SASx Final Exam - Head Surgery (Dentistry, Oral, Ear) Flashcards
1
Q
What are some complications associated with mandibulectomies?
A
- Swelling
- Wound dehisceince (more common with rostral mandibulectomy)
- Mandibular drifting -‘clicking’ sounds when the jaw is closed
- Decrease ability to prehend food
2
Q
Using the Triadan tooth numbering system, what number would identify the right maxillary middle incisor?
A
102
3
Q
What is the most common malignant oral tumor seen in the cat?
A
squamous cell carcinoma
4
Q
What are the surgical options for lip reconstruction?
A
- Direct apposition
- Labial advancement flap
- Labial rotation flap
5
Q
The most common Class 1 malocclusions that we see are:
A
Base Narrow Canines
- This is typically the result of retained deciduous canines. Once it impacts the soft tissues on the hard palate, it is locked in place! So if we don’t recognize this early, even if we extract the deciduous teeth, it will have no effect.*
- If we’re going to create space, we need to do it before the soft tissue is contacted. These can become so severe that they can create oronasal fistulas*
- ***
6
Q
What is the dental formula for deciduous teeth in the dog?
A
7
Q
The periodontal ligament isolates the tooth from the surrounding bone and, importantly, the ________ that remodel the surrounding bone
A
osteoclasts
The periodontal ligament isolates the tooth from the surrounding bone and, importantly, the _osteoclasts_ that remodel the surrounding bone
8
Q
Collection of blood within the cartilage plate of the ear is termed:
A
aural hematoma
9
Q
Where do we typically see SCC in the oral cavity cats?
A
gingiva and under the tongue
- Gingiva and under tongue
- Extensive bone involvement common
- Often advanced before diagnosis is made
10
Q
Of the viral diseases in cats, which one is known to exacerbate periodontal disease?
A
Calicivirus
11
Q
What is the treatment for a tooth fracture?
A
-
Enamel fracture, Uncomplicated fractures
- +/- indirect pulp capping
- Crown restoration
-
Complicated fractures
- Vital pulpotomy or root canal
- Crown restoration OR Extract tooth
12
Q
At what age do we expect to see eruption of deciduous molars in cats and dogs?
A
the premise is false.
- There are no deciduous molars in cats and dogs.*
- Permanent molars should be expected around 5-7 months*
13
Q
What is the most important thing to remember for oral cavity surgery to prevent dehiscence?
A
avoid tension on oral closure
14
Q
What is the goal of treatment for periodontal disease?
A
to prevent development of new lesions at other sites and to prevent further tissue destruction at sites that are already affected
15
Q
A space or gap between two teeth is termed:
A
diastema
16
Q
What is the dental formula for adult teeth in the dog?
A
17
Q
Removal of primary teeth to avoid or correct the problem describes what malocclusion treatment?
A
interceptive orthodontics
18
Q
The potential space between the tooth and the gingiva is termed:
A
gingival sulcus
when you have an overgrowth of bacteria in the gingival sulcus and get destruction of the junctional epithelium (base of the gingiva that attaches to the tooth), the disease process changes from gingivitis to periodontitis
19
Q
The treatment of choice for a ranula is:
- Marsupialization into the oral cavity
- Ligation of the affected duct
- Placement of a drain through the intermandibular space
- Excision of the sublingual and mandibular salivary glands
A
Excision of the sublingual and mandibular salivary glands
20
Q
What is your diagnosis?
A
amelanotic melanoma
21
Q
What lip construction technique has been performed here?
A
labial rotation flap
22
Q
What procedure is illustrated below?
A
Single Flap Technique for oronasal fistula repair
Bonus question: what type of flap is present in the illustration? (Single pedicle advancement flap)
23
Q
T/F: Surgical removal of the involved gland is the definitive treatment for all mucoceles
A
True!
There are other procedures you can do depending on the patient or the condition, but they’re usually associated with a higher likelihood of recurrence… just remove the gland, don’t be a p***y
24
Q
What is the name of this treatment for base narrow canines?
A
incline plane
If they’ve been on there for a while, often times it will look like this (picture below) when you take it off. Food debris, bacteria, etc. will build up under there and cause a fairly significant mucositis. These tend to resolve very quickly once the appliance is removed.
Treatments for this: pain relievers, decaffeinated tea rinses. It will usually heal with time
25
What are the treatment options for **pulpitis**?
**monitor for progression, root canal, or extraction**
26
This oral tumor arises from remnants of epithelial cells that produce periodontal ligament. It is benign, but locally invasive:
**acanthomatous ameloblastoma**
27
Which of the following tumors commonly occurs in the vertical ramus of the mandible
* Complex odontoma
* Undifferentiated malignant oral tumor
* Multilobular osteochondrosarcoma
* Central ameloblastoma
**Multilobular osteochondrosarcoma**
28
What's the main difference between a **scaler** and a **curette**?
**A scaler has a sharp point. A curette does not.**
29
What is the **minimal sulcus depth** in the normal dog? Normal cat?
* Dog: 1-3 mm
* Cat: 0-1 mm
30
**Mandibular adult canines** erupt ________ to deciduous canines
**lingual**
*Mandibular adult canines erupt _lingual_ to deciduous canines*
31
T/F: In dogs, there is no deciduous 1st premolar
**True**
32
T/F: Benign oral tumors can be differentiated from malignant tumors because benign tumors do not invade the bone
**False**
*Example: Acanthomatous ameloblastoma is a benign lesion that is locally invasive into bone*
33
This is a benign proliferation of fibrous connective tissue containing displaced cells of dental supporting structures. Identify the tumor:
**Peripheral Odontogenic Fibroma**
*Local excision is curative, if complete*
34
What prognosis is associated with **undifferentiated malignant oral tumors**?
**grave**
*Survival is often one month or less*
35
In what age group of dogs do we typically see **undifferentiated malignant oral tumor**?
**YOUNG DOGS (6-24 months)**
These are VERY AGGRESSIVE tumors - rapid growth with early metastasis
They tend to grow on the maxilla, caudal to the canine tooth (~the same spot we normally see fibrosarcomas)
36
T/F: Oral plaque is initially Gram [+], aerobic, and non-motile cocci in the normal mouth, but as periodontitis progresses, the bacterial population changes to Gram [-], motile, anaerobic rods and spirochetes
**True**
37
What are the characteristics of a **tonsilar squamous cell carcinoma (SCC)**?
* **Highly malignant**
* **Usually unilateral**
* **Early metastasis**
* **\> 90% to distant sites at diagnosis**
38
An angled or curved root tip of a tooth is termed:
**dilaceration**
39
Identify the area(s) of **periapical lucency**:
40
What are the clinical signs associated with **undifferentiated malignant oral tumors**?
**external swelling, loose teeth, pain, periorbital swelling, exophthalmos**
41
If a dog has malpositioned teeth, but the jaw length is normal, this would be classified as a ________ malocclusion
**Class 1**
42
What modality is used to determine the _type_ of tooth resorption lesion present?
**radiographs**
* Type 1
* Focal or multifocal radiolucencies
* _Periodontal ligament remains intact_
* Moderate to severe gingivitis and periodontitis
* Type 2
* Focal or multifocal radiolucencies in tooth
* Disappearance of the periodontal ligament with varying degrees of root resorption
* No or minimal evidence of periodontitis
* Type 3
* Features of type 1 and 2 in same tooth (especially multi-rooted teeth)
43
Salivary gland neoplasia is pretty rare, but adenocarcinoma is the most common. In dogs, it usually occurs in the ________ gland. In cats, it usually occurs in the ________ gland
Salivary gland neoplasia is pretty rare, but adenocarcinoma is the most common. In dogs, it usually occurs in the **_parotid_** gland. In cats, it usually occurs in the **_mandibular_** gland
44
T/F: **Retained deciduous teeth** are most commonly seen with canines and premolars
**False**
* Retained deciduous teeth are most commonly seen with _canines and incisors_*
* Retained deciduous teeth are seen most frequently in toy breed dogs and cats*
45
What is the most common malignant oral tumor in the dog?
**melanoma**
* *In general, with melanoma:*
* *If it's on a mucocutaneous junction or nail bed - think MALIGNANT*
* *If it's on haired skin, think BENIGN*
46
What age is typically ideal for performing a **complete root canal**?
**mature tooth (\>24 months)**
*\<24 months the apex may not be closed or pulp chamber is still very wide, increasing risk of failure*
47
Identify the malocclusion present in this image:
**wry mouth**
*Wry bite develops when the two sides of the maxilla (typically) are not growing at the same rate*
48
Which of the following pairs of oral tumors occurs most commonly in maxilla caudal to canine tooth?
* Squamous cell carcinoma, undifferentiated malignant oral tumor
* Fibrosarcoma, acanthomatous ameloblastoma
* Squamous cell carcinoma, acanthomatous ameloblastoma
* Fibrosarcoma, squamous cell carcinoma
* Fibrosarcoma, undifferentiated malignant oral tumor
**Fibrosarcoma, undifferentiated malignant oral tumor**
49
Impacted or malformed teeth can result in abscess or ________ cyst formation and should be extracted in most cases
**dentigerous cyst**
*Impacted or malformed teeth can result in abscess or _dentigerous cyst_ formation and should be extracted in most cases*
50
If a tooth is partially dislocated from the alveolus but retains some attachment, this is termed:
**tooth luxation**
51
Of the crown root fractures, what type do we see most commonly?
**slab fracture**
*very commonly on the upper 4th premolar*
52
What type of **tooth resorption lesion** is present here?
**Type 3**
* *In general, don't make your judgement completely off the radiographs*
* *Features of type 1 and type 2 in same tooth*
* *Most often seen in multi-rooted teeth, where one root shows type 1 features and the other root shows type 2 features*
53
This is the canine equivalent to feline gingivostomatitis:
**CUPS**
* *(Canine Ulcerative Paradental Stomatitis)*
* *Treatment:*
* *Similar to feline gingivostomatitis*
* *Home care: 1-2x daily brushing*
* *May require total mouth extractions to control*
54
What type of **mandibulectomy** is shown here?
**bilateral rostral**
55
Gingival recession with 25-50% bone loss and slight to moderate mobility is categorized as Stage ____ periodontal disease
**Stage 3 - Moderate Periodontitis**
56
What age is typically ideal for performing a **vital pulpotomy**?
**young animals (\<18-24 months)**
*can attempt in older animals, but success rate lower because pulp less resilient (\<5 years)*
57
What is the most common treatment for oral neoplasia?
**surgical resection**
58
When using a dental scaler, the most important thing to remember is to never use sharp tip below \_\_\_\_\_\_\_\_\_\_
When using a dental scaler, the most important thing to remember is to never use sharp tip below the **_gingival margin_**
## Footnote
*You don't want to risk traumatizing the junctional epithelium at the base. So these are only used supra-gingivally (ABOVE the gum line)*
59
Cats have the same salivary glands as dogs, but because cats are jackasses sometimes, they have an extra salivary gland. What is it called?
**molar salivary gland**
60
What prognosis is associated with **SCC** in cats?
**guarded to poor**
* *Results with surgery not as good as in dogs*
* *Radiation therapy can cause significant side‐effects*
* *Chemotherapy: Piroxicam*
* *Because these tumors tend to be more advanced by the time the diagnosis is made, achieving adequate margins is more difficult compared to dogs and local recurrence is more common than in dogs*
61
**Dentin** is formed by ________ throughout the life of the tooth
**odontoblasts**
*Dentin is formed by **_odontoblasts_** throughout the life of the tooth*
62
What's going on in this tooth?
**enamel infraction (abraction)**
* *Tooth is a dynamic structure, so it flexes and cracks. These cracks are just in the enamel*
* *There is _no loss of structure_ with this abnormality*
63
What are the goals of a **complete root canal**?
**remove pulp contents** and **seal the apex**
## Footnote
*complete removal of pulp contents and _seal apex to prevent bacteria from escaping from tooth_*
64
What type of **mandibulectomy** is shown here?
**unilateral rostral**
65
T/F: **Salivary mucoceles** do not need to be removed. They will go away after you remove the affected salivary glands
**True**
66
Shortening of the oral commissure is most commonly performed in conjunction with which the following surgical procedures?
* Bilateral rostral mandibulectomy
* Unilateral caudal maxillectomy
* Total unilateral mandibulectomy (hemimandibulectomy)
* Unilateral central mandibulectomy
**Total unilateral mandibulectomy (hemimandibulectomy)**
67
What critical step of the dental cleaning process is being performed here?
**subgingival calculus removal**
68
The only visible part of the **periodontium** in a normal mouth is the \_\_\_\_\_\_\_\_
**gingiva**
69
What is the purpose of **shortening the lip commissure** in a total mandibulectomy?
* Improves ability to prehend food and drink water
* Prevents the tongue from lolling out to the side
70
\_\_\_\_\_\_\_\_\_\_ resorption is the predominant activity in tooth resorption
**osteoclastic (odontoclastic)**
*odontoblasts do not play an active role in attempts at repair in most cases*
71
T/F: If caught early enough, **periodontitis** is reversible with proper treatment and home care
**False**
*Periodontitis can be controlled, but not completely reversed*
72
What is the **cingulum**?
**The shelf on the inside (palatal) surface of the maxillary incisors where the mandibular incisors occlude or "rest"**
73
How would you treat this?
**remove excessive tissue to return sulcus depth to normal**
* *The image shows gingival hyperplasia*
* *Etiology:*
* *Focal: due to periodontal disease*
* *Generalized: often seen in boxers*
* *Drugs: cyclosporine, calcium channel blockers, anticonvulsants*
74
Shown below is a double flap technique for oronasal fistula repair. The "hinge" flap receives its blood supply from the __________ so elevation of this flap toward the fistula must be done carefully to avoid damaging the blood supply
**nasal mucosa**
*The "hinge" flap receives its blood supply from the _nasal mucosa_ so elevation of this flap toward the fistula must be done carefully to avoid damaging the blood supply*
75
What anatomic landmark is used to determine where to section a multi-rooted tooth prior to extraction?
**furcation**
76
Name the three lymphocentrums that drain the oral cavity:
**mandibular, parotid, retropharyngeal**
77
T/F: Dental scalers are used for supra- or sub-gingival calculus removal and root cleaning
**False!**
* A **_curette_** is used for supra- or sub-gingival calculus removal and root cleaning*
* You don't want to risk traumatizing the junctional epithelium at the base. So _dental scalers_ are only used supra-gingivally (ABOVE the gum line)*
78
Draining tract associated with the teeth is called a:
**parulis**
*This type of opening _at_ the mucogingival line or beyond it is most likely caused by endodontic disease. If you see it and it is coronal, it is more likely to be caused by periodontal disease*
79
This illustration shows excision of the mandibular and sublingual salivary glands. What structure is indicated by the **pink arrow**? What about the **cyan arrow**?
**digastricus muscle** and **lingual nerve**
80
**Retained tooth root tips** usually should be removed. What are the two primary exceptions?
**Type II and III tooth resorptive lesions**
*Root tips may be intentionally left in these cases but owner should be informed*
81
**Level bite** is a Class 3 malocclusion and leads to abnormal wear on incisors commonly repaired by tertiary dentin. This type of wear is called:
**attrition**
82
What type of **mandibulectomy** is shown here?
**central**
83
When is a **double flap technique** used for oronasal fistula repair?
**congenital defects and chronic fistulas where the oral mucoperiosteum has healed to nasal mucosa**
84
What is the #1 preventative method for periodontal disease?
**GOOD HOME CARE!**
* mechanical abrasion, surface acting agents (brushing their teeth)*
* Useful to start daily tooth brushing prior to professional therapy (try an inexpensive powered toothbrush)*
85
What is considered the best treatment for **gingivostomatitis**?
**Tooth extraction**
*the sooner, the better - and must get ALL of the tooth including the entire root(s)*
86
What is the recommended treatment for **Type 2 tooth resorption lesions**?
**amputate the crown and superficial root structure and leave ankylosed part of the root since it is being absorbed anyway**
*You can extract the entire tooth if root structure and pulp chamber are still discernable, but this is very difficult*
87
Periodontal index of 4 means there is \>\_\_\_\_% gingival attachment loss
**\>50%**
* Periodontal index of 4 means there is _\>50%_ gingival attachment loss*
* At this level, undoubtedly there is some pathologic tooth mobility and it is imminent that the tooth will be lost*
88
What diagnostic modality is required for diagnosing impacted teeth?
**dental radiographs**
89
Which of the following is the most important reason for achieving complete filling of the pulp chamber during a complete root canal?
* It prevents staining of the tooth
* It significantly increases the strength of the tooth
* It minimizes risk of periapical inflammation and failure of the root canal
* It insures survival of the periodontal ligament
**It minimizes risk of periapical inflammation and failure of the root canal**
90
What type of **mandibulectomy** is shown here?
**caudal mandibulectomy**
91
What diagnostic modality is most sensitive for diagnosing middle ear disease?
**MRI**
92
The portion of the pulp that is below the crown is the \_\_\_\_\_\_\_\_
**root canal**
93
Is this draining tract more likely caused by endodontic disease or periodontal disease?
**endodontic disease**
*This type of opening at the mucogingival line or beyond it is most likely caused by endodontic disease. If you see it and it is coronal, it is more likely to be caused by periodontal disease*
94
The adult maxillary canine tooth erupts in what location relative to its deciduous counterpart?
* Rostral
* Caudal
* Palatal (medial)
* Labial (lateral)
**rostral**
95
What are **inflammatory polyps**? Where are they usually located?
**Inflammatory polyps are benign, fibrous, pedunculated masses that may be found in the oropharynx, middle ear, or external ear canal.**
96
The most common tumor of the middle ear, inner ear, and pinna in cats is:
**squamous cell carcinoma (SCC)**
97
**Gingivitis** is stage ____ periodontal disease
**Stage 1**
98
Stages of periodontal disease are based on several criteria. List them.
* Gingival appearance
* Sulcular (sulcus) depth
* Percentage of bone loss
* Tooth mobility
99
Identify the area(s) of **root resorption**:
100
Identify the **tragus**
101
The objective of a vital pulpotomy is to:
**maintain a viable tooth that will continue to mature**
*The pulp is necessary to maintain dentin (a dynamic structure). Without a viable pulp, the tooth will become dehydrated and more brittle over time*
102
Most likely diagnosis?
**oral melanoma**
* *Locally invasive*
* *Metastasize early to regional lymph nodes and lungs*
* *Gingiva \> labial and buccal mucosa \> palate \> tongue*
* *Melanotic and amelanotic*
103
This is a collagenous connective tissue structure extending from cementum to periosteum:
**periodontal ligament**
* *Two types of fibers: PDL fibers and Sharpey's fibers*
* *_Periodontal ligament functions_*
* *Attaches teeth to alveolus*
* *Absorbs shock from the impact of occlusal forces and transmits them to the alveolar bone*
* *Supplies nutrients to alveolar bone and cementum via arterioles and drainage via venules and lymphatics*
* *Provides tactile and proprioceptive information - essential in coordinating the neuromuscular activity of mastication*
104
What **malocclusion** is present in this image?
**posterior cross bite**
*maxillary premolars are lingual to mandibular premolars or molars (they shouldn't be)*
105
T/F: **Periodontitis** is a site-specific disease
**True!**
106
T/F: There is a vaccine that is approved for the treatment of melanoma
**True**
107
When using the **Triadan tooth numbering system**, the canine teeth will always end with _____ and the 1st molar will always end with \_\_\_\_
When using the Triadan tooth numbering system, the canine teeth will always end with **_04_** and the 1st molar will always end with **_09_**
108
What are some complications associated with **maxillectomies**?
* **Wound dehiscence with oronasal fistula**
* **Bilateral rostral maxillectomy caudal to canines will allow nose to droop and affect prehension of food**
109
The most common oral disease that we deal with in dogs and cats is:
**periodontal disease**
* *Most common oral disease*
* *Present in \>70-85% of dogs and cats over 3 years of age*
* *Number 1 cause of tooth loss*
* *More common now due to diet, malocclusion*
110
A four year old Golden retriever is presented after the owner found a nonulcerated firm mass in the hard palate at the level of the upper fourth premolar. This presentation is most consistent with which one of the following oral tumors?
* Squamous cell carcinoma
* Melanoma
* Acanthomatous ameloblastoma
* Fibrosarcoma
**Fibrosarcoma**
*Oral fibrosarcomas occur most frequently in the gingiva of the maxillary dental arcade, especially between the canine tooth and fourth premolar. The hard palate is another common site of occurrence. They occur more commonly in large breeds (Golden Retriever). In older dogs, fibrosarcomas are usually firm, slow growing tumors that ulcerate less frequently than other types of oral tumors.*
111
What is wrong with this tooth?
**pulpitis**
* tooth has a purple discoloration. May be reversible, but not often. The older the patient, the less likelihood the pulp will survive.*
* Radiographs are used to determine whether the tooth is viable*
112
\_\_\_\_\_\_\_\_\_\_ is the most common disease of tooth structure in domestic felines
**tooth resorption (TR)**
113
Using the Triadan tooth numbering system, what number would identify the **left mandibular 4th premolar**?
**308**
114
The portion of the pulp that is _above_ the crown is the \_\_\_\_\_\_\_\_
**pulp chamber**
115
What is the difference between **apical** and **coronal**?
* **Apical always means toward the root** (away from the crown)
* **Coronal means toward the crown**
116
What type of **mandibulectomy** is shown here?
**total mandibulectomy**
117
What is the most frequent location for oral **fibrosarcoma** in the dog?
**maxilla - caudal to the canine tooth**
118
In this image, the mandible is too long. This is a Class ___ malocclusion
**Class 3**
119
T/F: If you notice there is a deciduous tooth that is missing, it is generally safe to assume that the adult tooth will also be missing in that location
**True**
*Deciduous buds form in utero, which give rise to permanent buds also in utero*
120
A client comes in all flustered and freaking out. You're all like, "Calm down, what's going on?" and they're all like, "YOU WON'T BE TELLING ME TO CALM DOWN WHEN YOU SEE THIS THING IN MY DOG'S MOUTH!" Then they show you this image below and you're all like:
**"Please stop speaking in all CAPS. It's a normal structure called the incisive papilla"**
121
What is tight lip syndrome? What breed is most commonly affected?
**The lower lip is so tight that it may cover the incisors and cause trauma when the mouth is closed.**
*Most common in Shar Pei*
122
What are the 'big three' malignant oral tumors in the dog?
1. **Malignant melanoma**
2. **Squamous cell carcinoma**
3. **Fibrosarcoma**
123
What important anatomic structure is shown below?
**mucogingival line**
*area where alveolar mucosa and attached gingival tissues meet*
124
How do you treat **odontogenic tumors**?
**surgical resection**
*Primary treatment will be surgical resection. They ARE radiosensitive as well, but consider the side effects of radiation therapy*
125
In this image, the mandible is too short. This is a Class ___ malocclusion
**Class 2**
126
Actinic keratosis is caused by actinic damage to lightly pigmented or non-pigmented, sparsely haired skin on the nose or trunk. If medical treatment fails, what treatment is indicated?
**pinnectomy**
127
Using the Triadan tooth numbering system, what number would identify the **right mandibular 1st molar**?
**409**
128
Disappearance of the periodontal ligament with varying degrees of root resorption occurs with **Type \_\_\_\_** tooth resorption lesions
**Type 2**
* *Focal or multifocal radiolucencies in tooth*
* *Disappearance of the periodontal ligament with varying degrees of root resorption*
* *No or minimal evidence of periodontitis*
129
What is the second most common malignant oral tumor in dogs?
**squamous cell carcinoma**
* *Biological behavior varies with location*
* *Tonsillar vs. Nontonsillar*
* *Nontonsillar – the further caudal in the mouth the worse the prognosis*
130
An 8 year old Doberman presents with this lesion on the maxilla, caudal to the canine tooth. What is the most likely diagnosis?
**fibrosarcoma**
131
What is the recommended treatment for **Type 1 tooth resorption lesions**?
**extract entire tooth**
*Since often associated with periodontitis and endodontic disease, complete extraction is indicated*
132
When is a **lateral ear canal resection** indicated in a case of otitis externa?
* **When skin changes are reversible**
* **Tumor involving tragus or lateral wall of vertical canal**
133
A **central ameloblastoma** is a non-inductive odontogenic tumor that arises from \_\_\_\_\_\_\_\_\_\_
**dental laminar epithelium**
*May be cystic or multiloculated with considerable bone destruction*
134
Gingival recession with \>50% bone loss and advanced tooth mobility is categorized as Stage ____ periodontal disease
**Stage 4 - Advanced Periodontitis**
135
**Crowding** is seen most commonly in brachycephalic breeds. Which teeth are most frequently affected?
**maxillary 3rd premolars**
*If this is not interfering with closing the mouth, eating, etc. and it is not causing any discomfort, this does not need to be specifically addressed*
136
Name three treatment options for **attrition**
* **orthodontic correction**
* **crown reduction**
* **extraction**
137
If a dog has mandibular prognathism (undershot), this would be classified as a ________ malocclusion
**Class 3**
138
T/F: **Maxillectomies** are typically associated with more hemorrhage than mandibulectomies
**True**
*especially if nasal turbinates are affected*
139
Dryness of the mouth is termed:
**xerostomia**
140
If a tooth is completely displaced from the alveolus, this is termed:
**tooth avulsion**
* If a tooth is avulsed, you MUST keep the tooth moist (saliva, milk, saline)*
* Flush the tooth with saline if it is dirty, but DO NOT use antiseptics or scrape the surface*
141
What is the postoperative care after a **maxillectomy** or a **mandibulectomy**?
* **IV fluids for the 1st 24 hours**
* **Pain meds**
* **Most will drink & eat day after surgery**
* **Feeding tube for ¾ mandibulectomy cases**
142
Using the Triadan tooth numbering system, what number would identify the **left maxillary canine**?
**204**
143
**Abrasions** are caused by abnormal contact with crown surface by foreign object (tennis balls, cages, rocks, etc.). How do you treat this?
**remove offending objects and monitor pulp exposure and crown fractures**
* You must establish if there is endodontic exposure! Probe with explorer. If it enters the chamber, **_then you must extract or do a root canal_**!*
* Reparative dentin is brown and hard*
144
You note this abnormality in your patient's mouth. It has a soft leathery appearance and a brownish color. What is your diagnosis?
**dental caries**
* *Treatment:*
* *Indirect or direct pulp capping*
* *Root canal*
* *Extraction*
145
**Anterior cross bite** is considered a Class ___ malocclusion
**Class 1**
146
This cat presented with ptyalism, halitosis, dysphagia, anorexia, and weight loss. What is your diagnosis?
**gingivostomatitis**
* *Etiology: unknown*
* *Calicivirus, bacterial, or immunological - "allergic to plaque"*
* *Siamese, Abyssinians, Persians, Himalayans, Burmese*
* *Signs*
* *Ptyalism, halitosis, dysphagia, anorexia, weight loss*
* *Diagnosis: Histopathology, clinical signs, typical history*
147
What are the four major salivary glands in the dog?
**parotid, mandibular, sublingual, zygomatic**
148
Which salivary gland is most commonly affected with **salivary mucocele**?
**sublingual**
*removing the polystomatic portion of the sublingual salivary gland is an important part to consider for treatment*
149
Carnassial tooth root abscesses are a common problem in dogs. The carnassial teeth are the:
* Maxillary and mandibular 4th premolars
* Maxillary and mandibular 1st molars
* Maxillary 4th premolar and mandibular 1st molar
* Maxillary 1st molar and mandibular 4th premolar
**Maxillary 4th premolar and mandibular 1st molar**
150
What instrument is used to assess access into the pulp cavity and assess for dental caries lesions?
**periodontal probe/explorer**
151
What type of **mandibulectomy** is shown here?
**3/4 mandibulectomy**
152
This radiograph shows ________ formation due to an un-erupted canine tooth
**cyst**
153
**Enamel** is formed by ________ on the crown of the tooth prior to eruption
**ameloblasts**
*Enamel is formed by _ameloblasts_ on the crown of the tooth prior to eruption*
154
What are the top four **systemic antibiotics** that are used for treatment of periodontal disease?
1. **Clindamycin**
2. **Clavamox**
3. **Metronidazole**
4. **Doxycycline**
## Footnote
*Keep in mind that we don't always use antibiotics!*
155
Local recurrence is more commonly seen with **fibrosarcomas** than with melanoma and squamous cell carcinoma in dogs. Why?
**margins are more likely to be dirty since tumors cells often extend beyond the apparent edge of tumor**
156
What are 'wide margins' with regard to oral surgery?
**1-2 cm**
1-2 cm around the edge of the mass in all directions
157
An 8 year old German shepherd is presented to you for an annual check-up. You note a slab fracture in 108 (PM4) . The owner is unaware of when it occurred but says she hasn’t noticed any changes in the dog’s eating habits. You confirm exposure of the pulp chamber with your dental explorer. Based on the information available which of the following would be most appropriate course of action?
* Tell the owner to just continue monitoring the dog for evidence of pain and to contact you if noted.
* Tell the owner that the tooth is not necessary for function so extraction is the best treatment option.
* Tell the owner that either vital pulpotomy or complete root canal is the best treatment option because the tooth is necessary since the dog is fed dry food.
* Tell the owner that either complete root canal or extraction can be performed and explain the risks/benefits of each option
**Tell the owner that either complete root canal or extraction can be performed and explain the risks/benefits of each option**
158
Would you say this is a very young animal or a very old animal?
**very young animal**
*The pulp chamber is huge and the wall of the tooth is very narrow*
159
T/F: **Marsupialization** is the treatment of choice for ranulas
**False**
* Marsupialization is a _salvage procedure_ for high risk patients (poor anesthesia candidates, etc.).*
* The treatment of choice for a ranula is surgical excision of the mandibular and sublingual salivary glands*
160
The periodontal ligament remains intact with *what type* of tooth resorption lesion?
**Type 1**
* *Focal or multifocal radiolucencies*
* *_Periodontal ligament remains intact_*
* *Moderate to severe gingivitis and periodontitis*
* *Very frequently associated with periodontal disease*
161
Subcutaneous (submucosal) accumulation of saliva within a nonepithelial, nonsecretory lining is descriptive of:
**salivary mucocele**
162
What is the difference between a complicated and an uncomplicated tooth fracture?
* **Complicated: pulp exposed**
* **Uncomplicated: pulp not exposed**
163
The picture shows a 3.5 month dog with a fractured canine tooth resulting in exposure of the pulp chamber. The most appropriate treatment for this case is:
**extraction**
164
What type of **tooth resorption lesion** is present here?
**Type 2**
* *Focal or multifocal radiolucencies in tooth*
* *_Disappearance of the periodontal ligament_ with varying degrees of root resorption*
* *No or minimal evidence of periodontitis*
165
If a dog has mandibular brachygnathism (parrot mouth, overshot), this would be classified as a ________ malocclusion
**Class 2**
166
What are the odontogenic tumors?
**central ameloblastoma** and **odontoma (complex and compound)**
167
T/F: With regard to **non-tonsilar** **squamous cell carcinoma**, the more caudal the tumor is in the mouth, the better the prognosis
**False**
*The more **caudal** the tumor is in the mouth, the **worse** the prognosis. Tumors in the caudal part of the mouth are often larger at Dx making it more difficult to get adequate margins.*
168
T/F: **Supernumerary teeth** are most often incisors and/or premolars
**True**
* More commonly seen in the premolars*
* \*\*Remove supernumerary teeth if causing malocclusions\*\**
169
Electrical burns in the oral cavity are most commonly a result of chewing on electrical cords. In addition to the local injury seen, what complication is also commonly seen, especially in cats?
**pulmonary edema**
*exact mechanism is not fully understood, but it is a pretty common complication*
170
Identify the areas of **horizontal bone loss**:
171
An **odontoma** is an inductive odontogenic tumor and can be classified as compound or complex. How would you classify the odontoma shown below?
**compound odontoma**
* Compound odontomas contain tooth structures in various stages of development. With complex odontomas, dental tissues are not differentiated enough to resemble teeth*
* (I would be able to ID this picture)*
172
What is the most common site for a **lip avulsion**?
**mucogingival junction**
* Suture reconstruction is effective for maxillary lesions*
* Reconstruction of lower lip often fails because of the weight of lip (in this case, place interdental stent sutures to support weight of lip first, then suture mucogingival junction*
173
Name two salvage procedures for uncorrectable palatal defects:
**acrylic appliances** and **nasal septal button**
174
T/F: **Enamel** is not replaced if it is damaged
**True**
175
How do you manage **inflammatory polyps**?
**traction extraction** or **ventral bulla osteotomy**
* *_Traction extraction_*
* *Although traction has been used to remove masses when there is no evidence of otitis media, performing a ventral bulla osteotomy in conjunction with this procedure is recommended to decrease the recurrence rate.*
* *If traction-avulsion alone is used, concurrent treat- ment with an antiinflammatory*
* *_Ventral bulla osteotomy_*
* *Most commonly done in cats for polyps*
* *The best results are seen when a ventral bulla osteotomy is performed; with this procedure, the recurrence rate is less than 2%. Ventral bulla osteotomy should always be performed if middle ear disease is evident on radiography or CT.*
176
**Tetracycline** given when teeth are developing will stain them \_\_\_\_\_\_\_\_
**yellow**
*_dentin_ is the affected layer*
*No treatment is needed except for cosmetics - can be bleached or resin bonded. Doxycycline is much less of a problem than tetracycline*
177
What structures do you need to avoid during a **TECA** and where are they located?
* **Facial nerve** (just caudal to the horizontal ear canal)
* **Auricular artery** (at the medial aspect of the vertical canal)
178
What is the most common complication associated with **gingivectomy**?
**generation of excess heat, causing alveolar necrosis**
*this is the result of not fully understanding the surgical method (electrosurgery, radiosurgery)*
179
T/F: Some degree of tooth mobility is normal
**True**
* This is referred to as **physiologic mobility** and represents the movement of a tooth within the periodontal ligament space*
* Movement in excess of physiologic mobility is referred to as pathologic mobility*
180
This cat presented to the emergency room with episodes of severe oral bleeding. What structure are we concerned about in this area of the mouth when we see ulceration?
**greater palatine artery**
*this is where the greater palatine artery comes into the oral cavity, so watch out for erosion through this artery!*
181
What are the clinical signs associated with **Horner's syndrome**?
**ptosis, miosis, enophthalmos, and protrusion of the third eyelid**
*Horner's syndrome may occur as a complication associated with TECA - as a result of damage to the sympathetic trunk as it courses through the middle ear*
182
Identify the **anthelix**
183
T/F: When extracting a canine tooth, it is important to make your incision over the center of the alveolus
**False**
* The incision should start in the diastema, rostral to the alveolus.*
* If you incise directly over the alveolus and you discover an oronasal fistula (or create an oronasal fistula), it will increase the risk of wound healing complications*
184
Using the Triadan tooth numbering system, what number would identify the **right maxillary carnassial tooth**?
**108**
