Lecture 3: oral exam Flashcards
Two parts of the oral exam
1) extraoral exam
2) Intraoral exam
Extra oral exam assess
Facial symmetry
Oral or nasal discharge
Muscle mass
Lumps and bumps
Pain
Odour
Patient demeanour
Intraoral exam examines
Lips
Teeth and their spatial relationship
Gingiva
Rest of the soft tissue structures in the oral cavity
Occlusion (alignment ) should be checked while patient is awake
Scissor bite
Maxillary incisors are rostral to mandibular incisors
Crown cusps of mandibular incisors contact cingulum of maxillary incisors
Mandibular canine tooth inclined labially and sits in space between 3rd maxillary incisor and canine
Maxillary premolars do not contact mandibular premolars
Crown cusps of mandibular premolars are lingual to arch of maxillary premolars
Crown cusps of mandibular premolars sit in spaces rostral to corresponding maxillary premolars
The mesial crown cusp of maxillary 4th premolar sits lateral to the space between the mandibular 4th premolar and 1st molar
Pedodontics is
ontics
Treatment of dental disease in the puppy and kitten
Puppies and Kittens exhibit both genetic and acquired dental conditions
ie: missing teeth, persistent primary teeth, et
Missing teeth medical term and causes
Anodontia = absence of teeth
Causes:
Never developed
Slow to erupt
Fell out
Missing teeth need to be radiographed why
Check for absence of root
Absence of root may be due to trauma or inherited
Charting – circle around tooth indicates it is missing
Persistent primary teeth are
Also known as retained deciduous teeth
Can lead to orthodontic problems → may cause displacement of permanent teeth
Can lead to periodontal disease→ plaque becomes trapped between deciduous and permanent tooth
Interceptive orthodontics is
Process of extracting primary (or adult) teeth to prevent orthodontic malocclusions
Removes any possible obstruction to full development of jaw
To be effective this type of treatment should be performed before the patient reaches 12 weeks of age
Fractured primary teeth are
Occurs fairly frequently
If left untreated, can result in abscess and possible stoma (fistula) formation
Can cause enamel hypoplasia in the underlying adult tooth (defect in enamel production)
Rule of thumb for persistent primary teeth
Rule of thumb - NEVER should a deciduous tooth and its corresponding adult tooth be in the same mouth at the same time.
As soon as it is observed extract deciduous tooth, don’t wait
Supernumerary teeth are and should be charted as
Commonly found in incisors or 1st premolars in dogs
Causes overcrowding
Charting – “SN” with additional tooth drawn where it appears
Shark mouth is
Third set of teeth aka “Shark Mouth”
Extreme form of supernumerary teeth
Entire second row of incisors
Requires extraction
Fusion of teeth is
joining of 2 developing teeth that have different tooth buds
On radiographs, there will be 2 separate roots
Gemini tooth is
single tooth bud that has partially divided
On radiographs, there will be one root with a split crown.
Can only differentiate with x-ray
Dilacerated roots is
Abnormally formed/curved roots
May be caused by trauma during development or genetic conditions
May or may not be accompanied by pathology
Important to know about before extraction! (x-rays are essential)
Malocclusion is
the incorrect relationship between teeth of the two dental arches when they approach each other and the jaws close (abnormal bite)
Class I, II, III, IV
Malocclusion is
the incorrect relationship between teeth of the two dental arches when they approach each other and the jaws close (abnormal bite)
Class I, II, III, IV
Class I malocclusion is
Overall normal bite except that one or more teeth are out of alignment
Due to dental malalignment (not skeletal)
Charting -”MAL1”
Distoversion malocclusion is
(MAL1/DV) – anatomically correct position but abnormally angled distally
Mesioversion malocclusion is
(MAL1/MV) – anatomically correct position but abnormally angled mesially
Linguoversion malocclusion is
(MAL1/LV) – anatomically correct position but abnormally angled lingually
Palatoversion malocclusion is
(MAL1/PV) – anatomically correct position but abnormally angled palatally
Labioversion malocclusion is
(MAL1/LABV) – anatomically correct position but abnormally angled labially
Buccoversion malocclusion is
(MAL1/BV) – anatomically correct position but abnormally angled buccally
Lance canines are
Type I malocclusion
aka spearing
Upper canines are tipped rostrally causing abnormal occlusion with lower canines
Common in shelties and persians
Require surgical correction or extraction
Spearing can also occur with the lateral incisors
Rostral crossbite looke like
Normal except one or more misaligned incisors
At least one mandibular incisor is labial to the corresponding maxillary incisor
Malocclusion I
Caudal cross bite looks like
One or more of the mandibular cheek teeth are buccal to the opposing maxillary cheek teeth when the mouth is closed
Malocclusion I
Base narrowed canines look like
aka mesioversed or longuoversed canines
Mandible too narrow or mandibular k9’s erupted too upright (normally should tip out laterally)
Can lead to damage to the palate and oronasal fistula
Malocclusion I
Rotated P3 look like
Maxillary P3 is rotated → tooth is now oriented buccal-palatal
Often no bone holding the buccal root → recommend extraction
Very common in brachycephalic dogs
Madibular distoclusion looks like and how to chart
Other terms are overshot or parrot mouth
Due to skull configuration rather than dental malalignment
Lower canines and incisors may cause trauma to the hard palate
Charting – “MAL2”
Class II malocclusion
Class III malocclusion is called and looks like
Mandibular mesioclusion
Due to skull configuration rather then dental malalignment
Charting “MAL3”
Two types
Mandibular prognathism- mandible too short
Maxillary brachygnathism- maxilla too short
Both result in undershot lower jaw, and can lead to trauma to the teeth and soft tissues of the lower jaw
Almost universal occlusion seen in brachycephalics
Class 4 malocclusion looks like
Maxillomandibular Asymmetry
Charting: “MAL4”
Asymmetry in rostrocaudal direction looks like
(MAL4/RC) – one side of the face has mandibular mesio- or distoclusion while the other side is normal
Asymmetry in side-to-side direction looks like
(MAL4/STS)– loss of the midline alignment of maxilla and mandible
Asymmetry in dorsoventral direction looks like
(MAL4/DV) – results in open bite, defined as abnormal vertical space between opposing dental arches when mouth is closed
Level bite is and looks like
Incisors meet exactly surface-to-surface
Causes teeth to wear against each other
Feline oclussion
More uniform dental structure and malocclusions are rare
Exception- persians (brachiocephalic head configuration)
Incisor bite and canine interdigitation form dental interlock
Incisors same as in canine
Mandibular canines sit equidistant in diastema between maxillary 3rd incisor and canine (touch neither)
Mandibular premolar tooth positioned mesial to corresponding maxillary premolar
Maxillary 2nd premolar sits in space between mandibular canine and 3rd premolar
Subsequent teeth interdigitate with mandibular premolars and 1st molar situated lingual to maxillary teeth
Incisive papilla
Small fold of mucous membrane situated at the anterior end of the raphe of the hard palate near the openings of the incisive canals
Stains on teeth are
From wear and exposure of dentin→ brown discoloration of the tooth surface that cannot be removed
Some drugs can also cause staining (ie: tetracycline)
Need to distinguish from internal staining (dead teeth)
Abrasions on teeth are
Wearing of teeth caused by friction against other teeth
charting-”AT”
Level bite
Enamel hypoplasia is
Can be caused by trauma or high fever which can temporarily prevent enamel production
Tooth surfaces are rough, flaky, often with exposure brown dentin
Charting – “E/H”
Caries
Most common on the occlusal surface of molars in the dog
Defect in the enamel +/- dentin
Requires extraction
Charting – “CA”
Fractures in teeth are based on
Depth of fracture
Part of tooth affected:
Crown, root, or both
Age of fracture
Chronic – present for a period of time
Pulp appears as black/brown
Acute – fresh injury
Pulp appears as red
Enamel fracture includes
Enamel only
Uncomplicated fracture includes
Enamel and dentin
Complicated fracture includes
All the way done to the pulp
How to chart a tooth fracture
During charting a jagged line is drawn over the area of the fracture
Chip fracture
Loss of enamel only
Usually do not require treatment
Charting – “EF”
A jagged line drawn over the area of the fracture
Uncomplicated crown fracture is
Involves both enamel and dentin but has not entered pulp chamber (use explorer)
May or may not require treatment
Charting – “UCF”
a jagged line drawn over the area of the fracture
Uncomplicated Crown-Root Fracture is
Enamel and dentin are involved but not pulp chamber
However, fracture extends below the gumline
May or may not require treatment depending on significance of damage
Charting – “UCRF”
a jagged line drawn over the area of the fracture
Complicated Crown Fracture is
Penetrates enamel and dentin and exposes pulp cavity
Requires extraction or endodontic treatment
Charting – “CCF”
a jagged line drawn over the area of the fracture
Complicated = it enters the pulp cavity
Endodontic treatment = treating the pulp cavity (root canal)
Complicated Crown-Root Fracture is
Involves enamel and dentin and exposes pulp chamber
Extends below the gum line
Requires extraction or endodontic and possible periodontal treatment
Charting – “CCRF”
A jagged line drawn over the area of the fracture
Root fracture is
Involves the root
Tooth often mobile
Usually requires extraction
Charting – “RF”
A jagged line drawn over the area of the fracture
Endodontic disease is
Disease of the pulp chamber (the inside of the tooth)
Can be due to fractures, trauma or iatrogenic injury (ie: heating up the tooth during a dental prophy)
May have external evidence during the oral exam:
complicated crown or crown-root fracture
draining tract at apex of tooth
discoloration of tooth
May only be evident on radiographs → lucent areas at the apex of the teeth
Tooth discolouration is
Normal healthy tooth is white
Brown - if wear has exposed dentin
Black - if pulp has been exposed (extract or root canal)
Pink, purple, tan, or grey - indicates pulpal hemorrhage and tooth death (extract or root canal)
Most commonly due to trauma
Colour changes as tooth dies – pink, purple, tan, then grey
Luxation is
Partial displacement of the tooth from the socket
Tooth may still be viable and immediate repositioning and splinting is recommended
Avulsion is
Complete displacement of the tooth from the socket
Must be replaced immediately if to be saved
Special solutions available to preserve the lost tooth
Clients may place the tooth in milk as a first aid measure
Endodontic therapy is required to save the tooth
If cannot save tooth - clean socket where tooth was lost and suture gingiva closed
Tooth reabsorption is
Very common in cats, uncommon in dogs
Resorption of the hard structures of the tooth (enamel, cementum, and dentin) until the pulp chamber is exposed and eventually the crown of the tooth is lost
Charting = “TR”
What does tooth absorption look like
May be visible evidence on oral exam:
Focal gingivitis
Loss of enamel +/- dentin (rough spot on the tooth)
Visible pulp exposure
Complete crown loss
May only be evident on x-rays → YOU MUST DO DENTAL X RAYS TO APPROPRIATELY PRACTICE FELINE DENTISTRY
Gingivitis is
Inflammation of gingiva
Can progress until attached gingiva becomes involved
Marginal gingiva becomes swollen, edematous, and encroaches on the crown of the tooth
Considered to be reversible
Periodontitis is
Most common oral disease among cats and dogs
This is the result if dental disease is not treated at the gingivitis stage→ destruction of gingiva, alveolar bone, periodontal ligaments and tooth structure
Radiographs will show bone loss →permanent
Prevention is the best treatment for periodontal disease
Unfortunately, there is usually gross calculus, bone loss, and gum recession present before the client seeks assistance
Stomatitis is
Inflammation/infection of the mucous lining of the mouth
More extensive than gingivitis
Common in cats, less often in dogs
Typically see extremely red and inflamed tissues in the oral cavity
Often there is an underlying disease causing lowered resistance of oral cavity to infection ie: FeLV, FIV
Some cats have unusually strong immune response to the components of plaque
May require full mouth extractions or aggressive plaque control measures
Uremic ulceration is and c/s
Seen in patients with advanced renal disease
Clinical signs include
Ulcerations seen on tip of tongue
Increased calculus formation
Periodontal disease
One reason why preoperative blood panels should be run
Oronasal fistula is
Result from advanced periodontal disease
Often find a deep pocket on the palatal aspect of the canines
Inflammation and infection has eroded the bone between the canine tooth and the nasal cavity
Often present but not diagnosed before extraction of the canine
Need to be closed carefully in order to prevent reoccurrence
Charting – “ONF”
Granulomas
Common
Result from periodontal disease, irritation, or foreign body
Can be part of eosinophilic granuloma complex in the cat
Biopsy to be sure!
Benign
Gingival hyperplasia
Gums simply grow over teeth
Often secondary to plaque accumulation
Create pseudopockets (not from bone or attachment loss)
Can trap food material or even prevent normal chewing
Common in brachycephalics, especially Boxers
Treatment = gingivectomy removal of excess gingiva
Benign
Oral papillomas
Common in young dogs < 2 years of age
Warty growths on the oral mucosa +/- lips
Caused by papillomavirus
Usually resolve on their own
Benign
Fibromatous Epulis
Gingival tumor made of fibrous tissue
Generally responds well to excision
benign
Ossifying Epulis
Similar to fibromatous epulis but contains bone
Usually needs wide excision including part of the jaw
Benign
Acanthomatous Epulis
Primarily composed of epithelial cells
Tumor of the gums
Tends to invade bone
Malignant
Malignant Melanoma
Found on any site within the oral cavity
Locally invasive and highly metastatic
Poor prognosis as reoccurrence is common
Fibrosarcoma
Create fleshy, protruding firm masses
As grow can become ulcerated and infected
More problems with local growth rather than metastasis
Squamous cell carcinoma
Found on any site within oral cavity
Epithelial cell type
Stages of tooth reabsorption
Staging system:
TR1 through TR5 → progression from mild dental hard tissue loss through complete crown loss
Painful if pulp is exposed
Usually start at the neck of the tooth
Cause and treatment of tooth reabsorption
No known cause, only treatment is extraction if lesion involves the neck or crown
Lesions just involving the root may be monitored
