Oral Medicine Flashcards
In Kilcoyne’s 2014 study, “Septic sialoadenitis in equids: A retrospective study of 18 cases (1998-2010),” what was the most commonly cultured bacterial species?
Fusobacterium sp
According to Kilcoyne’s 2014 study, “Septic sialoadenitis in equids: A retrospective study of 18 cases (1998-2010),” which salivary gland is most commonly affected by disease?
Parotid salivary gland
According to Kilcoyne’s 2014 study, “Septic sialoadenitis in equids: A retrospective study of 18 cases (1998-2010),” what factors contribute to the development of sialoadenitis in the horse?
Sialoliths and dental abnormalities (oral trauma and bacterial colonization such as secondary to sharp enamel overgrowths or crown fracture with feed packing)
According to the 2015 study by Dixon et al., “Computed tomographic appearance of melanomas in the equine head: 13 cases,” what were the respective attenuation values of melanomas versus the adjacent masseter muscle?
113.5 HU vs. 69 HU
In the 2015 study by Dixon et al., “Computed tomographic appearance of melanomas in the equine head: 13 cases,” what was the attenuation of melanomas in comparison to the adjacent masseter muscle?
All (216) melanomas were hyperattenuating compared to masseter musculature
In the 2015 study by Dixon et al., “Computed tomographic appearance of melanomas in the equine head: 13 cases,” what percentage of masses contained hypoattenuating areas at what median attenuation value?
19.4% (41/216)
45.1 HU
In the 2015 study by Dixon et al., “Computed tomographic appearance of melanomas in the equine head: 13 cases,” what percentage of masses contained mineralized areas at what median attenuation value?
25.9% (56/216)
326 HU
In the 2015 study by Dixon et al., “Computed tomographic appearance of melanomas in the equine head: 13 cases,” describe the type of mineralization seen on histological exam of melanomas of the head.
Dystrophic mineralization
In the figure below of a decalcified transverse section through EOTRH affected incisor from Hole’s 2016 review article: Equine odontoclastic tooth resorption and hypercementosis what structure is the red arrow head
pointing to?
Howship’s lacunae (arrow heads)- resorption cavities containing multinucleate odontoclasts (arrows)
As stated in Nicholls 2016 VCNA Chapter, what % of geriatric animals have documented dental abnormalities?
VCNA 2016
95.4%
What geriatric dental disorder is noted here once the food has been removed from the incisors?
VNCA 2016
Senile diastamata
In the paper cited in the 2016 VCNA Nicholls chapter, what were the reported prevalence of sharp enamel points, periodontal disease and cheek teeth diastemata in horses >15 years old?
Ireland JL, Clegg PD, McGowan CM, et al. Disease prevalence in geriatric horses in the United Kingdom: veterinary clinical assessment of 200 cases. Equine Vet J
2012;44:101–6.
mandibular lingual enamel points (64%), maxillary buccal enamel points (51%), periodontal disease (42.9%), and cheek teeth diastemata (41.9%)
In the study cited in 2016 VCNA Nicholls chapter, what was the relative prevalence of cheek teeth diastemata, periodontal disease , and smooth mouth in horses > 30 years old?
Ireland JL, McGowan CM, Clegg PD, et al. A survey of health care and disease in geriatric horses aged 30 years or older. Vet J 2012;192:57–64.
> 70%
cheek teeth diastemata
(78.7%), periodontal disease (75%), and smooth mouth (71.7%) t
In Kern’s 2016 study “Bacteraemia before, during and after tooth extraction in horses in the absence of antimicrobial administration,” what percent of horses developed positive blood cultures at one or more time points during the study?
EVJ 2016
90% (18/20 horses)
In Kern’s 2016 study “Bacteraemia before, during and after tooth extraction in horses in the absence of antimicrobial administration,” what were the four most commonly isolated bacterial genera?
EVJ 2016
Streptococcus spp.
Actinomyces spp.
Fusobacterium spp.
Prevotella spp.
In Kern’s 2016 study “Bacteraemia before, during and after tooth extraction in horses in the absence of antimicrobial administration,” what surgical step was most commonly associated with the presence of bacteremia?
EVJ 2016
Elevation of the gingiva
In Earley’s 2017 study “Hematologic, Biochemical, and Endocrine Parameters in Horses With Tooth Resorption and Hypercementosis,” what was the most consistent abnormality on the CBC and chemistry profiles?
JVD 2017, Issue 3, Rawlinson
Hypoalbuminemia 88%
mild
In Earley’s 2017 study “Hematologic, Biochemical, and Endocrine Parameters in Horses With Tooth Resorption and Hypercementosis,” what endocrine parameter was of note?
JVD 2017, Issue 3, Rawlinson
parathyroid hormone (PTH) concentration increased in 7/15 horses (47%)
Authors speculated that elevations in PTH could be reflective of mild nutrional secondary hyperparathyroidism and that if the concentrate feeds fed to older horses with oral pain from EOTRH contain elevated amounts of calcium chelators that could cause NSH
In Jackson’s 2019 paper “Peripheral caries and disease of the periodontium in Western Australian horses: an epidemiological, anatomical and histopathological assessment,” what was the cited critical pH at which demineralization of cementum vs dentin and enamel will occur?
EVJ 2019, Staszyk
Cementum 6.7
Dentin 6.2
Enamel 5.5
In Jackson’s 2019 paper “Peripheral caries and disease of the periodontium in Western Australian horses: an epidemiological, anatomical and histopathological assessment,” peripheral caries were present in what percent of horses and most commonly in what teeth?
EVJ 2019, Staszyk
58.8% horses examined
molars most commonly
In Jackson’s 2019 paper “Peripheral caries and disease of the periodontium in Western Australian horses: an epidemiological, anatomical and histopathological assessment,” feed accumulation between teeth was present in horses without or with significant gingival recession respectively?
EVJ 2019, Staszyk
Without sig gingival recession 52.8%
With gingival recession 39.8%
In Jackson’s 2019 paper “Peripheral caries and disease of the periodontium in Western Australian horses: an epidemiological, anatomical and histopathological assessment,” what factors were stat sig associated with interdental feed accumulation, and what arcades were sig more likely to have interdental feed accumulation and peripheral caries?
EVJ 2019, Staszyk
Peripheral caries, horse’s age, presence of displaced teeth, diastemata
Mandibular
In Steinfort’s 2019 paper “The Equine Gingiva: A Histological Evaluation,” what do A, B, C, and D in this image represent?
Staszyk Frontiers 2019
A. Oral epithelium
B. Sulcular epithelium
C. Junctional epithelium
D. Lamina propria
In Steinfort’s 2019 paper “The Equine Gingiva: A Histological Evaluation,” what was the gingival sulcus depth range and average depth?
Staszyk Frontiers 2019
0.1-2.7mm
average depth 0.8mm
In Steinfort’s 2019 paper “The Equine Gingiva: A Histological Evaluation,” were differences seen in the gingiva based on tooth type, upper and lower jaw, different locations around the tooth or between human/dog and equine gingiva?
Staszyk Frontiers 2019
No
In Steinfort’s 2019 paper “The Equine Gingiva: A Gross Anatomical Evaluation,” what percent of cases had a sulcus depth of less than 1mm?
Staszyk Frontiers 2019
90%
Authors suggest that the equine sulcus depth should be described as < 1mm
In Steinfort’s 2019 paper “The Equine Gingiva: A Gross Anatomical Evaluation,” periodontal pockets occurred significantly more in which teeth and with what factor?
Staszyk Frontiers 2019
Sig more in cheek teeth than incisors
Occurence of PPs in cheek teeth increased significantly with age
In Steinfort’s 2019 paper “The Equine Gingiva: A Gross Anatomical Evaluation,” what percent of diastemata were found between cheek teeth and were upper or lower cheek teeth diastemata most prevalent?
Staszyk Frontiers 2019
89% diastemata between cheek teeth
Most in upper cheek teeth
In Birmingham’s 2019 study “The Effect of Sedation, Oral Examination, and Odontoplasty on Systemic Inflammation as Measured by Serum Amyloid A in the Adult Performance Horse,” what was the main conclusion?
JVD 2019 issue 3
Results of study showed that sedation, oral exam and odontoplasty had no effect on systemic inflammation as measured by SAA in the adult performance horse
Blood collected from jugular vein before sedation and 48 and 72 hours after exam and float
In Kennedy’s 2016 paper “The microbiome associated with equine periodontitis and oral health” what bacterial genera dominated the periodonitis horses and control horses respectively?
Vet Research 2016
The periodontitis group was dominated by the genera Prevotella and Veillonella.
Healthy group was dominated by the genera Gemella and Actinobacillus
In Borkent’s 2019 study “A microbiome analysis of equine peripheral dental caries using next generation sequencing” what was the most common genus associated with the healthy samples vs the peripheral caries samples?
EVJ 2019
Streptococcus species was the genus most commonly associated with equine PC
Gemella species was the genus most associated with the control group.
Corynebacterium also associated with control
In Borkent’s 2019 study “A microbiome analysis of equine peripheral dental caries using next generation sequencing” what was the most common genus associated with rostral vs caudal peripheral caries?
EVJ 2019
Veillonella species was the most commonly associated genus with PC of the rostral cheek teeth
Streptococcus species was the most associated genus with the PC of caudal cheek teeth
In Nottle’s multicenter study “Fibro-Osseous Lesions Of The Craniofacial Complex In Horses: 30 Cases (2001-2019)” what are the three main diagnoses in the complex, and how many were diagnosed of each?
Vet Surg 2021
Ossifying fibroma in 20/30 (67%) horses
Osteoma in 8/30 (27%) horses
Fibrous dysplasia 2/30 (6%) horses.
In Nottle’s multicenter study “Fibro-Osseous Lesions Of The Craniofacial Complex In Horses: 30 Cases (2001-2019)” was there a trend for signalment of horse and location of lesion?
Vet Surg 2021
12/30 lesions were diagnosed in horses <1 year old.
20/30 lesions originated from the rostral mandible
Median age 2 yrs (4mo-21yo)
Other sites were maxilla or paranasal sinuses
In Nottle’s multicenter study “Fibro-Osseous Lesions Of The Craniofacial Complex In Horses: 30 Cases (2001-2019)” what were the outcomes reported?
Vet Surg 2021
Recurrence was not reported after complete excision.
Incomplete excision was confirmed in 8 horses – 4 ossifying fibromas, 3 osteomas, 1 fibrous dysplasia
Recurrence occurred in one horse, while six horses had long-term resolution of clinical signs.
In Kunz’ 2020 study “High Prevalence of Orodental Disorders in South Brazilian Cart Horses: Walking a Tightrope Between Animal Welfare and Socioeconomic Inevitability”, what was the prevalence of diastemas, and what Triadan position were they most associated with? What were other common patholgogy noted?
JVD 2020 issue 3
Cheek tooth diastemata 66%
Diastemata were more likely to be present between Maxillary and mandibular 06/07 or Mandibular 10/11
Excessively sharp enamel points 97% of horses
Mucosal ulcers 66%
What was the overall conclusion from Smyth and Carmalt’s 2019 paper “Histologic assessment of age-related changes in the temporomandibular joints of horses”
Smyth JAVMA 2019
The histo assessed lesions were associated with osteoarthritis, and they accumulated in the TMJs as horses aged.
No known clinical relevance
In Pusterla’s 2020 study “Investigation of the Shedding of Selected Respiratory Pathogens in Healthy Horse Presented for Routine Dental Care,” true respiratory pathogens (EHV-1, EHV-4, EIV, ERBV or MRSA), were detected in what percent of horses?
JVD 2020, Henry, Rice
22%
In Pusterla’s 2020 study “Investigation of the Shedding of Selected Respiratory Pathogens in Healthy Horse Presented for Routine Dental Care,” commensal respiratory pathogens were detected in what percent of horses?
JVD 2020, Henry, Rice
89%
In Pusterla’s 2020 study “Investigation of the Shedding of Selected Respiratory Pathogens in Healthy Horse Presented for Routine Dental Care,” which population of horses Wisconsin or California had a 3-fold higher detection rate of respiratory pathogens and what were the differences in the population demographics?
JVD 2020, Rice, Henry
Wisconsin population younger, more Warmbloods, greater occurrence of nasal discharge and 3-fold higher detection rate of respiratory pathogens
In Pusterla’s 2020 study “Investigation of the Shedding of Selected Respiratory Pathogens in Healthy Horse Presented for Routine Dental Care,” what percent colonization rate of MRSA did the Wisconsin population have compared to the California population?
JVD 2020, Henry, Rice
Wisconsin 25%
California 9%
Wisconsin sig higher
In Nitzsche’s paper “The Gingiva of Horses With Pituitary Pars Intermedia Dysfunction: A Macroscopic Anatomical Evaluation” what was the conclusion in regards to presence of diastema in the PPID vs control groups?
Frontiers 2021
The presence of diastemata was significant (p < 0.0001) associated with age.
When controlling for age, PPID horses exhibited in 16.2% of cheek teeth with diastemata, compared to control horses that showed diastemata in 19.8% of cheek teeth interdental positions (NOT SIGNIFICANT)
In both groups, the lower CT showed more frequent (p = 0.0006; OR: 1.8) diastemata (22.7%) than the upper CT (14.0%). Triadan positions 406/407 and 306/307 were the most frequent locations for diastemata in both groups.
In Nitzsche’s paper “The Gingiva of Horses With Pituitary Pars Intermedia Dysfunction: A Macroscopic Anatomical Evaluation” what was the overall takeaway in regards to PPID vs controls for the factors of gingival sulcus depth, gingival texture, peripheral caries, and perio pockets?
Frontiers 2021
Age had no influence on gingival texture alterations or on presence of gingival sulci ≥ 1 mm depth, and both alterations were found more frequently in the PPID group than in controls.
Peripheral caries as well as periodontal pockets were found more frequently in controls than in horses affected by PPID.
In Reisbig’s study “The effect of acute equine temporomandibular joint inflammation on response to rein-tension and kinematics” what were the changes noted when one TMJ was injected with LPS to induce inflammation?
Frontiers 2023
All horses showed reduced rein-tension on the injected (inflamed) side - SIG different at both walk and trot
Increased rein-tension was required on the non-injected side at trot, to maintain them in the correct position on the treadmill post-injection – because they are trying to take pressure off the inflammed side
only kinematic variable to show any significant change due to rein tension or TMJ inflammation during the walk or trot was an increase in forward head tilt in presence of rein tension
In Rehrl’s 2023 study “Equine odontoclastic tooth resorption and hypercementosis: Investigating individual incisor disease patterns using radiological classification,” what distribution pattern was noted to be stat significant?
EVJ 2023
Bilateral disease
There was a significant positive correlation between age and tooth stages (p < 0.001) irrespective of Triadan position
There was a difference between the occurrence of the tooth stages in the different tooth positions (Triadan 01, 02, and 03) in the jaw (most in 03s, least in 01s)
In Smyth’s 2022 paper “The effect of acute unilateral inflammation of the equine temporomandibular joint on the kinematics of mastication” what was the change in chewing cycle noted after LPS injection into one joint?
EVJ 2022
All horses developed reduced vertical pitch (vertical opening) of the mandible (significant) - smaller ROM post-injection
The closing phase and power stroke were significantly affected, but not the opening phase for rostrocaudal movement
In the 2015 study by Smedley et al, “Equine Odontoclastic Tooth Resorption and Hypercementosis: Histopathologic Features,” what were the common histopathologic findings?
- Cemental lesions: all affected incisors and canine teeth → cemental hyperplasia & lytic lesions
- Dentinal lysis: 2/17 (12%); varied from replacement resorption in all cases to inflammatory resorption
- Endodontic lesions: 12/15 horses (mild neutrophilic to lymphoplasmacytic inflammation (n=6), internal lysis of dentin (n=4), fibrosis (n=10), rim of atubular mineralized material (n=11))
- Periodontal disease: at least one tooth in 15/17 horses (88%); primarily lymphoplasmacytic inflammation and fibrosis of the PDL
- Gingival lesions: at least one tooth in 5/9 horses that had gingiva present (Mild to moderate lymphoplasmacytic and neutrophilic inflammation (n=3), mild lymphoplasmacytic inflammation (n=2), occasional downward growth of epithelium in regions of neutrophilic inflammation (n=1), mild hyperplasia (n=1))
- Lesions in the alveolar bone: at least one tooth in 5/9 horses that had alveolar bone present; scalloped surface w/ occasional osteoclasts within resorptive pits
According to the study by Arnbjerg in 2014, “Generalized hypercementosis in geriatric horses”, hypercementotic lesions are seen concentrated on which aspects of incisor tooth roots?
Arnbjerg, 2014
Axial and lingual
In Townsend’s 2021 study “Exodontia associated bacteremia in horses characterized by next generation sequencing,” they concluded that bacteremia by oral commensal bacteria was present how long after exodontia?
Scientific Reports 2021
One hour
In Townsend’s 2021 study “Exodontia associated bacteremia in horses characterized by next generation sequencing,” what type of testing was used to characterize the bacteria and what were the most common taxa indentified?
Scientific Reports 2021
16S rRNA sequencing
Actinobacillus, Fusobacterium, Leptotrichia, Porphyromonas, Prevotella, Streptococcus, Veillonella
In Beste et. al (2020) article, “Culture-independent and dependent evaluation of the equine paranasal sinus microbiota in health and disease,” what organisms were found to be part of the normal microbiome of the sinuses?
Beste 2020 EVJ
Aspergillus and Malazezia were suggested to be part of the normal fungal microbiota of the paranasal sinus cavity.
In Uldahl’s 2019 study “Lesions associated with the use of bits, nosebands, spurs and
whips in Danish competition horses”, which of the following increased the risk of lip commissure lesion?
A. Type of bit
B. Type of bridle
C. Breed of horse
D. Level of competition
EVJ 2019
D. Level of competition
Oral lesions or blood were visible at the commissures of the lips in 9.2% of horses and increased with level of competition but did not differ between bit types or bitless bridles.
In Tumola’s paper “Risk factors for bit-related lesions in Finnish trotting horses” what bit types were associated with oral lesions and which with bar lesions?
Tumola EVJ 2020
Moderate and severe oral lesion status was more common in horses wearing a Crescendo bit, a mullen mouth regulator bit or a straight plastic bit than in horses wearing a single-jointed snaffle trotting bit
Bar lesions were more common in horses wearing unjointed bits than in horses wearing jointed bits
In Tumola’s paper “Risk factors for bit-related lesions in Finnish trotting horses” what risk factor was associated with bit lesions?
Tumola EVJ 2020
Mares had a higher risk for severe lesions than geldings or stallions
Lesions in the buccal area and the inner lip commissures were NOT associated with bit type.
Bit thickness was NOT associated with severe lesion status
Using a tongue-tie or an overcheck, galloping, placement in the top three or money earned in the race were NOT associated with lesion risk
In Roberts’ study “The safety and efficacy of neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in 168 horses” what was the success rate and complication rate of this tx?
Roberts EVJ 2020
Success: 53% (72/136)
Non-responders: 47% (64/136)
Complication rate: 8%
What % of horses have at least 1 dental abnormality on exam by the age of 15+ yo?
Easley ch 27
95.4%
What abrasion pathology is shown in this image and is almost a normal finding in aged donkeys?
Easley ch 27
“Smile mouth”
What portion of the incisor is most comonly affected by EOTRH lesions?
Easley ch 27
Apical 1/3-1/2
What extraoral abnormality is noted in the image below?
Easley 2022
Bilateral bony enlargements of the temporomandibular joints
What is the normal amount of rostro-caudal mandibular excursion in a foal and adult horse respectively?
Easley 2022
Foal: 3-4mm
Adult: 6-8mm
What is the normal excursion to molar contact of light breed horses, miniature horses and ponies and draft breeds respectively according to Easley’s 2022 textbook?
Light breed horse: 12.3mm
Minis and ponies: 5-6mm
Draft breeds: 15-16mm
What abnormality is seen in the image below and what is the cause?
Easley 2022
Gingival hyperplasia secondary to an environmental irritant
What were these nodular masses diagnosed as from Easley’s 2022 textbook?
Easley 2022
Lymphoma via biopsy and histopath
What are the definitions of the tooth mobility index for equine teeth according to Easley’s 2022 text?
0: normal with no crown mobility
1: up to 0.5mm of movement
2: Movement of crown up to 3mm
3: Greater than 3mm movement in any direction
In Ireland’s 2012 study “A survey of health care and disease in geriatric horses aged 30 years or older,” at least one dental abnormality was found in what percent of horses over 15 years?
The Vet J 2012, referenced in Easley 2022
95.4%
In Du Toit’s 2009 paper “Clinical dental examinations of 357 donkeys in the UK. Part 1: prevalence of dental disorders,” what incisor occlusal surface profile was present in 96% of aged donkeys with dental disease and 99% of donkeys without dental disease and may be considered a normal incisor occlusal table surface appearance in older donkeys?
EVJ 2009
Smile mouth (ventral convex curvature)
The image below shows what type of incisor occlusal surface?
Easley 2022
Smile mouth (ventral convex curvature)
Can be seen with excessive wear of the maxillary incisors but is considered a potentially normal finding in aged donkeys
What inflammatory mediator is suspected to play a key role in the stimulation of odontoclasts that perpetuate tooth resorption in cases of EOTRH?
Easley 2022
PGE2
What structure is dilated in the image below?
Easley 2022
Parotid salivary duct
What do A and B indicate in the figure below
A. Dorsal buccal salivary glands
B. Polystomatic sublingual salivary gland
What’s your diagnosis on nasal endoscopy?
Easley ch 14
Progressive ethmoid hematoma
What’s your diagnosis?
Easley ch 14
Reactive hypercementosis
secondary to inflamma around PDL, can be chronic or acute, can also happen after extraction is cementoblasts remain and are inflammed
What’s your top differential around this maxillary canine tooth?
Easley ch 14
Dentigerous cyst
What’s your top differential?
Easley ch 14
Radicular cyst
What type of cyst do you suspect and is it a true or pseudocyst?
Easley ch 14
Bone cyst
Pseudocyst
This horse presents with a draining tract at the ear base. What is your top differential, and was are other ddx to rule out?
Easley ch 14
Temporal teratoma
other ddx: Otitis externa, otitis media, abscess, foreign body, septic TMJ, THO, neoplasia, and dermal parasitic invasion
This horse presents with a ~5cm diameter swelling at the nostril area. What do you suspect?
Easley ch 14
Epidermal inclusion cyst, AKA atheroma
What is the characteristic imaging sign for osteosarcoma?
Easley ch 14
Sunburst bone reaction - periosteal-driven new bone and osteoid formation
In Rehrl’s paper “Radiological prevalence of equine odontoclastic tooth resorption and hypercementosis” what EOTRH-related pathology is noted by the circle?
Rehrl 2017 EVJ
Blunted root tip
What is the name of this bit?
Easley 2022
Loose ring snaffle with single jointed mouthpiece
What is the name of this bit and what advantage does it have over a Loose ring snaffle bit?
Easley 2022
D-ring snaffle
Has a metal cylinder that connects the mouthpiece to the cheek rings, thus avoiding the pinching at the corners of the mouth sometimes caused by loose rings.
Egg butt bits also have this advantage
What is the name of this bit?
Easley 2022
Waterford Snaffle
What is the name of the bit below?
French link snaffle with egg butt cheek pieces
What is the name of the bit below?
Mullen mouth snaffle with loose rings
What is the definition of a leverage bit?
Easley 2022
Leverage bits have bridle rings above the mouthpiece and rein rings below the mouthpiece
What is the name of the two parts of the double bridle shown on top and bottom respectively?
Easley 2022
Top: Weymouth with straight shanks
Bottom: Loose ring Bradoon snaffle
What is the definition of a Pelham bit?
Easley 2022
Curb bit and snaffle bit combination
Designed to give the advantages of a double bridle using a single mouthpiece
What type of biting system is pictured below and what conformation does not work well with this bit type?
Easley 2022
Pelham bit with double reins and curb chain
does not work well in horses with exceptionally long bars of the mouth
What is the name of this bit and where does it place pressure?
Easley 2022
Cheltenham Gag Bit
Bit slides back and upwards and places pressure on the poll
What type of bit is pictured below?
Easley 2022
Gag Bit (Three Ring Dutch)
Places pressure on the poll
What is the name of the bridle shown below?
Easley 2022
Side pull Bitless Bridle (Dr. Cook’s Bitless Bridle)
What kind of bit is shown below and what is its purpose?
Easley
Chifney bit
Used to lead difficult to lead horses in hand
can cause a lot of damage
