Small Animal Dentistry: Extractions, Feline Dental Disease, Interactive Flashcards
What are reasons for teeth extraction?
- Periodonitis
- Pulp necrosis- if inflamed or exposed
- Persistent deciduous teeth/ malocclusion
- Abnormal response to plaque levels
- Dental fractures
- Tooth resorption
- Mobile teeth
- Caries
- Ectopic, unerupted or impacted teeth
- Failed restorative treatment
What is closed tooth extraction?
When is it used?
Closed extraction is performed without making an incision through the gingiva other than through the gingival sulcus
Uses:
Smakk single rooted teeth- incisors
Mobile teeth with significant periodontal disease
1st and 2nd PMs
What is required and describe the process of closed extraction?
Elevator, luxator, scalpel and extraction forceps needed
- Luxation- apply controlled pushing force to periodontal space with luxators sharp blade- aiming to cut through the peridontal ligament attachments
- Elevation- apply, sustained, rotational force to the tooth, using alveolar bone as fulcrum- aim to fatigue the peridontal ligament and ultimately tear its attachments
- Extraction- gripping close to the root, apply gentre rotation to detach entire tooth from alveolus
What is surgical tooth extraction?
When is it used?
What is required?
Surgical extraction involves vertical releasing incisions through the gingiva as well as bone removal and/or tooth sectioning
Uses-
Most multirooted teeth
Canines
Tooth resorption or retained roots
Bizarre rooth morphology
Required-
Knowledge of tooth morphology
High speed burr
Gingival flaps
Periosteal elevator, luxator, elevator
Dental radiography
What are the three types of flaps used in surgical extraction and what are they used for?
Envelope flap- gingival sulcus incision but no releasing incisions, useful got PM tooth where FP is close to gumline, good for crown amputation in cats
Triangle flap- sulcal incision +1 releasing incision, crearted a drap-like flap, easy to close, perfect for triangular rooted teeth- maxillary 4th PM
Pedicle flap- Involved 2 releasing incisions, grants excessive access to alveolar space
Other then flaps what surgical techniques are needed for surgical extraction?
Periosteal elevation- elevate the mucoperiosteal flap awat fromn the bone, use the pushing/rotation strokes to reveal alveolus
Alveolectomy- remove alveolar bone from buccal aspect of tooth to then expose the tooth root for elevation/luxation
Tooth sectioning
Sectioning technique- locate the furcation point using dental probe, use burr from FP to crown until all the way, wedge elevator between sectioned roots
What are some complications of surgical extraction?
Mandibular jaw fractures- assess bone density
Surrounding soft tissue trauma- drills rotate fast, correct techniques
Ankyolosis of roots
Flap dehiscence
Retained/fractures roots
How should a fractured or remnant root tip be managed?
- Can be iatrogenic or incidental
- Best chance is surgical extraction
- Root tips can be left in place if the risks outweigh the benefits
- If leaving the root tip in situ- doccument on radiographs, inform owners, anually check
How should a fractured root tip be managed?
- May need to convert to surgical
- Keep the tooth to view
- Dental radiographs invaluable in assessing remaining root
- Visualise root tip before removing it
- Can create ‘moats’ will small burr to allow luxator/elevator access
- Mobilise the root- never apply apical pressure
- Use root tip extraction forceps once mobilised
What different nerve blocks can be used for SA dentistry?
- Caudal maxillary
- Inferior alveolar- caudal mandibular
- Mental
- Infra-orbital
Why are nerve blocks indicated for tooth extractions?
What locals can be used?
- Involves soft tissue and bone dissection- painful
- Reduces GA use
- Reduced potential ‘wind up’
- Immediate post-op comfort- better recoveries
- Multimodal analgesia
Lidocaine- rapid, short duration, 4mg/kg, cheap
Bupivicaine- delayed, long duration, 2mg/kg, more expensive
Administer periodically, not all at once, always draw back (cardiotoxic)
Describe the process of surgical extraction of a maxillary canine tooth
- Pedicile flap- sulcal incision and 2 vertical releasing incisions, elevate periosteum (sweeping motions to seperate gingiva from bone)
- Alveolectomy- small burr on high speed, sweeping motions, follow colour change between root and bone
- Create gutters or moats for insturment access
- Use extraction forceps, remove in direction of root curvature
- Completing extraction- smooth edges, gingival flap closure, 333 (3mm from wound, 3mm bites, 3mm suture ears)
How should surgical extractions be managed peri and post operatively?
Peri- rinse mouth with hexarinse, local anaesthesia
Post- dentisept oral paste both sides of gum line for 5-10 days, pain relief for 5-10 days, softened food for 2-3 days
Checks- 3 and 10 days to assess healing
What are the clinical signs of feline tooth resorption?
What is it?
- Cold sensitivity
- Possible weight loss
- Hypersalivation
- Pawing at face
- Halitosis
Progressive destruction of hard dental tissue by odontoclast cells, replaced with granulation tissue- 307 and 407 most common
What are the three types of feline tooth resorption?
Type 1- inflammatory cause, associated with PD, neck/cervial area lesion location
Type 2- replacement resorption, root replaced by bone, usually over 4yo
Type 3- features of 1 and 2 in same tooth
7 month old female entire terrier for prespay check
- What is your assessment of this mouth?
- What is indicated
- Retained deciduous teeth
- Removal of 504- deciduous canine
Open surgery is indicated
Caudal maxillary block
6 yo lab presented for booster vaccination
Owner noticed one tooth looks strange, happened after playing in the park with friends
Otherwise well
- Describe what can you see
- What are the differentials?
- What do you want to do in todays consultation?
- What radiograph would be used for this tooth?
- Discloured tooth- pink/grey
- Single whole tooth- pulpitis
Single/isolated part of tooth- dentine exposure from wear
Multiple teeth- generalised staining, enamel hypoplasia, tetracycline exposure of puppy (brown) - Provide analgesia/biofilm control/other measures depending on disease, plan/book next steps
- Dorsal for a bisecting angle view
This shows the radiograph?
What is your diagnosis?
When can radiographs be limited?
What is the treatment options?
Pulpitis with radiographic change
Widended pulp cavity in affected tooth and periapical lesion
Tooth morphology isn’t initially affected- can take time
Treatment- extraction, root canal
10 year old dog with halitosis
Pawing at mouth and unilateral nasal discharge, owner thinks dog have lost tooth- you find upper canine (204) missing on the same side of nasal discharge, rest with severe periodontal disease
- What is your top differential?
- With the top DDxs how would you manage?
- Oronasal fistula- could be from periodontal disease/rubber jaw- it was from PD
- Surgically close the defect- create and elevate gingival flap, closure
Following an anaesthetised oral exam the following is found
What is your likely DDxs?
Consider which cell types are present in the affected area
Assess the infiltration/margination of mass
Which layer is affected (mucosa or below)
Squamous epithelial cells- squamous cell carcinoma
Pigmented cells- melanoma
Fibrous connective tissues- fibrosarcoma
Bone- osteosarcoma
Dental tissues- acanthomatus ameloblastoma, peripheral odontogenic fibroma
Non masses- papilloma, eosinophil complex
8 yo dog was presented with halitosis, hypersalivation and pain when eating. Colleague booked patient in for dental evaluation and treatment
Full radiographs are taken
What would you like to do with this tooth?
Extraction indicated- peridontitis
Loss of alveolar bone on root and below bifurcation
Multi-rooted with hooked roots- unusual anatomy
Will be difficult
Open (surgical) extraction indicated
