Dentistry for the surgeon

Question 1

What separates the alveolar mucosa from the gingiva?

Answer 1

The mucogingival junction.

Question 2

Describe the modified Triadan tooth numbering system in the dog.

Answer 2

Question 3

Describe the modified Triadan tooth numbering system in the cat.

Answer 3

Question 4

What are common local anesthetic agents used for dental nerve blocks (including duration of action)?

Answer 4

Bupivacaine: 6-10 hours.
Mepivacaine: 4-hours.
Lidocaine: <2 hours.

The longer the duration of action the slower the onset (bupivacaine = 30 minutes, lidocaine = a few minutes).

Question 5

How can the affect of dental nerve blocks be prolonged?

Answer 5

Addition of buprenorphine or dexmedetomidine may prolong the effects of nerve blocks to beyond 24-hours.

Question 6

What nerve blocks can be used for the maxilla?

Answer 6

1. Maxillary: administered just caudal to the last molar tooth. Blocks the incisive bone, maxilla, palatine bone, ipsilateral maxillary teeth.
2. Infraorbital: administered at or inside the infraorbital foramen. Blocks the incisive bone and maxilla, maxillary incisors, canine, and premolars/molars (depending on depth of injection).
3. Major palatine: just rostral to the major palatine foramen. Blocks the palatine shelf of the maxilla and adjacent soft tissues.

Question 7

What nerve blocks can be used for the mandible?

Answer 7

1. Inferior alveolar (intraoral or extraoral). Blocks the mandibular body, all the mandibular teeth and adjacent soft tissues.
2. Middle mental nerve block: administered ventral to the second premolar (dog) or half way between the canine and 3rd premolar (cat). Blocks the rostral mandibular body and rostral teeth.

Question 8

Care must be taken to avoid which structure during inferior alveolar nerve block?

Answer 8

The lingual nerve, as this can cause self-mutilation of the tongue post-operative.

Question 9

What is the difference between periodontal and endodontic disease?

Answer 9

Periodontal disease affects the gingiva, periodontal ligament, alveolar bone, and cementum.

Endodontic disease affects the dentin, pulp, and periapical region.

Question 10

If there is contact between a mandibular canine tooth and palate following mandibulectomy, what procedure can be performed to reduce tooth-to-palatal contact?

Answer 10

Crown reduction and vital pulp therapy.

Question 11

When teeth are within the fracture line of a jaw fracture should they be extracted?

Answer 11

No, they should be retained if healthy and monitored for periodontal or endodontic disease.

If periodontal disease is present they should be extracted, if endodontic disease is present they can be treated with root canal therapy or extracted.

If only one root of a multirooted tooth is affected the tooth can be segmented, the affected root/crown removed, and the remaining tooth treated endodontically.

Question 12

What are some principles of jaw fracture repair?

Answer 12

1. Use non-invasive techniques if possible.
2. Utilize teeth for anchorage.
3. Preserve sound teeth.
4. Avoid injury to other teeth, bone and soft tissues.
5. Maintain proper occlusion.

Question 13

What non surgical techniques can be considered for treatment of maxillomandibular fractures?

Answer 13

1. Tape muzzle.
2. Bis-acryl composite bridges between the maxillary and mandibular canines.

Complications associated with these techniques include dermatitis (tape muzzle), heat prostration, dyspnea and aspiration pneumonia.

Question 14

How is mandibular symphyseal separation treated?

Answer 14

Circumferential wiring

Question 15

Should interdental wiring and splinting be used together when treating oral fractures?

Answer 15

Yes, should always be used concurrently.

A Stout multiple loop wiring technique is most commonly used.

Question 16

What is the most common compound used for intra-oral splinting?

Answer 16

Bis-acrylic. Should be placed on the lingual surface of the mandible and the labial/buccal surfaces of the maxillary teeth.