export_jvd oral med papers Flashcards
Hale Dental Caries in Dogs
JVD June 1998
435 dogs
What was the number of dogs with Caries and where were the caries
23 dogs 5.3%
47 caries
19 (40%) Pit Fissure
17 ( 36%)Smooth surface
11(23%) Root caries
How many dogs had symmetrical lesions and what teeth were most affected
12 dogs
Fourth premolar and first and second molar teeth
Caries definition
action of microorganismon carbohydrates causing decalcification of the inorganic portions of the tooth and accompanied by the disentigration of the organic portion Latin term for “Rottness”
What stain is specific for identifying areas of carious dentin from healthy dentin
Rhodamin B
What oral substance provides minerals and antibacterial properties to protect against caries forming?
Patient’s Saliva
Which portion of the tooth is lost first in caries?
Inorganic portion first
5 Reasons dogs have a low prevalence of caries?
- little to no salivary amylase to break down starch retained in the mouth
- higher salivary pH
- diet low in fermentable carbohydrates
- conical shape of most teeth
- Lower number of cariogenic bacteria in the normal oral flora
3 Factors of Dental Caries
- Susceptible Tooth Surface
- Cariogenic Bacteria
- Dietary fermentable carbohydrates (sucrose)
WHEN ALL THREE PRESENT HIGH RISK OF CARIES
3 acids produced from carbohydrates fermented by bacteria in the mouth
Lactic, acetic, Propionic
In humans the 2 predominate bacteria associated with caries
Strep Mutans
S. Sanguis
Acids initially dissolve what from the enamel ______ causing cavitation in the ______
- Surface Hydroxyappetitie crystals
2. Planes of Retzius
Once demineralization occurs what is the progression of caries
- Hydroyappetite dissolved micro caviatations plane of Retzius
- Coalescence of the micro cavitation
- Undermining of the overlying enamel and collapse
- Then digestion by bacteria of the protein organic matrix by enzymes
How are carious lesions reversible and when is it irreversible
By remineralization mostly by minerals in the oral fluids
Irreversible when the overlying enamel and protein matrix has collapsed
Caries can be classified in three stages
- Acute
- chronic
- arrested
GV Black’s Classification of dental caries and restorations
Class 1 - Pits and fissures of Anterior and Posterior teeth
Class 2- Proximal surface of posterior teeth
Class 3 - Proximal surface of anterior teeth not involving the incisal edge
Class 4 - Proximal surface of anterior teeth involving the incisal edge
Class 5 - Cervical 1/3 of the F and L surface
Class 6 - Incisal edge of anterior teeth or cusp tips of posterior teeth
Smooth surface caries need what to start
Plague they cause a cone shaped lesion in the enamel followed by another cone shaped lesion when the penetrate the dentin. or a stacked up pattern of 2 snow cones
Pit and fissure caries need plaque to form Tor F
False it the impaction of food into the pits and fissures
What is an important feature of dentin that leads to expansion of the caries 2 things
- Spread through the tubules
2. Protein matrix provides nutritional support to the bacteria
In humans factors that increase caries formation
- Xerostomia
- decreased brushing
- hormonal imbalance
- Chronic dehydration or dry mouth
all particularly increase risk of cervical caries
What type of caries are more likely treated by extraction
Root
The single most common site for caries in the dog in this paper was?
Maxillary first molar
Dentigerous Cyst in a dog
JVD 16 1999
Sitzman
2 year old springer spaniel neutered male
Unerupted Left canine tooth.
Dentigerous cysts are
subclassification of odontogenic cysts
1. Eruption cysts
- follicular cysts (Dentigerous cysts are follicular )
Proliferative Gingival lesion in a Cat with Disseminated Cryptococcosis
Odom and Anderson
JVD 17 Dec 2000
case of disseminated cryptococcus in 11 year-old Siamese Cat
What was the initial complaints
- chronic non productive cough
- Left ante brachial cutaneous mass
- Proliferative gingival mass @ 404
What is the most common fungal disease in cats?
Route of infection?
What percent of cats have cutaneous lesions?
Cryptococcus
Inhalation
30-50% have cutaneous forms
What is seen in the nasal passages of some cats with Cryptococcus
Polyps that may protrude from the nostril, sneezing, and discharge
What should be tested for in these cats
FELV/FIV
Cryptococcus Titer
In Tx montior hepatic function and renal function
What other fungal disease can cause oral granulomatous lesions
Blastomyces dermatididus
Candidiasis can cause oral lesions when especially?
Immunocompromised patients or long term antibiotics
what test is used for Cryptococcus
CALA=
Cryptococcal Antigen Latex Agglutination - evaluated serum or CSF
What stain is used for cryptococcus
Romanowsky type stains
Organism stains pink to bluish purple with a clear capsule
How long is treatment for cryptococcus
Long, median treatment is 8.5 months. Base treatment on serum titers, oral fluconazole
Metaplasia
When a mature epithelium changes to a different form of mature epithelium.
osseous metaplasia
- in response to trauma
- involves mesenchymal tissue
- bone forms within collagen
3 drugs that can cause gingival hyperplasia
- Phenytoin
- Cyclosporine
- Ca channel blockers
3 types of gingival hyperplasia
- Inflammatory
- Non-inflammatory or Fibrous
- Combination of inflammatory and fibrous
What are the grades of mast cell tumors?
Grade 1 - well diferentiated, stay within dermis, low metastatic potential (<10-25%)
Grade 2 - moderately differentiated, invade into surrounding tissues, moderately low metastatic rate (15-40%)
Grade 3 - poorly differentiated, invade tissues, (50-95%); special stains may be needed to identify intracytoplasmic granules in these MCTs
(Nerdbook)
What grade was the mast cell tumor in this dogs
Grade 2
What were the biopsy results of the the three masses biopsied in this dog
- Inflammatory and fibrous
- Fibroumatous epulis
- Grade 2 mast cell tumor
Dental and Craniofacial finding in 8 miniature schnauzer dogs affected by Myotonia Congenita
Gracis, keith,Vite
JVD 17 2000
Minature schnauzers appear to have this disease due to an autosomal recessive mode of inheritance
It is associated with a defective chloride ion conductance across the skeletal muscle membrane
Signs of Myotonia Congenita
delay of skeletal muscle relaxation after the cessation of electrical, mechanical stimulation, or voluntary activity
Craniofacial signs related to Mytonia Congenita
- delayed eruption of deciduous and permanent teeth
- Persistent decidous teeth
- unerupted or partially erupted permanent teeth
- Crowding of teeth decreased space k-9-I3
- Flatten zygomatic arches, malocclusion increase in mandibular body curvature and disto-occlusion of mandible
Skeletal signs of Mytonia Congenita
- Dimpled tongue
- Muscle stiffness that decreases with exercise Bunny hopping gait
- Postural reactions, segmental reflexes, sensation, and cranial nerves are normal
- Skeletal muscle Hypertrophy is severe!!!!!!!!
What is the electromyographic findings
Waxing or waning sound or classic Dive bomber sound
What drugs are used to treat Myotonia Congenita
Antiarrhythmic agents
Procamide, mexilitene
How many dogs were evaluated with MC and how many without
8 with
45 without
Why did the propose the zygomatic arches were flattened and the mandibular bodies had a greater curvature?
Constant muscle activity and the insertion points
Eruption schedule in dogs deciduous teeth
Canines
Incisors
Premolars
Canine first
I3,I2,I1
PM3,PM4,Pm2
Maxillary generally first
Eruption of teeth in dog by age
D-I 3-4w P-I3-5M
D-C 3w P-C 4-6M
D-PM4-12w P-PM4-6 M
P-M 5-7 M
Odontoclastic resorptive lesions of a RmanM1 in a cougar
Mendoza Mangra Klippert
JVD 17 2000
2 year-old neutered male cougar
FRL was first described by
Hopewell-smith in 1920’s
The incidence in north american zoos is higher than that of european zoos what was the percentage in European zoos that was stated in this paper
<2% thought to be due to a more natural diet
Which tooth was affected in this paper in the cougar
409
What were the premed for sedation in the cougar
Ketamine
Medetomidine
What was absent from the Histo report that was surprising
Osteoclasts and odontoclasts thought to cause initial resorption of cementum,dentin and bone. Proposed that this was due to chronic nature and after granulation tissue is present these cell types are no longer a factor
Scanning EM description of cellular activity and mineral changes in FRL Lesions
Gauthier, Boudigues,Aguado etc
JVD 18 2001
10 teeth from 10 different cats
What were the teeth preserved in
4% Glutaraldehyde for 2 hours at 4C
What was placed on the teeth to allow imaging with SEM
Gold- Palladium
Teeth for mineral composition testing with electron micropore analysis were fixed in what?
10% Formol solution and were carbon coated
Where were resorptive cells not seen?
Enamel surface
What minerals were found to be higher in FRL lesions in the dentin and what happened to the Ca/P ratio
Was enamel changed?
Increased levels of Mg,P and Na and lower Ca/P ratio
Enamel was normal composition
How were the odontoclasts thought to move on the dentin
Filopodia and microvilli on the cell membranes
They proposed that the darker dentin was what
Poorly mineralized tissue and not a reparative bone/cementum like tissue, (resorptive lesions)
This study supports the theory of what for FRL lesions
Confirmed a cellular etiology for FRL of a odontoclastic like cell which progressively destroyed dentin and caused changes in the mineral makeup of dentin further allowing dissolution and facilitating elimination
Describe the embryologic development of the infundibulum
cone-shaped invagination from the occlusal surface of the tooth.
What provides the necessary means for caries within an infundibulum
Voids in the deposition of cementum allowing food to impact
The rate of decay is balanced by what?
Eruption and attrition of the equine tooth
Complications of progressive tooth decay
sagittal fracture, pulp exposure, and periodontal disease
In the author experience what material was suitable for restoration of infundibular caries
hybrid composite resin in 2mm layers
Gingival Hemangiosarcoma in a dog
JVD 2002
Spelling is wrong in the paper
10 year-old spayed female Golden R
Gingival swelling 104-105
What teeth were extracted and what were the surgical margins in this case?
104 and 105 with 0.5 cm margins because the thought it was an epulis
what was different about this lesion and the response to the teeth than epulis like lesions
Resorptive like lesions of the tooth crown, CEJ, and root
Was there reoccurrence at 1year clinically
No although radiographs were not obtained
Which LN receive afferent lymphatics from the head and neck?
- mandibular
- parotid
- medial retropharyngeal
which of the 3 nodes receives efferent lymph from the other 2 nodes
Medial retropharyngeal recieves efferent lymphatics from the mandibular and the parotid
what was suggested as the best way to evaluate and determine lymph node involvement
Open surgical biopsy
Where is the parotid LN found?
How many nodes in lymphocentrum?
- along rostral edge of parotid salivary gland
- 1-3 at a level paralleling the ventral border of the zygomatic arch
Medial retropharyngeal node is what shape
Elongated and overlying the thyropharyngeus muscle
How many nodes does the mandibular lymphocentrum have?
Where are they located?
1- 5
- between tributaries of the jugular vein and the division of the linguofacial vein into the lingual and facial veins
Recurrent Ossifying Epulis in a dog
Woodward
JVD 19 (2) June 2002
7 YO MN Siberian Husky LmaxPM1,PM2
The oral cavity is the ___ most common site for neoplasia,
accounting for___ % of all malignant neoplasms
- 4th
- 5%
The epulides are the most common oral neoplasms accounting for what % of all oral neoplasms
List the 3 types
30%
1.Fibromatous
- ossifying
- Acanthomatous
What origin are epulides
Periodontal ligament and are benign
Typical % solution of oral chlorhexidine
0.12%
Are epulides sensitive to radiation treatment
Yes but is generally not done due to cost and side effects
Neoplasms are surrounded by 3 layers what are they
- Pseudocapsule
- reactive zone
- Normal tissue
- what are 4 types of oncological surgical dissection?
- intracapsular (within pseudo capsule)
- marginal (removal within reactive zone)
- wide excision (removal with margin of normal tissue)
- 4. radical - removal of supporting tissue compartment (e.g. entire margin) e.g.. a whole mandible
- wide excision (removal with margin of normal tissue)
What types of excision is required for each type of epulis
Fibromatous= Mariginal or in the reactive zone Ossifying = Wide or more aggressive than fibromatous
CAA is wide or radical
What are factors in treatment planning for a tumor
- Tumor type
- biologic behavior
- clinical appearance
- location of the tumor
How much tissue should be included in the sutures and how far apart should the sutures be?
2-3mm of tissue
2-3 mm apart
How long was bupivacaine in the infraorbital nerve block expected to last?
3-6 hours
Ameloblastic Fibro-odontoma in a G shepherd dog
Boyd JVD 19(3) SEP 2002
8 month old male GS right mandible mass at 403-408, 404 missing
Polyglactin 910
Vicryl Absorbable braided multifilament 75% at 2wks 50% 3 weeks Absorption 56-70d
Suture used in this case
https://s3.amazonaws.com/classconnection/199/flashcards/1405199/jpg/ameloblastic_fibro-odontoma_jvd2002_19(3)-14BB2C385172F882D25.jpg
Extra oral radiographic view of the rostral mandible showing radiolucent expansile lesion, impacted canine
What was the first diagnosis that carried a fair to guarded prognosis
ameloblastic odontoma
What was the final diagnosis by a second pathologist
ameloblastic fibro-odontoma
What is the description of ameloblastic fibro- odontoma
A benign mixed odontogenic neoplasm composed of odontogenic epithelium embedded in cellular mesodermal tissue and is capable of elaborating dentin and enamel than may appear as tooth structure
Where have ameloblastic Fibro odontomas been reported in dogs?
both mandible and maxilla more common in humans in the mandibles of teenagers
What is the difference between ameloblastic fibroma and ameloblastic fibro-odontoma
Odontoma has tooth material
What is the difference radiographically between Ameloblastic Fibro odontomas and odontomas
AFO has a wider area of radiolucency around the mass and less dense tooth structure
Oral SCC in in a pregnant mare
Faragalla
JVD 19(2) June2002
17 YO mare pregnant right mandible mass at 406-408 and draining tract
What was given to reduce hemorrhage during the extraction procedure
20 ml amincaproic acid
Erupted Bilateral compound odontomas in a dog
Eickhoff, Seeliger,Simon, Fehr
JVD 19(3) Sep2002
6 month old black russian terrier Male
R and L mandM1-M2
tissue of origin of odontomas
odontogenic epithelium
Compound odontoma vs complex
Compound composed of toothlike structure (denticles)
Complex is unorganized at cellular level and no toothlike structures
Tomes fibers
Odontoblastic processes - cytoplasmic extensions of cell body
What is incidence of odontogenic tumors in dogs and cats?
humans?
- 0.5 - 0.7% dogs and cats
- 1.3% humans
diagnosis of odontoma is often associated with a failure of what?
eruption of normal secondary tooth
3 types of Mixed Odontogenic Tumors?
1) Odontoma
2) Ameloblastic Fibroma
3)Ameloblastic Fibro-odontoma
presence of denticles is pathognomonic for ___.
Odontoma
What is a proposed mechanism of odontoma formation
Local hyperactivity of dental lamina resulting in multiple schizodontia
what did they consider these bilateral odontomas to be likely caused by
Developmental “error” not a spontaneous neoplastic disease process
What can be used to induce odontogenic tumors in the hamster and rat
Trauma in the rat and N-nitrosourea in the hamster and rat
Location of Complex versus compound odontomas in humans
Compound = incisor canine region
Complex odontoma and ameoloblastic fiber odontoma the posterior region.
Dogs not known from the literature
Odontomas are usually associated with what
Abnormally erupted or Unerupted tooth
This was a different case because the denticles were erupted
In humans, incidence has been reported at 41%, 61% and 75%.
Lymph node staging of oral and maxillofacial neoplasms in 31 dogs and cats: Herring, smith, et al JVD 19 (3) Sep 2002
28 dogs, 3 cats with confirmed neoplasms
All visible LN in each of the 3 regional lymphocentrums (parotid, mandibular, medial retropharyngel) were removed surgically in 25 cases through one incision (2 actually had bilateral lymphocentrum removal since the tumor was midline)
Lymph node staging of oral and maxillofacial neoplasms in 31 dogs and cats, herring and smith
- of palpably enlarged mandibular ln’s, 17% had metastatic dz histologically
- thoracic metastatic dz was in 7%
- pre-operative cytologic evaluation of the mandibular ln concurred with histo in 90%
- post-op cytologic evaluation of regional ln’s concurred with histo results in 80%
- Only 54% of cases with metastatic dz had mets to the mandibular ln’s (so they might not be as useful in staging)
Mean age of the dogs
9 years
Cats were what age
12 y
What percentage of patients in this study had metastatic disease to lymph nodes?
- 35.5% to one or more LN:
- parotid, mandibular and medial retropharyngeal
mandibular lymph node metastasis was positive in only __% of the positive cases
in only 54.5% of all of the cases with mets
How accurate was FNA of the mandibular lymph node in detecting metastasis in the mandibular LN?
90.5% concurrence with the LN histopath results
What percent of enlarged lymph nodes had metastasis
20.0%
What percent of palpable normal lymph nodes were reactive histologically
58.3%
Conclusions of the LN article
- LN aspirates are very accurate and sensitive
- Mn Ln not only LN that shows mets, Mn LN, since only 54% of these met to the Mn LN
- enlarged LN do not always indicate mets, non enlarged LN can be positive
Lingual Calcinosis Circumscripta in a Dog
Collados Rodriguez Quiros Roman
JVD 19(1) March2002
8 month old German shepherd X male
A calcium supplement had been given during the first 3 months Post Partum
calcinosis circumscripta or tumoral calcinosis
characterized by mineral deposits that are located in soft tissues (especially near joints), and it’s most common in young adult dogs, 5-15 months especially German shepherds common in foot pads
calcinosis circumscripta
idiopathic deposition of amorphous calcified material in the skin and subcutaneous tissues of large breed dogs
RARE in dogs and cats
What were potential causes for Calcinosis Circumscripta
repeated trauma that caused dystrophic mineralization, Neoplasms, chronic inflammation and Foreign body reaction or pyoderma.
What was stated to be a refuted theory for C Circumscripta
Apocrine gland of the oral cavity mucosa undergoing degeneration.
Fibrous dysplasia of mandibular bone in a dog
Fitzgerald, Slocombe, Caifa
JVD 19(2) June 2002
9 yo G shepherd left mandibular PM3,PM4 lingual side.
Fibrous dysplasia of bone
rare non aggressive radiolucent non neoplastic lesion considered developmental in origin
Osteoma, Ossifying fibroma, and fibrous dysplasia are benign lesions found in what type of bone?
Intramembranous bone
- Origin of which is osteogenic connective tissue
- Only ossifying fibroma is restricted to the facial bones
Hallmark histologic features of Fibrous dysplasia is
Presence of thin, arched trabeculae of poor quality woven bone forming in a fibrous connective tissue stroma.
Fibrous dysplasia differs from ossifying fibroma how
In fibrous dysplasia, pre-existing bone is replaced by an expansile mass of fibro-osseous tissue. Ossifying fibroma tends to have an intermediate achitecture comparatively.
The bone in FD is fused with the normal bone where the OF does not.
Radicular cyst of the premaxilla in a dog
Beckman
JVD 20(4) Dec 2003
13 YO male neutered border collie Lmax I2
Radicular Cysts
- Aka apical periodontal cyst or Periapical cyst
- True cyst consisting of pathologic cavity lined by stratified squamous epithelium.
- Occurs in association with the root of a nonvital tooth and apical periodontitis.
- Result of inflammatory activation of the epithelial cell rests of Malassez adjacent to the tooth root in the periodontal ligament
Radicular cysts
- most common cyst in humans
- are associated with inflammation of the periodontal ligament at the root apex
- also referred to as apical periodontal cysts
- aggressive nature
- potential for malignant transformation to odontogenic cysts.
Histologic appearance of radicular cysts
- Stratified squamous epithelium supported by dense fibrous CT with inflammation
- Rushton bodies (calcification within lining) and cholesterol clefts (in lumen) are common
They stated a difference between True periapical cysts and periapical pocket cysts what are they and why is it important in RCT
- Periapical true cysts lined by epithelium and do not communicate with the root canal.
- Periapical pocket cysts have sac like epithelium that communicates directly with the root canal.
Can not tell radiographically which is which but if Pocket cysts then it will heal with RCT treatment, radicular cyst will not.
Radicular cysts form as a result of chronic apical periodontitis, which is…
reaction to the destruction of the pulp and microbial occupation of the root canal.
Trismus Secondary to Squamous cell carcinoma in a cat
Brown
JVD 20(4) 2003
15 year old cat MN DSH Left side mass base of ear to commissure
Cats >10 years what is the % of all oral tumors that are SCC
60-75%
Where does SCC metastasize first and then in late stages
Regional lymph nodes first and in late rare stages is found in the lungs
Most oral SCC in cats occur…
at base of tongue, but also can affect lips, gingiva, palate, and tonsils as well as maxilla and mandible.
trismus
difficulty opening mouth
Prevalence of dental resorptive lesions in Swedish Cats
Mannerfelt
JVD 20(3) Sept 2003
96 cats oral exam radiographs
32 % had lesions either gross or radiographically and there was a positive relationship with age
cats over the age of 10, % with resorptive lesions?
76%
What was important about this study populations?
Randomized cats not admitted for primary dental disease
What were other cited studies results and why were they potentially higher or lower in prevalence
- Not randomized cats were presented for dental disease =higher %
- Radiographs not obtained= lower % prevalence
- Dental disease presented cats and radiographs obtained = higher % prevalance
Compound odontoma in 3 dogs
Felizzola et al
JVD 20(2) June2003
3 young F dogs, stage III tumors, partial mandibulectomy or maxillectomy, aggressive sx resulted in prolonged tumor free interval
Odontomas arise from ____?
Odontogenic epithelium.
- further potential sites of origin are the cell rests of Malassez, original enamel organ or the odontogenic epithelium that is incorporated into the gingival epithelium
3 classification of odontomas
ameloblastic
complex
compound
World health organization tumor stages
- stage 0: carcinoma in situ (absence of tumor invasion into surrounding tissue)
- stage I: localized cancer, can be surgically removed
- stage II: locally advanced; can be treated by chemotherapy, radiation or surgery
- stage III: even more locally advanced; can be treated by chemotherapy; radiation or surgery
- stage IV: metastasized cancer, spread to other organs; can be treated by chemo, radiation, or surgery
Harmartomas
Developmental anomalies characterized by the proliferation of normal tissue with an abnormal organization
Odontogenic periorbital fistula in a cat
Negro and Hernandez
JVD 20(1) March2003
4 YO female DSH, chronic history of periorbital fistula, treated for 3 mo w/AB