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X Clinical Veterinary Nursing Theory > Dentistry > Flashcards

Dentistry Flashcards

1
Q

what is periodontal disease the result of?

A

inflammatory response to dental plaque

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2
Q

how many dogs does periodontal disease affect?

A

87% over 3 years of age

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3
Q

how many cats does periodontal disease affect?

A

70% over 3 years of age

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4
Q

what is the earliest sign of periodontal disease?

A

ginvivitis

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5
Q

can gingivitis be reversed?

A

yes

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6
Q

what happens if gingivitis is left untreated?

A

will progress to periodontitis

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7
Q

is periodontitis reversible?

A

no

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8
Q

what is the cause of periodontal disease?

A

accumulation of plaque on the tooth surfaces

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9
Q

what is plaque?

A

a biofilm that accumulates on all surfaces of the teeth

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10
Q

what is plaque comprised of?

A

salivary mucopolysaccharides and glycoproteins
bacteria
oral depris

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11
Q

what oral debris can form plaque?

A

food remnants
desquamated epithelial cells
occasional inflammatory cells (if infection present)

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12
Q

what is calculus?

A

mineralised plaque

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13
Q

what always covers calculus?

A

plaques

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14
Q

what is calculus an ideal location for?

A

dental biofilm to stick to

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15
Q

does calculus cause gingivitis?

A

no

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16
Q

what does cause gingivitis?

A

plaque

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17
Q

what is gingivitis?

A

reversible plaque induced inflammation limited to the gingiva

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18
Q

what are the clinical signs of gingivitis?

A

inflammation
reddening (erythema)
often bleeding of gingival margin
halitosis

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19
Q

how is severity of gingivitis decided?

A

graded 1-3

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20
Q

what is grade 1 gingivitis?

A

mild

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21
Q

what are the clinical signs of grade 1 gingivitis?

A

redness
swelling
no bleeding on probing

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22
Q

what is grade 2 gingivitis?

A

moderate

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23
Q

what is grade 3 gingivitis?

A

severe

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24
Q

what are the clinical signs of moderate (G2) gingivitis?

A

redness
swelling
bleeding on probing

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25
Q

what are the clinical signs of severe (G3) gingivitis?

A 
redness
swelling
bleeding on probing
ulceration
spontaneous bleeding
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26
Q

how is gingivitis prevented?

A

removal of accumulated calculus (periodontal dental treatment)
improved oral hygeine

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27
Q

how can oral hygiene be improved?

A

oral antiseptics
short term antibiotics
dietary change
tooth brushing

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28
Q

how is gingivitis prevented?

A

daily oral hygiene by owners from a young age

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29
Q

when may periodontitis develop?

A

untreated gingivitis

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30
Q

what does inflammation in periodontitis involve?

A

gingiva but also the surrounding periodontal ligament, alveolar bones and cementum

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31
Q

what will happen if periodontitis is left untreated?

A

teeth will fall out

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32
Q

what are the clinical signs of periodontitis?

A 
dental deposits
halitosis
mucosal and glossal ulcers
gingival recession
bleeding
dysphagia
pain
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33
Q

describe clinically healthy teeth and gums with no gingivitis

A

no signs of gingival inflammation

no periodontal disease clinically evidant

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34
Q

describe the presentation of a tooth with gingivitis only (no periodontitis)

A

gingivitis
no attachment loss
height and architecture of the alveolar margin are normal

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35
Q

describe the signs of early periodontitis

A

less than 25% attachment loss (probing or radiographic assessment)
at most grade 1 furcation involvement in multirooted teeth
early radiographic signs of periodontitis

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36
Q

what are the signs of moderate periodontitis?

A

25-50% attachment loss (probing or radiography)

grade 2 furcation involvement in multirooted teeth

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37
Q

how is attachment loss in teeth assessed?

A

probing

radiographs

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38
Q

describe the signs of advanced periodontitis

A

more than 50% attachment loss

grade 3 furcation involvement in multirooted teeth

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39
Q

what is furcation involvement?

A

Furcation is the anatomical area where the roots divide. Therefore, furcation involvement refers to bone loss at the branching point of the roots.

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40
Q

in what type of teeth can furcation involvement during periodontitis occur?

A

Furcation involvement can only be present on multi-rooted teeth

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41
Q

where are dentals most often carried out?

A

prep

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42
Q

why are dentals most often carried out in prep?

A

dirty procedure

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43
Q

what table is needed for dentals?

A

grid over the top of a tray to catch water/blood etc (Torbridge set up)

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44
Q

what should be looked for during a conscious clinical dental exam?

A

halitosis
dysphagia
hypersalivation

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45
Q

why is the conscious dental exam of limited value?

A

gingivitis may be an indication of periodontitis which requires investigation under GA

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46
Q

what should be assessed during a conscious clinical dental exam?

A

gingival health rather than presence of calculus

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47
Q

why is the presence of calculus not of interest during a conscious dental exam?

A

will be removed during a scale and polish

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48
Q

what are the main steps involved in a dental?

A

exam
recording
scale and polish

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49
Q

how many teeth should adult dogs have?

A

42

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50
Q

how many teeth should adult cats have?

A

30

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51
Q

what level of sedation is needed for a dental?

A

full GA

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52
Q

how should the patients airway be managed during a dental?

A

tracheal intubation

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53
Q

why is a throat pack needed during a dental?

A

prevention of aspiration of irrigation fluids and debris

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54
Q

what is used during a dental to prevent aspiration?

A

mouth pack

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55
Q

how can the patient be positioned to aid the vet and reduce aspiration risk?

A

head down slightly

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56
Q

what should the surface of the dental table be like?

A

grid with a trough/sink underneath to catch water/blood

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57
Q

what drugs will be needed during a dental?

A

IVFT - considered

analgesia

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58
Q

what analgesia will be used for dentals?

A

methadone (opioid)
CRI - ketamine
local blocks - lidocaine/bupivicaine

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59
Q

where may local blocks be placed?

A

infraorbital

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60
Q

what must be prevented in dental patients?

A

hypothermia as tend to get wet and cold

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61
Q

what should be examined once the patient is under GA before the dental is started?

A

head shape
occlusion
each individual tooth (all surfaces)
oral cavity

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62
Q

what parts of the oral cavity should be examined during a dental?

A 
lips
cheeks
tongue
hard and soft palate
larynx
tonsils
MM
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63
Q

what is occlusion in dentistry?

A

how the teeth come together (the bite)

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64
Q

what does AB stand for?

A

abrasion

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65
Q

what is abrasion caused by?

A

action of something abrasive against the teeth (e.g. a sandy ball)

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66
Q

what does AT stand for?

A

attrition

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67
Q

what is attrition caused by?

A

teeth grinding/knocking against teeth

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68
Q

what does Ca stand for?

A

caries lesion

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69
Q

what does CCF stand for?

A

complicated crown fracture

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70
Q

what does ED stand for?

A

enamel defect

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71
Q

what does GH stand for?

A

gingival overgrowth

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72
Q

what does GR stand for?

A

gingival recession

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73
Q

what does NAD stand for?

A

no abnormality detected

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74
Q

what does PE stand for?

A

pulp exposure

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75
Q

what does TR stand for?

A

tooth resorption

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76
Q

what does UCF stand for?

A

uncomplicated crown fracture

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77
Q

what does # stand for?

A

fracture

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78
Q

in the modified Triadan system what does the first number stand for?

A

the quadrant of the mouth

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79
Q

what are the quadrants of the mouth used for permanent dentition in the Triadan system?

A

R upper - 1
L upper - 2
L lower - 3
R lower - 4

80
Q

what are the quadrants of the mouth used for deciduous dentition in the Triadan system?

A

R upper - 5
L upper - 6
L lower - 7
R lower - 8

81
Q

what do the second and third numbers of the Triadan system denote?

A

tooth position within the quadrant

82
Q

what number are canine teeth according to the Triadan system?

A

04

83
Q

what number are the first molars in the Triadan dental system?

A

09

84
Q

what numbers are the carnassial teeth in the dog?

A

upper - 4th premolar - 08

lower - 1st molar - 09

85
Q

what teeth are cats missing compared to dogs using the Triadan system?

A

upper - first upper premolar 05, last molar 10

lower - first and second lower premolars 05 and 06, second and third molars 10 and 11

86
Q

when do dog deciduous incisors erupt?

A

23-30 days

~1 month

87
Q

when do dog deciduous canines erupt?

A

11-25 days

<1 month

88
Q

when do dog deciduous premolars erupt?

A

27-31 days

1 month

89
Q

when do dog deciduous molars erupt?

A

N/A no molars in deciduous dentition

90
Q

when do cats deciduous incisors erupt?

A

11-25 days

<0.5 months

91
Q

when do cats deciduous canines erupt?

A

17-19 days

<1 month

92
Q

when do cats deciduous premolars erupt?

A

24-30 days

1 month

93
Q

when do cats deciduous molars erupt?

A

N/A - no molars in cats deciduous dentiton

94
Q

when do cats permanent incisors erupt?

A

103-135 days

3-4 months

95
Q

when do cats permanent canines erupt?

A

149 - 153 days

5 months

96
Q

when do cats permanent premolars erupt?

A

150-174 days

5-6 months

97
Q

when do cats permanent molars erupt?

A

130-162 days

4-5 months

98
Q

when do dogs permanent molars erupt?

A

132-175 days

4-6 months

99
Q

when do dogs permanent premolars erupt?

A

105-156 days

3-5 months

100
Q

when do dogs permanent canines erupt?

A

145-146 days

5 months

101
Q

when do dogs permanent incisors erupt?

A

115-134 days

3-4 months

102
Q

what score can be assigned to calculus?

A

cs/1
cm/2
ch/3

103
Q

what is the health periodontal probing depth for dogs?

A

1-3 mm gingival sulcus

104
Q

what is a healthy periodontal probing depth for cats?

A

0.5 - 1mm

105
Q

what is a sulcus?

A

space between tooth and gingiva

106
Q

how is gingival sulcus depth measured?

A

using periodontal probe inserted gently into the gingival sulcus and scale on the side of probe used to measure distance moved under gum

107
Q

what are the causes of attachment loss?

A

periodontal pockets
gingival recession
furcation exposure (Grade 1-3)
tooth mobility

108
Q

what are dental caries?

A

softening and then loss of enamel resulting in formation of a pit in the tooth substance

109
Q

what teeth are typically affected by dental caries?

A

occlusal surface of molar teeth

110
Q

how are dental caries treated?

A

early cavities filled but extensive disease best managed by extraction

111
Q

what are the most commonly affected teeth by crown fractures?

A

all can be affected but canines, carnassials and incisors are most commonly affected

112
Q

what can crown fractures be?

A

anything from enamel chips to partial loss of the crown to complete loss of the crown

113
Q

what are the 2 types of crown fracture?

A

uncomplicated

complictaed

114
Q

what is the difference between complicated and uncomplicated crown fractures?

A

Uncomplicated crown fractures have direct dentin but no pulp exposure.
Complicated crown fractures have direct pulp (nerve) exposure

115
Q

what does the management of crown fractures depend on?

A

severity
duration
patient factors
tooth affected

116
Q

when are crown fractures most important?

A

if affects the canines of gripping/bite trained dogs (e.g. police dogs)

117
Q

how can small chip crown fractures be treated?

A

may be polished

118
Q

how may healthy teeth with recent fractures be treated if fracture due to trauma?

A

restoration

119
Q

how may older teeth with fractures be treated?

A

may need endodontic treatment

120
Q

what is endodontic treatment?

A

treatment at tooth centre (e.g. root canal)

121
Q

what is the most appropriate treatment for dental fractures in many cases?

A

extraction

122
Q

what is the issue with conservative treatment of crown fractures?

A

long term discomfort

123
Q

where is crown attrition common?

A

in all dogs but particularly those that chew or carry stones and mouth on crate bars

124
Q

when does crown attrition become significant and need to be treated?

A

if it results in pulp exposure or tooth fracture

125
Q

why is restoration of teeth with crown attrition difficult?

A

cause of problem likely to persist without significant work by owner as is behavioural

126
Q

what is required to treat severely affected crown attrition?

A

extraction

127
Q

what are feline neck lesions also known as?

A

dental resorptive lesions
cervical line lesions
odontoclastic resorptive lesions

128
Q

what are feline neck lesions?

A

pits affecting the enamel / dentine / cementum

129
Q

how are feline neck lesions different from caries?

A

an active destruction of tooth substance of unknown cause

130
Q

what area of the tooth is affected by feline neck lesions?

A

root / crown junstion

131
Q

are feline neck lesions obvious on exam?

A

no - may need GA to see

132
Q

are feline neck lesions painful?

A

yes

133
Q

how should teeth affected by feline neck lesions be treated?

A

extraction

134
Q

what are the most common retained deciduous teeth?

A

incisors or upper canines

135
Q

what is the issue with retained deciduous teeth?

A

adult and deciduous teeth should not be present concurrently
retained teeth will lead to maleruption and malocclusion

136
Q

how should retained deciduous teeth be treated?

A

extraction

137
Q

why must care be taken when removing retained deciduous teeth?

A

deciduous teeth are fragile

care is needed so that permanent teeth are not damaged in the process of extraction

138
Q

what breed is predisposed to retained deciduous teeth?

A

sheltie

139
Q

how do deciduous teeth appear?

A

smaller than permanent

white / translucent

140
Q

what is malocclusion?

A

abnormal opposition of teeth

141
Q

when is malocclusion of concern?

A

if leads to tooth wear or injury to the mouth

142
Q

what may malocculsion affect?

A

a single tooth or the whole bite

143
Q

how is malocclusion managed?

A

conservative management
extraction
orthodontics
reconstructive procedures (rare)

144
Q

what is scaling?

A

the removal of plaque and calculus (mineralised plaque) from the tooth both above and below gingival margin

145
Q

what equipment may be used for scaling?

A

manual
ultrasonic
sonic

146
Q

what should happen to the patients mouth before scaling?

A

rinsing of oral cavity with chlorhexadine solution

147
Q

why is rinsing of the oral cavity with chlorhexidine prior to scaling useful?

A

reduces bacterial aerosols (and so improves staff and patient safety)

148
Q

what is the benefit of ultrasonic scalers?

A

greatly improve the results of scaling

149
Q

what is critical when using ultrasonic scalers?

A

they are used correctly

150
Q

what must be followed when using ultrasonic scalers?

A

manufacturers instructions

151
Q

what is critical when using an ultrasonic scaler?

A

tuning frequency of handpiece

adjustment of water flow

152
Q

what part of the scaler should be used to contact the patients tooth?

A

flat surface of probe in contact with the tooth, never the tip

153
Q

what part of the scaler should never be used on a patients tooth?

A

the tip

154
Q

how long should each tooth be scaled for?

A

15 seconds at a time max

155
Q

how should the scaler be held?

A

modified pen grip in the dominant hand using the ring finger to stabilise against other teeth

156
Q

what should you ensure is happening before there is any contact with the tooth?

A

water is flowing

157
Q

when should the subgingival scaler tip be used?

A

to briefly enter the subgingival pocket

158
Q

what type of scalers are less commonly used?

A

sonic and rotosonic

159
Q

what are sonic and rotosonic scalers driven by?

A

pneumatic dental machine

160
Q

why must care be taken with sonic and rotasonic scalers?

A

potentially damaging to teeth and adjacent structures

161
Q

where must sonic and rotasonic scalers never be used?

A

sub-gingivally

162
Q

what are the steps involved in scaling?

A

remove gross deposits of calculus
irrigate mouth
identify missing or loose teeth, those where there is gross retraction of the gums and any other oral abnormalities
remove loose teeth
remove supragingival scale
remove calculus below the gingival margin

163
Q

what should be identified during scaling?

A

identify and missing or loose teeth and those where there is gross retraction of the gums
any other oral abnormalities

164
Q

what should be done with loose teeth during scaling?

A

removal

165
Q

how should you approach scaling?

A

be methodical

spend a few seconds on a tooth, move on to the next and go back if necessary

166
Q

how can supragingival scaling be performed by hand?

A

lightly push the sub-gingival scaler into periodontal pocket and with pressure against the tooth pull out

167
Q

what should happen following tooth scaling?

A

tooth should be polished

168
Q

what may happen if polishing is not performed after scaling?

A

damage to the tooth surface caused by scaling can speed up subsequent calculus formation unless polishing is used afterwards

169
Q

what is required for polishing?

A

air-driven dental machine or micromotor dental unit
suitable handpiece
‘prophy’ cups
polishing paste

170
Q

what are the potential benefits of antibiotics before dental procedures?

A

matter of preference
can reduce gingival inflammation before procedure and maybe reduce tissue trauma
unlikely to be of long term effect

171
Q

is antibiotic use peri and post operatively required for dentals?

A

not in most cases

172
Q

do the majority of dental cases need antibiotics at all?

A

no

173
Q

when are peri-op antibiotics indicated for dentals?

A

when another surgery is carried out concurrently (not ideal!!)
patients with congenital heart disease
patients with severe systemic disease

174
Q

how should hand instruments be cared for?

A

well maintained

replaced whhen work out or borken

175
Q

what must happen to dental hand instruments after each use?

A

sharpened
cleaned
sterilised

176
Q

what are the main dental hand instruments used?

A 
curettes
scalers
explorer / periodontal probe
extraction forceps
dental mirror
root elevators
177
Q

what are curettes used for in dental surgery?

A

removal of subgingival calculus

178
Q

what are scalers used for in dental surgery?

A

removal of supragingival calculus

179
Q

what are explorers / periodontal probes used for in dental surgery?

A

search for and measure pockets

180
Q

what are extraction forceps used for in dental surgery?

A

remove gross calculus and remove loosened teeth

181
Q

what is a dental mirror used for in dental surgery?

A

examine all teeth surfaces

182
Q

what are root elevators used for in dental surgery?

A

disrupt the periodontal membrane and lift tooth from the alvelous

183
Q

of these instrument tips which is the curette and which is the scaler?

A

upper is scaler

184
Q

what are the indications for dental extraction?

A 
advanced periodontal disease
caries or feline neck lesions
retained deciduous teeth
tooth trauma with pulp exposure
malocclusion causing damage to soft tissues
185
Q

what are the 3 main instrument kits ideally prepped for dentals?

A

examination and diagnostics
calculus removal
etraction

186
Q

what is found in a dental examination and diagnostics kit?

A 
mouth mirror
periodontal probe
explorer
mouth props and gags
retractors
187
Q

what is found in a dental calculus removal kit?

A

calculus removing forceps
subgingival curette
hand scaler
polishing cups and paste

188
Q

what is found in a dental extraction kit?

A

surgical set
elevators and luxators
extraction forceps

189
Q

what is found in a dental extraction surgical kit?

A 
fine thumb forceps
scalpel blade and handle
fine needle holder
surgical scissors
separate stitch cutting scissors
periosteal elevator
190
Q

what is essential to prevent further issues after dentals?

A

owner compliance

191
Q

what is involved in patient aftercare following dentals?

A 
tooth brush daily (once mouth has healed)
mouth washes after food
diet
no hard chews / treats
soft toys, no tug games
192
Q

when should tooth cleaning start after dentals?

A

once mouth has healed

193
Q

what diet changes may be made following a dental?

A

specific dental diet if needed

soft food only when mouth is healing (can soak kibble for 15 mins in warm water)

194
Q

how can owners be educated about dental care?

A

start from first puppy/kitten visit

encourage research

195
Q

what toothpaste should be used?

A

enzymatic

196
Q

what products should owners used to maximise pets oral health?

A

products approved by Veterinary Oral Health Council (VOHC)

197
Q

what is the benefit of nurse dental consults?

A

appointments are cheaper or free of charge so owner is happy to attend
focusing on prevention and patient / client needs and expectations
client rapport can be built and effective communication provided
nurses may be able to dedicate more time

X Clinical Veterinary Nursing Theory (70 decks)

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