Dentistry

Question 1

Describe periodontal disease.

Answer 1

The result of inflammatory response to dental plaque
Gingivitis is earliest sign and can be reversed
If gingivitis left untreated, will progress to periodontitis which is not reversable

Question 2

Describe plaque.

Answer 2

A biofilm that accumulates on all surfaces of the mouth

Composed of: salivary mucopolysaccharides and glycoproteins, bacteria, oral debris

Question 3

Describe calculus.

Answer 3

Mineralised plaques, always covered by plaque
Prime location for dental biofilm to stick to
Does not irritate the gingiva or cause gingivitis - plaque does

Question 4

What is gingivitis and what are the clinical signs of this?

Answer 4

Reversible plaque-induced inflammation limited to the gingiva
Clinical signs = inflammation, reddening, bleeding of gingival margin, halitosis

Question 5

How do we grade the severity of gingivitis?

Answer 5

Mild (G1) = clinical signs (redness and swelling) but no bleeding on probing
Moderate (G2) = clinical signs plus bleeding on probing
Severe (G3) = clinical signs plus ulceration and/or spontaneous bleeding

Question 6

How can we treat gingivitis?

Answer 6

Removal of accumulated calculus (periodontal dental treatment)
Improved oral hygiene (oral antiseptics, short-term antibiotics, dietary change, tooth brushing)
Prevented by daily oral hygiene by owners from a young age

Question 7

Describe periodontitis.

Answer 7

May develop from untreated gingivitis
Inflammation involves the gingiva but also surrounding periodontal ligament, alveolar bones and cementum
Eventually teeth will fall out

Question 8

What are the clinical signs of periodontitis?

Answer 8

Dental deposits
Halitosis
Mucosal and glossal ulcers
Gingival recession
Bleeding
Dysphagia
Pain

Question 9

What considerations should we have when prepping a patient for a dental?

Answer 9

GA - tracheal intubation
Suitably sized throat pack - prevent aspiration of irrigation fluids/debris
Body position of patient
Surface of dental table
IVFT during anaesthesia and recovery
Preventing hypothermia
Correct analgesia

Question 10

What do we look at during a dental examination?

Answer 10

Head shape
Occlusion
Each individual tooth
Oral cavity - lips, cheeks, tongue, hard/soft palate, larynx, tonsils, MMs

Question 11

What is the normal periodontal probing depth in dogs and cats?

Answer 11

Dogs = 1-3mm gingival sulcus
Cats = 0.5-1mm gingival sulcus

Question 12

What can cause loss of tooth attachment?

Answer 12

Periodontal pockets
Gingival recession
Furcation exposure (grade 1/2/3)
Tooth mobility

Question 13

Describe dental caries.

Answer 13

Softening and then loss of enamel resulting in formation of a pit in the tooth substance
Typically affects occlusal surface of molar teeth
Early cavities can be filled but extensive disease best managed by extraction

Question 14

Describe crown fractures.

Answer 14

Can affect any tooth but most commonly canines/carnassials/incisors
Vary in extent - enamel chips/partial loss/complete loss of crown (complicated/uncomplicated)
Management depends on severity, duration, patient factors and tooth affected
Most important if affects canines of gripping/bite-trained dogs

Question 15

How can we treat crown fractures?

Answer 15

Small chips can be polished
Healthy teeth with recent fractures can be restored if due to trauma
Older fractures may also need endodontic treatment
Extraction most appropriate in most cases
Conservative treatment may lead to long-term discomfort

Question 16

Describe feline neck lesions.

Answer 16

Pits affecting enamel/dentine/cementum
Distinct process from caries - an active destruction of tooth substance of unknown cause
Typically affect root/crown junction - may not be apparent on cursory examination
PAINFUL lesions
Affected teeth should be extracted

Question 17

Describe retained deciduous teeth.

Answer 17

Most commonly incisors / upper canines
Adult and deciduous teeth should not be present concurrently
Retained teeth will lead to maleruption and malocclusion - should be extracted

Question 18

Describe malocclusion.

Answer 18

Defined as abnormal apposition of teeth
Is of concern if leads to tooth wear or injury to mouth
May affect single tooth or whole bite
Management depends on severity - conservative extraction, orthodontics, reconstructive procedures (rare)

Question 19

What is scaling?

Answer 19

Removal of plaque and calculus from tooth, both above and below gingival margin
Rinsing oral cavity with chlorhexidine prior to scaling has been shown to reduce bacterial aerosols

Question 20

Describe ultrasonic scalers.

Answer 20

Greatly improve results of scaling
Correct use of instrument is critical
Tuning frequency of handpiece and adjustment of water flow are critical and manufacturers’ instructions must be followed

Question 21

How do we use an ultrasonic scaler?

Answer 21

Use flat surface of probe to contact tooth - use the side of the scaler, never the tip/point
Scale each tooth for a max. of 15 seconds at a time
Hold scaler in a modified pen grip with your dominant hand
Ensure water is flowing before contact with tooth
Only use a subgingival tip to briefly enter the gingival pocket

Question 22

Describe sonic and rotosonic scalers.

Answer 22

Less commonly used
Driven by pneumonic dental machine
Potentially damaging to teeth and adjacent structures and must be used with great care
Do not use sub-gingivally

Question 23

How do we carry out scaling?

Answer 23

Remove gross deposits of calculus
Irrigate mouth to allow exam of all teeth
Identify any missing/obviously loose teeth and those where there is gross retraction of gums
Remove loose teeth
Look for and report any other oral abnormalities
Use probe to identify teeth with deep subgingival sulcus
Remove supragingival scale
Remove calculus below gingival margin
Be methodical - spend a few secs on one tooth, move on to next, go back if necessary

Question 24

Describe polishing.

Answer 24

Following scaling, tooth should be polished
Damage to tooth surface by scaling can speed up subsequent calculus formation unless polishing is used afterwards
An air-driven dental machine/micromotor dental unit are required for this, with suitable handpiece, ‘prophy’ cups and polishing paste

Question 25

When are peri-op antibiotics indicated?

Answer 25

When other surgery carried out concurrently (often done, not ideal)
Patients with congenital heart disease/severe systemic disease

Question 26

List some dental hand instruments and their uses.

Answer 26

Curettes = removal of subgingival calculus
Scalers = removal of supragingival calculus
Explorer/periodontal probe = to search for and measure pockets
Extraction forceps = to remove gross calculus and remove loosened teeth
Dental mirror = to examine all tooth surfaces
Root elevators = to disrupt periodontal membrane and lift tooth from the alveolus

Question 27

What are some indications for dental extraction?

Answer 27

Advanced periodontal disease
Caries or feline neck lesions
Retained deciduous teeth
Tooth trauma with pulp exposure
Malocclusion causing damage to soft tissues

Question 28

What aftercare do we need an owner to provide post-dental?

Answer 28

Teeth brushed daily (once mouth has healed if any extractions) - enzymatic toothpastes, Veterinary Oral Health Council approved
Mouthwashes e.g. hexarinse twice a day after food
Specific dental diet if needed, advise only soft food whilst mouth is healing
No hard chews/treats
Soft toys, no tug games