Tooth resorption Flashcards
Describe TR – tooth resorption in cats & dogs.
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!
Types of tooth resorption broadly.
2 types:
type 1. inflammatory (painful)
type 2. non-inflammatory/replacement (non-painful unless crown is involved)
odontoblasts do what
odontoclasts do what
odontoblasts build
odontoclasts destroy/take apart
tooth resorption lesion that has reached the crown and granulation tissue as formed a strawberry red uloke
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
Periodontal disease leads to what loss
attachment loss!
Tooth resorption stages.
Note that this is out of date and in fact, no longer clinically useful.
Describe:
FCGS
CUPS
+ tx?
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.
FCGS = Feline chronic gingivostomatitis response to tx
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.
stomatitis
stomatitis
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.
what breed of cat is predisposed to Juvenile hyperplastic gingivitis?
maine coons
drug sometimes used in the treatment of FCGS
FCGS = Feline chronic gingivostomatitis response
Interferon omega, Interferon alfa-2b drugs etc., e.g. product Roferon-A
inj. commonly diluted into an oral liquid
normal probing depth in cats?
0.5-1 mm
Majority of oral procedures are prevention, periodontal treatment, extractions, traumas.
How should you consider the above in your client communication?
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!
Dental Treatment sequence.
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!
Requirements for dental procedures. (11)
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)
Dental procedure Work safety.
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
Dental Instrument grips.
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.
neuropraxia =
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.
left: dental explorer & right: periodontal probe
Total attachment loss is
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)
AL =
PD =
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
GR =
GH =
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.
Describe COHAT. (4)
- Charting (+ xray) before or after removal of calculus. (after if the calculus is so abundant it may give you false probing depth readings)
- 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. - Polishing
- Radiographing imaging at minimum of
pathological findings if not full mouth (but you should really do full mouth).
Describe subgingival cleaning for < 4-5 mm gingival pockets and > 5 mm pockets.
< 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.
What are theses and what are the differences?
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.
what is this and what is its purpose?
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.)
dental probe
dental explorer
Periosteal elevator
for opening flaps
Bone curette
Top left: elevator
Top right: luxator
Bottom right: luxating elevator
(I think…)
Describe dental Elevators.
Definition:
Design
Function:
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.
Describe dental luxators.
Definition:
Design
Function:
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.
Describe dental luxating elevators.
Definition:
Design
Function:
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.
What is the difference between Elevator, luxator, luxating elevator?
Forceps, root fragment forceps
Root tip pick
A dental Surgical set includes: (5)
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!
What should you know about yourr dental unit? (6)
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.
What to consider about Dental hand pieces? (4)
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.
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!
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.
Describe dental Polishing
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.
