need to wait to do surgery for electrical cord injuries
may take up to 6 months to see full extent of damage (osteonecrosis)
SURGICAL TREATMENT MUST BE DELAYED
What is the only time you see the gums recede but the bone does not come with it *
Osteonecrosis
Osteonecrosis may be secondary to
Radiation, electric cord injury, or idiopathic
very painful
What breeds are predisposed to oral ostenecrosis (ulcerative)
Cocker spaniels
How do you treat osteonecrosis ulcerative lesions
Require large surgeries to remove all devitalized bone
poor prognosis
very painful, control pain
Why should you not take dental radiographs when the dog is just sedated
it can break the radiograph plate, insurance will not cover this
you notice ulcers on the palatoglossal folds. What do you do next
-Collect biopsy samples
-during the week that youre waiting for sample to come back
-treat for pain (NSAIDs, magic mouthwash, soft food)
-TOT (tincture of time)
-biopsy results - mucosal ulcersations, no cause determined
Are proliferative or ulcerative lesions more painful
Ulcerative
sublingual and buccal granulomas are associated with
physical trauma from mastication
sublingual and buccal granulomas are more common in what dogs
small / brachycephalics - they have a lot of cheeks
sublingual and buccal granulomas often unilateral or bilateral
bilateral
How do you treat sublingual and buccal granulomas
excise only if it becomes ulcerated
What might cause gingival proliferative lesions
-Idiopathic
-PD
-Breed disposition (Boxers, Doberman)
-Cyclosporine
-Calcium channel blockers
-Anti-seizure medicine
How do you treat gingival proliferative lesions
1) excise pseudopocket
2) change medications
3) Azithromycin toothpaste
need to control plaque
Why is gingival proliferative lesions clinically significant?
it causes pseudo-pocketing underneath the gum tissue
What is the typical signalment for viral papillomatosis
young dogs with a history of exposure to other dogs
How do you treat viral papillomatosis?
-Mild = No treatment
-Medical management includes immunomodulatroy therapy and vaccine
-For severe cases, surgery or laser treatment of the lesions
What might viral papillomatosis indicate in older dogs
May indicate a compromised immune system
try to identify the immune dysfunction
a mass-type lesion associated with periodontal diseases
MUST be diagnosed with biopsy
may appear to be malignant (especially SCC)
Focal fibrous hyperplasia
How do you treat focal fibrous hyperplasia
Surgical excision AND treatment of underlying periodontal disease is curative
What does focal fibrous hyperplasia look like
Cancer!! it may appear malignant (especially SCC)
must be diagnosed with a biopsy
How must focal fibrous hyperplasia be diagnosed
via biopsy
What conditions might cause an animal to have trouble or painful opening the mouth
1) Masticatory Muscle Myositis
2) TMJ anklyosis
3) Retrobulbar disease
What conditions might caise an animal to have trouble or painful closing the mouth
1) Fracture / trauma
2) Dental Disease
3) TMJ luxation
4) Trigeminal Neuropathy
antibodies being produced against the specific 2M muscle fibers found in the muscles of mastication
Masticatory Muscle Myositis
With Masticatory Muscle Myositis, antibodies are produced against 2M muscle fibers in what muscles
1) Temporalis
2) Masseter
3) Ptyergoids
NOT digastricus
In masticatory muscle myositis, which masticatory muscle is not targeted ie spared
Digastricus
Is the acute or chronic phase of masticatory muscle myositis typically painful
Acute: can be extreme on opening the mouth
Chronic: often not painful
In acute masticatory muscle myositis, there is extreme pain on closing or opening the mouth
pain on opening the mouth
How does the acute phase of masticatory muscle myositis differ from the chronic ***
Acute: muscle inflammation
-Pain (extreme) on opening the mouth
-Swelling of muscles of mastication
Prognosis: good if treatment started in acute phase
Chronic: muscle fibrosis
-Significantly reduced ability to open the mouth
-Often not painful
-Atrophy of muscles of mastication
-Prognosis- guarded depending on the fibrosis
What is the prognosis of masticatory muscle myositis *
good if treatment is started in the acute phase and has long duration
if in the chronic phase, it is guarded dependent on the amount of fibrosis
muscle biopsy is really important for prognosis because thats how you tell the amount of fibrosis
What is seen with the chronic phase of masticatory muscle myositis *
Chronic: muscle fibrosis
-Significantly reduced ability to open the mouth
-Often not painful
-Atrophy of muscles of mastication
-Prognosis- guarded depending on the fibrosis
What is seen with the acute phase of masticatory muscle myositis *
Acute: muscle inflammation
-Pain (extreme) on opening the mouth
-Swelling of muscles of mastication
Prognosis: good if treatment started in acute phase
How do you diagnose masticatory muscle myositis
1) Measurement of CK +/- (very high)
2) 2M muscle antibody test (ideally before giving prednisone)
3) CT- guided biopsy of temporalis or masseter
4) 2mg/kg PO BID prednisone, use until aperture opening is normal, wean over 4-6 months (can also consider mycophenylate)
What is the treatment of masticatory muscle myositis in acute phase
2mg/kg PO BID prednisone, use until aperture opening is normal, wean over 4-6 months (can also consider mycophenylate)
How do you diagnose TMJ ankylosis
History (trauma, neoplasia)
Radiographs
CT (best)
What are the typical causes of TMJ ankylosis
Trauma
Neoplasia
often unilateral but can be bilateral
How do you treat TMJ ankylosis
-Condylectomy or Mandibulectomy
-Analgesia / Anti-inflammatories
T/F: a dog can still open their mouth with unilateral TMJ ankylosis
False- they cant open with unilateral
Retrobulbar causes trouble/painful opening or closing the mouth
trouble/ pain opening
Dental disease causes trouble/painful opening or closing the mouth
trouble/ pain closing
TMJ luxation causes causes trouble/painful opening or closing the mouth
trouble/ pain closing
TMJ ankylosis causes trouble/painful opening or closing the mouth
trouble / pain opening
Trigeminal Neuropathy causes trouble/painful opening or closing the mouth
trouble / pain closing
How do you diagnose Retrobulbar disease
1) Painful / decreased retropulsion of eye
2) Often unilateral
3) Oral exam, CT
4) Pain / trouble opening the mouth
What are the potential causes of retrobulbar disease
Foreign Body
Infection
Trauma
Neoplasia
What is the prognosis of retrobulbar disease
varies widely depending on the cause
What should you do to work up masticatory muscle disorders
prepare the owners for CT and if you suspect foreign body, do CT when the dog is inflammed
For masticatory muscle myositis you need to get samples prior to
starting steroids
With bilateral mandibular fractures what will you see clinically
the animal cannot close mouth but is very painful if you try to close
What are the causes of bilateral mandibular fracture
1) Severe periodontal disease
2) Bilateral trauma
How do you diagnose bilateral mandibular fracture
Intraoral Rads
CT
How do you treat bilateral mandibular fracture
1) Rigid fixation (miniplates)
2) Mandibulectomy
3) Conservative therapy
Why might an animal with dental disease be unable to close mouth fully
1) Super-eruption of maxillary canine teeth in cats
2) Periodontal disease causes teeth to partially exfoliate
How do you diagnose dental disease
oral exam - then treat the same way you normally treat dental disease
What might you see with TMJ luxation
The mouth is open and deviated to one side
cant close the mouth
What causes TMJ luxation
trauma
How do you diagnose TMJ luxation
radiographs (skull) or CT (best)
How do you treat TMJ luxation
1) Closed reduction (make sure mandible is not fractured first)
Support in a tape muzzle
2) Open surgical reduction
3) Condylectomy
What should you do for TMJ luxation before doing closed reduction
make sure the mandible is not fractured first
T/F: Trigeminal neuropathy is painful
False - it is nonpainful just has inability to close mouth
What causes Trigeminal neuropathy
1) Idiopathic
2) Trauma (carrying large/ heavy sticks)
For Trigeminal neuropathy cases, what should you do first
Make sure the pet is rabies vaccinated
How do you diagnose Trigeminal neuropathy
rule out other diseases
How do you treat Trigeminal neuropathy
Supportive care/ helping with eating
Anti-inflammatories
Usually resolves in 1-3 weeks
If an animal comes in with the inability to close the mouth, and it is painful. What disease can you rule out
Trigeminal neuropathy
