L25: Clinical Approach To Oral Disease (Stone) Flashcards
Canine permanent dental formula**
I 3/3 C 1/1 P 4/4 M 2/3 = 42
Feline deciduous dental formula**
I 3/3 C 1/1 P 3/2 = 26
Feline permanent dental formula**
I 3/3 C 1/1 P 3/2 M 1/1 = 30
Periodontum
Tissues that hold the tooth in the mouth (alveolar bone, periodontal ligament, gingiva)
No 2 teeth should occupy the same space!**
:)
All dogs and cats should have adult teeth by what age?
6-7 months
Components of normal occlusion**
1) maxillary incisors fit in front of mandibular incisors
2) mandibular canine fit between maxillary 3rd incisor and canine
3) space between premolars should be zig-zag shape (scissors bite)
4) upper 4th premolar fits lateral to lower 1st molar
Caries are most common on what teeth?**
Maxillary molars
Abrasion vs. attrition**
Abrasion = wear from external source Attrition = wear from occluding tooth source
Approach for discolored teeth**
1) Rads
2) Extract if disease visible on rads
3) rads again in 6 mo- 1 yr if no dz visible
When do deciduous premolars erupt in dogs?
4-12 wks
3 primary patterns of canine tooth resorption**
1) internal resorption - starts in root canal, tooth may turn pink
2) idiopathic bony replacement (external) resorption - starts apically, common in premolars
3) osteoclastic resorption - like cats, uncommon
-trauma, orthodontic tx, malocclusion can incite
When must action be taken against tooth resorption?***
When it enters the oral cavity (above the gum line)
- this is when it becomes painful
- must be extracted
2 types of tooth resorption. In which can a crown amputation be performed?**
Type 1: crown affected but periodontal ligament intact
Type 2: crown and periodontal ligament affected (crown amputation possible**)
Chars. Of tooth resorption in CATS**
- odontoclasts resorb cementum
- mandibular 3rd premolar first involved in 80% of cases
- can cause ankylosis and tooth destruction as alveolar bone fuses to cementum, periodontal ligament lost
- crown amputation possible if there is ankylosis and NO stomatitis
Grades of periodontal disease***
0 (Normal): clinically normal, no gingivitis
Stage 1: gingivitis without attachment loss, normal alveolar bone (ONLY REVERSIBLE STAGE***)
Stage 2: early periodontitis, 50% attachment loss, or in multirooted teeth a stage 3 furcation involvement; tooth should come out***
Steps of a dental prophylaxis
**only called a prophy if done in a mouth free of disease
1) complete oral exam
2) supra gingival scaling
3) sub gingival scaling or curettage
4) polish (with fluoride)
5) flush
6) repeat oral exam
Indications for use of antibiotics in periodontal disease***
Oral ulceration
Severe periodontitis +/- osteomyelitis
Systemic dz (renal, cardiac, diabetes, Cushing’s)
Additional sx being performed
Bone implants
Pulp capping, vital pulp therapy or root canal (5-7 days)
Oral medicine case process**
Hx Conscious oral exam Full PE and anesthetic work up Exam under anesthesia Tx Follow up Home care
Causes of enamel hypoplasia/hypocalcification
Hereditary Systemic infection causing high fever Viral infection during tooth formation Enamel organ damage during early extraction of deciduous tooth Other trauma during formation
*rapidly accumulates plaque and calculus
2 types of enamel staining
1) intrinsic (ie. Abx use)
2) extrinsic (ie. Metal from objects)
92% of discolored teeth are non-vital or dying
:)
Periodontal disease/stomatitis can cause what bloodwork abnormalities?**
ALT, AST, ALP 1.5-2x normal
Globulins and TP mild to severely elevated
BUN mildly elevated
Therapy process for stomatitis in cats**
- thorough prophy
- abx, analgesics, and anti-inflammatories
- extractions (distal to canine first, or full mouth)
- home care
- continue w/ anti-inflammatories and/or adjunctive laser tx for proliferative tissues
- stem cell therapy is coming about
- always potential for tx failure and possible euthanasia
Sentinel tooth for tooth resorption in the cat**
Mandibular 3rd premolar (80% of the time it’s this one affected!)
Most common tooth to get fractured
4th premolar
Canine deciduous dental formula**
I 3/3 C 1/1 P 3/3 = 28
Classes of malocclusion
0: normal
1: jaw normal, but at least one tooth out of position
2: mandible shorter than maxilla - brachygnathic (overbite)
3: maxilla shorter than mandible - prognathic (under bite)
Which classes of malocclusion are more likely to be genetic/hereditary?***
Class 2 and 3 occlusions
Even bite
Malocclusion occurs in such a way that there is constant attrition of teeth
Tx for tight lip
(Frenulum is too far over so teeth ram into it –> oral trauma and malocclusions)
-requires early aggressive sx correction
Pedodontic (pediatric) abnormalities
Missing teeth Supernumerary teeth Malocclusion Palatal and lip defects Odontoma Hairy tongue Papillomatosis Juvenile gingivitis (feline) Enamel problems Lack of teeth Germination (fusion of two teeth) Retained or persistent deciduous teeth Fractured deciduous teeth
Adontia
Missing all teeth
Oligodontia
Missing one or more teeth (never developed, never erupted, or due to trauma)
Dentigerous cyst
Fluid-filled cyst surrounding the crown of an unerupted tooth leading to pressure atrophy of the surrounding bone
Odontoma
Odontogenic tumor that contains both epithelial and mesenchymal cells
2 types of odontomas**
Compound: tooth-like structure present
Complex: conglomerate of dental tissue
Oral papillomatosis
- self-limiting viral dz of young dogs
- affects tongue, lips, oral mucosa
- causes salivation, dysphagia, hemorrhage
- sx excision is necessary
Cranial mandibular osteodystrophy
- inherited condition in Westies
- non-cancerous bone formation at the TMJ and spreads to the mandible
- CS: pain, fever, reluctance to eat or open jaw
Diseases of the gingiva and buccal mucosa
“Cheek-Chewers” or “gum-chewers” syndrome (buccal granulomas)
Gingival enlargement (ie. Boxers)
Gingival trauma most common where?
Palatal side of 4th premolar
Neoplastic tumors of gingiva
Malignant melanoma (dogs most common)
SCC (cats most common)
Fibrosarcoma
Osteosarcoma
Feline juvenile gingivitis
8-18 mo. Cats
Purebreds most common
Requires early and aggressive tx (plaque removal)
Can be proliferative
Endodontic vs. periodontal disease
Endodontic: dz of tooth itself
Periodontal: dz of structures holding tooth in
Effects of periodontal dz
ST loss Deep gingival pocket formation Tooth attachment loss Periodontal bone resorption Ultimately, tooth LOSS
Indications of the use of abx to treat periodontal disease***
Oral ulceration
Severe periodontitis including purulent discharge
Additional surgery being performed
Bone implants
Pulp capping (pulpotomy) or vital pulp therapy
Canine chronic ulcerative stomatitis (Trench Mouth) + CS
- an immune mediated rxn to bacteria
- mostly a CANINE disease
- CS: halitosis, oral pain, inappetence, anorexia, ptyalism
Canine chronic ulcerative stomatitis (Trench Mouth) Ddx
- severe periodontal dz
- bullous autoimmune skin disease
- contact dermatitis
- systemic lupus erythmatosus
- discoid lupus erythmatosus
- 2ary immune complex dz
- drug eruptions
- immunodeficiency dz
Tx of Canine chronic ulcerative stomatitis (Trench Mouth)
Symptomatic (anti-inflammatory) Prophy Extractions PRN Broad spec abx Tube feeding PRN
Tx for eosinophilic granuloma complex
Immunomodulators (ie. Cyclosporine, steroids)
Requires life-long therapy
Lesions assoc. with mycotic stomatitis
Obvious white, plaque-like lesions at the mucocutaneous jxs
Caused by overgrowth of Candida albicans (assoc. with long-term abx therapy)
Causes of feline viral respiratory dz that causes oral changes***
Feline rhinotracheitis
Calicivirus*** (may have ulcers on tongue and hard palate
FHV
Oral lesions assoc. with blastomycosis
Granulomatous yellow-white, up to 1.5 cm lesions
Oral CS and PE findings assoc. with hypoparathyroidism
Oral ulcers Necrosis* Halitosis Pryalism Swollen lips and tongue Osteoporosis 2ary infections
Oral CS and PE findings assoc. with uremia (uremic stomatitis)
- ulceration at pressure points of tongue/oral cavity**
- occasional hemorrhage
- stomatitis
- necrosis of tip of the tongue
Differential for uremic stomatitis
Lepto
Many IM disorders cause erythema and ulceration of the oral mucous membranes. They present similarly and must do a biopsy or test of immune function to differentiate
:)
Pathologies of the salivary system and pharynx
Sialoceles
Salivary gland tumors
Sialoliths
Tonsilitis
Which animals get tonsilitis most commonly
Tonsilitis
Causes of tonsilitis
Predisposing factors (ear or anal gland dz) Unknown
Tx for tonsilitis
Symptomatic - tonsillectomy is NOT indicated and won’t cure symptoms
-most resolve on their own
Cause of secondary tonsilitis
2ary to diseases causing chronic vomiting, coughing, or regurge
-assoc. with ears and anal glands
Tx for secondary tonsilitis
- symptomatic
- remove underlying cause
- tonsillectomy CAN be successful and curative
Causes of severe feline stomatitis
Neoplasia Immune-mediated Toxic Infectious Periodontal dz Idiopathic (likely genetic)
Only virus that has proven association with stomatitis in cats***
FCV
FeLV, FIV, FHV, FIP are suspected only but not associated
Fauces
Lateral walls of the oropharynx medial to the palatoglossal folds
Hx and CS assoc. with stomatitis
Difficulty eating and drinking Grinding teeth/tooth chattering Facial rubbing Halitosis Facial hair loss Encrusted lips Swollen eyes Cachexia
Diagnostics for stomatitis***
Histopath is CRITICAL** CBC normal Chem: hypergammaglobulinemia FeLV/FIV test UA Oral rads (to differentiate other things) Culture NOT helpful!
Therapy for stomatitis
Abx (Anaerobic spectrum) Analgesics Anti-inflammatories Extractions (all teeth with severe dz --> premolars and molars --> full mouth extractions) Home care Adjunctive therapy
*all root fragments must be removed (don’t just do a crown amputation)
Problems with the muscles, bones, and joints
Masticatory myositis Craniomandibular osteopathy Idiopathic trigeminal neuritis TMJ luxation TMJ dysplasia Fxs Osteomyelitis Hyperparathyroidism Tumors and cysts Tooth avulsion Tetanus and botulism
