SA Dentistry: Intro, Dental Radiography, Peridontal Disease Flashcards
What is the primary and permanent dentition of dogs?
Primary- 2x [I 3/3, C 1/1, P 3/3] = 38
Permanent- 2x [I 3/3, C 1/1, P 4/4, M 2/2] = 42
With the triadan teeth naming system where do the 100, 200, 300 and 400 numbers refer to?
100s- Upper right
200s- Upper left
300s- Lower right
400s- Lower left
What is the primary and permanent dentition formula for cats?
Primary 2x [I 3/3, C 1/1 P 3/2] = 26
Permanent 2x [I 3/3, C 1/1, P 3/2, M 1/1] = 30
What are the following surfaces of a tooth?:
Rostral
Vesicular/buccal/labial
Linguinal/Palatal
Caudal
Rostal- towards the nose
Vesicular/buccal/labial- towards the cheek
Linguinal/Palatal- towards the tongue
Caudal- towards tail
Can you state where the following anatomical terms for a tooth go?:
- Free gingival margin
- Enamel x2
- Peridontal ligament x2
- Bone x2
- Attached gingiva x2
- Muco-gingival ligament
- Mucous membrane
- Peridontal ligament fibres
- Dentine
- Cementum x2
- Junctional epithelium
- Pulp
- Root dentine
What is enamel?
What are its general features?
What happens when it gets damaged?
White, smooth outer layer of the crown
No nerve or blood supply, hardest/most mineralized substance in the body, protective of the sensitive tooth structures
When damages it causes plaque retention leading to periodontal disease
What is the function of dentine?
How does it differ to enamel?
Where does it originate?
Can it regenerate?
Encloses the pulp cavity
Softer and darker than enamel
Originated from odontoblasts lining the pulp cavity
Capable of some regeneration
What is the pulp?
What are the two different portions?
What is cementum, what is its function?
Sensitive tissue- exposure = pain
Sensory nerves, arteries, veins, capillaries and connective tissue
Crown portion- pulp cavity
Root portion- root cavity
Cementum is an avascular bone like material
Covers the root surface and is the attachment point for peridontal ligament
What is the function of the peridontal ligament?
What is the gingiva?
What is the function of the gingiva?
Attachment of root cementum to alveolar bone
Allows slight movement and absorbs impact
Epithelial tissues and connective tissue aroud the teeth
Barrier for the external environment
Free ginvgiva, attached gingiva, gingival sulcus
What does the alveolar bone consist of?
Perioesteum
Compact bone
Cancellous bone
Cribriform plate
When should deciduous be present in kittens and puppies?
At 6 weeks
In dogs what permanent teeth erupt at the following times?:
2-5 months
4-5 months
5-6 months
6 months
6-7 months
2-5 months-
Central incisor
Middle incisor
4-5 months-
Corner incisor
First premolar
Fourth premolar
5-6 months-
Canine
First molar
6 months-
Second premolar
Third premolar
6-7 months-
Second molar
Third molar
How long does it take for cats permanent dentition to erupt?
Incisors 2-4 months
Canines- 3-5 months
Premolars- 4-5 months
Molars- 5-6 months
Why should you perform dental examinations in juvenile patients and adult patients?
Juvenile
Detect anatomical issues which may cause problems without intervention
Adult
High incidence of dentral disease
Owners can dismiss clinical signs and may not be aware of severity
Routine dental examination important part of any consultation or annual booster
What history should be taken in a dental examination?
Oral health information
Rule out concurrent diseases
Assess ASA status of patient
Appetite/drinking changes
Viral infections
Previous dental work undertaken
At home dental care routine
In a conscious dental examination what should be examined of the head and oral?
Head:
Face symmetry
Palpation of facial bones and muscles
Palpation of LN and salivary glands
Assessment of eye position
Assessment of temporomandibular joint
Oral examination
Signs of periodontal disease: calculus, gingivitis, regression, tooth mobility
Missing teeth
Examination of oral soft tissues: tongue, pharynx, vestibular mucosa
Malocclusion
What is occlusion and what determines it?
What is malocclusion and the two types?
Occlusion (the bite)- relationship between beeth in the same jaw and opposing jaw
Determines by the shape of the head, jaw length and position of the teeth- brachycephalic most affected
Malocclusion- abnormalitiy in the position of the teeth
Skeletal malocclusion- jaw length or width decrepency
Dental malocclusion- teeth malposition
What is brachygnathism?
Brachy- short
Gnathism- facial angle
The mandible is too short- short mandible vs long maxilla
Over bite- JENNY
What is prognathism?
Mandible too long relative to the maxilla
Underbite- undershot
What instruments are needed for a dental examination in an anaesthetised animal?
Sharp probe explorer
Periodontal probe
Dental chart: record, medico-legal doc, good to prepare treatment plan
What dental equipment is needed for a scale and polish?
Scaling and polising:
Ultrasonic scalers with a fine scaler tip vs hand scalers
Curettes- sub and supragingival scaling
Air driven turbine with disposable prophy cups
Prophy paste pots
Calculus forceps- crack off calculus
Dental explorer probe
Peridontal probe No14- pocket measuring probe
What equipment is needed for tooth extraction?
Air turbine handpiece to section teeth
Luxators- thin end (slim fragile), used to cut down peridontal ligament
Elevators- thick shank (fat, strong), used to break down and stretch the peridontal ligament- apical pressure and leverage
Forceps- rotational force
Periosteal elevator- used for open extractoins
How does detnal equipment need to be cared for?
Elevators- working blade, honed after every use
Dental machine- hand pieces oiled, autoclave
General care- autoclave, dedicated dental kit
What are the different dental x-ray machines available?
Multidirectional generator head-
Mobile attached to stand/wall
Limitless positions
Reduced movement during procedure
Hand-held generator
Easier to store/set up
May see some movement during exposures
Can be harder to set angles
Care with setting up control zones and operator safety
What is direct dental radiography?
What are the advantages and disadvantages?
Image sent straight to computer, no processing needed
Adv-
No need to move sensor between exposures- easier to correct positioning fault
Faster- less GA
Sensor has longer lifespan
Small sensor, easy to move and store
Dis- one size- does not fit all well
What is indirect dental radiography?
What are the advantages and disadvantages?
Digital film that needs to be processed after exposure
Advantages-
Size flexibility: variety of shapes and films
Films thin and easy to place in mouth
Disadvantages:
Slower: removing the film to be processed
Less accurate- harder to correct positioning fault
Why are dental radiographs needed?
- Provides more accurate diagnosis
- Plan treatment more appropriately
- Identify problems below the gum line
- Some problems are treated differently on radiographic appearance
What is assessed in dental radiography?
Anatomy- abnormal number or shape of roots
Extra or missing teeth
Pathology- periodontitis, pulp necrosis, dental fractures, tooth resoption, supernumary teeth, unerupted teeth
Teeth evaluation- all roots out
What are each of the colours refering to in this radiograph?
Blue- mandible
Purple- mandibular canal
Green- pulp cavity
Lower arrow- peridontal space
On this radiograph, identify the following anatomical structures:
Pulp cavity
Root
Furcation
Crown
Nasal cavity
Maxillary
Peridontal space
How does radiographic anatomy differ in a young dog and mature dog?
Pulp stone- incidental finding- normal in young animals
Pulp cavity in young dogs larger
What is wrong with this radiograph, what is indicated?
Peridontal disease with horizontal bone loss
Line of mandible is dropped compared to normal leading to root exposure
Extraction of all three teeth
What is wrong with the following two radiographs?
What is indicated?
What does halitosis mean?
Peridontal disease
Both show vertical bone loss and root exposure
Extraction of top tooth
Pocket of lowe tooth needs to be probed and may need extraction
Halitosis- bad breath
What is resorption?
What is type one and two and what treatment do both indicate?
Resorption of the tooth
Type 1- Destruction of the tooth with preserved peridontal ligament
May see root exposure and/or bone loss- open extraction indicated
Type 2- destruction of tooth and periodontal ligament
Abscent periodontal space on affected tooth
Coronectomy indicated
Which one of these radiographs shows type 1/2 resorption?
Left- type 2
Right- type 1
What problem is shown in this radiograpy?
What is indicated?
Complex fracutre of the crown and caudal root
Pulp cavity has been exposed and peridontal space interupted
Extraction is required
What is an apical lesion?
When the periodontal space around the roots is widened at the root apex
Due to bone loss
What is pulpitis?
When does pulpitis indicate a tooth extraction?
Inflammation- widened, not due to age
Extraction is needed when pulpitis with a developing tooth root abscess
What is parallel dental radiography and what teeth can it be used for?
‘Normal’ technique
Good for caudal mandibular premolars and molars- 407-411
Patient in lateral with side examining up
Sensor parallel to teeth
Beam perpendicular to sensor
What is the bisecting angle technique for dental radiography?
Why can parallel not be performed for all teeth
Sensor at angle to teeth- beam perpendicular to bisecting angle between the tooth root axis and the sensor
Allows radiography of teeth where parallel is not possible
Parallel?- palate and other hard tissues in the way or opposite tooth would prevent parallel views with sensor outside mouth
What are the different bisecting angles and what teeth are they used for?
Occlusal view- maxillary canine, incisors
Lateral canine- canine- used in larger dogs
Describe how to use the bisecting angle to obtain a mandibular molar and PMs radiograph
- Position patient so region of intrest on top (dorsal recumancy)
- Sensor across mouth- rest crown of teeth being imaged on closest edge of sensor
Describe how to solve trouble shooting of dental radiographs:
- Image not fully on plate
- Area of intrest not within cone
- Roots elongated
- Roots compressed
- Move plate futher into region of intrest
- Plate and tube need to be repositioned to include region of intrest
- Angle too shallow- adjust head position
- Angle too steep- adjust tube head position
Identify the following structures
- E= enamel
- D= dentine
- FG= free gingiva
- AG= attached gingiva
- MGJ= mucogingival junction
- OM= Oral mucosa
- AB= alveolar bone
- PDL= periodontal ligament
- C= Cementum
- JE= Junctional epithelium
What is periodontitis?
What is periodontal disease?
What is plaque?
How does plaque form?
Plaque- induced inflammation- gingivitis and periodonitis
Peridontal disease is an inflammatory and destructive condition affecting the support tissues of the teeth
Plaque- biofilm- aggregation of bacteria and debris and inflammatory cells
- Pellicle- acellular film of salivary glycoproteins/polypeptides and lipids, lay down enamel
- Forms quickly- bacteria adhere
- Mineralises, bacteria start to absorb calcium from saliva
What is calculus?
Where can it be located?
Calculus is mineralised plaque
Minerals, calcium from saliva
Rough porous surface provides attachment to plaque
Location-
supra-gingival- crown
sub-gingival- gingival sulcus
What is gingivitis?
What are the stages?
What can be done after it occurs?
Inflammation of the soft tissues of the gingiva secondary to plaque accumulation
Stages-
Marginal gingivitis: free edge by gingiva affected
Gingival sulcus colonies by anaerobic bacteria
Inflammation- bacterial enzymes
endotoxins released and host immune system reacts
This is reversible
What is periodontitis?
What can be done once this occurs?
What are the influencing factors?
Inflammation and destruction of periodontal ligament and alveolar bone- attachment loss of the tooth
Develops in the sub-gingival pocket extension- periodontal pocket
Irreversible!
Influencing factors-
Breed- brachy, greyhounds- malocculusion
Immune status
Developmental defects- retention of deciduos teeth
Diet- soft food reduced mechanical abrasion
Describe the disease process of periodontal disease?
- Plaque formation
- Deepening of the sulcus- secondary to the junctional epithelium becoming inflammed
- Proliferation of the subgingival plaque and increased anaerobin microflora
- Toxins leads to tissue damage- bacteria and cytotoxins
- Continued attachment loss- calculus helps plaque to overgrow- increased periodontitis
- Tooth loss- junctional epithelium seperated from tooch- periodontal pocket- osteoblastic resorption- loss alveolar bone- tooth mobility
What are the different stages of periodontal disease?
- Stage 0- Normal healthy
- Stage 1- gingivitis, no attachment loss
- Stage 2- gingivitis and plaque, upto 25% attachment loss
- Stage 3- gingivitis, plaque and calculus- 25-50% attachment loss
- Stage 4- Gingivitis, calculus, root exposure, mobile teeth, over 50% attachment loss
What are the clinical signs and diagnostic tests for periodontal disease?
Clinical signs
- Halitosis
- Salivation and blood tinged saliva
- Variable amounts of plaque +/- calculus
- Inflammed/bleeding ginvgiva
- Purulent discharge from periodontal pocket
- Loss of gingival contour
- Furcation exposure
- Tooth mobility
- Dysphagia
Diganostic tests- Gingivitis index, attachment loss, radiography
What is the goal of treatment for periodontal disease?
What is done?
Goal- suppress inflammation and stop progression of disease
- General health assessment- rule out contributing factors
- Full mouth periodontal probing and charting
- Formulate treatment plan- owner compliance for postoperative home managment
- Reduce bacterial load- flush with chlorohexidine- reduce bacteraemia
- Supragingival scaling- remove of the plaque and calculus
- Subgingival debridment- removal from pocket
- Polishing- removes plaque and stains- smooths to stop adherence
- Sulcular lavage- use air-water syringe gently remove excess of paste
- Extractions
- Periodontal surgery- surgical flaps to expose root surfaces
What are the options for home managment of periodontal disease?
Tooth brushing- gold standard
Brush around the gum line from caudal to rostral
Can bleen intitally do not stop
Chemical anti-plaque agents- chlorohexidine
Owner training
