Tooth resorption

Question 1

Describe TR – tooth resorption in cats & dogs.

Answer 1

More in cats but also in dogs.

2 types:
type 1. inflammatory (painful)
type 2. non-inflammatory/replacement (non-painful unless crown is involved)

Generally, the process begins at root level,
painful only when reaching the crown.
Progressive, currently no way to stop
the process.

With Changes at root level, monitor
progression (Xray, regular checking under
GA).

With Defects at crown level, do extraction (or crown amputation in qualifying cases).

RADIOGRAPHIC IMAGING is essential!

Question 2

Types of tooth resorption broadly.

Answer 2

2 types:
type 1. inflammatory (painful)
type 2. non-inflammatory/replacement (non-painful unless crown is involved)

Question 3

odontoblasts do what
odontoclasts do what

Answer 3

odontoblasts build
odontoclasts destroy/take apart

Question 4

Answer 4

tooth resorption lesion that has reached the crown and granulation tissue as formed a strawberry red uloke

Question 5

Answer 5

tooth resorption at the stage of healing where the crown has already fallen off and the gingiva has healed over leaving a faint bump where P3 used to be

Question 6

Periodontal disease leads to what loss

Answer 6

attachment loss!

Question 7

Answer 7

Question 8

Tooth resorption stages.

Answer 8

Note that this is out of date and in fact, no longer clinically useful.

Question 9

Describe:
FCGS
CUPS

+ tx?

Answer 9

FCGS = Feline chronic gingivostomatitis
CUPS = Canine ulcerative paradental stomatitis

Immune background?
Painful!

Severe gingivitis + stomatitis (oral mucosal
inflammation) (+/- ulcers), often only minimal amounts of plaque present.

For owners, “plaque allergy” might be an OK simplification sometimes to include.

Not the same disease in dog and cat but similar enough to each other. It’s not exactly known why they happen.

Tx: COHAT, impeccable homecare, use of
medicines, extraction of (all or most) teeth.

Question 10

FCGS = Feline chronic gingivostomatitis response to tx

Answer 10

80-90% respond to total teeth extraction treatment

10-20%/the rest of them will sometimes have relapses despite the teeth already having been removed.

Question 11

Answer 11

stomatitis

Question 12

Answer 12

stomatitis

Question 13

Answer 13

Question 14

Answer 14

Juvenile hyperplastic gingivitis

• (3) 6-8 mo kittens after eruption of permanent dentition
• Some breed predispositions, but also common european shorthair.
• Removal of calculus and plaque,
  gingivectomy, establishing
  homecare.
• Usually needs several repeat procedures; may either disappear upon adulthood or progress into periodontitis.

Question 15

what breed of cat is predisposed to Juvenile hyperplastic gingivitis?

Answer 15

maine coons

Question 16

drug sometimes used in the treatment of FCGS

Answer 16

FCGS = Feline chronic gingivostomatitis response

Interferon omega, Interferon alfa-2b drugs etc., e.g. product Roferon-A

inj. commonly diluted into an oral liquid

Question 17

normal probing depth in cats?

Answer 17

0.5-1 mm

Question 18

Majority of oral procedures are prevention, periodontal treatment, extractions, traumas.

How should you consider the above in your client communication?

Answer 18

Do not talk to client about ‘dental cleaning’
or ‘calculus removal’ – this sounds like a
cosmetic procedure – favor terms like
professional oral health procedure or
comprehensive oral health treatment and
assessment (COHAT) – this MUST include
oral examination under GA, diagnosing and
treatment.

This is a continuously developing aspect of vetmed.

Recording data, follow-up and owner’s role
are important!

Question 19

Dental Treatment sequence.

Answer 19

 Treatment options and pricing info –
communicate with owner thoroughly!

 Decision making

 Procedure(s)

 Homecare instructions – communicate with
owner!

 Follow-up checks: short and long term.

 Talk to people!

Question 20

Requirements for dental procedures. (11)

Answer 20

 Large part is prevention, periodontal
disease Tx, extractions, some trauma.

 Do what you are reasonably competent
at. Refer the rest!

 Do according your means – start small
and grow :)

 Continuously developing and changing area of vet med.

 Recording info and case follow-up is
important.

 Separate room for ‘dirty procedures’ is essential.

 Light, assistant/nurse, anesthesia support.

 Intubation for most procedures (e.g. xrays can be taken without)

 Good instruments + (heat)sterilization

 Regular maintenance of equipment and
instruments.

 X RAY! (intraoral/dental the best)

Question 21

Dental procedure Work safety.

Answer 21

 Protect eyes, respiratory tract, clothes

 Protective eyewear is a MUST (additional
light and magnification are a bonus)

 Surgical mask, cap, (gown), non-sterile
gloves

 Ergonomics: posture, instrument grip, headlight, saddle chair, table with adjustable height

Question 22

Dental Instrument grips.

Answer 22

Either modified pen grip, (sometimes
3.),4. and 5. finger support and ‘fix’ the hand being in contact with table or patient

OR a grip with handle resting in palm, instrument grasped mainly w thumb and 3. finger, 4. and 5. acting as support and 2. (index) finger as a ’finger stop’ (elevators, luxators, luxating elevators)

or as an additional fixating point on top of the instrument/handpiece (an alternative grip for polishing handpiece or periosteal elevator).

Wrist in neutral position.

Question 23

neuropraxia =

Answer 23

nerve damage simply

is the mildest form of peripheral nerve injury commonly induced by focal demyelination or ischemia.

Beware that mouth openers can cause this.

Question 24

Answer 24

left: dental explorer & right: periodontal probe

Question 25

Total attachment loss is

Answer 25

the combined total of periodontal pocketing and root exposure.

Attachment loss is calculated, taking into account whether:
a) there exists a pathological PD (probing depth)
b) there is GR (gingival recession)
c) there is GH (gingival hyperplasia)

Question 26

AL =
PD =

Answer 26

AL, attachment loss = how many mm has the level of tooth attachment
(periodontal tissues: gingiva, alveolar bone, periodontal ligament that normally
have their upper or coronal attachment margin at the level of cementoenamel
junction) migrated apically (down) towards the root – compared to normal.

PD, probing depth = measurement in mm from the bottom of gingival sulcus
(normal – in a dog less than 2-3 mm, in a cat less than 0.5-1 mm) or periodontal pocket (pathological) to the gingival margin.

AL is not the same as PD!

AL is calculated, taking into account whether:
a) there exists a pathological PD
b) there is GR
c) there is GH

Question 27

GR =
GH =

Answer 27

GR, gingival recession = extent of exposure of root surface in mm. How much has the normal attachment level migrated apically, while PD is still normal.

GH, gingival hyperplasia/overgrowth = PD is over normal measurement (in mm), while the normal attachment level of periodontal tissues to cementoenamel junction has been preserved.

Question 28

Describe COHAT. (4)

Answer 28

1. Charting (+ xray) before or after removal of calculus. (after if the calculus is so abundant it may give you false probing depth readings)
2. Supragingival and subgingival cleaning
    < 4-5 mm gingival pockets can be cleaned
   closed (closed root planing), > 5 mm open
   cleaning (lifting of full-thickness flap,
   cleaning, reattaching flap) or extraction of
   tooth.
3. Polishing
4. Radiographing imaging at minimum of
   pathological findings if not full mouth (but you should really do full mouth).

Question 29

Describe subgingival cleaning for < 4-5 mm gingival pockets and > 5 mm pockets.

Answer 29

< 4-5 mm gingival pockets can be cleaned
closed (closed root planing)

> 5 mm open cleaning (lifting of full-thickness flap, cleaning, reattaching flap) or extraction of the tooth.

Question 30

What are theses and what are the differences?

Answer 30

left: periodontal curette

right: Hand scaler

both can be straight or angled.

scaler has a pointed tip, curette has a more blunt tip.

scaler cross section is triangular, curette cross section is sort of half moon shaped.

curette has a smooth back in order to go under the gum line against the tooth without damaging the inside surface of the gingiva. curette is for pockets, NOT the sharp scaler.

Question 31

what is this and what is its purpose?

Answer 31

dental curette

curette has a smooth back in order to go under the gum line against the tooth without damaging the inside surface of the gingiva. you then scrape the root surface to clean out the debris and inflammatory tissue.

(scaler has a pointed tip, curette has a more blunt tip.

scaler cross section is triangular, curette cross section is sort of half moon shaped.

curette is for pockets, NOT the sharp tipped scaler.)

Question 32

Answer 32

dental probe

Question 33

Answer 33

dental explorer

Question 34

Answer 34

Periosteal elevator

for opening flaps

Question 35

Answer 35

Bone curette

Question 36

Answer 36

Top left: elevator
Top right: luxator
Bottom right: luxating elevator

(I think…)

Question 37

Describe dental Elevators.

Definition:
Design
Function:

Answer 37

Definition: Elevators are dental instruments used to loosen teeth and separate them from the surrounding bone or periodontal ligament before extraction.

Design: Elevators typically have a broad, strong handle with a thicker shank. The working end is usually wider and more spoon-shaped or triangular.

Function: They apply leverage and rotational forces to loosen and lift teeth from their sockets. Elevators are generally used to apply strong forces, making them effective for loosening larger teeth, like molars or teeth with heavy attachments.

Question 38

Describe dental luxators.

Definition:
Design
Function:

Answer 38

Definition: Luxators are specialized instruments designed for gentle extraction and are primarily used for severing the periodontal ligament rather than prying the tooth out.

Design: Luxators have a thinner, sharper, and more delicate blade compared to traditional elevators.

Function: The purpose of a luxator is to cut the periodontal ligament gently and to create a space between the tooth and bone, allowing the tooth to be removed with minimal force. They are not designed for prying or levering, but rather for a slicing or twisting motion.

Question 39

Describe dental luxating elevators.

Definition:
Design
Function:

Answer 39

Definition: Luxating elevators are a hybrid instrument combining features of both elevators and luxators. They can cut the ligament like a luxator while also providing a slight leverage like an elevator.

Design: Luxating elevators have a slender, sharp blade similar to a luxator but are slightly more robust to withstand moderate levering force. The handle and shank design may look similar to traditional elevators, but the tip is designed to be thinner.

Function: These instruments are used to both cut the ligament and gently luxate or elevate the tooth. They provide a balance of the two actions, making them versatile in extraction procedures, particularly for teeth that are difficult to access or have fragile roots.

Question 40

What is the difference between Elevator, luxator, luxating elevator?

Answer 40

Question 41

Answer 41

Forceps, root fragment forceps

Question 42

Answer 42

Root tip pick

Question 43

A dental Surgical set includes: (5)

Answer 43

 Scalpel blade no. 15 and appropriate
handle

 Forceps (eg. Adson)

 Tissue and suture scissors (eg. Iris scissors for tissue)

 Hemostats (small)

 Needle drivers (small, suitable for 4-0, 5-0
suture material)

Washing and sterilization – dry heat or
autoclave!

Question 44

What should you know about yourr dental unit? (6)

Answer 44

 Always read the manual!

 Oil free or oil compressor?

 Air and water filters?

 Pressure air tank? Condensation!

 Turbine or high speed, low speed or micromotor.

 Straight handpiece or contra-angle.

Question 45

What to consider about Dental hand pieces? (4)

Answer 45

 Read the manual!

 Often cannot be machine-washed or
immersed nor dry heat sterilized.

 Oiling, cleaning (wiping the outer surface,
running after oiling).

 Autoclaving or minimally wiping outer
surface with suitable disinfectant.

Question 46

Answer 46

Burs:

 Different ones for high and
low speed (FG, HP, RA)

 Diff materials, sizes, shapes (fissure, round etc.; carbide, diamond)

 In theory, to be used once, in practice often used for several patients.

 If reusing, washing, min. disinfection, but better is dry heat/autoclave

 Discard after a number of uses!

Question 47

Answer 47

Ultrasound dental scaler:

 Piezoelectrical vs. magnetostrictive

Tip wears down!
 -1mm -25 % effectiveness
 -2 mm -50% effectiveness – discard!
 Use Tip card to estimate wear (pictured)

 Tip – wash, desinfect or heat sterilize
 Handpiece maintenance, see manual – wiping usually.

Question 48

Describe dental Polishing

Answer 48

 Low speed handpiece + decelerator or turning down rpm + polishing attachment

 Polishing attachment – single- or
multiple-use, combined with single-use rubber cup; or brush type

 Aways w polishing paste!

 Care – wash; handpiece/ decelerator according to manufacturer instructions.