Equine Dentistry 1 Flashcards
what are the clinical signs of dental disease
not uncommon for horses with dental disease to present without any clinical signs at all
abnormalities are usually identified during routine appointments for occlusal equilibration (rasping or floating)
what are the common clinical signs associated with dental disease that you may observe (5)
- swellings or discharging tracts of mandible or maxilla
- unilateral nasal discharge
- weight loss due to a chronic painful condition
- packing of feed into cheeks
- submandibular lymph node enlargement
what are less common clinical signs that might be seen
- quidding
- headshaking
- increased fibre length/poor masticated food in feces
- not taking a bit
what is the first step in investigating a suspected dental disease
- clinical examination
what is important in the clinical exam
palpate the patients face/skull
check overall facial symmetry and watch out for any abnormalities, lumps or depressions, submandibular lymph node swelling, evidence of external draining tracts or masseter muscle atrophy
watch the horse eat if possible, is it chewing with both sides of its mouth? is it taking longer to chew than normal? quidding?
what equipment is needed for the oral examination
- bright light source
- speculum
- gloves
- dental syringe
- dental mirror
- pulpar explorer
- diastema forceps
- periodontal probe
what is a graduated periodontal probe used for
graduated periodontal probes are used for assessing the depth of periodontal pockets in cases of periodontal disease, as well as the depth of the infundibular caries
each demarcated band on the periodontal probe is 5mm in height
what are pulpar explorers used for
to identify dental pulps on the occlusal surface of teeth
how can horses be restrained for an oral exam
dental halter, or headstand
stocks or stall
sedation is highly recommended (alpha 2 agonist usually romifidine or detomidine and an opioid usually butorphanol)
what is the first step in the oral exam
- incisors
how do you examine the incisors (5)
starting without the speculum in place, assess the patient’s incisors
- count the number of incisors present (there may be supernumerary incisors, retained deciduous incisors, missing incisors)
- after counting the number, assess the incisors from the front –> is the occlusal surface of mandibular and maxillary incisors symmetrical? asymmetry of the incisors or unequal lateral excursion of the mandible may indicate a dental abnormality of the cheek teeth
- closely examine each incisor –> evidence of dental calculus (tartar) or draining tracts around the gingival margins, look for evidence of diastema (food packing between teeth)
- palpate each incisor individually to see if there is any tooth mobility
- assess the occlusal surface of each incisor, looking for evidence of pulp exposure
what is the second step in an oral exam
canines and wolf teeth
how are canines and wolf teeth examined
speculum placed
- check for evidence of of calculus formation, particularly around the lower canines, or fractures of the canines
- check for wolf teeth (displaced, blindly erupted or mandibular wolf teeth)
what is the third step in an oral exam
with speculum in place, palpate the cheek teeth
what is an important rule when palpating the cheek teeth
always keep one hand on the speculum when palpating the mouth to make sure you have control of the horse’s head
how are cheek teeth examined
palpate the cheek teeth for evidence of dental overgrowths and assocaited soft tissue trauma, dental fractures, displaced teeth, supernumerary teeth and diastema
what is the first step when evaluating the cheek teeth
evaluate without a dental mirror
count the number of cheek teeth present, assess soft tissue trauma if present and identify any fractures if present
what is the second step in examining cheek teeth (2)
use a dental mirror to assess the cheek teeth with a systematic approach
assess one triadan row at a time, paying close attention to
- the occlusal surface of every cheek tooth, including the pulps and infundibula
- interdental space between cheek teeth, buccally occlusally and lingual
what is shown here
infundibular caries
what is the third step in examining cheek teeth
use a pulpar explorar to assess the integrity of secondary dentine over individual pulp cavities on the occlusal surface of each tooth
when drawn across the occlusal surface of each tooth, the pulpar explorer should not be able to enter the occlusal aspect of a pulp cavity –> if it does there may be exposed pulp
what is the fourth step when evaluating the cheek teeth
use a dental mirror to assess the periodontium
when assessing the periodontium, ensure the mouth is well rinsed and pockets if present, are cleared of food
use a probe to determine the depth of periodontal pockets if present, it can also be used to assess the depth of infundibular caries
what is shown here
periodontal pocket after food has been removed
how can periodontal pockets be cleared of food
diastema forceps, and a diastema flusher
what is the fourth step in an oral exam
radiography
when is radiography indicated (6)
lesions involving endodontic or apical areas of the teeth are suspected
- pulp fractures
- exposed dental pulp
- apical pulpitis
- sinus disease
- skull fractures
- deep periodontal disease
how are the incisors radiographed
latero-lateral and intra-oral views
when are latero-lateral views helpful
in cases of jaw fracture
but are not useful in evaluating incisors individually due to superimposition of the incisors
what are intra oral views used for
dorsoventral view is used to evaluate the maxillary incisors
ventrodorsal view is used to evaluate the madnibular incisors
what views are shown here
intra oral views
what is shown here
intra oral view
retained deciduous incisor
what is shown here
intra oral view of normal incisors
what is shown here
intra oral view of fractured incisors
what is a latero lateral view used to evaluate
paranasal sinuses
how is laterolateral view taken
centre the x ray beam just dorsal to the facial crest and collimate to dorsal midline and the lateral canthus of the eye
what abnormalities can be seen in latero lateral views
fluid lines
intra sinus
soft tissue opacities
fractures
what is the dorso30lateral-ventrolateral oblique view used to evaluate
apices of the maxillary cheek teeth
how is dorso30lateral-ventrolateral oblique view taken
beam should be centred 1cm dorsal to the rostral aspect of the facial crest and aimed roughly 30 degrees vnetrally
the window for collimation is the same as latero-lateral view
how are dorsal obliques labelled
the image should always be labelled as the side adjacent to the plate
ex. right dorso30lateral-ventrolateral oblique
the right dorsal and left ventral skull will be superimposed, while the left dorsal side of the skull will be highlighted –> left marker should be placed on the plate
what is the ventr035-45lateral-dorsolateral oblique used to evaluate
apices of the mandibular cheek teeth
how is ventro35-45lateral-dorsolateral oblique taken
the beam should be centred on the hemimandible closest to the x-ray generator and aimed roughly 35-45 degrees dorsally
how are ventral obliques labelled
the image should always be labelled as the side adjacent to the x-ray generator. this is opposite to labelling dorsal obliques
ex. right ventro35-45lateral-dorsolateral oblique
right mandible is projected ventrally, therefore a right marker should be placed on the plate
what are radiographic anatomy of significance with oblique views
- enamel
- periodontal ligament
- lamina dura: cortical alveolar bone, which lines the alveolus in permanent teeth
what radiographic abnormalities can be seen when evaluating dentition on oblique views (5)
- periapical sclerosis and halo formation
- periodontal ligament widening
- loss of lamina dura
- clubbing of tooth apices
- hypercementosis
what is shown here
lamina dura (yellow)
and periodontal ligament (red)
what is shown here
periapical infection
what is shown here
periapical infection
what is shown here
periapical infection
what is shown here
normal cheek tooth
what is shown here
periapical clubbing
what is shown here
hypercementosis in periapical infection
what is the dorsal-ventral view useful for
nasal cavity and axial compartments of the paranasal sinuses
how is dorsal-ventral views taken
the xray plate is placed under the mandible and the beam is centred between the facial crests
what abnormalities can be seen on dorsal ventral views
ventral conchal sinusitis and space occupying lesions
what are the disadvantages in dental radiography
can be difficult to interpret because its a 2D image of a complex 3D structure
when is CT indicated
when rads are equivocal or normal in the face of disease
when medical and/or surgical treatment is unsuccessful
when there is evidence of multifocal or extensive disease, or the extent of disease is unknown
what abnormalities can be seen on CT
sclerosis, deformation or disintegration of the apical aspect of the lamina dura
thickening of overlying periapical soft tissues
gas inclusions
what power tools are used for floats
reciprocating burr
rotary burr
rotary discs
how are power tools used
be careful it is easy to remove a lot of dental tissue quickly
take great care to avoid pulp horn exposure when reducing dental overgrowths
carefully observe for colour changes in secondary dentine overlying pulp horns to avoid inadvertent pulp exposure –> normally secondary dentine is dark brown in colour. if it starts to go pink while reducing overgrowths, you have gone too far and exposed pulp
thermal damage to pulps can also occur so try to keep instrument moving
what should be removed during a float
- sharp peripheral dental prominences
- overgrowths of caudal mandibular 11s and rostral maxillary 06s –> reduce to the level of rest of arcade to facilitate normal chewing. if they are large, reduce them in stages over 3-6 months to prevent pulp exposure
- excessively large transverse ridges along the occlusal surface of cheek teeth –> they limit normal chewing action and may impact food into the interdental spaces on the opposite arcade
