Dental Pain Management Flashcards by Ashley Bednar

Bupivacaine

Dental anesthetic of choice
* rapid onset
* long duration
* reactions are rare - never exceed 2 mg/kg

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Rostral Maxillary Blocks

Also called infraorbital
* blocks nerve as it exits canal

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Rostral Maxillary Blocks

Teeth Affected

All incisors and canines
Dogs = first 3 PM
Cats = all teeth
Maxillary bone and surrounding soft tissue

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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

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Caudal Maxillary Blocks

Teeth Affected

All teeth on that side
Adjacent bone and soft tissue

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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

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Rostral Mandibular Blocks

Teeth Affected

Incisors
Canines
First 2 PM
Bone and soft tissue

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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

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Caudal Mandibular Blocks

Teeth Affected

All teeth on that side of mandible
* plus adjacent bone and soft tissue

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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

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Tooth Resorption

Synonyms

Feline odontoclastic resorptive lesions
Cervical neck lesions
Tooth erosions
Feline caries

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Tooth Resorption

Affects

Almost 50% of cat population affected
* no predisposition
* purebreds may start younger

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Tooth Resorption

Cause

NOT due to periodontal disease
True cause not completely understood

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Odontoclasts

Cells responsible for resorbing roots in deciduous teeth
* resorbes surface of cementum

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Tooth Resorption

Signs

PAIN
* chattering of jaw
* dropping food
* hypersalivation
* head shaking
* oral bleeding

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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