Dentistry Flashcards
1
Q
Describe dentine
A
Bulk enclosing the pulp cavity
Similar to bone composition
Capable of some regeneration
2
Q
Describe cementum
A
Thin covering found on roots
Provides anchorage for the periodontal ligament on the root
3
Q
Describe pulp
A
Composed of sensory nerves, arteries, veins, lymphatic capillaries and connective tissue
Contained in the pulp cavity (crown) and root cavity (root)
4
Q
Describe the periodontal ligament
A
Anchors root of tooth to alveolar bone - mild movement
Suspensory and shock-absorbing
Sensory innervations: pressure and pain
5
Q
Describe the gingiva
A
Epithelial tissues and connective tissue around the tooth
Barrier for external environment
6
Q
Kittens and puppies should have all deciduous (baby) teeth by when?
A
6 weeks
7
Q
Describe enamel
A
Pearly white outer layer of crown
Hardest substance in the body but not regenerative
Protects dentine from temperature changes
When damaged -> increased plaque retention
8
Q
Why should you always asses occlusion of the jaw when the animal is conscious?
A
Sedatives will relax the jaw and render the test useless
9
Q
What should you asses when doing a conscious dental exam?
A
Assessment of body condition (anorexia could indicate dental problem)
Examination of head (facial symmetry, palpate facial bones and muscles, palpate LNs and salivary glands, asses eye position and TMJ)
Occlusion (jaw lengths, teeth occlusion)
Oral exam (periodontal disease- calculus, gingivitis, tooth mobility, gingival recession; missing teeth; examine soft tissues eg tongue, pharynx)
10
Q
Give the gingivitis index scale
A
0= no inflammation 1= mild gingivitis: mild reddening and swelling of gingiva, but no bleeding when probed 2= moderate gingivitis: gingival inflammation with reddening and swelling, will bleed when probed
11
Q
What are the normal values for periodontal probing depth in dogs and cats?
A
Dog: 1-3mm
Cat: 0.5-1mm
12
Q
How do you asses periodontal probing depth?
A
Insert periodontal probe into gingival sulcus and take measurements at 4-6 locations around the tooth
13
Q
How do you measure gingival recession?
A
Measure from the cemento-enamel junction to the free gingival margin
Use a periodontal probe
14
Q
How do you do a periodontal index?
What are the grades?
A
Periodontal probing depth + gingival recession 0= no attachment loss 1= up to 25% attachment loss 2= between 25-50% attachment loss 3= greater than 50% attachment loss
15
Q
Describe the stages of furcation exposure
A
0: no furcation exposure
1: furcation felt with periodontal probe. Bone loss 1/3 of the width of the furcation
3: periodontal probe ca be placed through the furcation from Buccal to palatal side
16
Q
Give the grades for tooth mobility
A
0: physiologic mobility of 0.2mm
1: mobility of >0.2mm but 0.5mm but 1.0mm
17
Q
Which probes are used in SA dentistry?
A
Dental explorer probe (no6): right angled and straight
Periodontal probe (no14): pocket-measuring probe
Fine seeker probes: determine very small pulp canal exposures in fractured teeth
18
Q
What is the difference between an elevator and a luxator?
A
Both used to extract teeth
Luxators are thinner and thus sharper
Elevators are thicker with a with a slightly bowed shoulder on the back side
19
Q
Why would you recommend an owner to brush their pets teeth every 2 days?
A
This is how long it takes mature plaque to form
20
Q
What is the gingiva divided into?
A
Free gingiva
Attached gingiva
Gingival sulcus
21
Q
What does alveolar bone consist of?
A
Periosteum
Cancellous bone
Compact bone
Cribriform plate
22
Q
What is plaque?
A
A biofilm: aggregation of microorganisms
- Pellicle: acellular film of salivary glycoproteins/ polypeptides and lipids
- Gram positive aerobic bacteria (consume O2)
- Mature plaque: gram negative anaerobic bacteria (formed in 48 hours, reaches maximum harm potential in 7 days)
23
Q
What is calculus?
A
Calculus= scale= tartar = mineralised plaque
Able to mineralise due to the high levels of minerals in saliva
24
Q
What is gingivitis?
A
Inflammation of the gingiva, secondary to plaque accumulation
Stages:
-Marginal gingivitis: free edge of the gingiva
-Suculus colonisation of anaerobic bacteria
-Inflammation: bacterial enzymes, immune response
Reversible
25
What is periodontitis?
Inflammation and destruction of the periodontal tissue -> attachment loss of the tooth
Develops in the periodontal pocket
Irreversible
26
Define periodontal disease
Plaque-induced inflammation (gingivitis and periodontitis)
| Inflammatory and destructive condition affecting the support tissues of the teeth
27
Give some predisposing factors to periodontal disease
Breed: brachycephalics, malocclusions. Greyhounds, Maltese, Somali cats
Immune status: immune compromised= faster and more severe disease
Developmental defects: retention of deciduous teeth
Body mass: less body mass= higher risk
Diet: soft food reduces mechanical abrasion of the teeth (?)
28
What are the three skull types? Give a breed example for each
Brachycephalic (pug): skull as wide as it is short
Mesocephalic (German Shepherd): pyramid-shape head
Dolichocephalic (greyhound): skull in the shape of an elongated cone
29
How should normal occlusion appear?
'Scissor bite'
| Interdigital ion of canines and premolars
30
What is malocclusion?
Any deviation from the features of a normal occlusion/bite
- Skeletal abnormalities
- Dental defects
- Soft tissue trauma
- Abnormal tooth contact
31
What is brachygnathism?
'Overbite'
Mandible is too short relative to maxilla
Could be due to underdeveloped mandible, or maxilla may be too long (overgrown)
32
What is prognathism?
Mandible is too long relative to maxilla
| Maxilla might be too short (boxer)
33
Describe the disease process of periodontal disease
1. Plaque formation
2. Deepening of the sulcus (secondary to inflammation of junctional epithelium)
3. Proliferation of subgingival plaque (increased anaerobic microflora)
4. Toxins lead to tissue damage
5. Continued attachment loss
6. Tooth loss (junctional epithelium separates from tooth -> periodontal pocket -> osteoclastic resorption -> loss of alveolar bone -> tooth mobility
34
How do you diagnose periodontal disease?
Clinical signs: halitosis, inflamed/bleeding gingiva, salivation + blood tinged saliva, plaque +/- calculus, purulent discharge from periodontal pocket, tooth mobility, furcation exposure, loss of gingival contour, dysphagia/pain when eating
Diagnostic tests: radiography, gingivitis index, attachment loss
35
What are the aims when treating periodontal disease?
Suppress inflammation and stop progression of disease:
Reduce bacterial load (flush with Chlorhexidine)
Supra and sub-gingival scaling (removes small calculus, large calculus can be removed with calculus forceps)
Polish teeth to remove plaque and stains (also polish under gingival sulcus)
Extractions
36
What kind of brush should you use to brush a pets teeth?
```
Medium bristles (dog)
Puppy brush (cat)
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37
Describe the technique for brushing a cat or dogs teeth
Close the mouth
| Brush around the gum line, from caudal to rostral teeth
38
Should you stop brushing a pets teeth if you encounter bleeding?
Not if there is gingivitis
| Will improve when plaque decreases
39
What name is given to the folds at the back of a cats mouth?
Palatoglossal folds
40
What is FORL?
Feline odontoclastic resorptive lesion (Tooth resorption)
| Abnormal destruction of dental hard tissues and its replacement with granulation tissue
41
Give the types of tooth resorption that affect cats
Type 1
Inflammation at the cemento-enamel junction, root often unaffected
On a radiograph, tooth appears focally radiolucent (black)
Type 2-replacement resorption
Affects root surface
On a radiograph, tooth shows narrowing/loss of periodontal ligament space, and decreased radiopacity (black)
Type 3
Features of type 1 and 2- lost periodontal ligament space, and focal radiolucency
42
What are the stages of tooth resorption?
1. Mild dental hard tissue loss (cementum or cementum and enamel)
2. Moderate dental hard tissue loss (cementum or cementum and enamel, with loss of dentin that does not extend to pulp cavity)
3. Deep dental hard tissue loss (cementum or cementum and enamel, with loss of dentin that does extend to pulp cavity); most of tooth retains its integrity
4. Extensive dental hard tissue loss (cementum or cementum and enamel, with loss of dentin that does extend to pulp cavity); most of tooth has lost its integrity. 4a: crown and root equally affected. 4b: crown more severely affected. 4c: root more severely affected
5. Remnants of dental hard tissue are visible only as irregular radiopacities, gingival covering is complete
43
What is FCGS?
Feline Chronic Gingivostomatitis
Marked and severe inflammation extending onto the oral mucosa, and often the caudal oral mucosa/palatoglossal folds
98% of affected cats have calicivirus
44
What are some clinical signs of FCGS (feline chronic Gingivostomatitis)?
Pain, anorexia, halitosis, hyper salivation, dysphagia, poor grooming
45
How do you treat FCGS (feline chronic Gingivostomatitis)?
```
Extract affected teeth
Medical treatment (analgesia and antibiotics-6 weeks)
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46
Describe eosinophilic granuloma complex
Cats
Inflammatory skin disease with an allergic component
Eosinophilic ulcers on lips, tongue, palatoglossal folds
Treat with allergen control, steroids and cyclosporin (immunosuppressant)
47
Describe the 2 types of dental radiography
Direct dental radiography
- Dental sensor placed within mouth, image sent directly to computer
Indirect dental radiography
-Digital film that needs processing after exposure
48
What are the advantages and disadvantages of direct dental radiography?
Advantages:
Faster (less GA time)
Sensor has long lifespan of use
Sensor is small (easy to move and store)
Disadvantages:
Sensor only comes in one size
49
What are the advantages and disadvantages of indirect dental radiography?
Advantages:
Size flexibility (variety of film shapes and sizes)
Films are thin and easy to place in mouth
Disadvantages:
Slower as film has to be processed
Less accurate
Films susceptible to damage
50
Why do we need dental radiography?
```
Asses anatomy (eg root numbers)
Asses pathology (eg tooth resorption, unerupted teeth, dental fractures)
Asses post-operative treatment
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51
Which recumbency should an animal be in if taking a radiograph of the:
Mandible
Maxilla
Mandible: dorsal recumbency
Maxilla: sternal recumbency
52
What are the two techniques for taking a dental radiograph?
Parallel technique (place film behind tooth, parallel to long axis. Play X-ray machine so that central beam is perpendicular to film). Mandibular premolars and molars.
Bisecting angle technique (Central beam is placed perpendicular to the imaginary bisecting line). All other teeth.
53
What are the indications for tooth extraction?
Periodontal disease
Relief of tooth crowding and retained deciduous teeth
Tooth resorption – FORLs (cat), lesions in the dog
Fractured teeth - crown or root
Luxation (loosening) - with possible alveolar fracture
Pulp necrosis (trauma, iatrogenic damage)
Caries (tooth decay)
Feline chronic gingivo-stomatitis complex (FCGSC)
Ectopic, un-erupted or impacted teeth
Failed restorative treatment
54
What are the 2 techniques for tooth extraction?
Closed (non-surgical)
| Open (surgical)
55
Describe the closed technique for tooth extraction
Non-surgical
Luxate and elevate each tooth individually
1. Section roots with a small diameter fissure bur with water cooling. Locate root furcation with dental probe. Different withdrawal paths for each root.
2. Cut gingival attachment (scalpel blade/sharp luxator)
3. Root luxation: loosen tooth by disrupting periodontal ligament fibres, using an elevator
4. Root elevation and extraction: use extraction forceps once tooth is loose. Grip root as low as possible
5. Root 'atomisation': not recommended. Root drilled at high speed. Can damage inferior alveolar canal or nasal spaces
6. Treat socket: remove loose bone pieces, pack the socket (clot will form -> granulation tissue -> calcifies into bone), suture the pocket (without tension)
56
Why is it not so bad to leave a root in (once the tooth has been extracted) in a cat as opposed to a dog?
Root will be absorbed in cats
57
Give some complications of a closed (non-surgical) tooth removal
1. Ankylosis: calcified bridge between the root and socket, consider surgical extraction
2. Iatrogenic damage to adjacent tissue (damage from drill or elevator)
3. Fractured roots or remnant root tips
4. Displaced root fragments (avoid downwards force when removing root-can force root through base of socket)
5. Oro-nasal fistula: maxillary, usually canine. To check if there's a fistula, pour water into socket and see if it comes out of nose -> suture up hole and consider surgical extraction
6. Dry socket: lack of clot formation in socket -> pain and infection. Give antibiotics.
7. Jaw fracture
58
How would you repair a mandibular symphysis separation?
Make a small incision on ventral mandible
Pass cerclage wire around rostral mandible and tighten with ventrally-placed wire twist
Use a 16 or 18G needle to pass cerclage wire through mandible
59
When would you use the open technique to remove a tooth?
All canine teeth in dogs, lower canines in cats, retained roots
If closed technique encounters a problem (eg oro-nasal fistula)
Cat teeth with a FORL
Sometimes when extracting several neighbouring teeth
60
Describe the open extraction technique for tooth removal
Raise gingival flap
Remove bone from base of crown towards edge of root, also make bone gutters
Use elevators to break down periodontal ligament then break atipical attachment
Remove tooth in direction of root curvature
Close flap with simple interrupted suture pattern 2-4mm apart and round-bodied needle to prevent damaging the tissues
Give analgesia for 5-10 days
Chlorhexidine wash (antibacterial)
61
Where is the incision made when making a gingival flap?
Incise over the bone that will not be removed (to allow good support for sutures at closure)
Base of the flap should be broader than the edge (extend as far as 2nd premolar)
62
How do you raise the gingival flap?
Use periosteal elevator
Begin at caudal corner
Hold flap in place with stay sutures (forceps will damage the tissues)
63
Describe how you remove the bone when doing an open tooth removal
Apex of canine root is in line with rostral root of second premolar
Use dental drill to remove a line of bone from the base of the crown to the edge of the root
Make bone gutters bilateral to the long axis of the canine
Use cooling water at all times
Care not to go too deep-nasal fistula
Use cooling water at all times to avoid bone necrosis
64
When surgically removing the lower canine in a dog, how big should the gingival flap be?
From central incisor to premolar 2. Both sides (lingual and buccal)
Or large flap on floor of mouth-approach tooth from lingual side
65
Give some signs of pain a pet may display after a dental procedure
Pawing at the mouth, vocalisation, restlessness, rough recoveries, inappetence, depression, behaviour changes
66
Which LA blocks can you use when performing a dental?
Infraorbital nerve block (dog and cat)
Maxillary nerve block (dog)
Inferior alveolar nerve block (dog and cat)
Middle mental nerve block (dog)
67
Which teeth does an infraorbital nerve block affect?
Maxillary incisors, canines, 1st 2nd and 3rd premolars
| Soft and hard tissues rostral to upper 4th premolars
68
Which teeth does a maxillary nerve block affect?
Maxillary fourth pre-molar, upper molars, soft and hard tissue caudal to the maxillary fourth pre-molars, including hard and soft palate
69
Which teeth does the inferior alveolar nerve block affect?
All mandibular teeth, including soft and hard tissues
70
Which teeth does the middle mental nerve block affect?
Mandibular incisors and surrounding soft tissue
71
Why may the presence of a persistent deciduous tooth cause gingivitis?
The two teeth are sharing the same gingival collar, which creates a space for plaque to accumulate
Can lead to periodontitis and loss of both teeth
72
By when does a puppy and kitten have all their adult teeth?
Puppy: 7 months
Kitten: 6 months
73
Puppies and kittens do not have a deciduous precursor to which teeth?
First premolar
| Molars
74
What is meant by an impacted tooth?
Root is growing in wrong direction
75
Why may a tooth be missing?
Incorrect eruption-impacted or embedded
Previously extracted
Crown fractured but root remains
Never developed (hypo/oligo/anodontia)
76
What is meant by a complicated crown fracture?
Pulp has been exposed
77
How do we tell if the pulp is exposed on a tooth?
Use an explorer probe
| With pulp exposure, the probe will 'catch' in the pulp space
78
Why should you remove a tooth that has exposed pulp?
The nerves and blood vessels inside have been exposed to the environment and bacteria
Tooth will be painful (even though animal probably wont stop eating)
Bacteria will invade the pulp -> inflammation -> pulpitis -> chronic pain
Pulp may die (pulp necrosis) -> abscess may form around root tip (very painful)
79
What is the difference between open and closed extractions?
Closed extractions use instruments alone to remove the tooth
Open (surgical) extractions create a mucogingivoperiosteal flap, followed by removal of alveolar bone before tooth removal and suturing of the flap
80
What kind of sutures should you use when doing an open extraction?
Absorbable sutures
81
How long does it take for a mandibular symphysis fracture to heal?
8 weeks
82
Which local anaesthetic agents can you use when doing a local anaesthetic block during a SA dental?
What are the onset times and durations of action?
Lidocaine, onset 5-15 mins, duration 1-2 hours
| Bupivocaine, onset 10-20 mins, lasts 4-6 hours
83
98% of cats with feline chronic gingivostomatitis are postitve for which virus?
Calicivirus
