Dental pathology & indications for extractions

Question 1

What potential dental pathologies are there?

Answer 1

• oral mass
• jaw fracture
• dental trauma
• abscess
• caries
• resorptive lesions
• periodontitis
• malocclusion

Question 2

What does endodontics mean?

Answer 2

• treating pulp

Question 3

How can you avoid carnassial tooth fractures?

Answer 3

• avoid giving dog bone or overly-hard chews
  – these are the main sectioning teeth

Question 4

What is an uncomplicated oral/tooth fracture?

Answer 4

• pulp not exposed

Question 5

Why do you need to radiograph every uncomplicated tooth fracture?

Answer 5

• just bc pulp is not exposed doesn’t mean it is not damaged

Question 6

Why can damage to the enamel cause pulp infection?

Answer 6

• loss of enamel -> exposure of dentine tubules -> bacterial can pass down channels

Question 7

Why are young dogs more at risk of tooth abscesses following enamel fractures?

Answer 7

• tubules short + wide
  – easier for bacteria to pass down

Question 8

Why do tooth fractures tend to track to the mucogingival line?

Answer 8

• more delicate tissue than the gingiva
  – less resistance

Question 9

What is a complicated tooth fracture?

Answer 9

• pulp exposed

Question 10

How to tell whether the pulp is exposed?

Answer 10

• pink/black pulp in middle of tooth seen

Question 11

If exposed pulp is pink, what does this mean?

Answer 11

• fracture is fresh

Question 12

If a complicated fracture has black, necrotic pulp in the centre, what does this mean?

Answer 12

• the fracture is not recent
• the pulp is dead
• no longer painful but risk of becoming infected -> tooth abscess

Question 13

When pulp is necrotic + dies, what colour does the tooth go?

Answer 13

• grey

Question 14

Why are tooth root abscesses common when exposed pulp dies and becomes necrotic?

Answer 14

• pulp necrotised and exposed to oral cavity which is full of bacteria

Question 15

What does a purple tooth indicate?

Answer 15

• injured pulp
• bruised the tooth

Question 16

Why might teeth go from discoloured to white over a few months?

Answer 16

• inflamed pulp that bled can recover

Question 17

How does dead tooth appear radiographically if it died when the dog was young?

Answer 17

• thin dentine and thick pulp
  – i.e. suspended in time where pulp died

Question 18

How might you determine whether a tooth is normal or dead radiographically?

Answer 18

• radiograph contralateral tooth & compare

Question 19

Does it matter if the pulp dies if it’s not through a fracture?

Answer 19

• not really
• sterile death
• may be a time bomb for infection as dead tissue is a great place for bacteria to grow

Question 20

Acutely insulted + inflamed pulp that has turned the tooth purple tx

Answer 20

• NSAIDs for 3-5d
• hopefully tooth will recover

Question 21

Where is the classic location for a jaw fracture?

Answer 21

• through socket of canine as not much alveolar bone

Question 22

What is subluxation as a subset of dentoalveolar trauma?

Answer 22

• not moved much with no trauma to socket bone

Question 23

What is luxation as a subset of dentoalveolar trauma?

Answer 23

• more movement + trauma to socket

Question 24

What is lateral luxation/subluxation?

Answer 24

• knocked from 1 side to another
• tears blood vessels so pulp more likely to die

Question 25

What is intrusion luxation/subluxation?

Answer 25

- tooth pushed into socket - impacts into vessels at apex (mushes them) -> pulp dies

Question 26

What is extrusion luxation/subluxation?

Answer 26

- tooth lifted out of socket - more pull = vessels broken down

Question 27

What is avlusion luxation/subluxation?

Answer 27

- tooth completely out of socket

Question 28

How would you tx most dogs with an intrusion injury of tooth into the nasal cavity?

Answer 28

- extract - ensure good seal and haemostasis

Question 29

What is reparative dentine/tertiary dentine? why does the pulp lay this down?

Answer 29

- pulp exposed - tries to protect itself by laying down dentine ASAP

Question 30

If there's a solid layer of reparative dentine covering pulp that was exposed, is the pulp likely to be okay?

Answer 30

- no

Question 31

Radiographic findings of infected pulp

Answer 31

- halos on root

Question 32

Alternative tx for dead/insulted pulp and O doesn't want extraction

Answer 32

- root canal -- get rid of pulp through side and maintain tooth structure -- reshape canal + fill with coloured filling so bacteria can't enter -- inert tooth on inside + good attachment on outside

Question 33

Which dogs can root canal be indicated?

Answer 33

- competitive retrieval dogs - police dogs

Question 34

Which spp get caries?

Answer 34

- dogs - not cats

Question 35

Why do caries occur?

Answer 35

- refined sugars in diet -- acid produced -- lead to demineralisation of teeth

Question 36

Caries tx

Answer 36

- extract tooth or put filling

Question 37

Which spp are particularly affected by resorptive lesions?

Answer 37

- cats

Question 38

What causes resorptive lesions to form?

Answer 38

- cells that remodel tooth roots go out of kilter and become destructive - start at root and work up to crown

Question 39

Radiographic appearance of resorptive lesions

Answer 39

- root nibbled away - ghost appearance (i.e. black centre)

Question 40

What is the issue with resorptive lesions?

Answer 40

- weakens teeth + fuses root bone so can't be extracted

Question 41

Resorptive lesion tx

Answer 41

- crown amputation

Question 42

What factors would lead you to a diagnosis of periodontitis?

Answer 42

- pocket >5mm - gingival recession - fractional bone loss F2-F3 - mobility M2-M3

Question 43

What is stomatitis?

Answer 43

- inflammation that extends beyond the mucogingival line so affecting delicate mucosa

Question 44

What is gingivitis usually a reaction to?

Answer 44

- plaque

Question 45

Why might gingivostomatitis occur?

Answer 45

- immune system excessively reacting to plaque

Question 46

What conditions can cats get that heighten risk of gingivostomatitis?

Answer 46

- FeLV - FIV - FCV - FHV

Question 47

What potentially virus-negative animals are prone to gingivostomatitis?

Answer 47

- diabetics - renal failure Hence do biochem

Question 48

Gingivostomatitis tx

Answer 48

- perfect brushing on daily basis or remove teeth (premolars and molars removed)

Question 49

What could you use to dampen down gingivostomatitis that you would avoid in virus positive cats?

Answer 49

- corticosteroids e.g. cyclosporin

Question 50

What can gingivostomatitis transform into?

Answer 50

- SCC

Question 51

What must you prescribe cats with gingivostomatitis?

Answer 51

- NSAIDs - potentially amoxicillin, metronidazole

Question 52

What could pyrexia as a puppy lead to?

Answer 52

- missing enamel + exposed dentine -> developmental failure - can be sensitive + lead to influx of bacteria

Question 53

How might you treat sensitive teeth due to dentine exposure in dogs?

Answer 53

- sensitivity toothpaste (strontium) rubbed onto tooth 2x a day for 2-3w in hope that dentine tubules will close (nerves cut off)

Question 54

Why must you remove persistent deciduous teeth?

Answer 54

- to avoid plaque trapping

Question 55

What is class 1 malocclusion?

Answer 55

- dental: tooth out of alignment but jaw length/width fine

Question 56

What is class 2 malocclusion?

Answer 56

- skeletal maxilla > mandible (overshot)

Question 57

What is class 3 malocclusion?

Answer 57

- skeletal mandible > maxilla (undershot)

Question 58

How might malocclusion typically be treated?

Answer 58

- extractions

Question 59

What are epulides?

Answer 59

- collective term for gingival mass - varying in malignancy - must biopsy

Question 60

Which breed is prone to epulides?

Answer 60

- Boxers