Dentistry Flashcards
List at least 3 clinical signs of oral pain
Pytalism; Dropping food; Jaw chattering; Bruxism; Head shaking; Face-rubbing; Sneezing; Inappetance; Excessive licking; Depression; Weight loss
What is the most common “clinical sign” of oral/dental pain?
No clinical signs at all
Four most common causes of oral pain in dogs and cats
Periodontal disease; Fractured teeth; Tooth resorption; Malocclusion
What are the 4 layers of tissue that hold the teeth in their sockets, from most external to most internal?
Alveolar bone and gingiva –> periodontal ligament –> cementum
What are the two steps required to properly assess periodontal disease?
Dental probing; Intraoral radiographs
Periodontium
Supporting structures of the teeth
Cementoenamel junction
Transition between cementum which lines the root and enamel which lines the crown –> site of gingival attachment in healthy mouths
When probing for pockets, what are you actually probing for?
Probing from the free gingiva to where the gingiva attaches
Normal, acceptable pocket size in dogs
0-3 mm
Normal, acceptable pocket size in cats
0-1 mm
How many places should your probe the teeth?
1-2 regions on each side of the tooth, depending on its size
Is stippling around the tooth normal, or a sign of gingivitis?
Stippling is normal to some degree as it indicates the presence of blood vessels. With gingitivitis you’re looking for a more uniform redness
Total attachment loss =
Distance of gingival recession from the margin (mm) + size of periodontal pocket (mm)
How do you measure gingival recession?
Measure the distance from the cementoenamel junction to the gingiva (mm)
In healthy mouths, the height of alveolar bone should go from what region/structure to what region/structure?
Should go from the root to the cementoenamel junction
How do we measure bone loss?
Bone loss is measured as a percent of the normal total height of bone from the cementoenamel junction to the root
How many stages of periodontal disease are there?
Four stages
Stage 1 Periodontal disease
Gingivitis w/o attachement loss
Treatment for Stage 1 Periodontal disease
Dental cleaning
Stage 2 Periodontal disease
There is <25% attachment loss
Treatment for Stage 2 Periodontal Disease
Dental cleaning and root planing
What is root planing?
Cleaning out periodontal pockets associated with the tooth
Stage 3 Periodontal Disease
25-50% attachment loss +/- presence of furcation
Treatment for Stage 3 Periodontal Disease
Dental cleaning and root planing OR Extraction; Or referral for gingival tissue regeneration
What are the strategic teeth in dogs and cats?
Canines and carnassials
Normal dental formula for a dog
I(3/3); C(1/1); P(4/4); M(2/3)
Total number of teeth in the average dog
42
Normal dental formula for a cat
I(3/3); C(1/1); P(3/2); M(1/1)
Total number of teeth in the average cat
30
Stage 4 Periodontal disease
> 50% attachement loss
Treatment for Stage 4 Periodontal disease
Extraction
You do an xray of the incisors and note that in addition to ~40% bone loss, one of the teeth has a significantly wider pulp cavity than the others. What does this mean?
Wide pulp cavity –> tooth is likely dead
Pathognomonic sign for tooth resorption
Gingiva growing over the tooth
What species is commonly affected by tooth resorption?
Cats
An owner comes to you and tells you that her cat seems to be having trouble eating her food as of late. Her cat will start to eat and then jump back, almost as if she was startled, and may return to eating. The owner has also noticed that her cat is barely eating her wet food nowadays, but will still finish her dry food. What should be your primary differential based on this history?
Tooth resorption
Why do some cats with tooth resorption prefer hard kibble over wet food?
They can yeet the hard kibble into their esophaguses
With cases of suspected tooth resorption, how should you perform your oral exam?
Use a dental explorer to examine the lesion as it tends to develop at the neck of the tooth
What diagnostic is required to classify tooth resorption?
Intraoral radiographs
How do we characterize and classify tooth resorption?
We stage it, according to how deeply the lesion penetrates the tooth, and type it, based on whether the root is intact or actively being resorbed
Stage 1 Tooth Resorption
Loss of cementum or cementum and enamel, typically at the cemento-enamel junction
Stage 2 Tooth resorption
Penetration of dentin, and possible formation of a furcation
Stage 3 Tooth Resorption
Involvement of the pulp cavity
Stage 4 Tooth Resorption
Extrensive loss of tooth structure
Stage 5 Tooth Resorption
Complete loss of the crown
What is the proposed pathophysiological mechanism of tooth resorption?
Odontoblasts get exposed to alveolar bone and start degrading both alveolar bone and tooth; Odontoblasts are unable to properly remodel teeth or bone, unlike osteoblasts and osteoclasts
Type 1 Tooth Resorption
Roots are intact
Type 2 Tooth Resorption
Roots are actively resorbing
Type 3 Tooth Resorption
(In two-rooted tooth), one root is resorbed while the other is intact
Extraction is a viable treatment option for which stages of tooth resorption?
Stages 2 to 4 (assuming Type 1)
Treatment for Type 1 Tooth Resorption
Surgical extraction
Treatment for Type 2 Tooth Resorption
Crown amputation
Treatment for Type 3 Tooth resorption
Combination of surgical extraction and crown amputation
Before performing a crown amputation, what 4 criteria should be met?
Presence of root resorption on radiograph; No oropharyngeal inflammation (stomatitis); No endodontic disease; No advanced periodontal disease
What should a proper dental radiograp include?
Crown; Root; and surrounding supportive structures
List 4 benefits of intraoral radiographs
Allows for visualization of the entire tooth; facilitates diagnosis and treatment plan; monitors treatment progression; allows us to better educate clients
Ideally, full mouth radiographs should be done fro every patient. However, if you can’t do full mouth rads, always obtain rads for:
Teeth with abnormal findings on probing; Areas where teeth are missing (e.g. retained roots? impacted teeth?); If resorption is seen, do the entire mouth!!!
Dentigerous cyst
Cyst which forms in areas where gingiva has grown over a retained root; This leads to erosion of surrounding bone and pain
What are the two types of sensors we can use for dental radiographs, and the benefits and drawbacks of each?
Digital sensor (benefit: quick to process; con: only comes in one size); Digital phosphor plates (benefit: comes in various sizes
What groups of teeth can we use parallel technique on?
Mandibular premolars and molars
What does the parallel imaging technique consist of?
You place the plate or sensor parallel to the roots of the teeth, and place the xray cylinder along the parallel axis
What groups of teeth can we use the bisecting angle technique for?
Canines; Incisors; Maxillary premolars and molars (areas where plate cannot be placed parallel)
Describe how to properly set up a dental radiograph using the bisecting angle technique
Basically, you place the plate off-parallel to the tooth root. This forms an angle between the tooth root and the plate. You then imagine a line that bisects the angle that the root and plate make. You adjust your xray cylinder so it lies parallel to that bisecting line.
For the 4th maxillary premolar, you have three roots, the distal root, the mesial palatal root, and the mesial buccal root. If you were to do a bisecting angle, you would have superimposition of the mesial roots. Therefore, what radiographic technique can we use to separate out those mesial roots?
Beam shift technique
SLOB
Describes the underlying principle of how the beam shift technique works. Basically, the roots closest to the plate (lingual or palatal aspect), the mesial roots, will shift in the same direction as the xray; whereas, the distal root, which is closest to the buccal side, will move opposite of the xray
Describe how you would obtain a proper beam shift for the maxillary 4th premolar?
You determine the bisecting angle, and then move the machine (not by the head) slightly posterior (posterior oblique shift) or anterior (anterior oblique shift) to separate out the roots
Which root will be most anterior with the anterior oblique shift?
Lingual mesial root will be most anterior
Which root will be most posterior with the posterior oblique shift?
Lingual mesial root will be most posterior
