Exam 1 Flashcards

Question

Muscles of Mastication

Answer 1

-Masseter m. -Temporal m. -Pterygoid m. -Digastricus m. (caudal belly, facial nerve) Trigeminal nerve innervation (Facial branch)

Answer 2

Present in 70-90 % of patients to some degree Most common cause of oral infection and tooth loss Preventable disease, but once stablished only managed, chronically progressive

Answer 3

Normal: sharp, thin, non-inflamed margins. Firm, Coral-pink, stippled -Aerobic gram positive bacteria Abnormal: marginal gingivitis, rounded edges, erythematous, may bleed upon probing -Accumulation of calculus/plaque in sub gingival location creates anaerobic environment -Increased anaerobic, gram negative and spirochete bacteria. Plaque Induced Gingivitis -Bacterial plaque colonizes within 24-36 hours after cleaning -Plaque is inorganic, transparent, adhesive biofilm, salivary glycoproteins, oral bacteria and extracellular polysaccharides. -If not removed, within a few days, inflammatory response at gingival margin

Answer 4

Normal: sharp, thin, non-inflamed margins. Firm, Coral-pink, stippled -Aerobic gram positive bacteria Abnormal: marginal gingivitis, rounded edges, erythematous, may bleed upon probing -Accumulation of calculus/plaque in sub gingival location creates anaerobic environment -Increased anaerobic, gram negative and spirochete bacteria. Inflammation -Vasculitis -Edema -Collagen loss Diagnosed -When inflammation is limited to the gingiva -Advanced gingivitis can develop in periodontitis

Answer 5

-Black pigmented anaerobic bacteria is commonly associated with periodontitis **Inflammatory factors host's immune response and anaerobic bacteria cause the destruction of the tissue surrounding the tooth (periodontium)** Risks -Age: more common in older animals -Breed: brachycephalic, toy breeds, dolicocephalic breeds -Persistent deciduous teeth -Malocclusions -Genetic predisposition -Host's immune response -Non-abrasive diet -Chewing habits -Periodontal trauma -Oral foreign bodies Periodontitis Tissue destruction -Epithelium attachment loses integrity -Gingival sulcus increases in depth -Pockets are formed as periodontal ligament and alveolar bone are destroyed -Gingival recession -Tooth loss if not treated

Answer 6

-Gingivitis -Halitosis (bad breath) -Gingival enlargement -Gingival recession below neck of tooth -Periodontal Pockets -Abscessation (apical tooth abscess) -Facial swelling -Draining fistula -Ophthalmic sequela -Oronasal fistula - nasal discharge -Osteomylitis -Osteolysis -Mandibular fractures (when bone loss is severe) -Systemic organ lesions from bacteremia (kidney, liver), chronic pulmonary changes -Oral pain -Tooth mobility

Answer 7

Periodontal probing -Locating periodontal pockets -Checking for gingival sulcuses depth Diagnosis -Definitive Dx requires general anesthesia -Dental radiographs -Periodontal probing -PD (periodontal disease) refers to degree of severity on a single individual tooth. **Stages 0-4** Attachment Loss Concept -Refers to the destruction of periodontium (gingiva, cementum, alveolar bone, PDL) due to periodontitis -Determined by probing, measurement of gingival recession (if present) and radiographs -Probing depth: mm from gingival margin to the most apical point that the probe reaches when gently inserted into the gingival sulcus or pocket. Radiograph -Measure distance from the alveolar margin (AM) to the cementoenamel junction (CEJ) relative to the length of the tooth. Ex: 11/15 = 0.73 = 73% attachment loss

Answer 8

-Normal space in multicoated teeth -When disease is present bacteria inhabits the space Stage 1 -Involvement exits when the probe extends LESS than halfway under the crown in any direction of multicoated teeth with attachment loss Stage 2 -Involvement exits when the probe extends MORE than halfway under the crown in any direction of multicoated teeth with attachment loss, but not through and through Stage 3 -Involvement exits when the probe extends under the crown in any direction of multicoated teeth, through and through from one side of the furcation out the other. -Tooth needs to be extracted bc it's hard to keep it clean

Answer 9

Normal (PD 0) -Clinically normal -Gingival inflammation or periodontitis is not clinically evident Stage 1 PD -Gingivitis only without attachment loss -Height and architecture of the alveolar margin is normal -Mild gingivitis, mild calculus, no recession Stage 2 PD -Early periodontitis or at most there is stage 1 furcation -Periodontal attachment loss <25% -Or radiographic determination of the distance of the alveolar margin from the cemento-enamel junction relative to the length of the tooth.

Answer 10

Stage 4 -Advanced periodontal disease ->50% attachment loss or -Stage 3 furcation

Answer 11

-Most dental pathology is below the level of the gingiva and cannot be detected through visual examination -Diagnosis of periodontal disease -Diagnosis of endodontic disease -"missing" teeth -Extractions, prior, maybe during, and after -Resorptive tooth lesions -Screening radiographs during routine dental cleaning -Periorbital swelling, gingival swelling and oral neoplasia -Developmental abnormalities -Trauma -Malocclussions -Rule out dental cause of "nasal" disease

Answer 12

Conventional radiograph unit -Useful in imaging mandibular/maxillary fractures, trauma, masses, TMJ -Some practices without dental unit still may have regular unit -Not great for diagnosis -Difficult to isolate individual teeth -Can't take intra-operative films without moving patient from dental treatment table -Inconvenient, usually not in location where dental procedures are performed Dental Radiographs Unit -kVp and mA are often fixed and only time is selected -Most units have anatomic interface where operator sets the size and tooth the exposure is adjusted automatically

Answer 13

-Less radiation than conventional units -Required to be registered and inspected by the State Department of health -In Virginia, stand >9 feet from the tube when making an exposure -Stand at angle of 90-135 degrees from primary beam -Use Disometry badges -Use positioning aids (e.g., gauze sponge or play dough) to help stabilize the sensor/film to prevent exposure of staff by holding it

Answer 14

1. Conventional Intraoral film -Least expensive -Requires no automation -Several sizes available -Takes more time -Requires developing chemicals -Must store and catalog films as part of the patient record. -Processing errors can be a problem 2. Sensor based radiograph (DR) "digital radiograph" -Charged-coupled device (CCD) -Complementary metal oxide semiconductor (CMOS) -Need #2 sensor, laptop or desktop, software -Immediate images ~5 sec -Digital images, easy to store -More consistent quality -Less radiation required -Sensors can be expensive ~$2000 -Only #1 and #2 size available 3. Photostimulable phosphor plates (CR) "computed radiograph" -CR reader -Computer, software -Phosphos plare -Available in size 0, 1, 2, 3, 4. May be used in large animals -Digital images -#1 plate better for cats -Quality images -Slower ~30 sec for images -Hard-wired sensor

Answer 15

1. Parallel Technique -Film or sensor is parallel to the long axis of the subject **Distal mandibular (307/407)** -Film sensor can be placed parallel to the tooth and perpendicular to the primary beam 2. Bisecting angle technique -Due to anatomical interference with all maxillary teeth -Sensor can't be aligned parallel to the long axis of the tooth -Mandibular rostral teeth also -Angle is between the plate and perpendicular to sensor angle, and plate and sensor perpendicular to long axis of tooth angle. **Orient primary beam half-way between these those extremes, the image of the tooth will be same as the actual tooth** -Some dental x-ray units come with angle indicators

Answer 16

Foreshortening -X-ray beam is too perpendicular to the sensor beam -Correction: drop the angle to a more lateral position Elongation -The beam is too perpendicular to the tooth -Correction: increase the angle to a more vertical position

Answer 17

The function is to provide both structural and functional anchorage for the teeth within the mandible and maxilla 1. Gingiva 2. Periodontal ligament 3. Cementum 4. Alveolar bone

Answer 18

-Pellicle: protein film consisting of salivary glycoproteins which form within seconds of the teeth being cleaned -Plaque biofilm: bacterial pellicle forms within 24 hours -Calculus: forms via mineralization of the plaque biofilm by ions in the saliva. It is detectable within 48-72 hours after cleaning. -Mechanical removal of the biofilm is required to prevent and treat periodontal disease -supragingival bacteria influence the growth and pathogenicity of subgingival bacterial population

Answer 19

Locoregional -Periapical abscesses -Oronasal fistula: +/- chronic rhinitis -Retrobolbulbar cellulitis/ophthalmic inflammation -Epiphora (insufficient tear drainage/blockage): due to compression/inflammation of nasolacrimal duct -Pathologic fracture of the mandible in small/toy breed predisposition. Systemic -Bacteremia -Kidney damage -Liver damage -Cardiovascular damage (myocardium) -Left atrioventricular valve

Answer 20

Symptoms -Reluctance to chew -Head shyness -Pawing at the face -Dropping food when eating -Sneezing/nasal discharge -Exaggerated jaw motion when chewing -Aversion to food or water **Most patients still eat with severe periodontal disease** PE findings Intraoral -Halitosis -gingivitis -Calculus -Gingival recession/root exposure -Missing teeth -Mobile teeth Extraoral -Submandibular swelling -Periorbital swelling -Draining tracts Diagnosis (can't Dx on awake oral exam alone) Minimum database -CBS -Chemistry profile with electrolytes -UA with USPG if renal values borderline -Species specific with ELISA testing: HWT, FIV/FeLV Comprehensive Oral Health Assessment and Treatment (COHAT) -Requires anesthesia -Requires imaging **Dental radiographs is the standard of care** Cone beam Computed Tomography for advanced diagnosis -Probe Exam -Dental chart for documentation in addition to written SOAP notes

Answer 21

Stage: Periodontal disease -Assessment of the extent of pathological lesions in the course of the disease. Ex: stages of periodontal disease, stages of oral tumor. Grade: Furcartion Exposure -The quantitative assessment of the degree of severity of a disease or abnormal condition at the time of diagnosis, irrespective of wether the disease is progressive (e.g., a grade 2 mast cell tumor based on mitotic figures) Index: Gingivitis -A quantitative expression of predefined diagnostic criteria whereby the presence and/or severity of pathological conditions are recorded by assessing a numerical value (e.g., gingival index, plaque index)

Answer 22

Stage 1 (F1) -Furcation 1 involvement, periodontal probe extends less than halfway in any direction of multirooted tooth Stage 2 (F2) -Periodontal probe extends >halfway under the crown of a multirooted tooth WITH attachment loss, but not through and through Stage 3 (F3) -Periodontal probe extends under the crown of any multirooted tooth, through and through from one side to the other.

Answer 23

Stage 0 (M0) -Physiological mobility up to 0.2 mm Stage 1 (M1) -Increased mobility in any direction other than axial >0.2mm up to 0.5mm Stage 2 (M2) -Increased mobility in any direction other than axial >0.5mm up to 1mm Stage 3 (M3) -Increased mobility in any direction other than axial >1mm

Answer 24

Gingival Index 1 -Inflammation and swelling, NO bleeding during periodontal probing Gingival Index 2 -Inflammation and swelling, With bleeding during periodontal probing Gingival Index 3 -Inflammation and swelling, spontaneous bleeding during periodontal probing

Answer 25

Normal (PD0) -0% attachment loss, 0 gingivitis Stage 1 (PD1) -0% attachment loss, gingivitis present Stage 2 (PD2) - <25% attachment loss -Stage 1 furcation involvement Stage 3 (PD3) - >25% up to 50% attachment loss - Moderate periodontitis -Stage 2 furcation involvement Stage 4 (PD4) - >50% attachment loss -Advanced periodontitis -Stage 3 furcation involvement

Answer 26

A. Marquis color-coded probe -Calibrations are in 3mm sections -Dog only B. University of North Carolina-15 Probe -15mm long probe -With millimeter markings at each millimeter -Color coding at 5th, 10th, and 15th millimeter -Cat or dog C. University of Michigan "O" probe with Williams marking -Markings at 1,2,3,5,7,8,9, and 10mm **Requires dental chart to record findings**

Answer 27

Normal -Dog: 1-3mm -Cat: <1mm 1.Gently place the probe between the gingiva and tooth 2. Stop when you feel resistance 3. Record the pocket depth **Do not use too much force, can cause damage and create an accidental pocket**

Answer 28

Surgical -Requires referral (except certain extractions) -Defined as any procedure requiring a mucogingival flap -Examples: open root canal, bone grafting, etc. Non-Surgical -Can be performed at a general practice -Ultrasound scaling and polishing -Closed root planning (with or without perioceutic application) -Barrier/sealant application -Homecare

Answer 29

Parioceutics -Antimicrobial products available for dental application (FDA approved on non lactating dogs) 8.5% doxycycline -Powder contained within a slowly dissolving polymer gel 2% Clindamycin -Hydrated salt in a matrix that gels at body temperature **Act as a physical barrier to pocket contamination, doxycycline in addition has anticollagenase activity** -Local Infusion of antibiotics

Answer 30

Early Stage PD -PD0, PD1: managed with annual COHATs and homecare -PD2/F1: closed root planning +/- perioceutic application Advanced stage periodontal disease -PD3: open root planning +/- perioceutic application, GTR, extraction -PD4: extraction Combined periodontal and endodontic lesions -Extraction Periapical Pathology -Extraction

Answer 31

COHAT -Ultrasonic scaling and polishing **<10 secs per tooth** -Can cause thermal damage to pulp -Perio tip: appropriate for subgingival scaling -Universal tip: thick, for modertae to heavy supragingival calculus removal, NOT appropriate for subgingival scaling Homecare -Daily tooth brushing #1 most effective way to prevent periodontal disease -Daily dental chew, water additives, prescription diets -Anti-plaque barrier gels (OraVet)

Answer 32

Root planning -Closed -Open -With or without perioceutic application -Tools: Gracey, Universal curettes. 5-0 Monocryl to close ALL periodontal surgeries **Run the curette along the surface of the tooth into the periodontal pocket, "hook" the granulation tissue and calculus, scrape upward along the tooth to remove debris. Bone grafting -Performed to maintain alveolar bone height Guided Tissue Regeneration (GRT) Mucogingival flap osseous countouring/recontouring

Answer 33

Bone Grafting -Osteoconductive: materials that occupy space and acts as scaffold on which new bone can grow -Osteoinductive: contains growth factors or hormones that signal host to produce new bone -Bioceramic: Osteoconductive, Flap dehiscence. Ex: CONSIL -Autologous: Osteoinductive and osteoconductive, preferred grafting material. Ex: SYNERGY, PERIOMIX -Autogenous: Grafter from patient themselves, best integration, lowest risk of rejection. Osteogenic, osteoconductive, osteoinductive. Guided Tissue Regeneration -Allows for regeneration of the periodontal tissue, rather than repair. -Requires recheck under anesthesia with dental radiographs in 6 months to monitor osseous integration

Answer 34

Antibiotic Prophylaxis -COHATs cause transient bacteremia -AVDC statement: systemically administered antibiotics are needed only for animals that are immune compromised, have underlying systemic disease (cardiac, hepatic, renal) and/or when severe oral infections are present -Per human literature: NOT NEEDED in periodontal surgery **Clavamox (Broad-spectrum, aerobic and anaerobic bacteria)** **Clindamycin (limited spectrum)** Subantimicrobial Dose Doxycycline (SDD) -Clinical PD significantly improved -2mg/kg SID for 8 weeks

Answer 35

Endodontics -The study (practice) of the basic and clinical sciences of normal DENTAL PULP -Etiology, diagnosis, prevention, and treatment of diseases and injuries of the dental pulp along with associated PERIARDICULAR conditions

Answer 36

1. Enamel 2. Dentin 3. Pulp 4. Cementum **Apical delta** Cemetoenamel junction Alveolar Bone

Answer 37

Enamel -96% hydroxyapatite -4% water and fibrous organic material -Avascular: no regenerative capability -Thickest at the crown -Thinnest at the cementoenamel junction **0.1-0.3mm CATS** **0.1-0.6mm DOGS** Dentin -Hard yellow substance covered by the enamel -29,000-52,000 dentinal tubules per mm2 of cut dentin in the maxillary canine tooth -Made up of tubules -70% inorganic hydroxyapatite -Number increases with patient size, and closer to the pulp -Primary: forms prior to tooth eruption -Secondary: forms after eruption -Tertiary: forms in response to injury, brown discoloration -Sclerotic dentin occurs when tubules are mineralized (age, trauma)

Answer 38

Pulp -Tissue contained within the root canal consisting of blood vessels, nerves, fibroblasts, collagen fibers, undifferentiated mesenchymal cells, odontoblasts, and other connective tissue cells. -Produces dentin throughout the life of the tooth. -Wide in young dogs and narrow with age Zones 1. Odontoblastic 2. Cell-free (zone of wei) 3. Cell-rich 4. Pulp core Dentin-Pulp complex -Odontoblasts: move between the pulp and the dentin -Critical for the formation of new dentin -Odontoblasts themselves do not undergo cell division -Potential for differentiation into new odontoblasts decreases with age: impacts therapeutic decision for treatment of teeth with vital pulp therapy or pulp capping procedures.

Answer 39

-Cementum formation begins at CEJ -Exposure of dentin May cause tooth sensitivity -Cervical half to 2/3 of the root is covered by acellular cementum -Apical 1/3 of the root is covered by cellular cementum (cementocytes) -Hypercementosis: cellular cementum of the root apex increases in thickness, common in cats due to occlusal stress of the tooth. -Cementum has the ability to repair itself when injured

Answer 40

Traumatic Dentoalveolar Injuries -Alveolar fracture -Enamel fracture -Concussion -Tooth fracture: uncomplicated, complicated, root fracture -Tooth avulsion -Tooth subluxation -Tooth luxation: lateral, extrusive, intrusive Developmental Diseases -Enamel defects: enamel hypoplasia, enamel hypomineralization, dentinogenesis imperfecta, amelogenesis imperfecta. Intrinsically stained teeth -Idiopathic pulpitis

Answer 41

TDI (66% Considered severe injuries with significant consequences if not treated promptly) -Halitosis -Dropping food -Reluctance to play with toys -Lethargy -Inappetence -Facial swelling -Hypersalivation -Maxillofacial trauma: 75% cases at least 1 TDI -Most TDIs are incidental findings **Second most common oral disease to periodontal disease** -Canine>premolar>incisor>molar -Most common PM4>canine>incisor>molar

Answer 42

Enamel Infarction -Incomplete fractures of the enamel -No treatment needed -Monitor q6-12 mts -Predisposed to pathology longterm Enamel Fracture -Confined to the enamel -No exposed dentin -Rare -Treatment: Odontoplasty with or without bonded restoration -Evaluate pathology, Radiographs -Trauma usually involved, can lead to necrosis of pulp -Monitor q12mts Uncomplicated Crown Fracture -Does not expose the pulp -AKA enamel-dentin fracture -Tooth surface is lost -Evaluate, radiographs to ensure pulp is not involved -Premolar teeth most commonly affected -Treatment: acute - odontoplasty with bonding, full metal crown depending on location/tooth/amount lost. Chronic - removal of tertiary dentin, odontoplasty with bonding/restoration, root canal if pulp involvement. Complicated Crown Fracture -Pulp Exposed -AKA Enamel-Dentin-Pulp fracture -TDI most common -Affects strategic teeth most commonly -Painful, necrosis of pulp and periapical periodontitis if unattended -Acute: hemorrhage of pulp -Chronic: pulp necrosis (blackened or missing) -Evaluate, radiographs -Treatment: root canal or extraction Uncomplicated root-crown fracture -No pulp exposed -Mostly PM4 maxillary -AKA "slab fracture" -Requires surgical exploration -Treatment: root canal or extraction **Root canal therapy is made more challenging by root fracture, and often requires periodontal surgery** Complicated Crown-Root Fractures -Pulp involvement/Exposed -Canine teeth most often -Frequently concurrent with alveolar bone fracture -Treatment: root canal or extraction. Requires periodontal surgery Root Fracture -Involves ONLY the ROOT -Cementum, pulp, and dentin involved -Often incidental findings -Prognosis depends on location, degree of mobility, timing of treatment -Heal by 1. Hard tissue union between fracture segments IDEALLY 2. Connective tissue attachment only 3. Localized resorption of alveolar bone and tooth. -Treatment: best <48hrs. Splinting, endodontic therapy, pulpitis. -Guarded pronosis

Answer 43

-Abscess formation -Endo-perio lesions -Pain -Infection -Tooth death -Behavioral problems: head shyness, poor performance of working dogs, aggression due to pain, food/toy aversion Endo-Perio Lesions -Class 1: Fractured crown with pulp exposure. Periodontal tissue secondarily affected by migration of bacteria through the apical foramen or lateral canal. -Class2: Wide deep periodontal pocket extending to the apex of the tooth. Bacteria can gain access to the pulp through the apical foramen or a lateral canal. -Class 3: Combined endodontic and periodontic lesion.

Answer 44

Enamel hypoplasia -Thin enamel layer -Yellowish-brown discoloration due to visible dentin Enamel hypomineralization -Spots on the enamel, brown-yellow. -Crowns are soft and wear fast -Same density as dentin seen in radiograph Dentinogenesis imperfecta -Enamel separates from dentin -Translucent or opalascent hue -Border Collies Amelogenesis imperfecta -General term for enamel formation abnormalities -Often hereditary Intrinsic staining -Results from a change of structure or composition within the hard surfaces of the tooth. -Chronic pulpitis can develop. Narrower root canal prematurely. -Radiographic evidence of pulp death: arrested tooth maturation (wider root canal), root resorption, apex resorption, changes in the trabecular bone pattern around the root apex. Diagnosis of Instrinsically Stained Teeth -Radiographs -Transillumination: lacks accuracy Treatment -Monitor radiographically -Root canal therapy (preferred) -Extraction

Answer 45

Treatment Options

Answer 46

What type of fracture? When did the trauma occur? Is the tooth vital or non-vital? Is the apex open or closed? Endodontic Treatment -Standard root canal therapy -Surgical root canal therapy -Vital Pulp therapy: Complicated crown fractures <48 hours old. -Odontoplasty and restoration -Indirect pulp capping TDIs -Acute avulsion where owner recovers tooth: place tooth in milk and replace in alveolus within 24 hours -Avulsions >24hrs: unlikely to save tooth -Subluxation/Luxation: combination of intraoral splint and root canal therapy

Answer 47

-Indicated for treatment of enamel fractures and uncomplicated crown fractures. -Additional training in restorative dentistry -Not recommended for cage chewers, high anxiety dogs, working dogs, stron chewers. -Annual monitoring and dedicated homecare

Answer 48

-Involves removal of the pulp to repair a decaying or infected tooth -Preserves function of a critical chewing tooth -Performed in referral practice: 1-Acces 2-Preparation 3-shaping and disinfecting 4. Obturation

Answer 49

-Removal of infected pulp while allowing continued growth and tooth maturation -Keep the tooth alive to allow root closure and dentinal wall thickening -Performed in referral practice -Highly successful if treated within <48 hours

Answer 50

Gingivitis: inflammation of the gingiva Mucositis: inflammation of the alveolar and buccal mucosa Alveolar mucositis: inflammation of the gingiva and mucosa overlying the cheek teeth. Caudal stomatitis: inflammation of the mucosa lateral to the palatoglossal arches -Pathognomonic for FCGS Faucitis: incorrectly refers to inflammation in the area lateral to the palatoglossal folds. Glossitis: inflammation of the tongue Palatitis: inflamation of the palate

Answer 51

-Generalized Gingivostomatitis/CCUS -Autoimmune skin diseases: Erythema multiforme, Lupus erythematosus, Pemphigus vulgaris, Mucous membrane pemphigoid. -Uremia -Eosinophilic granuloma complex -Chemical or thermal injury -Infection: Acute viral, Candidiasis, other systemic infections -Neoplasia: Epitheliotropic lymphoma, amelanotic melanoma, Others.

Answer 52

-Feline Chronic Gingivostomatitis (FCGS) -Juvenile Periodontitis: particularly cats -Canine Chronic Ulcerative Stomatitis (CCUS): "cups"

Answer 53

-Stomatatis: widespread oral inflammation that is beyond gingivitis and periodontal disease and may extend into submucosal tissues. -Multifactorial involving viruses, bacteria, individual immune response, and living conditions. -No age predilection except more common in cats <7-8 yrs old -No sex or breed predilection -Ulceroproliferative caudal mucositis can be present Symptoms, PE findings -Dysphagia and pain -Extensive inflammation and ulceration of oral soft tissues -sublingual mucositis and contact mucositis can be present -PALATOGLOSSAL ARCHES is the most consistently affected region -Hard palate, labial mucosa, sublingual mucosa are usually spared -Hypersalivation -Halitosis Diagnosis -Oral exam findings -IgG very high, hyperglobulinemia -Dysphagia (swallowing difficulty), anorexia, pain. -Vocalization at opening the mouth Medical Management -Unrewarding, only temporary improvement -Surgical treatment including full or partial mouth dental extraction is the STANDARD of CARE for FCGS -Preoperative evaluation should include workup for any concurrent comorbidities such as FIV/FeLV, heart disease, renal disease. General Practitioner -Small punch biopsy -Correct oral diagnosis: bilateral caudal stomatitis, alveolar/labial/buccal/sublingual mucositis. -CBC, chemistry panel, viral testing -COHAT -Score lesions (location, nature, extent, depth) -Refer to specialist -May take up to 6mts to resolve -Revaluation at 3-4 weeks -Consider immunomodulating treatment of a poor responder (refractory cases) Refractory Cases -Immunomodulation therapy -Glucocorticoids: PREDNISOLONE preferred. 2mg/kg BID for 30 days. Re-check response, taper once inflammation has resolved, may require small dose for the rest of their lives. -NSAIDs -Cyclosporine: alternative to glucocorticoids. Whole blood levels >300ug/ml needed, dose varies from cat to cat. Careful, monitor for liver toxicity. Vomiting common sideeffect -Adjunct pain meds: Gabapentin, Buprenorphine, Fentanyl patch. -Antimicrobial therapy: ONLY IF secondary infection, immunocompromised or worsening lesions. Most are gram-negatives and anaerobes. AMOXICILLIN-CLAVULANATE, CLINDAMYCIN, METRONIDAZOLE. -Recombinant Feline Interferon-Omega

Answer 54

-<9mts of age -Siamese, Maine Coon, DSH predisposed PE Findings -Rapid accumulation of plaque and calculus, with subsequent gingivitis -NO CAUDAL mucositis -Non-painful -Significant early bone loss, periodontal pocket formation, gum recession and furcation exposure Treatment: dental homecare: 1-TDC capsules applied to gums daily -Effective treatment and management is difficult -COHAT with extractions as indicated by radiographs

Answer 55

-Severe inflammatory condition affecting the gingiva and mucosa of the oral cavity -Alveolar, labial, buccal mucosa, palatal mucosa along the dental arches, and the lateral margins, and the lateral margins of the tongue may be affected. **Characterized by contact mucositis, contact with the surface of the teeth "kissing lesions" ** Symptoms -Depression -Anorexia -Inability to fully open mouth -Restricted yawning -Pain -Drooling -Severe halitosis -Head shy PE Findings -Severe streaking erythema on attached and unattached mucosal surfaces -Ulcerations on the labial and buccal mucosa **Maxillary soft tissue next to canines and carnassial teeth are common sites for these ulcers** -"kissing lesions" (localized vestibular contact ulcers) -Intertrigo and dermatitis of the lower lip due to drooling -Scarring of mucosal tissues at the lip comissures in chronic cases. -Prevents complete opening of the mouth Diagnosis -Based on clinical history and excluding other causes -Histopathology of lesions can support diagnosis DDX -Uremic ulcers -Ulcers secondary to leptospirosis -Mucosistis secondary to contact with irritants -Autoimmune disease, etc. Treatment Planning -Consider patient and lifestyle -Accurately identify and characterize distribution of lesions -Minimum database CBC/Chem/UA required -Workup for any concurrent comorbidities prior to anesthesia Medical Management -Unrewarding, surgical preferred -Plaque control is critical -If conservative treatment desired, start with COHAT -Medications alone are not effective at controlling disease -Multimodal pain management critical: NSAIDs + Gabapentin +/- Opioid -Strategic extraction of teeth causing contact mucositis -Repeat cleanings q6mts -Diligent homecare, daily brushing Surgical treatment -Extraction of all teeth -Required multimodal pain management -Recommended for cases with severe inflammation or owners who can't commit to COHATs q6mts

Answer 56

-Erythema multiforme (EM) -Lupus erythematosus (LE) -Discoid Lupus erythematosus -Mucocutaneous lupus erythematous -Pemphigus vulgaris (PV) -Eosinophilic Granuloma Complex in Cats -Eosinophilic Stomatitis in the dog -Wegner's Granulomatosis

Answer 57

-Uncommon -Vesiculobullous and/or ulcerative skin disease -Non-specific gingivitis and stomatitis can mimic this disease -Affected areas include intraoral and extraoral sites: ventrum of trunk, footpads, ponnae, glossitis, etc.

Answer 58

-Discoid lupus erythematosus, mucocutaneous lupus -DLE: linchenified, crusted, depigmented, and ulcerated lesions nasal planum, perioral, periocular, and pinnal leisons -SLE: acute lesions on mucosa, skin and ORGANS

Answer 59

-RARE -Middle age dogs, SEVERE -Antibodies against Desmoglein-3 at the base of the epidermis and oral mucosa -Hard palate, gingiva, dorsal tongue affected -Mucocutaneous junction affected -Oral lesions before skin lesions occur in about 50% of the cases -Characterized by fragile vesicles, patchy areas of ulceration, crusting and inflammation quickly follow when vesicles rupture and slough -Subtypes: Paraneoplastic pemphigus has been described in rare cases in dogs

Answer 60

-Oral mucosa, lip, tongue, and palate -Histopath characteristic presence of Eosinophilic infiltrates -Lesions are typically linear, well-circumscribed, raised, yellow-pink color -May be seen in the skin, paws, cheek, lip commissure, chin, pinna of the ear and oral cavity. -"POUTING" look in the cat from lesions -C/S: Dysphagia, or ptyalism, interference with swallowing **More common in 2-6 yrs old** **Higher incidence in females** Associated with -Insect bites allergies -Food allergy -Atopy -Immunosuppression -Bacterial and viral (Calicivirus) infections **Eosinophilic Ulcer, usually concave when indolent** -Granular orange-yellow color upper lip near the philtrum (rodent ulcer)

Answer 61

-Palatal lesions mostly -Less involvement of the tongue **Cavalier King Charles Spaniels** = dysphagia, paroxysmal coughing or anorexia. Mucosal ulceration, plaque formation and granulomatous lesions. Familial predisposition **Siberian Huskies** -Palatal lesions = no clinical signs -Young 1-7 yrs old -Treatment same as cats: Corticosteroids or surgical excision -May be recurrent Oral Eosinophilic Granuloma **Siberian Huskies** -Believed to be hereditary or familial -Usually on the tongue, palatal mucosal -Halitosis and oral discomfort

Answer 62

-Uncommon -Autoimmune inflammatory disorder -C5a complementary system inhibition role in pathogenesis -Multifocal, bruised, erythematous, expansible, friable gingival lesions **Grossly looks like Neoplasm** -Severe alveolar bone loss on radiographs -Presence of GRANULOMATOUS inflammation, NOT secondary to fungal or infectious -DDX: traumatic granuloma, necrotizing ulcerative stomatitis, pyogenic granuloma, neoplasia, immune-mediated conditions.

Answer 63

AKA: Rubber jaw, renal osteodystrophy, Fibrous osteodystrophy, Osteodystrophia Fibrosa -Primary hyperthyroidism functional adenoma -Secondary hyperthyroidism as a result of diet with low calcium-to-phosphorous ratio such as all meat diets. **Radiographic findings are pathognomonic of disease** -Pathophysiology: low phosphorous or low calcium:phosphorous ratio. In renal insufficiency the reabsorption of phosphate is impaired, which results in hyperphosphotemia. -Hyperphosphotemia a decreased blood calcium stimulates parathyroid gland activity -Concurrently the synthesis of 1,25-dihydroxyvitamin D in the kidney is also decreased, an intestinal calcium absorption and impaired mineralization of osteoid.

Answer 64

-RARE -Darwfism, soft coat, wide eyes, flat face, delayed skeletal growth, dull mentation (depressed, less alert) -Historically megacolon and obstipation as primary presenting complain -Treatment: Levothyroxine and Gingivectomy to allow normal dental eruption Mentation Reminder 1) Bright, Alert and Responsive (BAR)–self explanatory. This is normal mentation. 2) Depressed or obtunded–the depressed pet is dull or less responsive to normal stimuli. 3) Stuporous–this means the pet is unresponsive until a noxious or painful stimulus is applied. 4) Comatose–this means the pet remains unresponsive with even a noxious or painful stimulus.

Answer 65

-Cats more common than dogs -Cause: chronic renal desease -Oral bacteria is capable of producing URASE generate cytotoxic levels of ammonia from urea in saliva -Multifocal oral ulceration -Fibrinoid necrosis or arterioles within the oral mucosa, necrosis and ulceration by infarction -Lesions along the ventral aspect of tongue and buccal mucosa -Foul-smelling film coating the ulcerated surface -Uremic odor may be detected

Answer 66

Interpretation of Dental Radiographs

Answer 67

Orientation Mandible

Answer 68

Periodontal disease Percent attachment bone loss

Answer 69

Periodontal disease

Answer 70

Periodontal disease

Answer 71

Endodontic disease

Answer 72

Normal Lamina Dura

Answer 73

Evaluation of Lamina Dura

Answer 74

Tooth Resorption

Answer 75

Tooth Resorption types based on radiographs

Answer 76

Tooth Resorption Based on Radiographs

Answer 77

-Most often in mandibular premolars -Often begins in the roots -If it doesn't extend beyond the level of gingiva, can monitor -If extends into crown or is communication with oral cavity = extract, painful -Roots can be ankylosed (fused, immobile)

Answer 78

Pre-extraction

Answer 79

Pre-extraction radiographs

Answer 80

-Sarcoma: characterizes tumors that arise from non-epithelial tissue -En bloc: a procedure in surgical oncology aiming to remove a tumoral mass in its entirety, completely surrounded by a continuous layer of healthy tissue -Palliative: palliative treatments aim to shrink cancer, slow down its growth or control symptoms, NOT cure -Definitive: therapy aimed to minimize the long-term adverse effects of therapy and to enhance the long-term control of the cancer. Definitive intent radiation therapy generally means that small dosages of radiation are administered daily over 2-4 weeks.

Answer 81

General symptoms and PE Findings -Generally Asymptomatic in early stages -Advance stage interference with prehension and mastication Symptoms include -Dropping food -Halitosis -Reluctance to eat or drink -Reluctance to play aggressively with toys -Hypersalivation: blood-tinged saliva PE findings -Raised smooth non-pigmented gingival swelling associated with affected tooth -Pseudopocket may be present -May bleed upon palpation

Answer 82

Minimum database -CBC -Chemistry profile with electrolytes -UA with USPG if renal values are borderline -Species specific ELISA test: HWT, FIV/FeLV -Comprehensive Oral Health Assessment and Treatment (COHAT) requires anesthesia, imaging. -Cone beam radiograph for advanced diagnostics -Perform punch biopsy for for definitive diagnosis -Request pathologist familiar with oral path Treatment -Local control of disease via surgery -Aggressiveness of surgery is determined by tumor type

Answer 83

**Second most common odontogenic tumor** AKA "Epulis" -Slow growing, bening, firm, sessile (immobile, attached, no stalk) to pedunculated (stalk present), non-ulcerated lesion -Usually associated with free gingiva of tooth -NOT invasive -No predilection sex, age, breed or jaw location -Can lead to secondary periodontitis -Traumatized during mastication possible 1. Fibromatous: only soft tissue 2. Ossifying: osseous metaplasia **Create pseudopocket** Diagnostics -Radiographs: soft tissue inflammation minimal osseous tissue involment -Histopath: Base of proliferative neoplasia, FIBROUS tissue anchored to the periosteal surface of the alveolar crestal bone near the CEJ with NO PDL involvement Treatment -En bloc resection of tumor and associated tooth/teeth -More aggressive Tx for recurrent cases

Answer 84

**Most common OT in dogs** -Not seen in cats -Locally infiltrative, NOT metastatic -Commonly appear as extraosseous inflammation with or without tooth displacement and bone invasion -Arises from odontogenic epithelium in gingiva of tooth-bearing areas of JAWS -Location: rostral mandible>>mandible>maxilla **Infiltration into surrounding bone, which makes it different from Central Ameloblastoma** **Golden Retriever, Akita, Crocker, Sheltie** Radiographs -Bone infiltration -Alveolar bone resorption -Tooth displacement CT -Interosseous cystic and appeared subjectively more aggressive than extraosseous Histology -Islands and sheets of mature cells that are clearly squamous epithelium. -PALISADING cells bonded to island sheets... Treatment of choice -Current recommendations is wide excision (en bloc) with 1cm margins Excellent prognosis with wide local exc

Answer 85

-Bening, inductive tumor -6-18 mts of age -Cats and dogs -Well differentiated cells -Non-painful, expansile, MN or MX -Associated with UNERUPTED tooth -Alveolar inflammation 1. Compound odontoma -Tooth-like structures -Orderly pattern -DENTICLES on radiographs 2. Complex odontoma -Didorderly dental tissue Radiographs -Well defined tumor mass calcified material Treatment -Marginal excision or even intracapsular may be curative

Answer 86

APOT -RARE -Suspected derived from ameloblasts -Gingival enlargement -Slow growing expansile mass -Middle age to older dogs Radiographs -Unilocular to multilocular radiolucency -Cystic appearance Treatment -Surgical resection with 1 cm margin appears to be curative in most cases -Enucleation alone = high recurrence

Answer 87

FIOT -8-18 mts of age -Inductive bc epithelium induces mesenchymal cells to form aggregated foci of dental pulp-like cells -Raised, submucosal, rapidly expansive, locally destructive, soft tissue masses -Usually unilateral on rostral maxilla -Does not metastasize Treatment -Wide excision is curative

Answer 88

-Term applies to a variety of gingival masses in the cat -Combination of fibromatous, ossifying, and acanthomatous (small red raised growth) features Treatment -Surgical management recommended, but challenging -High recurrence rate -Some cases may require multiple extractions and gingivectomy

Answer 89

General symptoms -Generally asymptomatic at early stage of disease -Late stage interference with prehension and mastication -Halitosis -Dropping of food -Reluctance to eat or drink -Hypersalivation -Bleeding from the mouth -Exophthalmia Exam findings -Destruction of local anatomy -Wide-based, +/- ulcerative mass spanning multiple teeth -Sometimes involves the tongue, lips, and tonsils -Extraoral distortion and inflammation -Regional lymphadenopathy because they are -Metastatic Overview Diagnosis and Treatment -Minimum database: CBC, chemistry with electrolytes, UA with USPG, Species specific ELISA test. -Consider stagging for metastasis if malignancy is suspected = Chest x-rays, biopsy. -COHAT: requires anesthesia, requires imaging, dental radiographs standard of care. Cone beam computed tomography (CBCT) for advanced diagnostics -Perform punch biopsy or incisional biopsy during COHAT for definitive diagnosis Treatment -Local control of disease -Curative intent surgery vs. palliative intent -Consider follow-up radiation and chemotherapy pending margins

Answer 90

**Second most common oral tumor in dogs** **First most common tumor in cats** -Aggressive local infiltration, associated with papillomavirus infections, flea collars, diet, prior radiation, chronic mucosal or periodontal inflammation, tobacco smoke. -Masses are typically friable, red, and vascular -On gingiva, tonsils, oral mucosa, lip, palate, tongue, pharynx. -May present as ulceration with no evidence of a mass, loose teeth, history of extraction with subsequent tumor growth at the extraction site. Radiographs -May resemble osteomyelitis -Primary osteolytic process, MOTH-EATEN appearance, radiolucent and ill-defined borders Treatment Dog -Surgery, aggressive resection with 1 cm margins -Mandibulectomy/Maxillectomy Treatment Cat -Surgery often not possible because of the size of the tumor -No tolerance for mandibulectomy/maxillectomy Radiation (non-tonsilar) -Limiting regional spread of disease Chemotherapy -NOT recommended **Combination of radiation and surgery are associated with a better prognosis** COX-2 inhibitors: NSAIDs PEROXICAM

Answer 91

-Maybe Papillomavirus association - <2-5mts of age in dogs - Adults up to 9 yrs also can be affected -Locally aggressive, with underlying bone lysis -Responds well to surgery and orthovoltage radiotherapy combined -NO reports of METASTASIS 1. Intraosseous: within the jaw bone (cavitating pattern = deep erosion, valley-like) 2. Exophytic: mass grossly similar to benign papilloma (non-cavitating pattern) Treatment -Surgical excision with 1cm margin may be curative

Answer 92

-One of the most common oral malignancies **#1 Most common in Dogs** -Gingiva, labial mucosa, palate, buccal mucosa, tongue. -Typically firm, grayish or brownish black, can also lack pigment -Ulcerative, friable, readily bleeds -Fast growing -NECROSIS common feature -Gingival tumors have the worst prognosis Treatment -Surgical resection for locoregional control -1 cm margins may be curative -May follow up with radiation -METASTATIC high rate to lymphnodes and lungs -Vaccine questionable efficacy Prognosis -Highly dependent on size at time of surgery -Variable

Answer 93

**3rd most common malignant tumor in the DOG** **2nd most common malignant tumor in the CAT** -More common in large breed dogs -Average age 8 yrs old -Lesions in gingiva, hard palate, labial mucosa, soft palate, tongue. -Tends to present in broad-based, firm swelling. Radiographs -Infiltrative: challenging to discern full extent of tumor even with advanced imaging Treatment -Aggressive surgery **2cm margins** -Post surgical radiation combined, best outcome -High level of local recurrence with surgery alone

Answer 94

-Appears benign histiologically but behaves like an aggressive malignant neoplasma **Golden retrievers predisposed** -3-13 yrs old Treatment -Low-grade histo but high grade biologically must be aggressive, 1-2 cm surgical margins -72% cases with bone lysis -12% Lymph node metastasis

Answer 95

-Often present as soft tissue mass -Red, friable, surrounding bone lysis rather than hard tissue proliferation -OSA - more common in appendicular than axial skeleton -Maxilla and mandible commonly affected sites Treatment -Surgery: median survival 9mts -28% local recurrence in dogs -Chemo NOT useful -Radiation therapy may be helpful Cats -Poor prognosis as surgical options are limited

Answer 96

-Young dogs -Multiple verrucous lesions on the tongue, lip, and cheeks. -"SEA ANEMONE" appearance Treatment -Most regress on their own -Cleated by immune system -Refractory cases: concurrently immunocompromised -Vaccine may be helpful

Answer 97

-Can occur in dogs or cats -Well circumscribed, firm raised boney lesions -Located in hard palate, zygomatic arch, caudal mandible Histiopath -May not show neoplasia characteristics -May show normal woven bone Treatment -Surgery -Maxillectomy, mandibulectomy, debulking all resulted in > 1 yr survival

Answer 98

-RARE -Well circumscribed red mass often <1 cm -Biologically more aggressive than cutaneous counterparts -May undergo local invasion to underlying bone Treatment -Surgical margins 1 cm have been curative

Answer 99

Review Anatomy One root -Incisors (01-03) -Canine (04) 104, 204 -PM1 (05) -M3 (11) mandible Two Roots -PM2 (06), PM3 (07), PM 4 (08), M1 (09), M2 (10) Mandible -PM2 (06), PM3 (07) Maxilla Three Roots -PM4 (08), M1 (09), M2 (10) Maxilla Cats -PM2 (06), PM3 (07), M1 (09) Maxilla - Two Roots -PM4 (08) Maxilla - Three Roots

Answer 100

-Simple extraction: not requiring a gingival incision or sectioning the tooth. AKA Closed, uncomplicated, or nonsurgical extraction -Surgical extraction: requiring a gingival incision, bone removal, and/or sectioning of the tooth. AKA open or complicated extraction -Elevation: The process by which the periodontal ligament is PDL FATIGUED or TORN and alveolar bone is expanded to facilitate removal of the tooth from alveolus. Using ELEVATOR as a lever, the tooth is lifted (elevated) from its alveolus. -Luxation: the process by which the PDL is CUT or severed to loosen teeth from the surrounding alveolar bone

Answer 101

Indications -Severe periodontitis -Pulp necrosis -Tooth resorption -Stomatitis -Fractures teeth: adult or deciduous -Traumatic malocclusion -Crowding -Unerupted teeth -Unhealthy teeth in jaw fracture line -Failed endodontic treatment Contraindications -Ethics: disarming procedures -Severe systemic disease: congestive heart failure, uremia, uncontrolled endocrine disease, severe coagulopathies, untreated leukemia/lymphoma -Previous radiation therapy: leads to osteonecrosis, poor wound healing.

Answer 102

Fundamental steps for successful extraction 1. Adequate visualization: of the tooth to be extracted 2. Unimpeded pathway for the removal of the tooth 3. Use of controlled force to luxate or elevate and remove the tooth

Answer 103

A. Minnesota lip retractor B. Feline lip retractor C. Miller bone curette D. Periosteal elevator E. Straight and winged elevators F. Small breed extraction forceps G. Needle holders H. Iris scissors I. Thumb forceps J. Scalpel blade handle -High speed hand piece: used to modified pen grasps, resting figure on patient -Burs: Round burs, taper fissure crosscut burs, Diamond burs. -#15 or 15C scalpel blade -Root tip pick -Root tip extraction forceps (small tips) -Miller bone curette for debriding granulation tissue, bone fragments, debris in alveolus -Suture: 4-0 or 5-0 Monocryl, reverse cutting or tapered needle

Answer 104

Elevators = Levers -Transmit a modest force into a small movement against great resistance. Mechanical advantage -Rotation of elevator in PDL space utilizes the surrounding alveolar bone as a fulcrum **Elevator is never placed or used adjacent to teeth that will not be extracted** Luxator = Wedges -Wedged into PDL space and pressure is directed apically -Made of softer metal and can't be used as a lever

Answer 105

Twist once and pull down and out in a continuous movement

Answer 106

High-speed hand piece

Answer 107

Different Burs

Answer 108

-Good exposure: sufficient size -Preserve blood supply: wide base compares to free margin -Prevent dehiscence/delayed healing: edges of flap must lie over intact bone -Non-tension closure: make vertical releasing incisions at line angles of adjacent teeth vs. parallel to allow for large non-tension flap

Answer 109

A. Insert at 90 degree angle B. Rotated to easily pass through tissue

Answer 110

-Intraoral radiographs PRIOR to any tooth extraction REQUIRED -Post-extraction intraoral dental radiographs REQUIRED

Answer 111

-Attempts should be made to remove retained tooth root fragments -Leaving fragments <4mm may be considered if patient is at high risk, unstable under anesthesia, or damaging surrounding structures. - >4mm poor practice -Exception end-stage resorption -If root tips are left for intentional resorption oral exam and x-ray follow up REQUIRED to track changes Post-operative care -Multimodal pain control: locoregional nerve blocks (perioperatively), NSAIDs, Gabapentin, Opioid +/- -Homecare: soft food 5-7 days, avoid chewing on toys and treats for 7-10 days. Wait 3-4 days to resume brushing and avoid extraction area -Ice packs can help with subcutaneous emphysema from high speed hand piece -Oral rinses chlorhexidine q12hrs after meals -Monitor for signs of halitosis, inappetence, lethargy -Post-op check 2 weeks later -Antibiotics typically NOT needed

Answer 112

Preparation -Remove calculus and rinse mouth with 0.05%-0.012% chorhexidine gluconate -Elevation technique 1. First class lever: between tooth and alveolar bone, which acts as a fulcrum (pivot point) to release the tooth 2. Wedge lever: elevator placed perpendicular to the long axis of the root and rotated so the force is directed outward from the alveolus 3. Luxator technique -Not intended for rotational forces -Always place it parallel to the root surface -Placed into the PDL space and advanced apically -Best place is along the mesial and distal surfaces of the tooth (not labial or lingual) Forceps: once loosened, place on the root as apically as possible and with the beaks parallel to the long axis, place rotational force.

Answer 113

-Requires gingival incision, bone removal, and or sectioning of the tooth -Technically can apply to any tooth -Commonly PM4 maxilla -M1 mandibular -Canine teeth -Others not affected by advanced stage periodontal disease PM4 Maxillary Indications: fracture, periodontal disease, non-vital tooth -15 blade, create incision for mucoperiosteal flap -Using periosteal elevator, elevate gingiva and mucosa off tooth and alveolar bone -Using either a diamond bur or 2-, or 4-, round bur, remove alveolar bone to expose the mesial and distal roots. Typically recommended to remove coronal 2/3 of alveolar bone -Using cutting but (701, 701L) section the tooth into 3 positions along root segments. -Using elevation technique of choice, remove each root individually. Remove distal, then mesial-buccal, then messial-palatal -Using a diamond bur (smoothing bur) remove sharp edges of alveolar bone (Alveoloplasty) -Using iris scissors perform a periosteal releasing incision on mucogingival flap to ensure tension-free closure -Suture the flap closed in simple interrupted suture pattern using 4-0 MONOCRYL in dogs and 5-0 MONOCRYL in cats.

Answer 114

Indications: fracture, periodontal disease, non-vital tooth **Watch out for mandibular canal, periodontal risk for jaw fracture M1** -15 blade, create incision for mucoperiosteal flap -Using periosteal elevator, elevate gingiva and mucosa off tooth and alveolar bone -Elevate lingual mucosa as well as either before or after extraction for tension-free closure -Using either a diamond bur or 2-, or 4-, round bur, remove alveolar bone to expose the mesial and distal roots. Typically recommended to remove coronal 1/2 of alveolar bone -Using cutting but (701, 701L) section the tooth into 2 positions along root segments. -Using elevation technique of choice, remove each root individually. Remove distal, then mesial-buccal, then messial-palatal -Using a diamond bur (smoothing bur) remove sharp edges of alveolar bone (Alveoloplasty) -Using iris scissors perform a periosteal releasing incision on mucogingival flap to ensure tension-free closure -Suture the flap closed in simple interrupted suture pattern using 4-0 MONOCRYL in dogs and 5-0 MONOCRYL in cats.

Answer 115

Indications: Fracture, periodontal disease, non-vital tooth **Watch out for penetration into the nasal cavity** -15 blade, create incision for mucoperiosteal flap -Using periosteal elevator, elevate gingiva and mucosa off tooth and alveolar bone -Using either a diamond bur or 2-, or 4-, round bur, remove alveolar bone to expose the mesial and distal roots. Typically recommended to remove coronal 1/2 of alveolar bone -Careful accidental iatrogenic ONF formation -Using elevation technique of choice, remove the tooth. -Can use butting bur (701, 701L) to "notch" either side of the alveolus (socket) at the level of the CEJ to create space to place your elevator or luxator -Using a diamond bur (smoothing bur) remove sharp edges of alveolar bone (Alveoloplasty) -Using iris scissors perform a periosteal releasing incision on mucogingival flap to ensure tension-free closure -Suture the flap closed in simple interrupted suture pattern using 4-0 MONOCRYL in dogs and 5-0 MONOCRYL in cats.

Answer 116

Indications: Fracture, periodontal disease, non-vital tooth **Watch out for mandibular canal, potential risk for mandibular fracture** **Never remove bone on the lingual aspect of the tooth = JAW FRACTURE** -15 blade, create incision for mucoperiosteal flap -Using periosteal elevator, elevate gingiva and mucosa off tooth and alveolar bone -Using either a diamond bur or 2-, or 4-, round bur, remove alveolar bone to expose the mesial and distal roots. Typically recommended to remove coronal 1/2 of alveolar bone -Using elevation technique of choice, remove the tooth. -Can use butting bur (701, 701L) to "notch" either side of the alveolus (socket) at the level of the CEJ to create space to place your elevator or luxator -Using a diamond bur (smoothing bur) remove sharp edges of alveolar bone (Alveoloplasty) -Using iris scissors perform a periosteal releasing incision on mucogingival flap to ensure tension-free closure -Suture the flap closed in simple interrupted suture pattern using 4-0 MONOCRYL in dogs and 5-0 MONOCRYL in cats.

Exam 1 Flashcards

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