Small Animal Dentistry Flashcards
what is the dental formula for canines
3-1-4-2/3-1-4-3
= 42
what is the feline dental formula
3-1-3-1/3-1-2-1
= 30 teeth
what are the steps to filling out a dental chart (3)
- count the teeth
- log calculus level in CI box – buccal
- log gingival inflammation in GI box
why might there be missing teeth? (4)
- removed or fell out
- congenitally missing
- crown missing: root still present
- tooth embedded and unable to erupt
what is the scale to calculus level
0 = none
1 = <25%
2 = 25%-75%
3 = > 75%
what is the scale to gingival inflammation
0 = no inflammation
1 = red line/edema etc
2 = bleeds on probing
3 = bleeds spontaneously
why are dental radiographs important
70% of a tooth structure is invisible on gross exam
almost all common pathology is below the gum line
diagnosis, prognosis and treatment planning is not possible without radiographs
when are dental radiogrpahs indicated
- all missing teeth or developmental defects
- all periodontal pockets >4mm deep
- all teeth suffering trauma
- full mouth survey of cats when TR lesions found
what is shown here
a missing 405 and 406 dog presented for another problem, owner aware of blister from time to time that bursts clear fluid
no pain or discomfort described
roots are resorbing and attachment loss
odontogenic detigerous cyst
what are the findings in these radiographs and how would you treat this
missing teeth
enamel is in poor conditions
pre molar 2 embedded, root apices formed large lucent area –> remove the tooth
pre molar 4 close to or in inferior alveolar canal (blood supply, nerves) –> remove the tooth
what is show in this radiograph
missing molars 310 and 311
pericoronitis – painful
dilacerated roots also
roated 90 degrees and erupted ventrally into the lower jaw
painful because there is enamel in the area
roots are trying to erupt into an area which is not easy to erupt into and have become disfigured
what is the normal sulcus depth in dogs
3mm max in dogs
what is shown here
periodontal pocket of 9mm
more than 50% of bone attachment is lost
why is 3mm the max periodontal pocket? (3)
- difficult to root plane a deep pocket
- impossible to brush >3mm at home
- deep pockets require advanced skills, expensive graft materials with “uncertain” outcome
what is a fracture without pulp exposed called
uncomplicated crown fracture
what is a fracture with pulp exposed called
complicated crown fracture
what type of fractures are most common in cats
most commonly expose pulp because the pulp is very close to the surface
what can occur if the pulp is compromised by trauma
bruised or ischemic
change of color
what is the anatomy of the tooth shown here
what is the purpose of periodontal ligament
tough fibres that hold the bone between the cemental surface and the alveolar bone
what is pulp
live tissue well innervated
subject to inflammation and necrosis
what is dentin
majority of tooth
made by cells within the live pulp
varies in thickness during life –> laid down throughout life
sensitive if exposed
what is the apical delta
blood/nerve/lymph supply to pulp via hundreds of small canals
could be crushed by trauma and loss of blood supply
what is shown on this radiograph
recent damage to pulp
and damage on the crown surface
describe the changes seen here
tooth was killed when it was developing
all the cells became necrotic and non-viable
no further dentin developed
what is shown here
draining sinus upper left carnassial
no visible fracture damage
often called malar abscess
- the rubber cone shows the origin of the sinus
2 lytic lesions in bone around all roots
- wide pulps compared with neighbours
- concussion/intrusion damage to apical delta and subsequent ischemic necrosis
what is shown here
doscoloured and suspect non-vital upper K9’s
left side longer term: lucency in apex, normal chevron lucency due to thin bone in area
right side recent: loss of dentin and pulp chamber wide, dead tooth
what is the flow chart if there is a retained root
more or less than 4mm?
>4mm = surgical removal
<4mm and superficial = surgical removal
<4mm and deep = eventual surgical removal unless patient very unstable
what type of radiographs should you take if there are tooth resorption lesions in cats
full mouth rads every time
what is shown here
tooth resorption lesions in cat
what is the difference between type 1 and 2 tooth resorption lesions in cats
type 1: focal or multifocal area of resorption on tooth surface. Look for pulp and/or PL
type 2: full root replacement with new bone
how do you evaluate TR lesions (6)
- rads are a snapshot in time
- some TR teeth will appear as ‘missing’/some currently affected/some teeth may appear normal
- lesions normally progressive – how fast?
- multiple rads required over life to evaluate progress
- dog TR is often later in life and is mainly premolars
- T1 vs T2: is there pulp or PL present? is there bone replacement of root?
what is shown here and how would you treat
lower canine 404 resorption
stage 4 type 2
treated by crown amputation and intentional root retention
what is shown here and how would you treat
upper canine 104
early resorption root apex
stage 3 type 2
tooth not mobile not sensitive to percussion still functional
more rads in 4-6 months
what is shown on these radiographs
upper right carnassial
- abnormal crown morphology
- unusual calculus deposition
- young dog
- only one tooth affected
on rads
- shell like morphology
2 compare with adjacent teeth
- compare with contralateral carnassial
- huge lucencies surrounding roots – osteomyelitis
why are CT more favorable
more detailed/accurate than dental radiography in most dental conditions
higher diagnostic yield due to unobstructed views especially in multiplanar recontrsuction mode (MPR)
tri dimensional rendering (3D) and reconstructed panoramic allows an overall impression of oral health and disease
what is disclosing solution
dental plaque disclosed
what is plaque
biofilm slime
comes off with a brush
daily
owner responsibility
true prophylaxis
what is calculus
mineralized plaque
comes off with an instrument or machine
by you under GA
professional dental procedure
what are the stages of periodontal disease
stage 0: healhty periodontium
stage 1: gingivitis
stage 2: perio up to 25% loss
stage 3
stage 4: >50% loss
what stage of periodontal disease is this
Gingiva is inflamed as a result of calculus building up both above the gum line (supra-gingival calculus) and below the gum line (sub-gingival calculus). If material is not removed the inflammation will get worse.
stage 0
what stage of periodontal disease is this
Stage 2 Periodontal ligament loss up to 25%: gingiva sulcus deepened. Bone support has receded away as well as periodontal ligament. Filled with necrotic debris. Still treatable with cleaning —> healing
what stage of periodontal disease is this
stage 4
with >50% loss: bone receded away and periodontal ligament is almost gone. Necrotic and food debris is almost down to the apical delta —> possibility of infection coming up into the pulp (endodontic disease). Removal of these teeth.
what stage of periodontal disease is this
Healthy Stage 0 Periodontium: the gingiva is healthy and the alveolar bone and periodontal ligament are where they should be
describe the 3 steps in periodontal disease progression
- Plaque, leading initially to gingivitis.
- Deepening of sulcus during active disease it is common for the sulcus to deepen as the junctional epithelium becomes inflamed. The tissues become oedematous and infiltrated with polymorphonuclear granulocytes.
- Proliferation of subgingival plaque. The accumulation of the supragingival biofilm reduces the oxygen available to the plaque in the sulcus. As a result, there is a transition from aerobic or facultative anaerobic to an overwhelmingly anaerobic microflora within the subgingival area. As the junctional epithelium swells from oedema and begins to break down, the gingival sulcus is deepened and the three deepest periodontal tissues - periodontal ligament, alveolar bone and cementum - all risk being exposed to the disease process occurring in the tissues close to them
what is home dental care not a substitute for
- for regular professional exam and treatment
- not an over the counter concept
- a treatment for established disease
- the best and only tool in the owner’s box is a brush
what are the options for tooth pastes
- chlorhexidine paste 0.12% – highly effective antibacterial but not for long term use, stains teeth badly and eliminates natural flora
- enzymatic paste: stops formation of calculus amd removes plaque effectively
what are the options when there is a complicated cornw fracture
- extract
- endodontics (root canal)
- never lets wait and see
how is a root filling done
remove organic material – pulp, etc
sterilize canal – bleach/saline/EDTA
dry canal
fill with rubber and cement
close access and reshape to smooth
what are the 3 bite classifications
- dolicocephalic
- mesaticephalic
- bracycephalic
what are the four requirements of a healthy bite classification
- the mandibular premolars biscuit the interproximal (interdental) spaces rostral to the corresponding maxillary premolar teeth. This has been described as ‘shear mouth’
- the mandibular canine tooth bisects the space between the opposing maxillary third incurs tooth and canine tooth. The lower canines are inclined labially
- the maxillary incisor teeth are all rostral to the mandibular incisors. The cusps of the mandibular incisor teeth contact the cingulum of the maxillary teeth (rest on the singular ridge) —> ‘scissor bite’
- the teeth are symmetrical in the sagittal plane
what is an ‘overshot’ called
mandibular distoclusion
what are the issues with mandibular distoclusion
likely to contact soft tissues on maxilla
what are the options for treatment of mandibular distoclusion
- crown amputation/partial pulpectomy
- surgical extraction
- orthodontic tipping
what is an undershot called
mandibular mesioclusion
