Lecture 14: Dental Extractions: equipment and techniques for small animals

Question 1

What wrong and what tx

Answer 1

advanced periodontal disease- abscesses and bone loss
Tx: extraction

Question 2

plaque is a __ and the __ is the most favorable environment

Answer 2

biofilm, sulcus/pocket

Question 3

what is stage 0 periodontal disease

Answer 3

clinically normal, no gingivitis, peritonitis, sulcus up to 3mm in dog, 1mm in cats

Question 4

what is stage 1 periodontal disease

Answer 4

gingivitis: inflammation without attachment loss or bone destruction

Reversible

Question 5

what is stage 2 periodontal disease

Answer 5

gingivitis and <25% attachment loss, may have stage 1 Furcation involvement

Question 6

what is stage 3 periodontal disease

Answer 6

gingivitis With 25-50% attachment loss, stage 2 Furcation involvement

Question 7

what is stage 4 periodontal disease

Answer 7

severe, gingivitis with >50% attachment loss, stage 3 Furcation, often mobile

Question 8

which stages of periodontal disease often require extraction

Answer 8

3 and 4

Question 9

what are the alternatives to extraction for fractured teeth with pulp exposure

Answer 9

root canal and crown restoration

Question 10

what wrong and what would you want to do

Answer 10

crowing of 3rd and 4th PM, extract 3rd PM in hopes of saving 4th PM

Question 11

What wrong

Answer 11

caries/decay

Question 12

what are some reasons not to extract a tooth

Answer 12

1. Patient in poor health
2. Undergoing Radiation or chemo tx
3. Bleeding disorders

Question 13

what these

Answer 13

burs

Question 14

What these and what used for

Answer 14

periosteal elevators- raise gingival/mucosal flap

Question 15

what these

Answer 15

dental elevators and luxators

Question 16

what these

Answer 16

left: dental luxators
Right: dental elevators

Question 17

what type of suture used for dogs and cats

Answer 17

absorbable for both
Dogs- 4-0 monocryl
Cats- 5-0 monocryl

Question 18

what are the pros of intra-oral analgesia

Answer 18

1. Decrease anesthetic gas requirements
2. Duration of up to 24hrs
3. Patients more comfortable
4. Self mutilation less likely

Question 19

how do local anesthetics for blocks work

Answer 19

bind Na+ channels and inhibit depolarization- no AP

Question 20

how does decreased pH affect duration of action of block

Answer 20

decrease

Question 21

how does increased vascularity affect duration of action of drug and what can you add to block to help

Answer 21

decrease, add epi

Question 22

what is % mix of bupivicaine commonly used

Answer 22

0.5%- 5mg/mL

Question 23

how long does bupivicaine last

Answer 23

2-10hrs

Question 24

what gauge needles do you want to use for block

Answer 24

25g, 1 inch
27g 1/2 inch, 1 1/4 inch
30g

Question 25

what is dose for 0.5%, 5mg/ml bupivicaine in dogs and cats

Answer 25

dogs: 2mg/kg total dose Cats: 1-2mg/kg total dose

Question 26

what is dose of 2% 20mg/ml lidocaine in dogs and cats

Answer 26

dogs: 5mg/kg Cat: 1mg/kg

Question 27

what is appropriate dose of 0.5% bupivicaine for 3kg yorkie

Answer 27

1. 3kg x 2mg/kg=0.000002 6mg 6mg/ 5mg/ml=1.2/mL 1.2 mL in 4 quadrants= 0.3ml/site max

Question 28

never use suture under__

Answer 28

tension= failure

Question 29

what is involved in a closed/simple extraction

Answer 29

1. No flap required 2. No alveolar bone removed 3. No sectioning of teeth

Question 30

what teeth can have a closed/simple extraction

Answer 30

1. Incisors 2. First premolars 3. Mandibular 3rd molar

Question 31

what are the steps in a closed extraction

Answer 31

1. Pre-extraction rads 2. Incise gingiva with scalpel 3. Loosen periodontal ligament with dental elevator or luxator 4. Remove tooth with small extraction forceps 5. Examine tooth- smooth and rads 6. Empty alveolus 7. Suture

Question 32

what is the short finger stop

Answer 32

place index finger towards working end of elevator to give more control and prevent trauma from instruments slipping

Question 33

what is involved in an open/surgical extraction

Answer 33

1. Mucoperiosteal flap created 2. Alveolar bone removed 3. Multi-rooted teeth sectioned

Question 34

what teeth need an open/surgical extraction

Answer 34

larger, solid single or multi-rooted teeth, fractured roots

Question 35

what are the steps in an open/surgical extraction

Answer 35

1.pre-op rads 2. Create mucoperiosteal flap 3. Elevate flap with periosteal elevators 4. Buccal bone removal with cutting burr 5. Section multi-rooted teeth with cutting bur 6. Make a moat with round bur for additional alveolar bone removal 7. Elevation- loosen periodontal ligament with elevators or luxators 8. Examine root tips and rads 9. Alveoplasty- smoothing sharp bone with round or diamond bur 10. Suture- make sure tension free

Question 36

where should you start when sectioning multi-rooted tooth

Answer 36

work from Furcation towards crown

Question 37

when elevating a multi-rooted teeth each tooth should move __when elevating otherwise not ___

Answer 37

independently, not completely sectioned

Question 38

t or f: intraoral radiographs required post extraction to confirm no tooth root remnant

Answer 38

true

Question 39

How do you relieve tension on flap to suture

Answer 39

fenetrate/release periosteum using scalpel or sharp scissors

Question 40

what can occur on bottom tooth as a result of removing opposing top tooth

Answer 40

increased calculus formation due to lack of lower tooth cleaning

Question 41

what do you do if you fracture root during extraction

Answer 41

1. Create good visualization of retained root- remove enough buccal bone 2. Take rads 3. Make a moat 4. Gently elevate tooth root coronally to avoid pushing into maxillary sinus or mandibular canal

Question 42

what wrong

Answer 42

retained tooth root

Question 43

what wrong

Answer 43

retained root

Question 44

what are the post op instructions following extractions

Answer 44

1. Soft food only 10-14 days 2. Antibiotics if needed 3. Pain control- rimadyl, metacam, tramadol, buprenex- cats 4. Recheck 2-4 weeks

Question 45

what is type 1 resorption

Answer 45

focal or multifocal radiolucency with otherwise normal radiopacity and normal periodontal ligament space

Question 46

what is type 2 resorption

Answer 46

narrowing or disappearance of periodontal ligament space in at least some areas and decreased radiopacity of part of tooth

Question 47

what is type 3 resorption

Answer 47

focal or multifocal radiolucency- disappearance of periodontal ligament space, decreased radiopacity in part of tooth

Question 48

what type of resorption

Answer 48

3

Question 49

what type of resorption

Answer 49

1

Question 50

what type of resorption

Answer 50

2

Question 51

What wrong and what tx

Answer 51

Absence of tooth root Tx: crown amputation

Question 52

how do oronasal fistulas occur

Answer 52

1. Too much tension on suture 2. Didn’t close

Question 53

what wrong

Answer 53

oronasal fistula