Dentistry Flashcards
What % of dogs and cats over 3 years of age have some kind of oral pathology?
80-85%
Discuss the following terms:
Mesial, Distal, Proximal, Interproximal, Diastema, Rostral/caudal, Lingual/Palatal, Vestibular, Occlusal
Okay!
What is the difference between the two terms: Apical and Coronal?
Apical always means towards the root away from the crown, Coronal means toward the crown away from the root
What is on the outermost surface of a tooth, and what is under it?
Enamel, dentin is under
What is outer layer of the tooth connects to the gum?
Cementum
How can you tell how young an animal is by looking at the canine tooth?
The apex of the canine tooth is open, with a large exposed root canal
What are the two canals in the tooth called? Which ones are buried within the gums?
Apical delta, lateral canal. Both are within the gums
What is the only visible part of the peridontium in a normal mouth called?
Gingiva
What are the functions of the periodontal ligament?
Attaches the tooth to the alveolus, absorbs shock from occlusal forces, supplies nutrients, provides nerve information (proprioception, coordination for mastication)
What happens to the periodontal ligament when there is trauma, or excess Vitamin D?
It ossifies, which leads to the osteoclast invasion, turning the tooth brittle and the roots to disappear
What is the cingulum?
The part of the maxillary incisors that form a groove for the mandibular incisors to rest behind
What organ is connected to the incisive papilla?
Vomeronasal organ
What tooth does the parotid salivary gland papilla come out above?
The fourth upper premolar
What cells form dentin? Enamel? Cementum?
Dentin - Odontoblasts
Enamel - ameloblasts
Cementum - cementoblasts
T/F: Enamel is not replaced after it is damaged
True
Which teeth do not have deciduous versions?
Molars
What is the dental formula for deciduous teeth in a dog?
I3 - C1 - P3
What is the dental formula for adult teeth in a dog?
I3 - C1 - P4 - M2/3
What is the dental formula for deciduous teeth in a cat?
I3 - C1 - P3/2
What is the dental formula for adult teeth in a cat?
I3 - C1 - P3/2 - M1
How do you number a cats maxillary premolars? Mandibular premolars?
Maxillary - 2,3,4
Mandibular - 3,4
What is the “Rule of 4 and 9”?
The canine is always the 4th tooth and the first molar is always the 9th. Any teeth missing or added should not disrupt these numbers
Which tooth is most commonly affected by crowding?
Maxillary 3rd premolar
What is fusion and gemination?
Fusion = joining of two teeth Gemination = incomplete splitting of two teeth
T/F: It is common that if you do not see a deciduous teeth erupt, the adult tooth is most likely not going to erupt either
True
How can you confirm if a tooth is missing or retained?
Radiograph
Where should the mandibular canine be with a scissors bite?
Between the lateral maxillary incisor and maxillary canine
What class of malocclusion has a normal jaw length? Longer mandible? Shorter Mandible?
Class 1, Class 3, Class 3 respectively
What class of malocclusion is it when the incisors of the mouth are have a leveled bite?
Class 3
What is wry mouth?
When the midline of the maxillary and mandible do not line up
What are some treatments for malocclusions?
Interceptive orthodontics, exodontics, crown reduction, orthodontic appliances, incline planes
What can form if an un-erupted [canine] tooth is left unattended?
Cyst
How can you treat enamel damage?
Extraction, composite restoration, crown
What does enamel hypoplasia look like?
Areas of the defect is thinner and discolored (brownish yellow)
Tetracycline causes teeth staining. What layer of the tooth is affected and what is a good alternative non-staining antibiotic?
Dentin is affected
Use Doxycylcine
How is attrition of the teeth caused and how do you treat it?
Caused by wear from opposing teeth from malocclusion. Treat with orthodontic correction, crown reduction, and extraction
What causes teeth abrasion and how is it treated
Trauma contact on the crown surface (rocks, balls, chewing)
Treated by removing the objects and monitoring for pulp exposure or fractures
What happens to teeth with endodontic exposure?
Extract or do root canal
What causes dental caries and where are the usually seen?
Bacteria producing organi acids that decalcify the enamel and dentin
Locations 9,10 of maxillary
9 of the mandible
What clinical signs are seen with periapical infection?
Nasal disease, abscesses, intraoral fistulas, retrobulbar disease, pathologic fractures
What is a parulis?
The draining tract associated with teeth
What teeth are affected that lead to retrobulbar nerve signs?
Maxillary molars 1 and 2. (109, 110, 209, 210)
What causes (3) gingival hyperplasia and how do you treat it?
Focal - periodontal disease
Generalized - Breed (boxers)
Drugs.
Treat via removal of excessive tissue (gingivectomy)
What two methods of gingivectomy are used, and which one is preferred?
Electrosurgery and radiosurgery (preferred)
T/F: Pulpitis is usually reversible
False. <10% chance
How do you treat pulpitis?
Monitor, root canal, extraction
What are three signs of endodontic disease?
Decreased wall size, Lucency around the apex, and Apical Resorption
Discuss the following fracture classifications:
Enamel infraction, enamel fracture, uncomplicated/complicated crown fractice, uncomplicated/complicated crown/root fracture, root fracture
Root fracture is the one that is extracted.
Complicated ones have the pulp exposed.
Enamel infraction have no loss in structure
How should you treat complicated fractures?
Vital pulpotomy, root canal, crown restoration, extraction
What are the advantages of endodontics?
Less invasive than extraction, and saves the tooth, its function, and jaw integrity
What is the goal when performing a vital pulpotomy?
Maintain a viable tooth that will continue to mature
What will happen to a tooth without viable pulp?
It will become dehydrated and brittle over time
What age of animals do you typically perform a vital pulpotomy?
Young animals, <18-24 months
T/F: Crown fractures are considered an emergency if you want to preserve the tooth
True
How do you perform a vital pulpotomy?
Fracture exposes pulp, removal coronal portion of pulp, flush, apply cement material to seal, apply artificial crown later
What does the ProRoot MTA or calcium hydroxide do for the tooth?
Stimulates odontoblasts to form dentin and seal the pulp canal
What age of the animal do you perform a complete root canal on a patient?
> 24 months
Is the tooth still considered viable after a complete root canal?
No
How do you perform a root canal?
Access pulp cavity, remove pulp, clean canal, fill canal, seal canal
What is the difference between a tooth luxation and avulsion?
Luxation - partial dislocation
Avulsion - complete displacement
How long after a tooth is luxated or avulsed will the success of surgical treatment go down exponentially?
30 minutes
What part of the tooth is a successful tooth luxation/avulsion surgery based on?
The survival of periodontal ligament
What are the five stages of tooth resorption?
Stage 1 - mild, noticeable loss of enamel. Periodontal ligament is there
Stage 2 - moderate dental loss, but has not reached pulp cavity
Stage 3 - Loss of dentin extends to pulp chamber but most of tooth is still viable
Stage 4 - Most of tooth has lost its integrity, most of the hard structure is destroyed (3 sub categories)
Stage 5- Only remnants of the tooth are there, most has been resorbed, leaving a raised area on the gum
What are the three substages of Stage 4 tooth resorption?
4a - crown and root are equally affected
4b - crown is more affected
4c - root is more affected
How do type 1 tooth resorption lesions look like on radiographs?
focal/multifocal radiolucencies. gingivitis present and periodontitis
How do type 2 tooth resorption lesions look like on radiographs?
focal/multifocal radiolucencies, disappearance of periodontal ligament. No signs of periodontal disease
How can tooth resorptions become painful in cats?
When the lesions extend coronally and bacteria cause inflammation and pain
What is ankylosis?
The process of bone fusing across the normally non-calcified periodontal ligament
What is the most common treatment option for tooth resorption?
Extraction
How to you treat tooth resorption with ankylosis?
Amputate the crown and superficial root but leave the ankylosed part since it is being reabsorbed anyway
What signs do you see with lymphocytic plasmacytic gingivostomatitis (LPGS)?
excess saliva, halitosis, dysphagia, anorexia, weight loss
What does pytalism mean?
excess saliva
Where are the lesions in an animal with severe marginal gingivitis?
The commisures of the lips, palatopharyngeal arches, and the palate
How do you diagnose gingivostomatitis?
Histopathology, clinical signs, history
What is the most effective treatment for gingivostomatitis?
Teeth extraction
What oral disease is seen in siamese, main coons, and DSH breeds?
Juvenile-onset periodontitis
What do you see with eosinophilic granulomas?
Ulcerations, linear granuloma
What do you see with canine ulcerative paradental stomatitis? (CUPS)
fetid halitosis, pytalism, anorexia, kissing lesions
How do you treat CUPS?
extractions, home care
What is considered a subtotal glossectomy?
Entire free portion of the tongue and rostral part of the base of the tongue caudal to the frenulum
What is considered a partial glossectomy?
removal of the free portion of tongue rostral to the frenulum
What would an indicator for a total glossectomy?
Lingual squamous cell carcinoma
What is the most common periodontal disease in the small animal?
Periodontal disease
What is the #1 cause of tooth loss?
Periodontal disease
T/F: Periodontitis is a site-specific disease.
True
T/F: Periodontitis is painful
True
What is Xerostomia?
Dry mouth
What are some diseases that make periodontal disease worse?
Neutrophil dysfunction, diabetes mellitus, hyperadrenocorticism, autoimmune disease, feline viruses
What is plaque?
A combination of bacteria, food, debris, oral epithelial cells and mucin
What is calculus?
Mineralized plaque containing bacteria that releases endotoxins and causes gingivitis. (also called tartar)
What happens with periodontal disease?
Subgingival plaque accumulates and causes an inflammatory response leading to a destruction of epithelium at the base of the gingival sulcus, exposing periodontium. The exposed pocket allows for bacteria to migrate and destroy the periodontal ligament and alveolar bone
T/F: Gingivitis is reverisble
True
T/F: Periodontitis is reversible
False
What are some signs with periodontal disease?
Halitosis, build up of plaque, gingivitis, pytalism, loss of teeth
What is a normal sulcular depth for dogs? cats?
Dogs - 1-3 mm
Cats - 0-1 mm
What do you see with stage 1 periodontal disease?
Gingivitis. Reversible, normal sulcus depth
What do you see with stage 2 periodontal disease?
Early periodontitis. Minor gum pockets, controllable periodontitis.
What do you see with stage 3 periodontal disease?
Moderate periodontitis. Gingival hyperplasia, deep pockets, bone loss, tooth mobility
What do you see with stage 4 periodontal disease?
Advanced periodontitis. Deep pockets, high bone loss, high tooth mobility
What are the goals of treatment for periodontal disease?
Remove the biofilms, minimize tooth loss and pocket depth, maintain the attached gingiva
What is the #1 preventative method for periodontal disease?
Mechanical abrasion of plaque
T/F: Dental chews and treats are known to help treat periodontitis.
False
T/F: Antibiotics cure periodontal disease
False
What are the top 4 systemic antibiotics used for periodontal disease?
Clindamycin, clavamox, metronidazole, doxycycline
What are some local antibiotic therapies for periodontal disease?
Doxirobe gel, Clindoral
T/F: With a scaler, you always want to work from the top of the tooth to the base.
False. Work away from the sulcus
What instrument measures sulcus depth?
Periodontal probe/explorer
What is the most recommended type of power scaler?
Ultrasonic
Which type of ultrasonic scaler produces less heat than the other
Piezoelectric produces less heat than the Magnetostrictive
What are the two ways of identifying any missed calculus after scaling?
Disclosing solution, air dry the tooth
Describe the stages of the periodontal index
Stage 0 - normal Stage 1 - gingivitis Stage 2 - <25% detachment Stage 3 - 25-50% detachment Stage 4 - >50% detachment, inevitable tooth loss
Describe the stages of furcation exposure
Stage 0 - normal
Stage 1 - probe can enter <1 mm
Stage 2 - probe can enter >1 mm
Stage 3 probe can go through the furcation horizontally
What is considered pathologic mobility?
Excess physiologic mobility
T/F: You need dental radiographs to complete a dental cleaning
True
What are some indications for tooth extractions?
Retained deciduous teeth, severe periodontitis, non-vital teeth, root exposed tooth, resorbing teeth
What do you need to do to confirm your dental extractions?
Radiographs
What are some ways to deal with retained root tips after extraction?
Root tip elevator, high speed burr (has complications)
Extraction of a multi-root tooth is just like the removal of a single root tooth except what?
Section the tooth at the furcation of the roots, and elevate and remove each segment individually
If the furcation is not present but the tooth needs to be removed, how do you perform a multi-rooted tooth extraction?
Lift the gingival flap by incising the epithelium attached and expose the furcation, separate the tooth by root, and remove individually
How do you perform a canine tooth extraction?
Cut the associated epithelial layer at the diastema and free the attached gingiva. Cut the alveolar bone at the rostral and caudal borders, elevate the tooth via rolling motion, remove, and suture back the soft tissue together
What suture do you use for suturing the oral gingiva?
Absorbable 3-0 to 5-0 suture with reverse cutting needles
T/F: Strong tension from the sutures is important when closure of oral mucosa.
False
What is the post-op protocol for gingival flap procedures?
Soft food diet, no chew toys/hard treats, recheck
What can cause an oronasal fistula?
Dental disease and extractions from complications, radiation, trauma, pressure necrosis from foreign body
What is the most common way to receive an oral electrical burn?
Chewing electrical cords
What signs do you see with oronasal fistulas?
Nasal discharge, sneezing, aspiration pneumonia
How many layers of closure is there for oronasal fistula repair?
- Nasal and oral mucosas
When would you perform an oral single flap technique on an oronasal fistula?
Acute fistulas or too large of a defect for a two layer closure
When would you perform a double flap technique on an oronasal fistula?
Congenital defects, chronic fistulas
What are some salvage procedures for oronasal fistulas?
Intraoral appliances - acrylic, nasal septal button
How would you treat hard palate trauma?
Suture, splint, pin and wire
What are the two biggest indicators for oral radiographs?
Survey films. Pre and post extraction of tooth
Where should the dimple of the radiographic film be placed in the mouth?
Coronally, facing the X-ray tube
What are the steps to making X-rays films?
Develop -> Rinse -> Fix -> Rinse
What are the two techniques for taking dental radiographs?
Parallel and Bisecting
What teeth are captured with the parallel radiograph technique?
Mandibular premolars and molars
Where is the film placed with the parallel radiograph technique, and the tube of the x-ray?
Film is placed in the intermandibular space, Tube head is perpendicular to film and tooth
How do you take a radiograph with a bisecting angle technique?
Make an angle between the film and the teeth. Focus the beam perpendicular to the bisecting angle between those two structures
What does SLOB stand for?
Same Lingual Opposite Buccal
What is the 4th most common neoplasm in dogs?
Canine oral tumors
What are the three most common types of malignant canine oral tumors?
Malignant melanoma, squamous cell carcinoma, fibrosarcoma
What is the most common type of oral feline tumor?
Squamous cell carcinoma
T/F: Oral melanoma is highly metastatic
True
What is the pathway of local spreading for oral melanoma?
Gingiva -> lips -> palate -> tongue
What is an amelanotic melanoma?
A melanoma without pigment
How do you treat oral melanoma?
Surgical resection, radiation, immunotherapy.
biopsy the regional nodes via FNA
What are the three lymph nodes that drain the oral cavity?
Mandibular, parotid, retropharyngeal
What is the prognosis for oral melanoma?
Poor. Greater the size, lower the prognosis
What is the second most common malignant oral tumor?
squamous cell carcinoma
T/F: A nontonsillar SCC is highly metastatic
False
How do you treat nontonsillar SCC?
Surgical resection, radiation, chemo
T/F: The more caudal the SCC, the worse the prognosis
True
T/F: Tonsillar SCC are highly malignant and usually are unilateral and metastasize early
True
Where do you see feline SCC in the mouth?
Under the tongue
What is the prognosis for feline SCC?
Poor
Where would oral fibrosarcomas be located normally?
Maxilla - caudal to the canine tooth
How do you treat fibrosarcomas?
Wide surgical resection, radiation
What is a peripheral odontogenic fibroma?
Proliferation of fibrous connective tissue
What is acanthomatous ameloblastoma?
Rise of remnants of epithelial cells that produce periodontal ligament
What is scary about acanthomatous ameloblastomas?
Can locally invade into the bone
How do you treat acanthomatous ameloblastoma?
Surgical excision, radiation
What is a central ameloblastoma?
A noninductive tumor that arises from the dental laminar epithelium, that can lead to bone destruction
What is an odontoma?
An inductive tumor that produces hard tissue. Can be compound and look like teeth, or complex and not
How do you treat odontogenic tumors?
Surgical excision, radiation
What age of dogs do undifferentiated malignant oral tumors affect mostly?
Young dogs ~12 months
What signs do you see with UMOT?
Swelling, loose teeth, pain, exophthalmos
How do you treat UMOT?
You can’t.
How wide do you typically make surgical excision margins?
1-2 cm
T/F: Electrosurgery is the tool of choice for oral surgery
False. Avoid and only use for hemostasis
What types of suture material is used for oral surgery?
Polyglactin 910, poliglecaprone
What does a total mandibulectomy mean?
Removal of one side of the entire jaw (left or right)
How do you treat a patient post op mandibulectomy/maxillectomy?
Fluids for 24 hours, pain meds, feeding tube for 3/4 or more removed
What complications can occur with mandibulectomies?
swelling, wound dehiscence, mandibular drifting, ability to eat
What are some complications with maxillectomy?
Wound dehiscence with oronasal fistula, can droop the nose and make it hard to eat
How do you treat a labial avulsion?
Suture reconstruction
Which side does suture reconstruction fail for labial avulsion?
Mandibular side
What do you need to aide in the labial reconstruction when suturing an avulsion?
Interdental stent to support the weight of the lip
What do you see with lip fold pyoderma and how do you treat it?
Foul odor, pain, dermatitis.
Treat with surgical resection of the lip
How do you treat tight lip syndrome?
Cheiloplasty - cut the lip along the mucogingival line to form a small avulsion and let heal by second intention
What types of dogs usually have nasal folds?
Brachycephalic breeds
What do deep nasal folds predispose animals to?
Dermatitis
How can you treat the dermatitis induced nasal folds?
Control inflammation with meds, or surgical resection of nasal folds
What are some things to consider when performing a lip reconstruction?
Species/breed, lesion size and location
What are some types of flaps for labial reconstruction?
Direct apposition, labial advancement, labial rotation flap
Which salivary gland is most susceptible to neoplasia in the dog? cat?
Parotid - dog
Mandibular - cat
What are the four main salivary glands in the dog?
Parotid, mandibular, sublingual, zygomatic
What are the additional salivary glands that the cat has?
Molar
What is a salivary mucocele?
Accumulation of saliva within the submucosa
What is the most common salivary gland disease in dogs and cats?
Mucocele
T/F: Mucoceles are not painful
True, but can be with inflamed
Which gland is most commonly affected by mucocele?
sublingual
How can you diagnose or confirm the presence of a mucocele?
FNA
What is the definitive treatment for salivary mucocele?
Surgical excision
What is the salvage procedure for salivary mucoceles?
Masupialization.
T/F: You want to perform a vertical incision when exposing the parotid gland
True
T/F: You want to perform a vertical incision when exposing the mandibular or sublingual glands
False!
What can you do if, during surgery, the mucocele was not adequately drained?
Place a drain
T/F: A mucocele does not have to be removed
True
What is the prognosis for a salivary mucocele?
Excellent
How does a parotid fistula occur and how do you treat it?
Result from trauma to the parotid duct.
Treat - ligate the parotid duct proximal to the defect
