Dental Flashcards
What age do permanent teeth erupt in dogs and cats?
3-6 months
Do teeth erupt later in small dogs or large dogs?
Small
When should permanent teeth erupt and at what age should animals have a check up to ensure permanent teeth are erupting correctly?
When deciduous teeth are ready to fall out
5 months
What age do deciduous teeth erupt in dogs?
3-6 weeks
What age do deciduous teeth erupt in cats?
2-8 weeks
Mesial
Closer to rostral central midline of skull
Distal
Further from rostral central midline of skull
Labial
Outer aspect of front teeth
Buccal
Next to teeth
Lingual
Next to tongue, lower teeth
Palatal
Next to palate, upper teeth
Occlusal
Biting edge
Which of these photos shows a mature tooth?
Right: apical delta (root) is fully formed
Which part of the tooth must be protected for longevity?
Periodontium
4 tissues that make up the periodontium
Steps in anaesthetised oral investigation
Induction
Intubation
Extra-oral exam (head and neck)
Run mouth around with chlorhexidine solution (1-2%)
Observe tissues in mouth (tongue and mucogingival line) for ulceration, abscesses and neoplasia
Debulk calculus
Probe
Chart
Radiograph
Biopsy
Probes in dental exam
Periodontal (measure depth of sulcus, walk around tooth, look for bleeding/pockets/gingival recession)
Explorer (scratches tooth, look for disparity in enamel)
Things recorded on a dental chart
Gingivitis score (G0-4)
Periodontal pocket (mm)
Gingival recession (mm)
Furcation involvement (F0-3)
Mobility (M0-3)
What makes a fracture complicated?
Exposed pulp
What happens when a deciduous tooth is fractured?
Normal mechanisms lost so tooth retained
When a tooth is discoloured can it recover?
Yes in acute presentation
If chronic/darker/more of tooth then the tooth is dead
Which tooth is non-vital?
Left canine (tooth maturation has stopped)
Chronic discolouration
What is the pathology?
Jaw fracture
What is the pathology?
Intrusion (incisor in nasal cavity)
Types of luxation/subluxations
Lateral (side to side)
Intrusion (tooth pushed in)
Extrusion
Avulsion (tooth comes out)
How do you manage a tooth avulsion?
Handle by crown only
Rinse off debris with saliva/Hartmann’s/saline/milk
Put it back in
What causes this brown/black discolouration?
Wear with reparative tertiary dentine
When is a root canal indicated?
Pulp necrosis with healthy periodontal attachment
Treatment of caries
Fillings (referral)
Extraction (severe)
What are these lesions?
Resorptive (start at root and move towards crown)
What dental pathology can exit at skin?
Periodontitis
Periodontal therapy
Gingivoplasty/gingivectomy
Management
Tooth salvage
Periodontal surgery
Viral causes of gingivitis/stomatitis in cats
Herpes
Calicivirus
FIP
FeLV
Sensitive toothpaste used in animals
Arginine and Strontium
(Not fluoride, highly toxic)
Why must persistent deciduous dentition be removed?
Leads to malocclusion
Non-specific, collective term for a gingival mass
Equilides
Classes of malocclusion
Class 1: dental
Class 2: skeletal (maxilla>mandible/overshot)
Class 3: skeletal (mandible>maxilla/undershot)
Site preparation before surgical tooth extraction
Scale (remove calculus)
Polish?
Flush (remove polish debris)
Disinfect (1-2% Chlorhexidine)
Simple/closed extraction
No flap, no bone removal
Teeth that should come out easily (single rooted/multi-rooted turned into single/mobile dentition)
Benefits of simple/closed extraction when done well
Tissue preservation
Faster healing
Reduced discomfort
Surgical/open extraction
Flap made to see bone over tooth root, bone removal
Difficult teeth (multi-rooted sectioned, immobile teeth, root remnants, persistent deciduous)
How do you cut the epithelial attachment between periodontal tissues and tooth root?
Intra-sulcular releasing incision
Luxation
Cut periodontal fibres
Elevation
Fatigue periodontal ligament fibres and expand alveolus
Flap closure in surgical dental extractions
Good, secure bite through gingiva (not mucosa)
No tension (dehiscence)
Appositional and everting patterns (interrupted: simple/cruciate/mattress, continuous)
Suture material (reverse cutting needle, monocryl/poliglecaprone 4-0/5-0 or vicryl rapide/polyglactin 4-0/5-0)
How many sections are maxillary carnassials sectioned into?
3
Do mandibular or maxillary canines have more bone? What does this mean?
Maxillary have more bone, use elevators
Mandibular have less bone, use luxators (rotation more likely to lead to tooth fracture)
When does wound breakdown typically occur after dental surgery?
3-5 days
Common oral tumours in dogs
(Most malignant)
Malignant melanoma
Squamous cell carcinoma
Most common oral tumour in cats
Squamous cell carcinoma
Other malignant oral tumours (less common)
Fibrosarcoma
Osteosarcoma
Multilobular osteochondrosarcoma
Benign oral tumours
Acanthomatous ameloblastoma (locally invasive)
Peripheral odontogenic fibroma
Mandible and maxilla blood supply
Major/minor palatine arteries
Benign growth of gum margin derived from cells of periodontal ligament
Epulis/peripheral odontogentic fibroma
What surgery has this dog had?
Bilateral rostral mandibulectomy
What surgery has this dog had?
Maxillectomy (dog can eat/drink)
What is this and how is it caused?
Rannula due to interference with salivary glands (dealt with by marsupialisation)
Primary cleft palate
Lip
Secondary cleft palate
Along roof of mouth affecting hard palate, soft palate or both soft and hard palate
Failure of soft palate to form around one/both tonsillar crypts (pseudovalvular)
Palatine hypoplasia
Which type of cleft palate has clinical signs (stunted growth due to poor weight gain, breathing difficulties upon exertion, coughing/gagging when eating and drinking) and requires surgery?
Secondary
Salivary glands
Parotid, zygomatic, submandibular and sublingual
What does this dog have?
Submandibular mucocoele
Best treatment for mucocoele
Removal of mandibular and sublingual glands (attached so must remove both)
What is this injury and what is the most common cause?
Oronasal fistula
Why do cats commonly suffer from symphyseal seperation?
No bony union in mandible, ligamentous attachment
How do you stabilise a rostral maxillary fracture?
Orthodontic buttons/elastics
Acrylic splint over buttons and elastics
How is a rostral mandibular fracture treated?
Remove fragment and attach labial to buccal mucosa
Consider repair with dental acrylic if site is vascularised
Acute stick injury
<7 days
Oral pain, dysphagia, blood stained saliva
Chronic stick injury
> 7 days
Cervical swelling with/without discharging sinus (owner has pulled stick out but some FB stays in and creates abscess)
How is an acute stick injury treated?
Remove piece of wood
Leave hole open to drain
Scope (rigid endoscope) tract to confirm removal/identify foreign material if gone through back of pharynx
How is a chronic stick injury treated?
Abscess developed, sinogram to identify tract
Post operative management after stick injury
Broad spectrum antibiotics (7-14d, clav. amox. for gram +ve, cephalosporin for gram -ve and +ve, fluroquinolone for gram -ve with C&S, metranidazole for anaerobic coverage)
Analgesia
Harness, not collar and lead
Feed as normal (moistened/wet?)
Complications of stick injury/treatment of stick injury
Recurrence/development of a discharging sinus
Pyrexia
Neck pain
Bacteraemia
Nerve damage
Dysphagia
Gingival inflammation that is reversible with plaque removal
Gingivitis
Pathogenesis of gingivitis
Plaque bacteria adjacent to gingiva, initially gram positive aerobes
Build up of bacteria in sulcus
Formation of biofilm
Undisturbed bacterial coat for 48h+ allows growth of anaerobes
Host responds with gingival inflammation (gingivitis) but not very effective as bacteria not in tissues
How does plaque turn to calculus/tartar?
Plaque biofilm mineralised by saliva
Gingivitis score
G0: no gingivitis
Gingivitis score
G1: some gingivitis, no bleeding
Gingivitis score
G2: oedema and erythema with a little blood on probing
Gingivitis score
G3: erythema and oedema which bleeds readily when probed
Irreversible sequel to gingivitis if untreated
Periodontitis
How does the damage progress from A-D?
A: health
B: loss of tissue with oedema (gingivitis) improving environment for bacteria
C: periodontitis (attachment loss and vertical bone loss)
D: horizontal bone loss, root is exposed
Systemic risk factors for periodontal disease
Underlying disease (diabetes mellitus)
Immune compromise (stress)
Local risk factors for periodontal disease
Site specific disease = plaque retention
e.g. calculus, overcrowding, trauma, gingival abnormalities such as hyperplasia, foreign bodies
Local complications of periodontal disease
Adjacent teeth effected
Abscess (due to periodontitis)
Bone loss (osteitis/osteomyelitis with aggressive progression)
Stomatitis (inflammation beyond mucogingival line)
Ulceration (contact between mucosa/tooth surface)
Faucitis (inflammation at back of mouth, if adjacent to periodontitis)
Systemic complications of periodontal disease
Bacteraemia
Dissemination to organs (kidneys, endocarditis, liver)
Pregnancy/performance affected
Best tool for debulking calculus before charting
Hand scale
(Calculus forceps can break teeth/damage enamel)
What hand scaler is in the red circle and what is it used for?
Scaler: supragingival only, sharp with cutting edges
What hand scaler is in the blue circle and what is it used for?
Curette: supra and subgingival, rounded tip
What tools are available for scaling?
Hand scalers
Sonic (slow)
Ultrasonic (fast and efficient but heating)
Best homecare for teeth
Brushing (soft-medium bristle brush daily)
What is helpful alongside brushing for aggressive periodontitis?
Mouth wash with chlorhexidine 30m before/after food
