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BVetMed - Alimentary > Equine Dentistry > Flashcards

Equine Dentistry Flashcards

1
Q

How is the equine mouth adapted to constant grinding and high forage diet?

A
  • Interdental diastema
  • limited rostrocaudal movement of the TMJ, lots of lateral movement
  • TMJ allows occlusional contact of all cheek teeth simluataneously (though usually only 1 side at a time is grinding
  • well developed masticatory musculature
  • hypsodont (high crowned teeth, enamel extends beyond the gum line)
  • irregular enamel ridges -> better grinding surface
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2
Q

What are the 3 strokes of mastication?

A

Opening, closing, power stroke (major pressure applied to one side at a time)

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3
Q

What may a preference for chewing on one side of the mouth indicate and cause?

A

May indicate pain/pathology

Will lead to further pathology due to innapropriate wear

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4
Q

What system of dental nomenclature is used for equine teeth?

A

Triadan

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5
Q

Outline the triadan system of dental nomenclature

A

First number indicates arcade, second indicates tooth
- Upper R (from horse’s POV) = 1
- Upper L = 2
- Lower L = 3
- Lower R = 4
>Numbered axial -> abaxial starting at central incisor 01->11
> Deciduous teeth labelled 5,6,7,8 -> young horses can look confusing!

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6
Q

What triadan number are the wolf teeth?

A

05

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7
Q

Which triadan numbers are the incisors?

A

01-04

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8
Q

Which triadan numbers are the premolars?

A

106-108

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9
Q

Which triadan numbers are the molars?

A

09-11

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10
Q

What is formed before a tooth is lost? How may this develop into a pathological state?

A

Cap - may be retained -> food stuck -> infection etc

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11
Q

What does anisognathism refer to?

A

Maxillary arcade wider than mandibular

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12
Q

What angle should the occlusional surface of the teeth be at?

A

10-15 deg

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13
Q

Which cheek teeth are often angled compared to the rest of the arcade?

A

1st and 6th

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14
Q

What is the upward slope of occlusional surface at caudal aspect of the mouth referred to as?

A

Curve of Spee

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15
Q

What 4 substances make up a normal cheek tooth? What may also be seen

A
  • cementum (attaches to periodontal ligament and in infundibulum)
  • dentine (bulk of tooth, tubular structure)
  • enamel (hardest tissue, laminated sheets)
  • pulp (blood/n supply to tooth)
    > infundibulum (infolding of enamel from occlusional surface)
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16
Q

Where are infundibula found?

A

2 in each maxillary cheek tooth
NONE in mandibular
1 in each incisor

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17
Q

What pathology may be associated with the cementum?

A

Hypoplasia -> impaction of food, bacteria, gas bubbles

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18
Q

How thick is the secondary dentine layer?

A

2mm -> 1cm

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19
Q

Why may dental exams be carried out?

A
  • routine annual checkup
  • problems:
    > swelling or discharging tracts of the mandible or maxilla
    > weight loss
    > quidding
    > headshaking
    > bitting problems
    > unilateral nasal discharge
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20
Q

What are the 4 parts of the dental exam?

A
  1. Distant observation (esp. eating)
  2. External exam inc. BCS
  3. Head exam - symmetry, pain, swelling, LNs, nasal discharge
  4. Oral exam - incisors to check malocclusion (before speculum)
    - interdental spaces for wolf teeth, canines, bitting and tongue injuries
    - cheek teeth
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21
Q

How often do dental examinations need to be carried out for a) the healthy horse b) maintainence of a problem horse c) active remodelling of the teeth in a problem horse?

A

a) 12 months
b) 6 months
c) 3 months

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22
Q

Is sedation for a dental exam advocated?

A

Yes, though not necessary persay. Allows a more thorough examination

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23
Q

Give 2 common types of gag

A

Hausmanns gag, wedge gag for incisors (bne careful as may chomp on this -> Fx)

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24
Q

What should cheek teeth be examined for?

A
  • buccal/lingual points, ulceration
  • deciduous caps/remnants
  • focal overgrowth eg. malerrupted tooth
  • molar table angle 10-15deg
  • wave/step mouth
  • Fx
  • excessive transverse ridges
  • FBs
  • periodontal disease
  • Infundibular caries in maxilla arcades, peripheral caries elsewhere
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25
Q

Outline the pathophysiology of “points” - where are they found on mandibular v maxillary arcades?

A
  • Buccal edge of maxilla, lingual edge of mandibular
  • Concentrates encourage vertical chewing cf. forage (lateral chewing action) -> uneven attrition, impairs mastication movements -> further overgrowth vicious cycle
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26
Q

What are the effects of enamel overgrowth?

A
  • prevent free movement of jaws
  • oral pain -> quidding and weight loss
  • bitting problems
  • headshaking
  • > SHEAR MOUTH (extreme cases)
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27
Q

How may shear mouth be treated?

A

Bute, diet mod (eg. wet hay), rasp in stages (~3 months) to protect secondary enamel - remember will be even thinner than normal on unworn sections of tooth

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28
Q

What secondary changes may occour with shear mouth?

A

Remodelling of muscles, ligaments and joints (eg. TMJ)

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29
Q

What are the two most common rasping blades?

A

Carbide chip blades (cheap, robust, routine work)

Tungsten carbide blades (expensive, brittle, only cut one way[pull], best for hooks etc.)

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30
Q

What 4 types of rasp are required for routine dental work?

A
  1. Straight head, long length (lower cheek, 3rd-6th upper cheek)
  2. Obtuse angled head, long length (caudal upper cheek teeth, curve of Spee) - low thin profile to get into upper buccal space
  3. Angled offset head, medium length (upper 1st-4th cheek)
  4. S float (smooth off first cheek teeth and 6th maxillary, bit seat, angle of curve of Spee) - carbide chip only
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31
Q

Are power tools advocated for rasping?

A

In some situations esp. if whole mouth is bad, removes hooks quickly BUT beware of slipping and causing unplanned damage!
- beware palatine artery - inside upper arcade ~1cm axial to arcade

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32
Q

At what ages should teeth be being shed? How may retained caps affect the horse?

A

2.5, 3 and 4 years
Retained-> anorexia, poor performance, malocclusion. Food gathers underneath, VFAs produced -> peridontal ligament breakdown

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33
Q

How can retained caps be treated?

A

Remove with forceps/screwdriver do not damage underlying permenant tooth beneath

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34
Q

Which teeth often overgrow?

A

106, 206, 311, 411 - rostral displacement of maxillary arcade (parrot mouth) or mandibular brachygnathism

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35
Q

Why may caudal hooks on the mandibular arcade be difficult to assess?

A

Curve of Spee means caudal teeth are raised anyway. Run finger entirely over last tooth to assess drop off the back.

36
Q

What may cause focal overgrowths? What can this progress to?

A

Diastema, displaced teeth, lost teeth, Fx

-> wavemouth

37
Q

How can focal overgrowths be removed? What care must be taken?

A
  • Rasp
  • Care: > do not expose pulp (white enamel on rasp -> pink. Non-occlusional surfaces have v 2dry dentine -> ^ risk of pulp exposure) -> apical tooth infections
    > do not create excessive heat (40secs burning -> pulp necrosis)
    > frank blood on the rasp more likely nicked a gum/buccal cavity than pulp - dont worry!
38
Q

How would you prevent over rasping revealing the pulp?

A

Investigate secondary dentine depth with probe

Give prophylactic ABs if suspected

39
Q

What may infundibular caries lead to?

A

Septic pulpitis

40
Q

Are infundibular caries “normal?” What can they result in?

A

In horses >15 years normal (~80% horses affected)

  • Usually benign
  • Can lead to sagittal Fx of tooth
41
Q

Does the appearance of infundibulea on the occlusal surface correlate with infundibulae in the body of the tooth?

A

No

42
Q

Is reduction of traverse ridges advocated?

A
  • Potentially removes usable clincial crown

- If necessary remove larger ridges but leave some normal ridging in places

43
Q

What is thought to be the most painful oral disease?

A

Peridontal disease

  • Ginvititis
  • Periodontal ligament
  • Alveolar disease
44
Q

Is primary peridontal disease common? What are the breed dispositions and

A

NO - caused by diastemata. Mandibular cheek teeth most frequently affected, draft breeds predisposed . Incidence ^^ with age (60% horses >15%)

45
Q

How does peridontal disease begin and what may ultimately occour?

A
  • Localised gingivitis with pocket formation
  • trapped debris stagnates
  • feed compressed during mastication
  • osteomyelitis (destruction of alveolar bone)
  • bacteria enter pulp cavity through root canals
  • usually begins in interproximal spaces (inbetween teeth)
    > buccal surface of maxilla
    > lingual surface of mandibular
46
Q

What may be considered a normal finding in dental checks of old horses? How may this cause problems potentially?

A

Diastemata - due to narrow tooth roots compared to initial occlusal surface (overgrowth/displaced teeth may predispose)

  • usually lower cheek teeth
  • often clincially silent
  • food may get trapped, cause pain and lead to quidding (smaller diastema more problematic than large)
  • very rarely causes osteomyelitits
47
Q

How may diastemata be treated?

A
  • monitoring
  • widening or extraction (take care not to cut into tooth)
  • removal of impacted food (transient improvement only)
  • replace long fibre foods with shorter (eg. alfalfa or grass)
  • keep overgrowths opposite in check
48
Q

What two ways may displacement of cheek teeth occour?

A

Developmental (overcrowding of arcades during eruption, often bilateral, usually 4/5th cheek teeth) or acquired (more common, usually lower 10/11th in old horses)
- May not require treatment just monitoring

49
Q

Why may cheek teeth fractures occour? What may result?

A
  • 2ndry to severe infundibular caries
  • may lead to septic pulpitis
  • can be the cause of aquired overgrowths
50
Q

What is often the “final common disease pathway” of dental disease?

A

Apical tooth infection

51
Q

What age is over represented with mandibular apical tooth infection?

A

5 year olds (5-7)

52
Q

What are the clinical signs associated with mandibular apical tooth infections?

A
  • assymmetrical jaw swelling (cf. normal symmetrical swellings in 2-3 year olds)
  • ventral discharging tracts
  • oral involvement RARE
  • quidding (potentially)
  • halitosis
  • sub mandibular LN enlargement
53
Q

Why may mandibular bumps be seen on a 2/3 year old? How may this be distinguished from pathological growths?

A
  • dental buds and increased activity in the jaw

- if symetrical probably not pathological!

54
Q

How are mandibular apical tooth infections diagnosed?

A

Radiography - halo around tooth root extends to base of jaw

55
Q

What is the aetiology of maxillary apical tooth infections?

A
  • Infundibular caries
  • premature pulp exposure during wear
  • pulp exposure after transverse Fx
  • peridontal fistulation
  • Iatrogenic due to rasping
  • Idiopathic common also
56
Q

Which cheek teeth generally communicate with the maxillary sinus?

A

caudal 2 communicate with caudal maxillary sinus
mid 2 communicate with rostral maxillary sinus
rostral 2 do not communicate
- can burst into nasal cavity (RARE)

57
Q

Where are tooth apices situated?

A

In maxillary sinuses (rostral and caudal)

58
Q

How would sinusitis present?

A

Unilateral nasal discharge

59
Q

What is the best diagnostic for diagnosis of maxillary apical tooth infections (08-11)? What may these infections lead to?

A
  • May lead to sinusitis presenting with unilateral nasal discharge
  • Dx which tooth? (Oral exam often insufficient)
  • CT best diagnositcs ( radiography sometimes useeful but rarely, scintigraphy too vague, sinoscopy rarely reveals anything specifc)
60
Q

What imaging technique provides an alternative to mirrors?

A

Oral endoscopy - enables magnified visualiation of occlusal surfaces, and caudal parts of oral cavity
> difficult to disinfect

61
Q

What can be visualised in a latero-lateral head radiograph?

A
  • exudate within paranasal sinuses appears as fluid lines

- teeth apices are superimposed preventing visualisation so NOT USEFUL!

62
Q

What radiographic angle is most useful to visualise apices? Which side should the plate be placed?

A

Lateral 45deg ventral lateral oblique -> reduced superimposition of mandibular apices
Plate placed on side you want to examine

63
Q

What is the best way to decide if a latero-lateral radiograph is properly aligned?

A

Nasal cavities should be perfectly superimposed

64
Q

Which cheek tooth is most likely to get a root infection?

A

09 (4th cheek tooth) as is oldest tooth in the mouth

65
Q

What radiographic signs of dental disease may be noted?

A
  • missing teeth
  • malpositioning
  • crown deformation
  • radicular distortion (ragged appearance)
  • loss of lamina dura denta (peridontal region lucency)
  • periapical lucency (halo)
  • cementoisis
  • localised maxillary bone proliferation - osteitis (coarsening and compaction of bone trabeculae)
66
Q

How is the diagnostic accuracy of scintigraphy described?

A

High sensitivity, low specificity

67
Q

What may be detected by sinusitis?

A

Dental sinusitis

68
Q

What are CT images composed of? What scale is used to measure these?

A

Voxels (3D pixels)

Measured in Hounsfield units (HU) - ^ in bone, v in air

69
Q

What are the advantages of CT v xrays?

A
  • avoids superimposition
  • windowing
  • view in multiple planes and dimensions
    > expensive
70
Q

What are the pros and cons of standing v GA

A

Risk of GA v motion blur from standing

71
Q

What are the radiographic signs of apical tooth root infection?

A
  • Periapical scleroisis
  • periapical halo
  • Cementoma formation
  • Clubbing of tooth roots
72
Q

What are the CT signs of apical tooth root infection?

A
  • gas within bulging root area
  • fragmentation of the root
  • ^ pulp volume
  • Abnormal pulp morphology
73
Q

Why may supernumerary teeth cause problems?

A

Diastema -> food packing, infection etc.

74
Q

How may older teeth be identified on radiograph?

A

Shorter tooth root

75
Q

Other than rasping, how may apical tooth root infections be treated?

A
  • Conservative ABs
  • Currettage
  • Tooth removal by repulsion, extraction [banged out from top] or lateral buccotomy (
76
Q

What complications are associated with treatment of apical tooth root infections by repulsion? How many cases are affected by complications?

A
  • 33% mandibular cheek teeth
  • 33% maxillary cheek teeth without sinusitis, 66% maxillary with sinusitis
  • orosinus fistula causes major problems as food -> sinus (pack with tampons and iodine, change ~24hrs)
    > increased need for dental care postoperatively to prevent stepmouth
77
Q

How does the complication rate for oral extraction v repulsion differ? Are these treatments equally easy?

A

> 1/3 (nowadays ~5%)

> difficult in caudal cheek teeth of young horses, but possible even in comminuted Fx/no occlusal surface

78
Q

What tools are used to perform an oral extraction?

A

Separators to break ligaments
Molar grabbers
Falcrum to use as a lever

79
Q

Which treatment for apical tooth root infection is minimally invasive?

A

Lateral buccotomy

80
Q

What triadan number are the wolf teeth?

A

05 (1st premolar)

81
Q

Are there deciduous precursors to wolf teeth? When do they erupt? When may they be lost?

A

No, erupt at ~1 year, many lost when 1st upper decidous cheek tooth “cap” shed

82
Q

Are lower wolf teeth common?

A

No

83
Q

Why may wolf teeth cause problems?

A

Bitting problems - advise extraction

84
Q

What type of nerve block is used for wolf tooth extraction?

A

Infra orbital nerve block or local infiltration into gum

85
Q

How are wolf teeth extracted? What vaccine is necessary? What complications may arise?

A
  • Extensive elevation of the tooth
  • tetanus
  • attempted removal can lead to fracture and development of bitting problem not present previously
86
Q

Are fractured incisors an emergency?

A

No

87
Q

How should fractured incisors be treated? Is the proognosis good?

A
  • starve
  • pain relief
  • ABs
  • lavage wound
  • mental foramen n block and cerclage wire to hold together
    > good prognosis!

BVetMed - Alimentary (30 decks)

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