Equine Dentistry 1 & 2 Flashcards
1
Q
Anatomy refresher
A
2
Q
Describe anatomy of single tooth?
A
» Cementum
» Enamel
» Dentine
» Secondary dentine at pulp horns
* pulp may lie as little as 2mm below this
» Infundibulae
* Maxillary only
3
Q
Maxillary cheek teeth?
A
» 3 roots: 2 buccal, 1 palatial
» 2 infundibulae
» 06 / 07 roots within maxillary bone
» 08/09 roots within Rostral Maxillary Sinus
» 10/11 roots within Caudal Maxillary Sinus
4
Q
Mandibular cheek teeth?
A
» 2 Roots: rostral and caudal
» No infundibulae
» Narrower bucco-lingually compared to maxillary teeth
5
Q
What good Hx questions?
A
- Has the horse ever seen a dentist?
- If yes when was the last time?
- Did they find any problems / what were their comments?
- What is the horse fed? How often? How much?
- Have you noticed any problems with eating?
- Do you use a bit in the mouth? What type?
- Any other general concerns?
6
Q
Palpate the head for:
A
Cheeks
TMJ
Submandibular lymph nodes
Masseter & temporal muscles
Commissure of lips
Lateral excursion to molar contact test
7
Q
What to look at with incisors?
A
Malocclusions?
Mucous membrane colour
Diastemata?
Periodontal disease?
Discolouration of teeth?
Ulcers?
Fractures?
8
Q
Essential dental equipment?
A
- Gag
- Headlight
- Head stand
- Gloves
- Flush
- Rasps
- Bucket
- Dental charts and pen
- Dental mirror
9
Q
How to approach dental systematically
A
- Look at the mouth pre-flushing (any food stassi? hypersal?)
- Examine all arcades in turn
- 3 side -> buccal, lingual/palatal of tooth, surface of tooth)
- Inspect gingiva
- Check the teeth
- Count teeth
10
Q
Routine dental charting should include:
A
- findings
- Tx
- Sedation given
- Management adviuce
11
Q
Re -exam date?
A
- Most horses 12 months
- If findings ‘severe’ but mostly resolved -9 months
- If findings require more than 1 session to resolve - 3 months
12
Q
Equine Dental Technicians -> Qualificartions & regulations?
A
» 2 DEFRA approved organisations regulating EDT’s
» Having a DEFRA recognised qualification allows you to carry out
‘Category 2’ procedures (acts of veterinary surgery)
» Only veterinary surgeons can legally carry out Category 3 procedures
13
Q
Category 1 procedures?
A
Procedures that may be carried out by anyone, irrespective of whether they have undertaken any training or have any qualifications
14
Q
What comes under cat 1 procedures?
A
- Examination of teeth
- Removal of sharp enamel points using manual (hand) floats only
- Removal of small dental overgrowths (maximum 4mm reductions) using
manual rasps only - Removal of loose deciduous caps
- Rostral profiling of the first cheek teeth (maximum 4mm reductions),
previously termed ‘bit seat shaping’ - Removal of supragingival calculus
15
Q
Category 2 proceudres must have????
A
must have passed a DEFRA approved exam to undertake procedures
16
Q
Category 2 procedures?
A
- Examination, evaluation and recording of dental abnormalities
- The extraction of teeth or dental fragments with negligible periodontal attachment.
- The removal of erupted, non-displaced wolf teeth in the upper or lower jaw under direct and continuous
veterinary supervision - Palliative rasping of fractured and adjacent teeth
- The use of motorised dental instruments where these are used to reduce dental overgrowths and remove sharp enamel points only
17
Q
What to be careful with in cat 1 procedures?
A
- DO NOT OVERRASP!!
- 2ary dentine staining -> dark turn to light brown -> STOP
- If you see any pink/red you have injured the tooth
18
Q
What cat is wolf teeth removal?
A
Category 2 -> removal of erupted, non displaced wolf teeth in upper or lower jaw under direct and continuous vet supervision
19
Q
Describe radiography use
A
» Essential diagnostic tool for apical infections (tooth root infections) and sinus disease.
» Signs can be subtle.
» CT is much more sensitive!
» Tips:
* Horse must be sedated – no movement blur.
* Take images of both sides for comparison.
* Good image quality requires accurate positioning.
20
Q
Superimposition?
A
- Lateral views fo sinuses
- Oblique views for apices ro crowns
21
Q
Radiograph naming?
A
- Where coming from
- What angl e
- Where going ot
22
Q
Describe incisor radiography
A
» Intra oral:
* Beware of plate damage from chewing!
» Angles will depend on age of horse – bisecting technique.
* Aim perpendicular to a line drawn between occlusal surface and
position of tooth root.
23
Q
Describe sinus radiograph?
A
» Lateral view.
» Both sides for comparison.
» Dorsoventral view.
24
Q
WHAT IS A RELIABLE RADIOGRAPHC FINDING?
A
- PEriapical Halo
25
Compare periapical sclerosis & Halo ro normal and to root clubbing
26
What might you see in an older equine?
» Wide PL.
» Mild halo.
» Mild sclerosis.
» Older equine
27
List some developmental Incisor Issues
- Malocclusions -> Oberjet or Overbite
- Retained deciduous teeth
- Supernumerary teeth / Hypodontia
28
Describe overjet?
* Upper incisors rostral to lower incisors.
* Horses cope clinically.
* Cheek teeth – overgrowths on upper 06 and lower 11’s.
29
Describe Overbite?
* Upper incisors overlie lower incisors.
* More severe CT issues.
* Secondary issues of ulceration.
* Try to correct when young – referral procedure
30
Describe retained deciduous teeth ?
* Deciduous are usually labial to permanent teeth.
* Displacement of permanent tooth – can resolve with exodontia of deciduous.
* If confusing – radiograph!
* Remove – easy vs. challenging.
31
describe supernumerary teeth/hypodontia?
* Important to count teeth!
* Often confusing which is normal vs extra – radiograph.
* Leave but monitor – check for wear abnormalities.
32
List some incisor issues that are ACQUIREd?
- Malocclusions: incisor slant/diagonal
- Incisor wear abnormalities
-Incisor diastema / periodontal dx
- Incisor caries
- Incisor fractures
33
Describe incisor wear abnormalities?
* Primary incisor issue - Missing tooth / fractured tooth.
* Behavioural – crib biting, windsucking (oral stereotypy).
* Age related.
34
Describe Incisor diastema / periodont dx?
* Often older horses (due to roots tapering).
* Food trapping, rots.
* Management via owners – teeth brushing.
35
Incisor caries?
* Not common.
* Associated with feed?
* Pain? Carrot test.
* Radiograph, check pulp - may need restoration or exodontia.
36
Describe incisor fractures?
* Individual tooth fracture.
* Avulsion fracture.
» Repair via removal or endodontics.
37
What is EOTRH?
Equine Odontoclastic Tooth Resorption & Hypercementosis
38
Describe EOTRH?
» Resorptive lesions.
» Hypercementosis.
» ?Older horses.
» Carrot test – pain.
» Treatment – extraction ?all ? in stages?
» Client concerns – needs good communication.
* Tongue protrusion
39
What developmental cheek teeth issues?
* Malocclusions. * Retained deciduous teeth. * Supernumerary Teeth. * Hypodontia (missing teeth). * Dysplastic teeth. * Displacements. * Diastemas.
40
What Acquired cheek teeth issueS?
* Wear abnormalities. * Caries. * Endodontic dz and apical infection. * Diastema and periodontal dz. * Fractures.
41
What wear abnormalities do we see in cheek teeth?
- Excessive Transverse ridges (ETRs)
- Sharp Buccal ad Lingual Points (BLPs)
42
Describe ETRs?
* Transverse ridges are normal – increase surface area.
* Do not remove.
* Beware individual ETR’s – look for a cause (diastema
opposite?).
* If abnormal – reduce.
43
Describe Sharp Buccal and Lingual Points
* Enamel overgrowths.
* Remember anisognathic!
* Mandibular lingual BLPs.
* Maxillary buccal BLPs.
* Need reducing to prevent soft tissue trauma.
44
Describe Rostral or Caudal hooks?
» Count teeth number – may be due to
supernumerary ‘12’ or extracted tooth.
» Beware – exaggerated curve of Spee is NOT
a caudal hook. Check distance from gum
margin compared to other teeth.
45
How do we reduce rostral or caudal hooks?
Reductions may have to be done in stages:
* Beware iatrogenic pulp exposure.
* May be as little as 2mm beneath surface.
* Water cooling?
46
Wheek teeth wear abnormalities can either be ... or ...
- steps -> single overgrown tooth
or
- Wave mouth - undulating occlusal curface in ostro-caudal direction
47
What is Shear mouth?
- >45°.
- due to minimal side to side mov when chewing
- usually due to pain - check carefully fo an inciting cause
- Reduce over several tx
48
Calculus on cheek teeth?
» Often found on canines and buccal aspect of upper 06/07/08’s.
» Having removed build up look for a primary cause.
49
teeth present at birth & first 3 molars?
» Teeth present at birth: 500,600,700,800.
» First 3 molars 06/07/08.
50
What is shedding time for pre-molar caps?
* 2.5, 3, 4 years
51
Should you remove pre-molar caps?
» Only remove if loose or causing issues:
* Diastemas.
* Fractures.
* Sharp – mouth ulcers
52
Eruption cysts are common in ....
3-4yo horses
- Vertical impaciton of teeth
- Predisp to apical infection?
53
Describe cheek teeth: smooth mouth
» Aged animals, normal physiological process.
» Tooth roots have no enamel.
» Hypercementosis of roots can develop as a
protective mechanism.
» Chewing ability reduced – manage diet.
54
Describe cheek teeth displacements?
» Can be medial or lateral.
» More common in miniature breeds – overcrowding.
» Varying degrees.
» Care with rasping – beware pulp horns.
» Best treatment may be extraction.
» Often a cause of diastema formation.
55
What are caries?
» Tooth decay: destruction of calcified dental tissue by bacterial fermentation and acid production
56
Peripheral caries?
often only cementum secondary to primary diastemata or
periodontal dz.
* Prognosis good – below the gum line healthy cement waits to replace
diseased cement
57
Infundibular grading of caries?
* 0 none visible.
* 1 Caries of infundibular cementum only.
* 2 Caries of infundibular cement and enamel.
* 3 Caries of infundibular cementum, enamel and dentine.
* 4 Caries of mesial and distal infundibula with coalescence.
* 5 Infundibular associated dental fracture, apical disease or tooth loss.
58
Tx for Caries?
May be restored according to grade.
* Grade 1-2: monitor, take out of wear.
* Grade 2-4: if > 10mm deep consider restoration.
* Grade 4-5: exodontia.
59
Describe Diastemas?
» One of the most painful dental disorders.
» Mandibular more common than maxillary.
» Teeth should act as one functional unit.
» Angulation of 06 and 11’s pushes teeth together.
60
Developmental causes of Diastemata?
» Developmental causes: * Tooth buds too far apart. * Inadequate angulation of 06’s or 11’s. * Overcrowding of teeth / displacements. * Supernumerary teeth. * Dysplastic teeth.
61
Acquired causes of Diastema?
Secondary displacement.
* Age related.
* Lost / extracted tooth.
62
CLS of Diastemata?
* None! * Quidding. * Halitosis / Frothy saliva. * Incisor slope / Shear mouth. * Buccal / lingual ulcers. * Food packing. * Nasal discharge (sinusitis). * Jaw swelling.
63
MOA of Diastemata?
64
Diastemata tx approach ?
» Treatment often involves management rather than cure.
» Can be expensive as often requires repeated treatments.
» Owners need to be on board – diet changes / mouth
flushing.
» Can get good results but can also be frustrating
65
How to actually treat diastemata?
* Sedation and pain relief.
* Rasp mouth.
* Pick out and flush.
* Packing with dental putty .
* Extraction of teeth.
* Diastema widening
66
Fractures can be ... or ...
Slab fractures or saggital fractures
67
Cause of fractures?
- Trauma (incisors)
- Idiopathic (cheek teeth)
- Caries
68
Investigation of fractures?
Endoscope ; radiograph
69
tx of fractures?
- Removal of segment
- Removal of whole tooth
70
Route of apical infection in mandibular vs maxillary cheek teeth?
71
CLS of Apical infection
* Pulp exposure. * Gas bubbles. * Discharging tracts. * Smell. * Fractures. * Caries. * Periodontal disease. * Facial swelling
72
Imaging of apical infection?
Radiograph & CT
73
Tx for apical infection
- Endodontic therapy
- Exodontia
74
What are the different sinuses?
75
Primary sinusitis can be ...
- Acute or chronic
- Idiopathic
- Tx: sinus lavage
76
2ary Sinusitis?
- Dental dx
- Sinus cyst
77
CLS of sinusitis ?
* Unilateral nasal discharge… plus…
* Submandibular lymphadenopathy.
* Epiphora.
* Facial swelling.
* Exophthalmos.
* Decreased airflow.
* Neurological signs.
* Pain?
78
What links between teeth and sinuses?
» Apex of (08),09,10,11’s in close association with the floor of the
maxillary sinuses.
» Examine oral cavity closely
79
What do we want to determine & do if teeth/sinus issue?
» Radiograph – fluid line? Which tooth is the problem?
» Treat the primary problem via exodontia.
» +/- Trephination to flush sinuses.
80
Describe sinus cyst / mass?
» Idiopathic, all ages.
» Facial swelling +/- airway obstruction.
» Inhibit sinus drainage causing sinusitis.
» DV or lateral radiograph.
» Needle aspiration diagnostic.
» Good prognosis.
81
why do we nerve block teeth?
* Analgesic protocols work better if pre-emptive.
* Multi-modal anaesthesia should be routinely employed.
* Allows for decreased sedation.
* Local + sedation eliminates need for general anaesthetic – safer for patient
82
What are out MAIN nerve blocks & WHAT DO THEY BLOCK?
83
Infraorbital nerve block - where and what for?
» Rostral end of maxillary nerve – use for removing maxillary
incisors.
» Halfway between naso incisive notch and rostral facial crest.
» Under levator nasolabialis muscle – move dorsally.
84
How do we DO our infraorbital nerve block
» Need to introduce needle into the foramen as nerve
branches 1cm within the entrance.
» 21g needle.
» 4-8 ml local.
» Exploding nerve block – don’t stand in front of the head!
85
Where & when do do mental nerve block?
» Blocks rostral aspect of mandible on same side – use
when removing mandibular incisors.
» Foramen is midway between 06 and 03
86
How to do Mental nerve block?
» 23/25g needle.
» 3-5 ml local.
87
How do we go about Maxillary nerve block?
» Block at maxillary foramen.
» Sedated patient and STERILE.
» 18 or 19g spinal needle (7-10cm).
88
Approaches to maxillary nerve blocks?
* Angled.
* Dorsal.
* Perpendicular.
89
How much fluid in Maxillary nerve block?
10 - 15 ml local - always draw back before injecting
90
Potential complications for maxillary nerve block?
* Excessive local will cause Horner's syndrome.
* Haematoma formation post damage to vessels – exophthalmos.
* Keep pressure on eye, if swollen keep moist.
* Symptoms resolve in 48-72 hours.
91
Where can we find Mandibular (Inferior Alveolar) Nerve Block?
» Also known as inferior alveolar NB.
» Foramen on medial side of mandible
92
How to find mandibular block site?
» Draw a line from lateral canthus of the eye and dental
crowns. Aim for where these lines bisect.
» Don’t block both sides as equine will traumatise tongue.
93
Needle, volume & post. op for mandibular NB?
» Use 12.5cm spinal needle.
» 10ml local
» Care post block, wait until worn off before allow eating
or will traumatise tongue
94
What considerations for doing exodontia?
» Equipment needed = n+1
» Remove the TOOTH, the whole TOOTH and nothing but the TOOTH.
» If you can’t handle the TOOTH – refer!
» Always have a plan B,C,D.
» Oral extraction with sedated patient (CRI vs top ups).
95
HOW TO Exodontia?
» Sedate – horse.
» Block – tooth.
» Elevate – gingiva.
» Spread – interdental space.
» Stretch – periodontal ligament.
» Extract – tooth.
» Plug – socket
96
What might be your plans B,C,D (advanced exodontia) ?
- Restoration extraction
- Dental sectioning -> post extraction or pre extraction (crowl removal)
- Fragment extraction
- Minimally invasibe repulsion (MIR)
- Minimally invasive trans-buccal screw extraction (MTE)
