Dental Pain Management Flashcards
Bupivacaine
Dental anesthetic of choice
* rapid onset
* long duration
* reactions are rare - never exceed 2 mg/kg
Rostral Maxillary Blocks
Also called infraorbital
* blocks nerve as it exits canal
Rostral Maxillary Blocks
Teeth Affected
- All incisors and canines
- Dogs = first 3 PM
- Cats = all teeth
- Maxillary bone and surrounding soft tissue
Caudal Maxillary Blocks
Also called maxillary, caudal infraorbital
* only for dogs
* blocks maxillary nerve and sphenopalatine nerve
* can cause ocular trauma
* for brachycephalic - use rostral maxillary block
Caudal Maxillary Blocks
Teeth Affected
- All teeth on that side
- Adjacent bone and soft tissue
Rostral Mandibular Blocks
Also known as middle mental
* inferior alveolar nerve via middle mental foramen
* not palpable in small dogs
* can have resistance on injection (dogs)
* can be difficult in cats - do caudal mandibular or inject in area and massage
Rostral Mandibular Blocks
Teeth Affected
- Incisors
- Canines
- First 2 PM
- Bone and soft tissue
Caudal Mandibular Blocks
Also known as inferior alveolar
* inferior alveolar nerve on lingual aspect as it enters canal
* increased chance of tongue chewing - inject less or use lidocaine
Caudal Mandibular Blocks
Teeth Affected
All teeth on that side of mandible
* plus adjacent bone and soft tissue
Tooth Resorption
Definition
Resorption of dental hard tissue by odontoclasts
* progressive
* 4 stages - 2, 3, and 4 are painful due to pulse and dentin exposure
Tooth Resorption
Synonyms
- Feline odontoclastic resorptive lesions
- Cervical neck lesions
- Tooth erosions
- Feline caries
Tooth Resorption
Affects
Almost 50% of cat population affected
* no predisposition
* purebreds may start younger
Tooth Resorption
Cause
- NOT due to periodontal disease
- True cause not completely understood
Odontoclasts
Cells responsible for resorbing roots in deciduous teeth
* resorbes surface of cementum
Tooth Resorption
Signs
PAIN
* chattering of jaw
* dropping food
* hypersalivation
* head shaking
* oral bleeding
Tooth Resorption Stage 1
Mild dental hard tissue loss
* can be cementum alone or cementum + enamel
* hardest stage to identify
* no radiographic changes
Tooth Resorption Stage 2
Moderate dental hard tissue loss
* loss of dentin, but not into pulp cavity
* loss of cementum or cementum + enamel
Tooth Resorption Stage 3
Deep dental hard tissue loss
* loss of dentin extends into pulp cavity
* pulp loss of cementum or cementum + enamel
Tooth Resorption Stage 4
Extensive dental hard tissue loss
* most of tooth has lost integrity
Tooth Resorption Stage 4a
Crown and root equally affected
Tooth Resorption Stage 4b
Crown more affected than root
Tooth Resorption Stage 4c
Root more affected than crown
Tooth Resorption Stage 5
Crown no longer visible
* remnants of dental hard tissue visible only as irregular radiopacities
* gingival covering is complete
Tooth Resorption Treatment
Based on radiographic evaluation
* stage 1 = none (recheck annually)
* stage 2-4a/b = extraction
* stage 4c = extraction or crown amputation
* stage 5 =none or crown amputation
Crown Amputation
When To Do
Only able to do if ALL apply
1. radiographic density of root same as that of bone
2. no radiographic evidence of endodontic canal
3. no evidence of periapical
4. no evidence of normal periodontal ligament separating tooth from bone
5. no evidence of periodontal disease
Crown Amputation
Advantages
- Less invasive
- Easier recovery
Feline CUGS
Feline Chronic Ulcerative Gingivostomatitis
* differ from gingivitis (does not extend beyond mucogingival line)
Feline CUGS Types
- Type 1 = alveolar and labial/buccal
- Type 2 = caudal oral cavity involvement
Feline CUGS Cause
Individual inappropriate response to antigentic triggers
* bacteria, virus, plaque, calculus
* immune mediated
Feline CUGS Signs
Severe pain
* reduced appetite
* may cry out when eating or drop food
* goes to bowl but doesn’t eat
* cry when mouth open
Feline CUGS Diagnosis
- Clinical signs
- Test for FIV, FeLV, Calicivirus, Herpes
- CBC/Chem
Feline CUGS Treatment
- Medical - temporary, use of meds to keep them comfortable
- Extraction - full mouth and smooth underlying alveolar bone (not guaranteed cure)
FOPS
Feline Orofacial Pain Syndrome
* pain disorder with signs of oral discomfort and tongue mutilation
FOPS Cause
- Damage to peripheral nerves
- Sensitization due to oral disease
- Inherited
FOPS Signs
- One-sided pain: grind teeth, paw at mouth
- Pain free intervals
- Resistant to pain meds
- Triggered by mouth movement
- Recurrent or consistent
FOPS Differential Diagnoses
- Retained root fragments
- Lymphoma
- IBD
FOPS Treatment
Anticonvulsants with analgesic effect
