exam 3 - equine dentistry Flashcards
why is dental care important for the modern horse?
- modified diets - designed to eat grass and but are fed hay and grain often times
- intermittent feeding - designed to eat small amounts, continually, but are fed 2-3x per day
- inc performance demands
- inc owner expectations
- general well being
t/f
young horses do not need dental care typically - it is more important for older horses only
false
ALL horses - different ages have different needs - but they all need dental care
what are some signs that a horse might be having dental problems / dz?
- dropping feed
- difficulty chewing
- weight loss
- bit problems
- poor performance
- foul odor
- nasal discharge / facial swelling
- lameness
t/f
if a geriatric horse is experiencing weight loss, the first differential on your list should be dental issues
false
MC geriatric horses experience weight loss to other issues
may be dental issue but this is not necessarily at the top of your list based on geriatric signalment
what are parts of a complete oral exam?
SYSTEMATIC EVALUATION
- Hx and PE
- observe horse in its environment
- assess physical condition
- assess feed and water source/s
what to evaluate on horse, specifically targeted at oral exam?
external evaluation occlusion [incisors and cheek teeth] periodontal dz endodontic components oral soft tissues
what to look for in the external appearance of the animal for an oral exam:
- head
- symmetry of Mm
- temporo mandibular joint (TMJ)
at what age should all incisors be “in wear” ?
by age 5
what to evaluate when looking at incisors:
- “in wear”?
- occlusion
- periodontal dz
- endodontic dz
- soft tissues
- excursion
t/f
a thorough oral exam can be carried out without the use of sedation and analgesia
false
sedation and analgesia allow for more thorough exam, less stressful for horse and less dangerous for human
what classes of drugs are often used for sedation during an oral exam?
alpha 2 agonists
butorphanol
+/- NSAIDs
combinations
what a 2 agonists are often used during sedation for an oral exam?
xylazine
detomidine
romifidine
what type of drug is butorphanol?
opiate partial agonist
controlled substance
t/f
light sedation is sufficient to conduct an oral exam
false
deeper sedation is better - ensure they feel no pain and do not struggle / potentially injure you
down sides to using Butorphanol for sedation:
- paperwork b/c it is a controlled substance
- do NOT use alone or it may cause hyperexcitability
how does detomidine compare with xylazine ?
detomidine lasts longer and causes a slightly deeper sedation
what simple tool is necessary for a well rounded dental / oral exam?
dental speculum
advantages to a full mouth speculum:
- visualizations
- digital palpation
- manipulations - floating, extracting teeth
disadvantages to a full mouth speculum:
- large and heavy
- can be a weapon when in the horse’s mouth if the horse is NOT cooperative
- adequate sedation is necessary
what does a speculum examination allow you to do?
- visualize
- feel for sharp points
- hooks
- loose or fractured teeth
- show owner [prove your worth]
what is a dental halter?
how might it be beneficial?
- provides a safe and effective way to support the horse’s head
- saves your back and your technicians
what should you rinse the mouth with before examination?
why?
- chlorhexidine rinse
- antiseptic and allows for better visualization
- evaluate sedation status of animal - if they allow you to rinse, they are probably sedated well enough for the exam
what is meant by the term “balancing the mouth” ?
- decrease abnormal force on teeth
what aspects of the teeth are floated while balancing the mouth?
- the buccal aspect of maxillary teeth
- the lingual aspect of mandibular teeth
- reduce tall teeth
- reduce hooks
- bit seat
- address sharp canines
t/f
when balancing the mouth or floating, it is important to wear down the occlusal surface of each tooth
false
do NOT get into the occlusal surface - just float the sharp points
t/f
hand floats are an equivalent alternative to power equipment used for floating
false
kind of a matter of opinion - but she does NOT like hand floats b/c they are hard on you and the horse - she only recommends using power float tools
when should a horse have its first dental exam?
during the “new foal” exam
what are common congenital abnormalities to look for during a first foal exam?
- wry nose
- cleft palate
- significant malocclusion
t/f
all congenital abnormalities should be corrected ASAP
false
controversial topic - we want the horse to be comfortable BUT many people will go on to breed the horse after the abnormality is fixed, passing on the poor genes [unethical]
if you don’t fix it, they are much less likely to breed it
age a horse should be floated for first time?
1 year
enamel points tend to be very sharp in young animals
also, wolf teeth can be addressed at this time
what is a common age many people start having their horse’s teeth floated?
why?
1.5 - 3 years
b/c all 24 deciduous teeth are shed at this time
also many horses will get “eruption cyst” - bony irregularity of mandible - periosteal rxn b/c roots of teeth go deep
how many permanent teeth do horses have?
36-44
what are “caps” ?
how are they dealt with?
retained deciduous incisors
carefully pop it off the top of the permanent tooth - easy to do - but do NOT be too rough or you risk damaging the pulp of the underlying permanent tooth
a “normal” adult horse has a full set of permanent teeth by what age?
5-6 yrs
a “normal healthy adult should have an oral exam how often?
annual
balance mouth - reduce abnormal forces
geriatric horses may develop special needs - such as….
more frequent exams
- look for loose or damaged teeth
- address nutritional needs [often need complete feed]
- ensure comfort
what is quidding?
when a horse balls up feed in its cheeks
often geriatric horses do it
what are some common abnormalities seen during dental exams?
- wave mouth
- prominent transverse ridges
- loose teeth
- fracture teeth
- hooks
what teeth MC develop hooks?
106/206 [maxillary]
311/411 [mandubilar]
what is periodontal dz?
inflammation of the supporting structures of teeth - gingiva, periodontal ligg, cementum, alveolar bone
t/f
periodontal dz is a 1* dz process
false
it occurs 2* to another issue
____% of horses over the age of ___ years have periodontal dz
60%
15 years
what % of 3-5 year olds have periodontal dz?
what is it MC d/t?
40%
d/t abnormalities of eruption
___ % of 5-10 year olds have periodontal dz
20%
when should periodontal dz be treated?
- to balance the mouth
- extreme discomfort
- weight loss
- tooth root infection
- tooth loss
what is the main goal when balancing the mouth?
taking pressure off areas in the mouth
what specific treatments are used when treating periodontal dz?
- clean pockets
- anti bacterial packing
- balance the mouh
- extraction if severe
what are indications for an extraction?
- fractured/fragmented teeth
- tooth root abscess
- severe periodontal dz
- EOTRH: equine odontoclastic tooth resorption and hypercementosis
- trauma
- impaction
what is EOTRH?
what teeth does it affect?
what age horse?
Equine Odontoclastic tooth resorption and hypercementosis
incisors and canines
geriatric
t/f
extractions are simple procedures that can be done under minimal sedation
false
extractions are technically demanding and time consuming procedures - require specialized equipment and PATIENCE
they can be done standing or under general anesthesia
complications are not uncommon
what types of patients require general anesthesia for extractions?
young horses
complicated cases
what type of restraint is used during extractions?
physical and chemical methods
- stocks
- Detomidine and Butorphanol combination
- single injection
- CRI
what types of nerve blocks are used during extractions?
maxillary N
infraorbital N
mandibular N
what are landmarks for a maxillary nerve block?
what regions does it desensitize?
pterygopalatine fossa
desensitizes: dental structures of maxilla and premaxilla, paranasal sinuses, nasal cavity
what canal does the pterygopalatine fossa take you into?
the infraorbital canal
a maxillary nerve block requires caution b/c which nerve is nearby?
optic N
what complications may occur with a maxillary nerve block?
infection, meningitis
retrobulbar hematoma [of the maxillary A]
what type of needle is used during a maxillary nerve block?
Tuey spinal needle - it is beveled
what region does the infraorbital nerve block desensitize within the canal AND rostral to the canal?
within the canal: premolars, alveoli and gingiva
rostral to the canal: skin of the lip, nostril and face
similar effect to maxillary N block
what procedure is the infraorbital N block used for?
incisor extractions
is there less resistance from the horse when doing a maxillary N block or an infraorbital nerve block?
horses prefer maxillary N block
they do NOT like the infraorbital N block so be very careful with this one…
what regions does the mandibular nerve block desensitize?
mandible and all of its dental structures
what is the landmark and injection site for the mandibular nerve block?
mandibular foramen
loc in the medial ramus
what nerve is nearby during a mandibular nerve block?
what might occur if you hit this structure?
the hypoglossal nerve
horse will lose sensitization and may chew on their tongue, causing self trauma
sterility is important during the madibular nerve block b/c what is a risk?
cellulitis
where is the mental nerve block?
where the mandibular alveolar N emerges from the mental foramen as the mental N
what region does the mental nerve block desensitize?
canine incisor rostral cheek teeth alveoli gingiva
rostral skin of lips and chin
what is the common appearance of an impaction?
what type of anesthesia is required and what type of surgical technique to remove it?
lumpy face
general anesthesia and a sinus flap
what do the bones/teeth look like in cases of EOTRH?
moth eaten appearance of incisor teeth and canines
what are endodontics?
structures w/in the tooth - dental caries that are drilled and filled
often occur with geriatric horses
what causes caries?
fissues and fractures
trauma (MC)
periodontal dz
t/f
caries are repaired very easily
false
technically difficult b/c access is limited
specialized equipment is required
indications for dental/oral x rays?
- nasal discharge
- draining tracts
- abnormal chewing
- reluctance to eat
- loose or fractured tooth
- skull fractures
what technique is used for incisor and canine x rays?
intra oral and lateral
low exposure
patient MUST be sedated
plate loc as far Cd as possible in mouth of animal
beam is 60-80* from dorsal plane
center on Triadan 01s, right btwn nostrils
t/f
lateral x rays are very helpful for tooth root abscesses
why or why not?
false
teeth and roots are super imposed on each other so you cannot see them clearly
lateral better for sinus views
what angle of x ray is best to see tooth root abscesses?
maxillary / mandibular oblique views
when shooting x rays, the plate is loc on the side you want to view or opposite the side you want to view?
plate loc on the side you want to view
where are dorsoventral projection x rays shot from?
above the horse’s head - centered rostral to the eyes - in btwn the eyes and the nostrils - and in the center of the face
what type of x ray angle / technique is best to view the clinical crown?
open mouth
what structures can be viewed well with open mouth x rays?
- erupted crowns
- alveolar crest
- diastema
- crown fractures
- abnormalities of wear
- dental fragments
what x ray view is very useful after extractions to visualize dental fragments?
open mouth views
what is the main benefit to intra oral technique?
what challenge does it pose?
excellent quality images
BUT are harder to acquire
benefits of CT?
cross section detail - no superimposition
good bone / soft tissue contrast
CT used to Dx what?
- fractures
- dental dz
- infection
- neoplasia
when using power equipment, what are 2 side effects you must be careful NOT to cause?
thermal damage to teeth
open pulp chamber
