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4th year > Equine dentistry > Flashcards

Equine dentistry Flashcards

1
Q

What type of teeth do horses have? How quick do they erupt?

A

Hypsodont (long crowned)

Erupt around 2mm/year

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2
Q

Deciduous and permanent dental formulae for horses?

A

Deciduous:
3/3, 0/0, 3/3, 0,0 (24 teeth)
Permanent:
3/3, 1/1 or 0/0, 3/3 or 4/4, 3/3 (36-44 teeth)

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3
Q

Timing of eruption of deciduous teeth?

A 
Central incisors (01): 6 days
Middle incisors (02): 6 weeks
Corner incisors (03): 6 months
Premolars (06, 07, 08): present at birth

(No deciduous canines, wolf teeth or molars)

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4
Q

Timing of eruption of permanent teeth?

A

Central incisors (01): 2.5 years (in wear 3 years)
Middle incisors (02): 3.5 years (in wear 4 years)
Corner incisors (03): 4.5 years (in wear 5 years)
Canines (04): 5 years
Wolf teeth (05): 1 year (many lost with 06 cap at 2.5 years)
06: 2.5 years
07: 3.5 years
08: 4 years
09: 1 year
10: 2 years
11: 3.5 years

(Deciduous premolars and permanent molars may be present at same time)

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5
Q

What are cups and stars on incisors?

A

Cup = enamel infundibulum
Star = secondary dentine
Both present at about 4yo

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6
Q

Why is ageing of horses by teeth inaccurate?

A

Different pulp and infundibulum depths

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7
Q

What is anisognathia?

A

Maxillary cheek teeth are 25% further apart than mandibular cheek teeth

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8
Q

Cheek tooth anatomy: Layers of teeth? Shape? How many infundibulae? How many pulp horns? Number of roots?

A 
Layers:
- cementum = outer yellow layer
- enamel = white
- primary dentine = inner yellow layer
- secondary dentine = brown in pulp cavity 
Maxillary:
- another layer of enamel and dentine
- 2 infundibulae
- square shaped
- 3 roots (2 lateral, 1 palatal)
Mandibular:
- no infundibulae
- more infolding of peripheral enamel (greater grinding surface)
- rectangular shaped
- 2 roots (rostral and caudal)
At least 5 pulp horns:
- 06s have an extra rostral pulp horn
- 11s have 1 or 2 extra caudal pulp horns
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9
Q

Where do the maxillary cheek teeth erupt from?

A

06s and 07s: maxillary bone
08s and 09s: rostral maxillary sinus
10s and 11s: caudal maxillary sinus

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10
Q

What curvatures of the cheek teeth are there?

A

Curvature of maxilla - widest at 08-10

Curve of Spee - more pronounced in Arabs, care removing caudal 11 overgrowth

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11
Q

What incisor abnormalities are there (to check for on examination)?

A 
Malocclusion:
- overjet/bite
- underjet/bite
- slope or slant mouth
Abnormalities of wear
Caries
Retained deciduous incisors
Supernumerary incisors 
Missing incisors
Fracture 
Neoplasia
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12
Q

What canine abnormalities are there?

A

Calculus formation (particularly lower canines)
Fractured canines
Apical infection

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13
Q

What wolf tooth abnormalities are there?

A 
Rostrally displaced wolf teeth
Blindly erupted wolf teeth
Mandibular wolf teeth
Fractured wolf teeth
'Bitting problems'
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14
Q

What to check for when examining cheek teeth?

A 
Overgrowths - sharp points, associated soft tissue trauma
Diastemata
Fractures
Displaced teeth
Supernumerary teeth
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15
Q

What are pulpar explorers used for?

A

Test integrity of secondary dentine covering the pulp horns
Normal = hard, probe scratches surface
Exposed pulp horn = irregular surface/probe penetrates (indicates devitalisation of that pulp)
Can be important to diagnose apical infection

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16
Q

Overjet and overbite: What is seen? Cause? Significance?

A

Overjet = rostral edge of upper incisors further rostral than rostral edge of lowers
Overbite = more severe, uppers rostral to and extending below occlusal surface of lowers
Brachygnathism - inherited?
Overjet rarely problem for grazing
Overbite can lead to ulceration of area behind upper incisors and severe CT abnormalities

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17
Q

Underjet: What is seen? Cause? Significance? Which horses?

A 
Rostral edge of lower further rostral than rostral edge of upper
Prognathism
Uncommon
Miniature breeds over-represented
Clinical Implications:
- few incisor problems
- CT problems can occur
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18
Q

Slope or slant mouth: What is it? Significance?

A

This is a secondary problem
Indicates chronic unidirectional chewing
Sign of a severe CT problem
Diagnose and treat CT abnormality first

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19
Q

What are valve diastemata?

A

Narrower at occlusal aspect
Wider at gingival margin
Trap food
May develop with age as incisors taper towards the apex

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20
Q

Retained deciduous incisors: Where? Treatment?

A

Usually rostral to permanent tooth - cause displacement of permanent tooth
If loose, remove with forceps
If firmly attached, remove with dental elevators
May need to radiograph

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21
Q

Supernumerary incisors: Features? Treatment?

A

Have long reserve crowns (up to 7cm)
Close to reserve crown and roots of normal permanent incisor
Usually cause little problem so often best not to remove

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22
Q

Treatment of oral neoplasias?

A 
Surgical excision/debulking:
- sharp excision
- laser surgery
- diathermy
- cryosurgery
Chemotherapy:
- topical and intralesional
- immunotherapy
- radiation therapy
- brachytherapy
- teletherapy
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23
Q

What oral neoplasia are there of dental origin?

A

Ameloblastoma
Cementoma
Odontoma
Temporal teratoma

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24
Q

What oral neoplasia are there of soft tissue origin?

A 
SCC
Sarcoids
Epulis
Melanoma
Oral papilloma
Ossifying fibroma
Fibroma
Myxoma/myxosarcoma
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25
Q

Ameloblastoma: Which horses? Where? Appearance? Significance? Treatment?

A

Most common in older horses on mandible
Cause a bony swelling +/- cystic cavity
Benign/locally invasive
Surgical excision

26
Q

Oral SCC: Where? Behaviour? Presentation? Diagnosis? Treatment? Prognosis?

A 
Mucosal junctions - lips, tongue, oral, palate
Most common oral neoplasm
Behaviour variable: rapid or slow growing
Presentation variable:
- swelling 
- loosening of teeth
Diagnosis:
- clinical appearance
- biopsy
Excision = TOC
Poor prognosis
27
Q

What developmental cheek teeth disorders are there?

A

‘Caps’ (retained deciduous CT)
Developmental diastemata
Displaced CT
Supernumerary CT

28
Q

Retained caps of cheek teeth: What are they? When normally shed? Significance?

A

Remnants of deciduous teeth
Normally shed during eruption of the underlying permanent tooth
Loose/retained caps can cause oral pain

29
Q

Developmental diastemata of cheek teeth: Why a problem? Why happens?

A

Food accumulates -> Fermentation -> Periodontal disease

Developmental - e.g. dental buds developed too far apart

30
Q

Cheek teeth displacements: Cause? Which teeth? Types? Significance?

A 
Cause = Overcrowding during eruption
Often bilateral
Usually 09s and 10s
Medial/lateral displacement +/- rotation
Buccal/lingual trauma
Diastemata -> periodontal disease
31
Q

Supernumerary cheek teeth: Where? Problems?

A

At beginning/end of arcade
May cause:
- Occlusion problems (overgrowth - ulceration)
- Diastemata - periodontal disease

32
Q

What acquired cheek teeth disorders are there?

A 
Wear abnormalities:
- Wavemouth
- Shearmouth
- Step overgrowths
- Exaggerated transverse ridges (ETRs)
- Smooth mouth 
Dental fractures
Apical infection
33
Q

Wavemouth: Where is there dominance?

A

Usually dominance of:

  • upper 09s and 10s
  • lower 07s and 08s
34
Q

Shearmouth: Appearance? Why happens?

A

Acute angle of occlusal surface
Reflects less chewing on that side - pain e.g. diastema
May be bilateral

35
Q

Causes of a step overgrowth of a tooth?

A

Missing teeth
Following extraction
Parrot/sow mouth
Supernumerary

36
Q

Smooth mouth: When happens? Why? Problems? Management?

A

Senile change
Cheek teeth enamel largely worn away
Some worn down to individual roots
Softer dentine and cementum become smooth - no good for grinding
Feed: young grass/chopped forage to maintain weight

37
Q

Dental caries: What are they? Types? Features of each?

A 
Demineralisation of dental material (affects cementum initially)
Infundibular caries:
- predispose to fracture
- degrees of severity:
- 1st: cementum only
- 2nd: cementum and enamel
- 3rd: cementum, enamel and dentine
- 4th: tooth integrity affected (involves fracture/apical infection)
Peripheral caries:
- less common
38
Q

What is the most common type of cheek tooth fracture? Where happens most commonly? Typical configurations? Significance? Signs? Treatment?

A

Idiopathic ‘slab’ fractures
Maxillary > mandibular
109 and 209 most common
Lateral sagittal (between first and second pulp horns):
- may be found incidentally by counting pulp horns
- may be quitting (painful if slab still in place)
- usually not associated with apical infection (pulp horns sealed off)
- extraction rarely required
Midline sagittal:
- through infundibulae (infundibular caries)
- result in apical infection +/- sinusitis
- extraction required

39
Q

Occlusal fissure fractures of cheek teeth: Signs? Significance?

A

Incidental finding
Subtle - need dental mirror
May predispose to atypical fracture

40
Q

Clinical signs of apical infection of cheek teeth?

A 
Maxillary 06, 07 (occasionally 08):
- facial swelling
- +/- draining tract
Maxillary 09, 10, 11 (occasionally 08):
- unilateral nasal discharge
All mandibular cheek teeth:
- bony mandibular swelling
- +/- draining tract
41
Q

Causes of apical infections of cheek teeth?

A
  1. Anachoresis (= local blood borne/lymphatic borne bacteria)
  2. Fracture
  3. Periodontal spread (diastema)
  4. Pulpar exposure (usually iatrogenic due to over-rasping)
42
Q

Pathogenesis of apical infections of cheek teeth?

A

Pulpitis

  • > pulpar oedema
  • > vascular occlusion
  • > necrosis
43
Q

Diagnosis and treatment of apical infections of cheek teeth?

A

Diagnosis:

  • clinical signs
  • oral exam: fracture, pulpar exposure
  • radiography (poor se)
  • CT (modality of choice)
44
Q

What radiographic views are used for equine teeth? Positioning? Centring? Useful for? Disadvantages?

A

Latero-lateral views:
- plate on affected side
- centring: rostral extremity of facial crest
- visualise fluid lines/soft tissue structures in sinuses
- can’t use to evaluate individual cheek teeth as superimposition
Latero 30 dorsal-ventrolateral oblique:
- plate on affected side
- centring: rostral aspect of facial crest
- beam angled 35-45 degrees down
- separates left and right cheek tooth apices
Latero 35-45 ventral-dorsolateral oblique:
- plate on affected side
- centring: on affected tooth
- beam angled 35-45 degrees up
- to view mandibular cheek teeth apices
- increase Kv if caudal due to masseter muscle
Dorso-ventral
Intra-oral dorso-ventral/ventro-dorsal:
- plate in mouth with corner as far back as possible
- centring: between central incisors
- angle beam 60-80 degrees from the dorsal plane
Open mouth obliques

45
Q

Signs of apical infection of a cheek tooth on radiography?

A 
Periapical sclerosis (can surround area of lucency)
'Clubbing' (destruction) of tooth roots
46
Q

Should wolf teeth be removed?

A

Unnecessary in vast majority:
- client/trainer pressure
- tradition
Do not cause problems when in normal position and normal size
Cause problems when:
- rostrally displaced or mandibular -> bitting problems, ulceration
- blindly erupted -> pain

47
Q

Wolf teeth removal?

A 
Standing sedation - a2 agonist and butorphanol
Local anaesthesia:
- infra-orbital/maxillary nerve block
- direct infiltration
If blindly erupted:
- incise gingiva over top with scalpel
- extraction may not be necessary
Extraction:
- dental elevators circumferentially around tooth to loosen and hammer if required
- risk of fracture
- remove with forceps when loose
- 2 weeks bit rest
48
Q

Where is often missed when rasping cheek teeth?

A

Lower caudal 11s - she of focal overgrowth

Difficult to assess and often missed

49
Q

How much of a cheek tooth can be rasped at a time? Why?

A

Max 3-4mm every 6 months
Excessive rasping will expose/thermally damage pulp - predisposes to apical infection
High risk sites:
- rostral 06s and caudal 11s (extra pulp horns)

50
Q

Treatment of diastemata?

A

Clean out completely with dental pick/high pressure lavage
Any ETRs on opposite arcade should be removed
Widen with mechanised burr only if:
- gingival recession
- periodontal disease
+/- Pack with impression material

51
Q

Treatment of a tooth fracture?

A

Assess of clinical signs of apical infection

If not, remove fracture fragment only (rest of tooth may be quiescent)

52
Q

Tooth extraction techniques in horses?

A

Oral extraction (first approach where possible)
Minimally-invasive transbuccal extraction (MTE)
Repulsion
Lateral buccotomy

53
Q

Tools used for oral tooth extraction?

A

Dental spreaders placed in the interdental space in front and behind tooth and closed gradually to stretch the periodontal ligament (careful as can cause further fracture)
Elevators
Molar forceps
Fulcrum

54
Q

What is minimally-invasive transbuccal extraction (MTE)?

A

Specialist equipment
Oroscopic guidance
Performed standing
Preserves alveolar bone

55
Q

Repulsion for tooth extraction: When used? How? Tools used? Disadvantages?

A

Reserved for complex cases
Tooth must be loosened as much as possible before hand
GA/standing
Radiographic guidance imperative
Trephine over top of tooth
Blunt instrument to drive the tooth into the mouth:
- mechanically very inefficient
- alveolar bone damage depends on instrument used (Steinnman pin = ‘minimally invasive’, Dental punch = very destructive)
High potential for complications

56
Q

Lateral buccotomy for tooth extraction? Risks?

A 
Very last resort
Incision through cheek
Potential damage:
- facial nerve
- parotid duct
High morbidity rate:
- iatrogenic trauma
- wound breakdown
57
Q

What is the difference between a qualified and non qualified EDT?

A 
BAEDT:
- passed the joint BEVA/BVDA examination
- responsible for the work that they do
- CAT1 and CAT2 procedures
Other 'equine dentists':
- attended a course but not examined
- CAT1 procedures only
58
Q

What are category 1 dental procedures?

A

Examination of teeth
Removal of sharp enamel points and small overgrowths:
- using manual rasps only
- max 4mm reduction
- ‘bit seat shaping’ (not advisable practice as pulp horn exposure!)
Removal of loose deciduous caps
Removal of supra gingival calculus

59
Q

What are category 2 dental procedures?

A

Additional procedures suitable for delegation to an EDT who has trained and passed an examination approved by DEFRA:

  • examination, evaluation and recording of dental abnormalities
  • removal of loose teeth/fragments with negligible periodontal attachments
  • 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
  • motorised dental instruments to reduce overgrowths and sharp enamel points only
  • horses should be sedated unless it is deemed safe to undertake any proposed procedure without sedation, with full informed consent of the owner
60
Q

What are category 3 dental procedures?

A

All other procedures (involving diagnosis or treatment of animals) and any new procedures, which arise as a result of scientific and technical development, would by default fall into category 3
Category 3 procedures may only be performed by qualified veterinary surgeons
Notably:
- diastemata widening
- unerrupted wolf tooth removal

Only qualified veterinary surgeons can dispense POMs and only vet/owner can then administer.

4th year (44 decks)

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