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CAEM Pt. 2 > LA Sx Exam #2: Dentistry > Flashcards

LA Sx Exam #2: Dentistry Flashcards

1
Q

Main causes of increased interest in equine dentistry

A
  • CLIENT DEMAND
  • Increased competition between practices
  • Development of improved dental equipment (power tools)
  • Educational help, Ex: AVMA, AAEP
  • Increased publications
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2
Q

Clinical signs of dental disease (oral-related)

A

+/- Poor BCS despite appetite (can have normal weight and poor dentition)
+/- Failure to maintain weight
+ Soaking hay in water before eating
+ Difficulties eating: dipping grain, drooping partly chewed wads of grass/hay (quidding)
+ Ptyalism
+ Feces with whole or recognizable pieces of unchewed grain
+ Face shyness or tenderness, lumps or bumps
+ Chewing difficulties
+ Halitosis
+ Accumulate food in cheeks, Ex: hamster syndrome
+ Draining tracts from pinna, ventral mandible, rostral to facial crest

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3
Q

Sequelae to poor dental diseases (systemic and behavior, 3)

A

1) Colic = not chewing properly, build up of fiber in GI tract, develop choke or impactions
2) Nasal discharge from sinusitis (usually unilateral)
3) Abnormal biting or riding behavior

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4
Q

What are eruption bumps? Normal?

A

+ Swellings on lower border of the jaw (mandibular), rostral to facial crest (maxillary)

  • Horses 3-5 yrs of age
  • Occurs when permanent cheek teeth are erupting
  • Normal unless retained, delayed eruption, or idiopathic = inflamed pulp, infection = draining tract
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5
Q

Which teeth are located in proximity to which sinuses?

A
  • Caudal maxillary sinus = last two cheek teeth (10, 11)

- Rostral maxillary sinus = middle two cheek teeth (08, 09)

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6
Q

What should be involved with taking the history of a suspected dental dz patient?

A
  • Signalment = age, breed, sex
  • Use or purpose of the horse
  • Vax status (esp tetanus)
  • Medical history = any systemic disease (Ex: Cushing’s = wt loss, retained hair coat, polydipsia)
  • Cardiovascular dz (concerned with sedation)
  • History or previous dental exams and treatments
  • Deworming protocols
  • Vices or behavioral problems
  • Owner concerns?
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7
Q

What should you do between every horse oral exam or treatment?

A

Disinfect equipment before moving on the next horse

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8
Q

Things to keep in mind with the treatment/exam area of the horse

A
  • Free from objects or distractions (pets, children)
  • Adequate space
  • Halter w/ noseband allowing them to open their mouth
  • Assess the temperament of the horse, will you need sedation (majority don’t)?
  • Twitches = NOT RECOMMENDED
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9
Q

What sedatives are recommended for a thorough oral exam?

A

> Alpha-2 agonists

  • Xylazine = short acting, cheap, ataxia at high doses
  • Detomidine = longer duration, less ataxia
  • Alpha-2 + torb = can cause them to stumble
  • Draft horses commonly requires less, ponies require more
  • Start w/ small doses
  • Wait 3-4 minutes to take effect before placing the mouth gag
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10
Q

What are the bars?

A

Interdental spaces - where canines or wolf teeth could be

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11
Q

Exam of the oral cavity

A
  • LAVAGE the mouth out first (often before sedation)
  • Ask then estimate the age
    1) External features = symmetry, swelling, depression, palpate TMJ
    2) Examine lips, incisors and interdental spaces from front and side (wear, cribbing, slant, smile, frown, missing teeth, bony swelling with blind wolf teeth)
    3) Determine alignment of incisors (parrot mouth, monkey mouth?)
    4) Examine the lateral excursion w/ the head in a neutral position (low)
    5) Lightly RASP upper arcades to avoid cheek laceration
    6) Insert mouth speculum and exam
    7) Flush out and probe periodontal pockets
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12
Q

Slant mouth (clinical signs, cause, tx)

A

> Diagonal bite to the incisors

  • Cause/effect? = cheek teeth abnormalities, TMJ joint pathology
  • Tx: power “grind” them down to horizontal alignment
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13
Q

Smile and frown mouth (clinical signs, tx)

A

> Smile = ventral curvature to the incisors (long central maxillary and lateral mandibular)
*Limits lateral excursion and grinding of cheek teeth

> Frown = dorsal curvature (incisors curve down)

Tx: power “grind” them down

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14
Q

How much do you want to take off of a crown at at time?

A

< 6 mm at a time

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15
Q

Interpretation of lateral excursion (normal, abnormal)

A
  • Neutral = all incisors in contact
  • Lateral = incisors separate, cheek teeth come into contact to grind
    » When do the incisors separate (0.5 mm? length of an incisor?)
  • Separate because of the 10-15 degree occlusal angle
    *No sound = may indicate lack of occlusal surface
  • Distance traveled should be symmetrical on left and right

> NO incisor reduction/wear = molar malocclusion will occur
EXCESSIVE incisor reduction/wear = cheek teeth are always in contact (painful, like grinding/clenching teeth) = gap between incisors at rest

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16
Q

When do the permanent 1st incisors erupt?

A
  1. 5 years

* Takes another 6 months for them to come into occlusion

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17
Q

When do the permanent 2nd (middle) incisors erupt?

A
  1. 5 years

* Takes another 6 months for them to come into occlusion

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18
Q

When do the permanent 3rd (lateral) incisors erupt?

A
  1. 5 years

* Takes another 6 months for them to come into occlusion

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19
Q

When do the permanent canines erupt?

A

4-5 years

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20
Q

When do the wolf teeth erupt?

A

5-6 months, fully by 6-18 months

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21
Q

Order of the cheek teeth eruption (1-6)

A

4-5-1-2-3-6

3 and 6 vary and erupt close

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22
Q

What are “caps” and when are they lost?

A

Deciduous pre-molars that are present over erupting permanent teeth

Lost at 2.5, 3.5, and 4 years

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23
Q

Is tooth aging accurate?

A

> Not really, especially over age 6

*Most accurate = eruption of permanent teeth

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24
Q

What is the oldest tooth in the mouth?

A

4th cheek tooth or 1st molar

25
Q

Things to NOT do when trying to open the mouth

A
  • Put your hands/fingers on the occlusal surface
  • Palpate in mouth w/o speculum
  • Using spools (thick wire coiled) = concentrated pressure that can crack teeth
26
Q

Don’ts of mouth gags (2)

A
  • Don’t leave it on for long periods of time = let them rest every 30 minutes (release gag)
  • Don’t release both sides of the gag at the same time (avoids biting the tongue)
27
Q

Three teeth numbering systems

A

1) Cheek tooth system = numbering cheek teeth 1-6
2) Standard system = letter (PM, I) and number, Ex: pm2, M4
3) Triadan = numbered 100-400 and 500-800, becoming universal (canines #04, wolf teeth = #05)

28
Q

Things that help wear teeth (2) Solution?

A
  • Time spent grazing
  • Abrasive silicates in plants and soil
  • Solution = change type of teeth (hypsodont) and erupt them over time, change design of grinding surface of the tooth
29
Q

True or false? Cheek teeth should be in tight contact mesially and distally

A

True = mesial and distal most teeth are tipped towards the other teeth

30
Q

What is anisognathia and what does it mean for the horse?

A

Mandible is narrower than the maxilla (maxillary CT are 30% wider than mandibular CT = 1/3 of occlusal surface of maxillary teeth contact 1/2 of corresponding mandibular teeth

  • Determines the amount of cheek teeth occlusal surface that is contact at any time
  • Creates the 10-15 degree occlusal angle after birth
31
Q

What are cingula? Why are they important?

A

Lateral ridges on the maxillary cheek teeth = may correspond to sharp enamel points

32
Q

Should you remove/level the occlusal ridges on the cheek teeth?

A

NO - animal will be unable to chew (may increase surface area for chewing)

  • Takes up to 6 weeks to reform
  • Correspond with ridges on the hard palate
33
Q

Three phases of chewing

A

1) Opening stroke = mandible drops, move laterally
2) Closing stroke = mandible is raised, trapping food between CT
3) Power stroke = mandible moves lateral to medial, crushes food
* Little rostral/caudal movement

34
Q

Due to the occlusal angle of the cheek teeth, where do we see enamel overgrowth?

A
  • Buccal edge of maxillary CT (outside)

- Lingual edge of mandibular CT (inside)

35
Q

True or false? Dental problems is exclusively an old horse problem?

A

False - should be instituting dental prophylaxis at an early age

36
Q

Dental problems we see with animals on higher grain diets (limiting grazing)

A

> Limited lateral excursion = develop sharp enamel points on CT (commonly maxillary #6 and mandibular #11)
Limited wear of incisors = continuous CT occlusion

37
Q

Parrot mouth

A

> Premaxilla hangs over the lower incisors (overbite)

  • Lower incisors can be caught on the hard palate
  • Common to see hooks on 106, 206, 311, and 411
38
Q

Sow mouth

A

> Mandibular incisors protrude out past premaxilla (underbite)
- Common to see hooks on 111, 211, 306, 406

39
Q

Overjet jaws

A

Incisors still have contact but the occlusal surfaces don’t line up completely

40
Q

How much of the crown erupts yearly?

A

2-3 mm or 1/8 inch per year

41
Q

Dental exam/tx frequency recommended

A

Yearly, up to every 6-8 months

42
Q

Goals with rasping

A

1) Remove enamel overgrowths = maxillary #06 (buccal side) and mandibular #11 (lingual side)
2) Smooth lateral cingula (thought to delay development of sharp points)
3) Level arcades BUT maintain 10-15 degree occlusal angle (gently and gradually)
4) Remove crown overgrowth (hook, beak, ramp)
5) Round premolars for bit-seats (#06’s)
* DO NOT REMOVE OCCLUSAL TRANSVERSE RIDGES

Goal = balance left/right arcades, permit free/symmetrical jaw motion

43
Q

Curvature of Spee and what it means with rasping

A

Jaw tends to curve up as you move more caudal (may need a closed angle/angled up rasp to reach the #11’s)

*Can used an open angle rasp for more rostral molars/premolars

44
Q

What is bit seating? Why do we do it?

A

> Rounding and smoothing the surface of upper and low #06 teeth (upper moreso than lower)
*Prevents loose gingival teeth in the mandibular interdental space (and cheek) get caught in the wolf and first cheek teeth

45
Q

True or false? Wolf teeth are brachydont

A

True

46
Q

Problems and tx with wolf teeth (4)

A
  • Blind = not erupted
  • Directed towards the cheek
  • Problem with biting and bit
  • Can’t access the first PM to round for bit seating

Tx: controversial extraction (don’t really serve a purpose) = circular cutters to cut gingiva, insert elevator to loosen tooth and extract

47
Q

True or false? Canine teeth are brachydont

A

True

48
Q

What do we need to remember with rounding canine teeth?

A

Need to remove/reduce crown gradually (pulp chamber may be within 5 mm of the “occlusal” surface)

*Can be helpful anchors for wiring with jaw fractures

49
Q

Dx? Tx? Unruly 4-5 year old animal, “mouthy”, “fighting the bit”

A
  • Dx: erupting canines

- Tx: cut the gum over the tooth to speed up eruption

50
Q

What is repelling teeth? Good or bad?

A

> Creating a hole in bone over a draining tract, drllling a core out of the tooth apex, and malleting out the tooth through the hole (common on mandible)
*Prefer to extract (lower morbidity, can do it standing)

51
Q

Wave mouth

A

Decreased eruption (or absence) of one tooth can lead to super-eruption of the opposing tooth = UNDULATION of the occlusal surface of the arcade

52
Q

What is step tooth or step mouth? Tx?

A

> No opposing occlusal contact (common with tooth damage/loss)
Opposing tooth erupts in the space
*Tends to form triangular outlines rather than rectangular steps (teeth drift, form diastema and periodontal dz)
*Make result in locking = reduced lateral excursion
- Tx: leveling of overgrown tooth

53
Q

What is smooth mouth? Causes (3)?

A

> Absence of enamel ridges on occlusal surface of CT

  • Due to increased attrition
    a) Diet and high silica (commonly wears out by 25-40 years)
    b) Pathology
    c) Iatrogenic and excessive dental tx
54
Q

What is shear mouth? Causes? Tx?

A
  • Steep occlusal angle > 10-15 degress
  • Causes = unilateral (more common) due to lack of unidirectional movement (pain on one side mouth), bilateral w/ limited lateral excursion
  • Sequelae = food stagnation, periodontal dz
  • Tx: re-establish angle gradually
55
Q

Causes of diastema (3)

A
  • Loss of teeth = shifting of teeth
  • Normal aging = teeth get shorter and more narrow
  • Supernumerary teeth or general overcrowding
56
Q

Problem of diastema? Tx?

A

> Cause food packing in pockets and periodontal disease

  • Tx: clean out, debride, pack with metronidazole or antibiotic gel, reduce any overgrowing teeth, modify diet (short fiber lengths), remove extra/displaced teeth
57
Q

Cause and treatment of tooth resorption and/or hypercementosis

A
  • Cause = gingivitis of incisors/canines = inflammation in alveolus = necrosis of alveolar cementum and PDL
  • May see reparative cementum created by odontoblasts (hypercementosis form, bulge of reserve crown “juga”)
  • Lytic form = invades enamel, dentin, alveolar bone = weaken tooth, draining abscesses, osteomyelitis

+ Pain, bulbous juga, mucogingival fistulas, gingival recession, lessing willing to bite/grasp with incisors

  • Tx: prolonged antibiotics, subgingival corticosteroids, wash mouth with chlorhex BID, OTHER = surgical extraction (standing w/ local block) and antbiotics
58
Q

Problems with deciduous caps (2), Tx?

A
  • Can break off and remain in the sublingual space = gingivitis and periodontal disease
  • Cause lingual displacement of the permanent tooth
  • Tx: remove if they are loose or you feel they’re separating w/ extraction forceps
  • Don’t remove prematurely, may damage the underlying permanent tooth

CAEM Pt. 2 (27 decks)

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