Dentistry Flashcards
what is periodontal disease the result of?
inflammatory response to dental plaque
how many dogs does periodontal disease affect?
87% over 3 years of age
how many cats does periodontal disease affect?
70% over 3 years of age
what is the earliest sign of periodontal disease?
ginvivitis
can gingivitis be reversed?
yes
what happens if gingivitis is left untreated?
will progress to periodontitis
is periodontitis reversible?
no
what is the cause of periodontal disease?
accumulation of plaque on the tooth surfaces
what is plaque?
a biofilm that accumulates on all surfaces of the teeth
what is plaque comprised of?
salivary mucopolysaccharides and glycoproteins
bacteria
oral debris
what oral debris can form plaque?
food remnants
desquamated epithelial cells
occasional inflammatory cells (if infection present)
what is calculus?
mineralised plaque
what always covers calculus?
plaques
what is calculus an ideal location for?
dental biofilm to stick to
does calculus cause gingivitis?
no
what does cause gingivitis?
plaque
what is gingivitis?
reversible plaque induced inflammation limited to the gingiva
what are the clinical signs of gingivitis?
inflammation
reddening (erythema)
often bleeding of gingival margin
halitosis
how is severity of gingivitis decided?
graded 1-3
what is grade 1 gingivitis?
mild
what are the clinical signs of grade 1 gingivitis?
redness
swelling
no bleeding on probing
what is grade 2 gingivitis?
moderate
what is grade 3 gingivitis?
severe
what are the clinical signs of moderate (G2) gingivitis?
redness
swelling
bleeding on probing
what are the clinical signs of severe (G3) gingivitis?
redness swelling bleeding on probing ulceration spontaneous bleeding
how is gingivitis prevented?
removal of accumulated calculus (periodontal dental treatment)
improved oral hygeine
how can oral hygiene be improved?
oral antiseptics
short term antibiotics
dietary change
tooth brushing
how is gingivitis prevented?
daily oral hygiene by owners from a young age
when may periodontitis develop?
untreated gingivitis
what does inflammation in periodontitis involve?
gingiva but also the surrounding periodontal ligament, alveolar bones and cementum
what will happen if periodontitis is left untreated?
teeth will fall out
what are the clinical signs of periodontitis?
dental deposits halitosis mucosal and glossal ulcers gingival recession bleeding dysphagia pain
describe clinically healthy teeth and gums with no gingivitis
no signs of gingival inflammation
no periodontal disease clinically evidant
describe the presentation of a tooth with gingivitis only (no periodontitis)
gingivitis
no attachment loss
height and architecture of the alveolar margin are normal
describe the signs of early periodontitis
less than 25% attachment loss (probing or radiographic assessment)
at most grade 1 furcation involvement in multirooted teeth
early radiographic signs of periodontitis
what are the signs of moderate periodontitis?
25-50% attachment loss (probing or radiography)
grade 2 furcation involvement in multirooted teeth
how is attachment loss in teeth assessed?
probing
radiographs
describe the signs of advanced periodontitis
more than 50% attachment loss
grade 3 furcation involvement in multirooted teeth
what is furcation involvement?
furcation involvement refers to bone loss at the branching point of the roots
in what type of teeth can furcation involvement during periodontitis occur?
Furcation involvement can only be present on multi-rooted teeth
where are dentals most often carried out?
prep
why are dentals most often carried out in prep?
dirty procedure
what table is needed for dentals?
grid over the top of a tray to catch water/blood etc (Torbridge set up)
what should be looked for during a conscious clinical dental exam?
halitosis
dysphagia
hypersalivation
why is the conscious dental exam of limited value?
gingivitis may be an indication of periodontitis which requires investigation under GA
what should be assessed during a conscious clinical dental exam?
gingival health rather than presence of calculus
why is the presence of calculus not of interest during a conscious dental exam?
will be removed during a scale and polish
what are the main steps involved in a dental?
exam
recording
scale and polish
how many teeth should adult dogs have?
42
how many teeth should adult cats have?
30
what level of sedation is needed for a dental?
full GA
how should the patients airway be managed during a dental?
tracheal intubation
why is a throat pack needed during a dental?
prevention of aspiration of irrigation fluids and debris
what is used during a dental to prevent aspiration?
mouth pack
how can the patient be positioned to aid the vet and reduce aspiration risk?
head down slightly
what should the surface of the dental table be like?
grid with a trough/sink underneath to catch water/blood
what drugs will be needed during a dental?
IVFT - considered
analgesia
what analgesia will be used for dentals?
methadone (opioid)
CRI - ketamine
local blocks - lidocaine/bupivicaine
where may local blocks be placed?
infraorbital
what must be prevented in dental patients?
hypothermia as tend to get wet and cold
what should be examined once the patient is under GA before the dental is started?
head shape
occlusion
each individual tooth (all surfaces)
oral cavity
what parts of the oral cavity should be examined during a dental?
lips cheeks tongue hard and soft palate larynx tonsils MM
what is occlusion in dentistry?
how the teeth come together (the bite)
what does AB stand for?
abrasion
what is abrasion caused by?
action of something abrasive against the teeth (e.g. a sandy ball)
what does AT stand for?
attrition
what is attrition caused by?
teeth grinding/knocking against teeth
what does Ca stand for?
caries lesion
what does CCF stand for?
complicated crown fracture
what does ED stand for?
enamel defect
what does GH stand for?
gingival overgrowth
what does GR stand for?
gingival recession
what does NAD stand for?
no abnormality detected
what does PE stand for?
pulp exposure
what does TR stand for?
tooth resorption
what does UCF stand for?
uncomplicated crown fracture
what does # stand for?
fracture
in the modified Triadan system what does the first number stand for?
the quadrant of the mouth
what are the quadrants of the mouth used for permanent dentition in the Triadan system?
R upper - 1
L upper - 2
L lower - 3
R lower - 4
what are the quadrants of the mouth used for deciduous dentition in the Triadan system?
R upper - 5
L upper - 6
L lower - 7
R lower - 8
what do the second and third numbers of the Triadan system denote?
tooth position within the quadrant
what number are canine teeth according to the Triadan system?
04
what number are the first molars in the Triadan dental system?
09
what numbers are the carnassial teeth in the dog?
upper - 4th premolar - 08
lower - 1st molar - 09
what teeth are cats missing compared to dogs using the Triadan system?
upper - first upper premolar 05, last molar 10
lower - first and second premolars 05 and 06, second and third molars 10 and 11
when do dog deciduous incisors erupt?
23-30 days
~1 month
when do dog deciduous canines erupt?
11-25 days
<1 month
when do dog deciduous premolars erupt?
27-31 days
1 month
when do dog deciduous molars erupt?
N/A no molars in deciduous dentition
when do cats deciduous incisors erupt?
11-25 days
<0.5 months
when do cats deciduous canines erupt?
17-19 days
<1 month
when do cats deciduous premolars erupt?
24-30 days
1 month
when do cats deciduous molars erupt?
N/A - no molars in cats deciduous dentiton
when do cats permanent incisors erupt?
103-135 days
3-4 months
when do cats permanent canines erupt?
149 - 153 days
5 months
when do cats permanent premolars erupt?
150-174 days
5-6 months
when do cats permanent molars erupt?
130-162 days
4-5 months
when do dogs permanent molars erupt?
132-175 days
4-6 months
when do dogs permanent premolars erupt?
105-156 days
3-5 months
when do dogs permanent canines erupt?
145-146 days
5 months
when do dogs permanent incisors erupt?
115-134 days
3-4 months
what score can be assigned to calculus?
cs/1
cm/2
ch/3
what is the health periodontal probing depth for dogs?
1-3 mm gingival sulcus
what is a healthy periodontal probing depth for cats?
0.5 - 1mm
what is a sulcus?
space between tooth and gingiva
how is gingival sulcus depth measured?
using periodontal probe inserted gently into the gingival sulcus and scale on the side of probe used to measure distance moved under gum
what are the causes of attachment loss?
periodontal pockets
gingival recession
furcation exposure (Grade 1-3)
tooth mobility
what are dental caries?
softening and then loss of enamel resulting in formation of a pit in the tooth substance
what teeth are typically affected by dental caries?
occlusal surface of molar teeth
how are dental caries treated?
early cavities filled but extensive disease best managed by extraction
what are the most commonly affected teeth by crown fractures?
all can be affected but canines, carnassials and incisors are most commonly affected
what can crown fractures be?
anything from enamel chips to partial loss of the crown to complete loss of the crown
what are the 2 types of crown fracture?
uncomplicated
complictaed
what is the difference between complicated and uncomplicated crown fractures?
Uncomplicated crown fractures have direct dentin but no pulp exposure.
Complicated crown fractures have direct pulp (nerve) exposure
what does the management of crown fractures depend on?
severity
duration
patient factors
tooth affected
when are crown fractures most important?
if affects the canines of gripping/bite trained dogs (e.g. police dogs)
how can small chip crown fractures be treated?
may be polished
how may healthy teeth with recent fractures be treated if fracture due to trauma?
restoration
how may older teeth with fractures be treated?
may need endodontic treatment
what is endodontic treatment?
treatment at tooth centre (e.g. root canal)
what is the most appropriate treatment for dental fractures in many cases?
extraction
what is the issue with conservative treatment of crown fractures?
long term discomfort
where is crown attrition common?
in all dogs but particularly those that chew or carry stones and mouth on crate bars
when does crown attrition become significant and need to be treated?
if it results in pulp exposure or tooth fracture
why is restoration of teeth with crown attrition difficult?
cause of problem likely to persist without significant work by owner as is behavioural
what is required to treat severely affected crown attrition?
extraction
what are feline neck lesions also known as?
dental resorptive lesions
cervical line lesions
odontoclastic resorptive lesions
what are feline neck lesions?
pits affecting the enamel / dentine / cementum
how are feline neck lesions different from caries?
an active destruction of tooth substance of unknown cause
what area of the tooth is affected by feline neck lesions?
root / crown junction
are feline neck lesions obvious on exam?
no - may need GA to see
are feline neck lesions painful?
yes
how should teeth affected by feline neck lesions be treated?
extraction
what are the most common retained deciduous teeth?
incisors or upper canines
what is the issue with retained deciduous teeth?
adult and deciduous teeth should not be present concurrently
retained teeth will lead to maleruption and malocclusion
how should retained deciduous teeth be treated?
extraction
why must care be taken when removing retained deciduous teeth?
deciduous teeth are fragile
care is needed so that permanent teeth are not damaged in the process of extraction
what breed is predisposed to retained deciduous teeth?
sheltie
how do deciduous teeth appear?
smaller than permanent
white / translucent
what is malocclusion?
abnormal opposition of teeth
when is malocclusion of concern?
if leads to tooth wear or injury to the mouth
what may malocculsion affect?
a single tooth or the whole bite
how is malocclusion managed?
conservative management
extraction
orthodontics
reconstructive procedures (rare)
what is scaling?
the removal of plaque and calculus (mineralised plaque) from the tooth both above and below gingival margin
what equipment may be used for scaling?
manual
ultrasonic
sonic
what should happen to the patients mouth before scaling?
rinsing of oral cavity with chlorhexadine solution
why is rinsing of the oral cavity with chlorhexidine prior to scaling useful?
reduces bacterial aerosols (and so improves staff and patient safety)
what is the benefit of ultrasonic scalers?
greatly improve the results of scaling
what is critical when using ultrasonic scalers?
they are used correctly
what must be followed when using ultrasonic scalers?
manufacturers instructions
what is critical when using an ultrasonic scaler?
tuning frequency of handpiece
adjustment of water flow
what part of the scaler should be used to contact the patients tooth?
flat surface of probe in contact with the tooth, never the tip
what part of the scaler should never be used on a patients tooth?
the tip
how long should each tooth be scaled for?
15 seconds at a time max
how should the scaler be held?
modified pen grip in the dominant hand using the ring finger to stabilise against other teeth
what should you ensure is happening before there is any contact with the tooth?
water is flowing
when should the subgingival scaler tip be used?
to briefly enter the subgingival pocket
what type of scalers are less commonly used?
sonic and rotosonic
what are sonic and rotosonic scalers driven by?
pneumatic dental machine
why must care be taken with sonic and rotasonic scalers?
potentially damaging to teeth and adjacent structures
where must sonic and rotasonic scalers never be used?
sub-gingivally
what are the steps involved in scaling?
remove gross deposits of calculus
irrigate mouth to allow examination of all teeth
identify any missing or loose teeth and those where there is gross retraction of the gums
look for and report any other oral abnormalities
remove loose teeth
remove supragingival scale
remove calculus below the gingival margin
what should be identified during scaling?
any missing or loose teeth and those where there is gross retraction of the gums
any other oral abnormalities
what should be done with loose teeth during scaling?
removal
how should you approach scaling?
be methodical
spend a few seconds on a tooth, move on to the next and go back if necessary
how can supragingival scaling be performed by hand?
lightly push the sub-gingival scaler into periodontal pocket and with pressure against the tooth pull out
what should happen following tooth scaling?
tooth should be polished
what may happen if polishing is not performed after scaling?
damage to the tooth surface caused by scaling can speed up subsequent calculus formation unless polishing is used afterwards
what is required for polishing?
air-driven dental machine or micromotor dental unit
suitable handpiece
‘prophy’ cups
polishing paste
what are the potential benefits of antibiotics before dental procedures?
matter of preference
can reduce gingival inflammation before procedure and maybe reduce tissue trauma
unlikely to be of long term effect
is antibiotic use peri and post operatively required for dentals?
not in most cases
do the majority of dental cases need antibiotics at all?
no
when are peri-op antibiotics indicated for dentals?
when another surgery is carried out concurrently (not ideal!!)
patients with congenital heart disease
patients with severe systemic disease
how should hand instruments be cared for?
well maintained
replaced when worn out or broken
what must happen to dental hand instruments after each use?
sharpened
cleaned
sterilised
what are the main dental hand instruments used?
curettes scalers explorer / periodontal probe extraction forceps dental mirror root elevators
what are curettes used for in dental surgery?
removal of subgingival calculus
what are scalers used for in dental surgery?
removal of supragingival calculus
what are explorers / periodontal probes used for in dental surgery?
search for and measure pockets
what are extraction forceps used for in dental surgery?
remove gross calculus and remove loosened teeth
what is a dental mirror used for in dental surgery?
examine all teeth surfaces
what are root elevators used for in dental surgery?
disrupt the periodontal membrane and lift tooth from the alvelous
of these instrument tips which is the curette and which is the scaler?
upper is scaler
what are the indications for dental extraction?
advanced periodontal disease
caries or feline neck lesions
retained deciduous teeth
tooth trauma with pulp exposure
malocclusion causing damage to soft tissues
what are the 3 main instrument kits ideally prepped for dentals?
examination and diagnostics
calculus removal
etraction
what is found in a dental examination and diagnostics kit?
mouth mirror periodontal probe explorer mouth props and gags retractors
what is found in a dental calculus removal kit?
calculus removing forceps
subgingival curette
hand scaler
polishing cups and paste
what is found in a dental extraction kit?
surgical set
elevators and luxators
extraction forceps
what is found in a dental extraction surgical kit?
fine thumb forceps scalpel blade and handle fine needle holder surgical scissors separate stitch cutting scissors periosteal elevator
what is essential to prevent further issues after dentals?
owner compliance
what is involved in patient aftercare following dentals?
tooth brush daily (once mouth has healed) mouth washes after food diet no hard chews / treats soft toys, no tug games
when should tooth cleaning start after dentals?
once mouth has healed
what diet changes may be made following a dental?
specific dental diet if needed
soft food only when mouth is healing (can soak kibble for 15 mins in warm water)
how can owners be educated about dental care?
start from first puppy/kitten visit
encourage research
what toothpaste should be used?
enzymatic
what products should owners used to maximise pets oral health?
products approved by Veterinary Oral Health Council (VOHC)
what is the benefit of nurse dental consults?
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
