Dental 4 Flashcards
what do you almost always need to discern oral inflammation
BIOPSY
this condition is characterized by ulceration, inflammation, and mucosal necrosis
ulcers typically on alveolar and buccal mucosa opposite plaque: on gingiva, larger margins of tongue, pall folds, or lip margins
canine ulcerative stomatitis, a plaque induced oral inflammation
Maltese, CCKS, Greyhounds, Labs predisposed to what condition? often history of pain, reluctance to eat, recents oral exam or bite, and systemic dz uncommon but there will be hyperglobulinemia
canine ulcerative stomatitis
what is mainstay of CUS therapy
daily diligent plaque control!!
- complete PD assessment
- complete PD tx
- extractions as needed
- homecare brushing
- +- medical therapy
- frequent reassessment
and then PD recalls (examine monthly, ones exam 6 mo)
med mgmt
if pt fails canine ulcerative stomatitis medical mgmt, what is next step
surgical intervention, once med options are exhausted (extract teeth)
this multifactorial cat condition, more common in muklticat environments, is a manifestation of aberrant immune response to chronic antigenic stimulation and current SOC involves extractions of at least all M and PM teeth, w or w/o med mgmt
FCGS feline chronic gingivostomatitis
inflammation that does NOT cross the mucogingival line and that is confined to attached gingiva is _______, but inflammation that crosses the gingival line into alveolar tissue and palatoglossal folds is _______ [name the chronic cat condition]
gingivitis
feline chronic gingivostomatitis
(frequently misdiagnosed as gingivitis)
is medical management for FCGS prior to sx therapy often successful?
other than pain control, NO
so you should REFER
you should focus on CUS, FGCS, tooth resorption, oral tumors, and prudent Abx use.
ok
________ is an idiopathic eosinophilic inflammatory lesion on the hard/soft palate, pharyngeal walls, and/or tonsillar region. pts often present for oral discomfort, dysphagia, repeated swallowing, inappetence, and dx is by histopath of the lesion
eosinophilic stomatitis
how is eosinophilic stomatitis treated
immunosuppression: prednisone, cyclosporine
may need to be ongoing, depends on pt.
treatment of tooth resorption is determined by stage or by type
type
what is type I TR? tx?
tooth retains normal density and the PDL space is unchanged
extraction
what is type II TR? tx?
narrowing or disappearance of PDL space in at least some areas, and decreased radiopacity of tooth; often the root structure also appears same density as adjacent bone
coronectomy (bc there is no root left to remove)
what is type III TR? tx?
resorption occurs in same tooth: there are areas of normal AND narrow or lost PDL space, and focal or multifocal radiolucency in tooth but decreased radiopacity in other areas of tooth. in multirooted teeth only
hybrid extraction - extract root with well defined PDL, coronectomy of other root
this kind of tooth resorption appears as a crescent shaped defect in medial root that appears as though it is being resorbed by bone. does not need to be treated.
ERR external root replacement
oral masses can be classified as reactive, odontogenic, or malignant.
what are 2 reactive masses to know?
gingival hyperplasia and focal fibrous hyperplasia
oral masses can be classified as reactive, odontogenic, or malignant.
what are 3 odontogenic masses to know?
- canine acanthomatous ameloblastoma - malignant transformation of jxnl epithelium
- peripheral odontogenic fibroma - cellular fibroblastic connective tissue separate from normal fibrous connective tissue
- odontoma (less common)
canine acanthomatous ameloblastoma more likely to show up on ______, while peripheral odontogenic fibroma more likely to show up on MN and on _______
mandible vs maxilla; rostral maxilla
top 3 malignant non-odontogenic oral tumors in dogs
melanoma
SCC
fibrosarcoma
most common malignant non-odontogenic oral tumor on cats is.
SCC
melanoma: males or females? more predisposed, age is _____, and typically involve gingiva
males, 10.5-12 years
melanoma: what site has better prognosis (although met rate is 50-80%)
melanoma of lip
SCC: what is breed and sex and age predilection
no breed or sex predisposed
8.4 years dog 10.5 cat
what has higher metastatic rate: melanoma or SCC
melanoma 50-80%
SCC low except for caudal tumors (tonsil) in dog; aggressive local behaviour but low met rate cats, although typically late dx so poor px
this oral tumor: large breed dogs overrepresented, 8 years, locally aggressive tumors, low met rate, and hi lo tumors
fibrosarcoma
hi lo means no hits features malignancy, but grow really aggressively
what are 2 important things to remember about oral tumor approach, in general
clinical photos
periodontal tx to prepare the oral cavity
biopsy
also: min database prior to anes and thorough exam under anes
2 types of biopsies, and which is preference of prof
incisional biopsy (intralesional)
this one
excisional biopsy (marginal excision)
take photo prior
when to refer an oral mass case
early: after history dx is achieved or after mass is ID’d in exam and prior to biopsy
after history dx and staging is complete, what are 4 possible surgical goals for oral oncologic sx?
curative intent surgery
debunking surgery
surgery for local ontrol
or palliative sx
what was the procedure
subtotal mandibulectomy
mandibular fractures are more common in dogs or cats?
cats
what does initial stabilization for maxillofacial trauma involve
if unresponsive, ABCs
vital parameters
primary surgery: MM, CRT, pulse quality, lung sounds, RR pattern, MENTATION, etc.
secondary surgery
CN EXAMINATION
analgesia
conscious +- sedated MF exam
name at least 4 signs of maxillofacial trauma
epistaxis
malocclusion
facial asymmetry
DAI (?)
ex or enophthalmos
pain on palpation
soft tissue disruption
often hard to tell wo imaging
what are at least 3 mechanisms of maxillofacial trauma
altercation esp dog: animal bite 50%
motor vehicle accident
fall from height esp cat
hit by object or horse
play
unknown
what is imaging modality of choice for evaluation of maxillofacial trauma
head CT
what are 6 tx goals of MFT
reestablish premorbid occlusion
rigid skeletal fixation of fractures
quick return to fxn
address DAI (diffuse axonal injury?)
soft tissue reconstruction
cosmoses
what are 3 special considerations in oral medicine pediatric pts
as conservative as possible
growth aberrations
malocclusions secondary to trauma to deciduous dentition and permeant tooth germs
indications for use of Abx as mono therapy for PDD
none
indications for use of prep Abx prior to processing with dental sx or PD tx
none
indication for use of pulse-dose Abx in pts deemed anes risk
none
5 indications for perioperative Abx prophylaxis for oral surgery
immunosuppressed patient: DM, Cushing’s, etc.
prosthetic joints and immunocompromised
historical infective endocarditis
heart valve replacement or pacemaker implant
repaired congenital heart defect with shunts or valvular regurgitation
indications for postoperative Abx tx for oral sx
clinical judgment
systemic risk factor for infection (immunosuppression)
ONF or major oromaxillofacial sx repair
implant or graft placement
NOT routine extractions
what are Abx treating in oral surgery? like the actual target
NOT tx or preventing tissue infection
they are aiding in dealing w bacteria creating when manipulating subgingival tissues
when Abx are used for oral surgery, when and how to deliver? which one?
at induction, IV, one time
ampicillin
