Veterinary Dentistry Flashcards
All information that was taught to me while attending Vanier College's "Animal Health Technology" Program, located in St-Laurent Montreal.
What are the components of the diphyodont dentation
I –incisorC-canineP- premolarM-molar
What is the primary canine dental formula
Primary teeth : 2 X I3/3, C1/1, P3/3 = __No primary molarsPrimary teeth eruption: 3 to 12 weeks of age
What is the permanent canine dental formula
Permanent: 2 X I3/3,C1/1,P4/4, M2/3=__ Eruption: 3 – 7 months of age
What is the primary cat dental formula
Primary: 2 XI3/3,C1/1,P3/2=___ no molars Primary teeth eruption: 2 to 6 weeks of age
What is the permanent cat dental formula
Permanent 2X I3/3,C1/1,P3/2, M1/1=___ Particularities: some teeth are missing (refer to Triadan system) Eruption: 3 to 5 months
What composes the bulk of the tooth
dentine
what is the dentine covered by on the crown
enamel
what is the dentine covered by on the root
cementum
what does the centre of the tooth contain
pulp
what is the composition of enamel
96% inorganic, mainly hydroxyapatite crystals, with 4% water and fibrous organic material.
describe enamel
Hardest substance in the body and covers the exterior surface of the crowns only.
how does enamel form
Formed by ameloblasts within the tooth bud before eruption.
what can cause damage to the enamel when young
Damage when animal is young: causes irreparable changes (enamel hypoplasia, tetracycline usage)
is the enamel capable of repair when it has already erupted?
yes but Capable of only very limited repair when damaged, once the tooth has erupted.
Describe dentine
Main supporting structure of the toothSecond hardest tissue in the body after enamel.
what is the composition of dentine
70% mineral and acellular, as hydroxyapatite crystals, and 30% organic as water, collagen and mucopolysaccharide.
what is the main structure of dentine
dentinal tubules, which extends rom the external surface to the pulp.
what is the function of the dentinal tubules if the dentine is exposed
which can transmit bacteria + pain to the pulp if the dentine is exposedCan also transmit bacteria to the PL
describe the primary dentine
Primary dentine forms before tooth eruption.
describe secondary dentine
Secondary dentine forms after eruption, as the tooth develops with age. It develops from the odontoblasts living within the pulp and is laid down in layers within the pulp cavity.
describe tertiary dentine
Reparative or tertiary dentine forms as a result of trauma to the odontoblasts; this can be thermal, chemical, bacterial or mechanical.
describe tertiary dentine and its appearance
Tertiary dentine has few tubules and is darker in colour and very dense in structure. We see tertiary dentine when enamel has been worn away, like stone chewers.
Describe cementum
Covers the enamel free roots & provides a point of attachment for the periodontal ligament. Capable of formation, destruction and repair and remodels continually throughout life. It is nourished from vessels within the periodontal ligament.
what is the composition of cementum
Similar in composition to woven bone it is 45-50% inorganic, primarily as hydroxyapatite crystals, and 50-55% organic material.
describe the pulp of the tooth
This living tissue within the tooth is located in the pulp chambers and root canals. Well innervated and vascularised
what is the pulp composed of
comprises connective tissue, nerves, lymph and blood vessels, collagen and undifferentiated reserve mesenchymal cells
what can physical trauma to the pulp cause
may cause bruising, hemorrhage or pulpitis.
what can over-heating from polishing or scaling cause to the pulp
pulp necrosis
what can happen to the pulp after pulp exposure after a tooth fracture
can cause pulpitis or pulp necrosis
what can happen to the pulp after a loss of blood supply following trauma
ischemic necrosis
describe the gingiva
surrounds the teeth and part of the alveolar bone, forming a cuff
what are the types of gingiva
free and attached
Attached gingiva is separated from the mouths mucosa at the _______
mucogingival junction
what is the name for the gingival tissue in the space between the teeth
Interdental Papilla
What is the name of the space between the teeth
interproximal space
What is formed by the gingival margin
sulcus
What is measured by the dental probe
the sulcus depth
what is the normal mm for the dental probe in a dog
1-3mm
what is the normal mm for the dental probe in a cat
0.5-1mm
describe the gingival sulcus
Many kinds of epithelium with rapid cell turnoverJunctional epithelium is where it attaches to tooth surface, and breaks down in periodontal disease.
What is the periodontal ligament composed of
Comprised of taut collagen fiber bundles
What does the periodontal ligament do
attaches the root cementum to the alveolar bone. It acts as a suspensory ligament for the tooth
to remove a tooth with an elevator, what do you need to break
the periodontal ligament
What are tooth roots encased in
alveolar sockets
What happens to the alveolar bone when there is tooth loss
the bone atrophies
what is the most dense alveolar bone that lines the socket is called
cribiform plate
on a radiograph of the alveolar bone, it is seen as a white line called ______
lamina dura
What are the components of the periodontium
1- Gingiva2- Periodontal ligament3- Cementum4- Alveolar bone
what is the function of the periodontium
Serves to support the tooth and absorb forces
When you have a disease of the gingiva, periodontal ligament, cementum or the alveolar bone, what is it called?
periodontitis
What does apical mean
towards the root
what does buccal mean
surface of tooth towards the cheeks
what does coronal mean
towards the crown
what does distal mean
surface away from the midline
what does facial mean
can be labial or buccal surface
what does inter proximal mean
surface between two teeth
what does labial mean
surface of tooth towards lips
what does lingual mean
surface of tooth towards tongue
what does mesial mean
surface towards front midline
what does occlusal mean
surface facing tooth in opposite jaw
what does palatal mean
surface of tooth towards palate
What is the cementoenamel junction
where the enamel of the crown meets the cementum of the root
what is furcation
the space between the roots of the same tooth
describe the modified triadan system
Each tooth is given a 3 digit numberThe 1st digit denotes the quadrantFor permanent teeth:Quadrant 1 : maxillary rightQuadrant 2: maxillary leftQuandrant 3: mandibular leftQuandrant 4: mandibulary right
How do you triadan number a deciduous tooth
After the 4 quadrants, deciduous teeth are numbered in quadrant 5,6,7,8
Why do we do preventative dental homecare
Critical to the overall success of a professional dental cleaningPlaque colonize the surface of a tooth within 24 hours of cleaning!If no home care: periodontal pockets can become recolonized within 2 weeks of dental procedure!Plaque at the gingival margin & subgingival area = inflammation + subsequent periodontal diseaseMaintenance of periodontal health depends on PLAQUE CONTROL AT AND BELOW THE GINGIVAL MARGIN (subgingivially)
Why do we tell clients to do dental homecare
To educate client about the importance of oral careTo gain complianceHelp develop a strong relationship between client and clinic
How do we encourage owners to be compliant with dental homecare
A picture is worth a thousands words!Poster of… Progression of the disease Impact on internal organsHealthy mouths vs diseased mouth modelPlastic modelsHandouts, pamphlets, websites…etc
When do we talk about dental home care with clients
At 1st visit (part of preventive health program)Through Puppy & Kitten packs/kitsYearly exam, talk about teeth, dietsPost dentistry, go over the importanceDuring the discharge (Vanier)2 weeks after ideally (In clinics)GOAL: Prevention!If not done: Get owners to commit to yearly PROFESSIONNAL DENTAL CLEANING!
What is prophylaxis
measure taken to maintain health and prevent the spread of disease
What are the 2 types of dental procedures performed in veterinary dentistry
1) Dental cleaning (prophylaxis) (rarely done)2) Dental treatment (what we perform most!)
What is active dental care methods
Require participation of the owner with activities like rinsing, toothbrushingMost beneficial for mesial (front teeth)
what is the passive dental care method
PASSIVE:Include treats, Px diet to enhance chewing behaviorsMost beneficial for Distal (back teeth)May be more effective because of regular compliance
What are 6 types of preventative dental care
- Tooth brushing2. Dental diets3. Treats4. Oral products5. Secure toys6. Natural Home remedies
What are some oral care products
Enzymatic oral care products (Gel, powder, rinse)Chlorexidine (gel, rinse) (to add in your notes)Zinc product MAXIGUARDHMP, Fluoride, Water additive (to add in your notes)
Describe tooth brushing
Most effective means of plaque control!But only an estimated 1% of clients brush their pets’teeth daily.Every day: Optimal to slow plaque formationEvery other day: Not as effective for gingivitis 2 times a week: minimal acceptable frequency for patients with good oral healthFocus brushing on gingival margin and interproximal spacesImportant to caution the owner about being bitten
What are 4 tips for toothbrushing compliance with animal
1) START EARLY!2) GO SLOW!3) BE CONSISTENT4) PROVIDE POSITIVE REINFORCEMENT
What is the use of the finger brush
will remove plaque, not tartare.g.: finger brush, cat tooth brush, gauze squaresNot as effective as bristles, but easier for some clients
Why is tooth brushing still the best way
Bristles go under the sulcusMassage action strengthens gingiva
Why do we use brushing agents
Need to taste good to improve compliancePaste: meant to be used on toothbrushHave a number of function:Help improve compliance (+ reinforcement)Can have abrasive material or grit to improve mechanical cleaning action of the brush
Why can’t we use human toothpaste for animal
It can be toxic if swallowed
Why can’t we use baking soda for brushing teeth in the animal
doesn’t taste good and has too much sodium
Why do we use dental diets
For passive home careAlone, not sufficient to maintain healthy gums as opposed to brushingHelps to plaque & tartar accumulationShould use both
Why do we use LARGE kibbles in dental diets
promotes chewing
why do we use an abrasive texture in dental diets
helps remove parts of tartar and plaque
why do we use ca chelators in dental diets
reduce calculus accumulation
What does the VOHC do
Assess efficiency of the dental products such as dental dietsCost: $$$$$Can be plaque or plaque & tartar approvedProducts with VOHC seal is objectively recommended by vetsIneffective for gingival margin: greatest efficacy around cusps tips
What are the hand instruments used during a dentistry procedure
Calculus forcepsDental Hoe or ChiselDental probe and explorer Dental mirrorHand-scaling instruments:Dental scalersCurettesPeriosteal elevatorsLuxatorsWinged- ElevatorsExtractor forceps Root tip pick
describe supra gingival
the exposed tooth surface (“above the gumline”)Most visible part of the procedure for the owner least important part for the patient’s dental health
describe sub gingival
Subgingival: part of the tooth that is covered by gingiva
What instruments are used to remove heavy gross calculus
Calculus removing forcepsDental Hoe scaler or Chisel
Describe calculus removing forceps
Curved beak instrumentUSE: Allow easy removal of HEAVY GROSS calculus from the tooth surface (SUPRAgingical) decreasing chance of fracturing the toothUsually is the 1st instrument to use before power scaling and manual scaling
Describe the dental hoe or chisel
Wide working tip, chisel*-like bladeDifferent sizes and shapesStrong instrumentUSE: SUPRAgingival HEAVY GROSS calculus removal onlyHow to use: pen gripCertain prefer hoe than calculus forceps
what are the instruments used to perform a dental exam and charting
Dental probeDental explorerDental mirror
Describe the dental probe
Also called periodontal probe, since evaluating periodontiumGraduated, blunt ended probe at one endSharp shepherd’s hook at the other end : explorer May also be single-endedThe blunt tip can be round or flat and graduated in mm or colour coded in bands.
What is the use of the dental probe
Used:1) subgingivally to explore the sulcus…Crevice that surrounds the tooth (between tooth and free gingival margin) to mainly to determine PPD: periodontal probing depth2) but also for locating the subgingival calculus and other problems This must be done before OR after the dental procedure. Record is written on a dental chart
What is the normal periodontal probing depth for a dog
1-3mm
what is the normal periodontal probing depth for a cat
0.5-1mm
what happens if your probing depth is deeper than it should be
If deeper: indicates a “pockets” due to:Detachment of the PLBone resorption
What is the dental explorer used for
Evaluate: enamel, subgingivally for plaque, caries, FORL (feline orthodontoclastic resorptive lesions)Calculus left behind
What is the dental mirror used for
Mirror good for seeing lesions palatally or lingually easily. Takes some getting used to
What are the instruments used for periodontal therapy
Manual Dental scalerManuel CurettesUniversalGracey
Describe the dental scaler
Triangular blade in cross section, with cutting capability at all three points of the triangle.2 parallel cutting edgesPointed toeUsed for removing supragingival calculus only. It is NEVER used subgingivally!Can distend or lacerate tissueIt requires a modified pen grip. This instrument must be kept sharp. Due to improvements in ultrasonic scaler tip technology, we tend to use it less but should be used after power scaling.
Describe the curette
Doubled-ended instrument for easier access of all sides of toothOn end going to the right, one end going to the left
What are the common elements of a curette
Common elements:Rounded backRounded toe (so less traumatic than scaler)Semi-circular cross section
Why do we use a curette
Type of scaler designed for moderate calculus removal on SUPRAgingival and SUBgingival surfaces (called periodontal therapy)Should be used after power ultrasonic scaling procedure.Be carefull! Stronger, sharper instrumentsTake more efforts that power ultrasonic scaling
Describe the universal curette
Universal: designed for easy adaptation on all tooth surfaces (thus the name “universal”)
Describe the gracey curette
Gracey: designed to use on specific tooth surfaces that improve adaptation and calculus removal
How do you use a universal curette
Shank parallel to the tooth surface being scaledCutting edge of blade is applied to the tooth surface and facial surface of blade is tilted toward the tooth to achieve 70-85° angle between tooth and blade Apply lateral pressure against the tooth and pull upward while maintaining contact with the tooth
How do you use a gracey curette
Shank parallel to the tooth surface being scaledLower cutting edge of blade is applied against the tooth surfaceApply pressure against the tooth (root) and pull upward, maintaining the parallel shank
What are the dental instruments used to extract teeth
Periosteal ElevatorsLuxatorsElevators (winged-elevators)Root tip pic
Describe the periosteal elevators
Other name: periosteotome: instrument used to cut the periosteum: membrane that cover the surface of all bonesThin and small very delicate ends
Describe the use of the periosteal elevators
USE: Mainly used to lift full thickness soft tissue flaps, usually gingiva from alveolar bone before extractionAfter incision is made on the gingiva of one side or either side of the tooth to be extractedThe tips require protection and need to be kept very sharp otherwise shredding of the flap can happen.
What do we use luxators and elevators for
“leverage”: displace tooth root from its socket PL: periodontal ligamentAlveolus : tooth socket
Describe luxators
Very fine and sharp instruments with flap tipCan be easily damaged if used as elevatorThe tip is not designed for the extra force used with elevation (not for “leverage”) : they will break!
How do you use a luxator
USE: for cutting the PL and expanding the alveolus (“to luxate the tooth”)…by inserting the instrument tip into the periodontal space with a gentle side to side rocking motion continuing down the length of the root
Describe elevator
Have thicker working endsWinged elevators: makes extractions easier, added leverage
How do you use an elevator
USE: to stretch, cut, tear the PL + displace tooth root from its socket (so for leverage) So can be used as luxator and elevator
What are the 2 uses of extraction forceps
1) Primarily for gripping the tooth or a root for removal during extraction once it has been luxated loose2) Can also be used to remove gross supragingival calculus instead of using calculus forceps
What do you use a root tip pick as
For removing small pieces of broken root tips Some use it as a luxator Very sharp
What is in a Vanier suture kit
fine scissors, scalpel handle, suture material, periosteal elevator, rat tooth tissue forceps, olsen hagar needle drivers, scalpel blades
How do you clean dental instruments
Cleaning and sterilization process same as surgical instrumentsSterilized dental instrument kit per patient
Describe the importance of dental instrument sharpening
Only basic sharpening techniques will be covered Sharpening should be done after each useOne vet tech should be in chargeSharp instruments is the key for an enjoyable procedure
What are the basic materials needed for dental sharpening
Basic materials:Mineral oil: provide fine finish, and little of the instrument is reducedWipe clean after usedMay be autoclavedArkansas flat stone (coarse and fine)Conical stone: to removed spiculesAcrylic test stick or syringe case: to evaluate sharpnessTo dig the instrument in not to scrape the acrylic
What is the basic instrument sharpening technique
Put 1 drop of oil on the stone and distribute the oil You want to sharp only the cutting end of the instrumentDepending of the instrument…. place on the stone and move back and forth (curette, scaler) OR Place on the stone, sharp down or in circle then replaced it up, then sharp down or in circle (periosteal elevators, winged elevators)
What is the checklist for occlusal evaluation
Incisor relationshipCanine occlusionPremolar alignment, Distal premolar/molar occlusion,Individual teeth positioning
What are some anatomical structures of the mouth
A - Opening of incisive duct B - Incisive Papilla C - Rugae Palitinae on hard palate D - Soft Palate E - Palatoglossal Fold
What is the checklist for oral examination on an asleep animal
OropharynxLips and cheeksOral MMHard palpateFloor of mouth and tongueTeethPeriodontium of each tooth
What does the examination of the oropharynx include on an asleep animal
Oropharynx including soft palate, tonsillar crypts and tonsils
Why do we found the heaviest calculus at the buccal surface of the upper cheek teeth?
Due to the location of the salivary glands, and tight lips of animal
What is the philtrum
Philtrum: vertical groove in the middle area of the upper lip, common to many mammals, extending from the nose to the upper lip
What is a frenulum
Frenula (pluriel) frenulum (singular): small fold of tossus that secure or restricts tissue motion
What is included in a lip and cheek examination for the asleep animal
mucocutaneous junction, philtrum, frenula, salivary papilla
What is included in a oral mucus membrane examination of the asleep animal
Oral mucous membranes: alveolar gingiva & mucosa, mucogingival line (junction), attached gingiva, free gingiva
What is included in an hard palate examination of an asleep animal
Hard palate: incisive papilla, duct openings , palatal rugae
What is the incisive papilla/jacobson’s organ
papilla is a projection, or small fold of mucous membrane, located at the anterior end of the hard palate incisors. In other words, it’s on the roof of a dog’s mouth in the middle behind his front teeth. It develops during the embryo stage, and it’s perfectly normal. It’s an extra olfactory organ, or chamber, called the vomeronasal organ. It has fluid-filled sacs that open into the mouth or the nose. It’s also known as Jacobson’s organ.
What is included in the floor of mouth and tongue examination of an asleep animal
sublingual frenulum, lingual frenulum, lingual salivary gland (cat only), tongue papilla
what is included in a teeth examination of an asleep animal
primary, permanent or mixed dentitionmissing and/or supernumeraryabnormalities size/shapeWear patterns (abrasion, attrition)Pathology
What is a dental chart and what is its importance
Info from exam or any treatment needs to be recordedBasic dental record: 2 parts: written notes & completed dental chartSupplemented with clinical notes, additional dx tests & radiographs
What is dental charting
Diaphragmatic representation of the dentition where info (findings & tx) can be entered in a pictorial and/or notational form
What is the periodontium
the tissues that surround and support the teeth
What is Periodontium:
periodontal tissues (4)
What is Gingivitis:
inflammation of the gingiva
What is Periodontal disease:
disease of any part ot the periodontium (gingivitis & periodontitis)
What is Periodontitis:
inflammatory disease affecting the periodontium resulting in loss of attachment and eventually tooth loss
Hw do you examine the periodontium
- identify presence of periodontal disease2. Differentiate between gingivitis and periodontitis3. Identify precise location of disease processes4. Assess the extent of tissue destruction
What are the criteria that should be examined for each tooth
Gingivitis indexPeriodontal probing depth (PPD) (pocket depth)Gingival recession (recession index)Furcation involvementMobilityPeriodontal attachment level
What is listed on the dental chart
Recession indexCalculus indexGingivitis indexPeriodontal index Furcation exposure indexMobility indexProbe depth
What does plaque lead to
Lead to gingival irritation and gingivitisAmount should be recorded before cleaning
What agents can be used to visualize plaque
ATP stripsSpecial Fluorescent dental lightStain plaque
what is the gingivitis index
Presence of degree of inflammation is assessed by combination of redness, swelling, bleeding
how do you measure the gingivitis index
by gentle probing
What is the periodontal pocket depth/probe depth
how deep you can stick your probe into the sulcus.
What is gingival recession
when the gingiva is eaten away and destroyed around the tooth
When can a pseudo pocket occur
when gingival hyperplasia (GH) occursNote: GH should be called gingival enlargement since GH is a microscopic diagnostic
What is furcation involvement index
how much of the furcation of a tooth is exposed :shows alveolar bone loss
What is the mobility index
how mobile a tooth is
what are the 4 stages of periodontal disease
stage 1stage 2stage 3stage 4
Describe stage 1 periodontal disease
Stage 1 – Gingivitis only with attachment loss.
Describe stage 2 periodontal disease
Stage 2 – Less than 25% attachment loss. Grade 1furcations present.
describe stage 3 periodontal disease
Stage 3 – 25 to 50% attachment loss. Grade 2furcations present
describe stage 4 periodontal disease
Stage 4 – Over 50 % attachment loss. Grade 3furcations present.
What are the indications for taking dental radiographs
Before and after extractions Periodontal diseaseDiscolored teethFractured teethGingival ulcersMissing teeth (Evaluate an area where the teeth appear to be missing)Malocclusions causing traumaMalformed teethTooth resorptions or root resorptionsPet dropping foodFoul odor in mouthReluctance to eatReluctance to eat chewsNasal discharge
What are the medical indications for taking dental radiographs
To document the obvious - supporting treatment decisions Preoperative, intraoperative, and postoperative endodontics Endodontics: dental speciality concerned with the study & tx of dental pulpFollow progression of pulpal pathology and/or periodontal disease
What are the legal indications for dental radiographs
Part of the file/ Legal documentationFor client communicationFor prepurchase exams on show dogs to see if the proper number of teeth exist
What are the practice management/economical reasons for doing dental radiographs
Dental radiology pays for the expensive “toys” that don’t pay for themselves……” Or “ we are losing money by not taking intraoral x-rays!“Because it is a diagnostic toolWe found lesions – we treat them!
Describe the dental X-ray machine
Provides the X-ray sourcePortable or wall-mountedPortableFloor trolley (less user friendlyHand-held dental x-ray unitKVp and MA settings are fixedUsually 50-70 KVpmA is fixed (8-10)Can use regular rad machine, but film-focus distance is only 30-50 cmBetter to use dental machine
What is the one exposure variable for the dental X-ray machine
time in seconds
What are two types of dental radiology
dental standard radiology digital dental radiology
What are the two types of digital dental radiology
indirect (CR)direct (DR)
Describe dental film
Small & flexibleNon-screen filmSize 0, 1, 2 (periapical), size 4 (occlusal)Non screen filmSingle emulsionSpeed: D (ultra) E, F(EKTA) E, F: lower detailD: commonly used
Why is the dental film in an envelope
to protect it from light exposure
why does the dental film contain a layer of lead foil
to absorb scatter radiation
Why does the dental film have a dot
to let you know which side is to be placed rostrally. So you can always tell right from left
How do you develop X-ray films
Chairside darkroomDeveloping solutionsFilm clips
Describe indirect dental radiology
Use photo-stimulable phosphorplates (PSP)Place in plastic holdersExposed and then digitally scannedFlexible, reusable plates or sheets instead of filmAfter exposure, plate→ scanner → latent formed image is retrieved point-by-point → digitized (laser light scanning)The digitized images are stored and displayed on a computer screen.
What are the advantages to the indirect digital dental radiographs
Sensor plates size 0,2, 4, (6)FlexibleLong used-lifeNot expensive to replace
what are the disadvantages to indirect digital dental radiographs
Sensor plates must be removed from mouth to get the imageMore time than directImage quality questionableKeep away from direct light while scanning
Describe direct digital dental radiography
Sensor (CCD-Type or CMOS)2 sizes (1 & 2)Rigid, relatively thickConnect to a computer with appropriate software (by wire or WIFI)
What are the advantages to direct digital dental radiology
FAST! Do not have to remove sensor to get the image Better quality image
what are the disadvantages to direct digital dental radiology
Disadvantages:Small sensor sizeDifficult to fit into small mouthsFragile!Expensive Only the sensor 8000$ (2012)
What are the methods for radiology safety for dental xrays
Proper tube angle is important Distance from the tube: 6 ftApron, thyroid lead protectorDosimeter
What is the intra-oral dental X-ray technique
intra-oral techniques: Film positioned inside the mouth
Describe the intra-oral dental X-ray technique
Patient can be left on lateral recumbency (as it is during the dental cleaning OR moved on dorsal or ventral recumbency
Describe the parallel technique
Film is placed parallel to the long axis of the toothCentral beam is directed perpendicular to the film
What happens when the beam is angled too vertically when using the bisecting technique
foreshortened
what happens when the beam is angled too horizontally when using the bisecting technique
lengthened
How do you get the perfect image representation of the tooth using the bisecting technique
If the primary bean is aimed at 90 degree to a bisecting angle, the image will be a true representation of the tooth!
When you’re taking an X-ray of the front tooth (maximally and mandibular incisors and canines) using the bisecting technique
view the animal from the side
when you’re taking an X-ray of the side tooth (maxillary molars and premolars) using the bisecting technique
view the animal from the front
How do you take a picture of all three roots in one picture
the parallax effect
What is radiopacity
relative inability for X-rays to pass through a particular material
what is radiolucency
transparency for X-rays to pass through
Describe the normal structure of dentine on the radiograph
less dense
describe the normal structure of the cementum on the radiograph
only seen when hyper plastic (hyperplasia)
describe the normal structure of the enamel on the radiograph
very radio dense on crown, tapers to cervical margin
describe the normal structure of the root on the radiograph
Root - below gum line surrounded by alveolar bone: appear gray and relatively uniform
describe the normal structure of the pulp cavity on the radiograph
Pulp Cavity - radiolucent zone. Pulp chamber in center to tooth & pulp canal in center of the roots
describe the normal structure of the periodontal ligament on the radiograph
Periodontal ligament - radiolucent (black) line surrounding the tooth root
describe the normal structure of the lamina dura on the radiograph
Lamina dura – sclerotic radiopaque (white) line just outside the PL. Represents bony wall of socket. Runs parallel to the tooth root.
What are the normal age related changes in teeth
have a decreased pulp cavityclosure of the apical foramenregression of alveolar crestsclerosis of alveolar bone
What composes the periodontium
the alveolar boneperiodontal ligamentcementumgingiva
what does the gingiva cover
Gingiva covers the alveolar bone of the maxilla and mandible, and surrounds the tooth itself.
what is found around the teeth
sulcus
where is junctional epithelium located
Junctional epithelium is where at the bottom of the sulcus, the cells are attached to the enamel surface.
describe the gingiva coronal to the CEJ
free gingiva
describe the gingiva below the CEJ
attached gingiva
where is the attached gingiva differentiated from alveolar mucosa at
the mucogingival junction
what is cementum
is the bony-like tissue covering the root
describe cementum
Less calcified than dentin and enamelDenser than boneDeposition occurs throughout lifeInvolved in both resorptive and reparative processes
What is the periodontal ligament composed of and what does it do
it is composed of collagen fibres and anchor the tooth to the alveolar bone. It also has many blood and lymphatic vessels, nerves, elastic fibres and cells
what do alveolar sockets contain
the roots of the teeth
what is the cribriform plate called
the lamina dura or white line
describe oral microbiology
About 100 billion bacteria from all oral surfaces are shed daily in the salivaTotal plaque flora constitutes about 5% of the salivary floraAbout 300 species from dental plaque alone
what is the flora of the healthy gingiva
Flora of healthy gingiva: AEROBIC + FACULTATIVE ANAEROBIC
What is periodontal disease
A disease process that affects one or more of the periodontal tissues…eventually leading to tooth loss.
what is a biofilm
A microscopic layer of glycoprotein molecules found on all moist surfaces. Bacteria live in this “slime” layer that helps them adhere to surfaces.
What is plaque
Plaque: A soft material found on tooth surfaces which is made of bacteria and protein. It is not easy to see, but it is easy to remove with toothbrushing; but returns quickly.
what is calculus
hardened plaque formed from saliva and food debris. It adheres to teeth and is difficult to remove; requires professional treatment under anesthesia for complete removal.
what is gingivitis
Gingivitis: Inflammation of the gingiva; leads to redness and/or bleeding gums.
what is the periodontitis
The active form of periodontal disease. Bacterial infection and inflammation cause destruction of the periodontal tissues, leading to attachment loss around the teeth.
what is the main cause of periodontal disease
plaque - without plaque the periodontal disease does not develop
describe the flora of a diseased mouth
gram - rodsmotileanaerobicspirochete
what can occur with chronic gingival inflammation
gingival enlargement: hyperplasia, pseudopocket
What happens if gingivitis is left untreated
→ extends subgingivally →more inflammation →more plaque accumulate → more tissue is destroyed by bacteria & host inflammatory response
what are the main sub gingival bacteria
faculative aerobic since there is less 02
how is calculus created
Mixture of bacteria, enzymes, toxins, by-products alter the host defense mechanism = induce calculus.
describe calculus
Itself : non-irritant But serves as an ideal surface for more plaque!
what are some factors that increase plaque accumulation
tight lipsexcess salivationteeth crowding
what are the factors that decrease resistance to infection
- Metabolic, organic disease- Nutritional disturbances- Immunodeficiency
What are the changes to the radiographs in stage 4 periodontal disease
Marked bone loss+/- tooth fracturePeriapical lucency consistent with a periapical granuloma (“abscess”)
How do you manage periodontal disease
PROFESSIONAL periodontal therapy- Cleaning versus treatmentPlaque control measured (homecare)
How do you encourage owners to manage periodontal disease
Educate owners to understand disease progression (at the clinic, website, facebook…etc)Train & motivate owner to perform daily homecare (demo, videos, data information sheet…)Do back up phone calls, with regular checkupsPerform regular professional periodontal therapy
How do you treat gingivitis
when you remove plaque and calculus the gingivitis will heal.effective homecare is critical
how do you treat periodontitis
Aim is to prevent new lesions at other sites, and prevent further tissue destructions at sites already affectedSame as gingivitis, but perform periodontal therapy, and may require periodontal sx
what are the goals of professional periodontal therapy
remove calculus above and below gingivarestore tooth to a smooth plaque attractant surface
what is sub gingival scaling
removal of plaque, calculus and other debris from the tooth surface below the gingival margin
what is root planning
is the removal of the calculus from the cementum from the root surfaces: produces a smooth root surface which is less likely to accumulate plaque and more likely to permit epithelial reattachment.
what instrument do you use to do root planning
the curette
what is the most common reason clients come to us about their dogs mouth
due to halitosis caused by bacteria, plaque and calculus
.what are some of the most common periodontal disease local consequences
Most common ones:1. Tooth loss 2. Abscess (lateral or periapical)3- Oronasal fistula (ONF)4- Pathologic fracture of the mandibuleOthers: oral cancer, chronic osteomyelitis,
describe a lateral periodontal abcess
Orifice of periodontal pocket is blockedMay drain around tissue or fistulate throught the oral mucosa
where are periapical abcess often seen
often seen at 208 pm4 (with suborbital swelling and draining)
describe a periapical abcess
Pathologic process surrounding the root of the tooth
what causes a periapical abcess
Inflammation or necrosis of the dental pulp from trauma or infection OR as an extension of PD
describe the radiologic appearance of periodical disease
periapical radiolucency.
what can periapical abscess causes
osteomyelitis, cellulitis, bacteraemia. can fistulate in oral mucosa or nose
What are 7 common pathologies that can be diagnosed by dental radiology
1- FORL (most common in cats) 2- Alveolar expansion (cats)3- Caries (dogs)4- Root abnormalities: extra roots, root ankylosis 5- Missing tooth6- Dentigerous cyst7- Traumatic lesions: dental and/or bony fractures or dislocation
when do feline oral resorptive lesions start
around 4-6 years of age. common in 20-75% of mature cats
where is the location of the FORL
apparent at the labial or buccal surface near the neck
describe FORL
Resorption →root surface → erode gingival attachment → expose to bacteria → painful inflammation of surrounding tissueThe first clinical manifestation of FORL is a late stage lesion
what generaly covers FORL
gingiva which may or may not be inflammed
what teeth are generally affected by FORL
107, 207, 307, 407, 108, 208, 309, 409
what are the clinical signs of FORL
Clinical signs: hypersalivation, head shaking, sneezing, anorexia, oral bleeding, or have difficulty with prehensionWhen dentine exposed, or affects pulp = painful…but in most cases: NO CLINICAL SIGNS despite the pain!
what is the cause of alveolar bone expansion
severe periodontal disease over canines
where can alveolar bone expansion happen
around one r both maxillary and/or mandibular canines.
what is the radiographic appearance of alveolar bone expansion
Radiographic appearance: bone loss around the root and expansile alveolar bone growth
how do you treat alveolar bone expansion
tooth extraction
what species gets caries
dogs
where are caries found
in pre-molars and molars where occlusal molars come in contactFlat chewing surface, with deep pits and fissures: more susceptible to food accumulation
what is a carie
plaque-induced destruction of the enamel of a tooth
what are periodontal disease are caries both caused by
plaque
how do plaque bacteria cause caries
Plaque bacteria use sugars (CHO) as energy, producing acidic fermentation products which demineralize enamel
what dental instrument is used to detect softened discoloured enamel pits and fissures?
the explorer
describe a carie
Large defects have food and debris packed within themOnce enamel is gone, process extends to dentineCan reach pulp cavity, causing periapical abcesses and pulpitis
what is root ankylosing due to
severe periodontitis
what is anondontia
absence of all teeth
what is oligodontia
absence of many but not all teeth
what is hypodontia
absence of a few teeth
what are the most commonly missing teeth
incisor
what are the reasons for missing teeth
CommonNeed rads to see if missingAbsence can be inheritedPrimary teeth give rise to permanent tooth budReason to know the deciduous formula, if missing, will miss adult tooth
what happens if a tooth is present and unerupted
there is increased risk of abscess formation
describe a dentigenous cyst
The follicle of unerupted teeth undergoes cystic transformation, causing dentigerous cysts with large, resorption of surrounding alveolar bone.Either monitor radiographically, or extract prophylactically
What is occlusion
normal position of teeth when jaws are closed
what is malocclusion
misaligned teeth
What are the consequences of malocclusion
Abnormal contact with other teeth or soft tissues = discomfort + painAccumulation of debris + foods, periodontal pockets, PD disease, tooth loss….Chronic pain = changes in behaviorDifficulty in mastication
how do you prevent malocclusion
Oral examination starting at initial puppy/kitten 1st visit!AHT: during pre-consultation
what can be done about a malocclusion if detected early
Can be treated with simple extraction / crown amputation orOrthodontics tx (eg. braces, wire, buttons, elastics, acrylic plates)
what happens if a malocclusion is not detected early
may result in permanent teeth malocclusions that require extensive extractions or multiple-procedure orthodontics.
describe the normal occlusion of dogs
Wild phenotype of domestic dogs and cats has interdigitating teeth cheek that create pinking shears effect.
describe the pinking shears effect on canines
a mandibular tooth (canine) that interdigitates with the maxillary 3rd incisor and canine (fits in the diasthema) (canine interlock)
describe the pinking shears effect on incisors
mandibular incisors that rest on the cingulae of the maxillary incissors
what are the 4 points to evaluate occlusion in dogs
Scissor incisor relationshipThe canine interlockThe PM interdigitation (“pinking shear” effect)Head symmetry
describe incisor scissor occlusion
scissor bite incisors. the mandibular incisors rest on the cingulae
describe the proper canine interlock
Mandibular canine fits into diasthema between maxillary 3rd incisor and upper canineNot touching each otherCreates an interlock situation that prevents one or the other jaw from overgrowing the other.
what is a diasthema
space or gap between 2 teeth
describe the normal canine PM interdigitation
Cusp tips of PM should point to the interdental spacePinking shear effectBuccal surface of the first 1st mandibular molar occludes with the palatal surface of maxillary PM4
what is a cusp
raised points on the crowns of teeth
What are the 3 dog head shapes
dolichocephalicmesocephalicbrachycephalic
what breed of dog has a dolichocephalic head
borzoi
what breed of dog has a mesocephalic head
lab
what breed of dog has a brachycephalic head
pug
describe the head of a mesocephalic head
Mandible is shorter and less wide than maxillaScissor bite incisorsMaxillary incisors are rostralIncisal tips of mandibular incisor contact cingulae of upper incisor
what is the normal dentition for a mesocephalic head
Interdigitation of canine teeth- mandibular one into diastema b/n upper 3rd incisor and upper canine, not touching eitherPremolars oppose interdental space opposite arcadeMaxillary 4th PM scissors with mandibular 1st molar
how does cusp to cusp premolars happen
How does this happen?Either mandibular prognathism (undershot) or brachygnathism (overshot)
what does prognathic mean
longer
what does brachygnathic mean
shorter
describe the dentition of a brachycephalic breed
shorter maxilla- normal mandibleCrowding and rotation upper teethMore prone to gingival hyperplasia due to open mouth breathingAlso prone to missing teeth
describe the dentition of a dolichocephalic breed
Have longer upper jawLarger interdental spaces
what is a lance tooth
Or rostrally displaced maxillary canine(s)One or both of the maxillary canine teeth deviating or pointing rostrally
what is the result of a lance tooth
Result: closed diastema space between the max 3rd incisor and max canine tooth (crowding)
what can lance tooth cause
periodontal diseaseocclusal problemsarea for plaque retention
how does lance tooth occur?
genetic
what breed commonly has lance tooth
sheltie
describe an anterior crossbite
reverse scissor bite of one, two or all incisorsDisplaced lingual to the lowers and the rest occlude normally
what is an anterior corset considered a secondary condition to
Usually secondary to retained deciduous incisors
what is a posterior caudal crossbite
Class 1 PM + M are lingual to lower ones(carnassial teeth are reversed)
what is a level bite
where the incisor teeth meet exactly, surface to surface
what can level bite cause
Cause abnormal wear of the incisal edges of these teeeth & even inflammation surrounding the roots
what is the common teeth crowding in toy breeds
incissors
what is the common teeth crowding in brachycephalic breeds
PM
what is brachygnathia
excessive shortness of one or both jaws
what is prognathism
abnormal profusion of one or both jaws
what is a mandibular brachygnathic bite
Upper jaw extends significantly over the lower jawAlso called overbite
what is a mandibular prognathic bite
Also called underbiteMandibular premolars rostrally displacedReverse scissor biteLower incisors are rostralMandibular canine touches 3rd incisor
what is a narrow mandible
Lower canines impinge on:maxillary gingivae orhard palate …..instead of going into diasthema
what is an open bite
the teeth do not meet properly and a space is created
what is a wry bite
When one jaw quadrant grows differently from the other and symmetry is lostFelt to be caused by one sided prognathism or brachygnathism
describe feline chronic stomatitis
Severe focal or diffuse inflammation of:oral mucosa (caudal stomatitis +/- buccal Gingiva (gingivitis)Ulcerative lesionsChronicityPoor response to medical tx
which cats are at risk for feline chronic stomatitis
0.7% of cats10 months to 17 years oldNo breed predilectionMay be more frequent in cat colony (environmental stress)
what is the ethiology of feline chronic stomatitis
unknown
how is feline chronic stomatitis seen
as gingivitis with stomatitisas stomatitis alone or with gingivitis
what are the clinical signs of feline chronic stomatitis
HalitosisPtyalism +/- with bloodAnorexia or ↓ appetit, refuse dry foodWeight lossDysphagia↓ grooming HidesAgressivity, irritabilityDo not yawn+++pain at mouth openingMandibular lymphadenopathy
how do you diagnose feline chronic stomatitis
Oral stomatitis (caudal +/- buccal) Clinical signsFIV, Felv & CBC – biochem to rule-out systemic disease (eg. kidney disease (causes stomatitis)), Bartonella testing
how do you treat feline chronic stomatitis
full mouth extraction
describe the effects of a full mouth extraction on cats with feline chronic stomatitis
Provide complete & rapid healing in 80% of the cases within 3 months30-35% will improve but will take longer & will need some Rx5-10% with poor response
describe feline juvenile onset gingivitis
Young cats (6-8 months)after the permanent teeth have eruptedSevere gingivitis with overgrowth around crowns, PM, M)Cause pseudopocketsNotable halitosisLittle to no tartar accumulationCause: unknown
how do you treat feline juvenile onset gingivitis
Early detectionFrequent professional cleaning (ev. 3-6 months!) with gingivectomy of hyperplastic gingival tissue.Daily brushing & home care
what is juvenile onset periodontitis
Prior to the age of 9 monthsAt the time of permanent tooth eruptionMarked inflammation at the gingival marginCan extend in the attached gingivaSiamese, Maine Coon and DSH are predisposed
what are supernumerary teeth
extra teethCause crowding = ↓ natural cleaning mechanism + predispose the area to PDIf crowding: should be extracted early
which animals are supernumerary teeth common in
brachycephalic breeds (pug etc)in cats: most common SN teeth: PM4Here in the picture, PM3
how do you differentiate supernumerary teeth from deciduous teeth
dental radiographs
describe fusion and germination of teeth
Gemination is attempt to merge 2 teethCause : unknown (trauma? Genetic?)Often involves supernumerary teethCan be observed in both deciduous & permanent teethDifficult to differentiate between supernumerary and germination without dental x-rays.
describe enamel
Very thin material (
what is enamel hypoplasia
result form disruption of the normal enamel development
what can happen if ameloblasts are injured
very sensitive/ minor injuries can result in enamel malformation
what are three causes for enamel hypoplasia
a) Trauma to the unerupted toothb) Severe systemic infectious or nutritional problemc) Hereditary condition: amelogenisis imperfecta
what are the two types of trauma that can happen to the unerrupted tooth
physical traumaOne or more adjacent teeth affectedTrauma during extraction of deciduous tooth
describe amelogenesis imperfecta
Created by a ↓ in the amount of enamel matrix applied to the teeth during development. Nearly all teeth are involved on all surfaces.
describe the appearance of enamel hypoplasia
Appear stained tan to dark brown (rarely black) colorMay appear pitted & roughTooth surface is hardAffected areas are easily exfoliated → expose the underlying dentin → resulting in stainingExpose dentin → discomfort!Roughness of tooth → ↑ plaque & calculus rentention → periodontal diseaseFor all these reasons: prompt therapy of these teeth is critical to the health of the patient
what is attrition
gradual physiologic wear resulting from natural mastication (tooth-to-tooth contact)
what is abrasion
mechanical wear of teeth from external forces (eg, brushing, dental instruments),(contact between the tooth and something other than the opposing tooth)also defined as wear from chewing on abrasive objects (eg, tennis balls, cage biters)May cause fracture
what is primary dentin
Primary dentin: dentin that forms before and during eruption
what is secondary dentin
Secondary dentin: normal, physiologic dentin that forms following eruption (as tooth develops) (develops from the odontoblasts living within the pulp)
what is tertiary dentin
Tertiary dentin (what you are seeing in the centre of the worn spots) is the darker, less organized dentin formed in response to some irritation or external stimulus (result of trauma to the odontoblasts).
what do you have to do if there is abrasion with pulp exposure
need to either extract or Refer to endodontic therapy (root canal)
what is endodontics
a branch of dentistry dealing with diseases of pulpal and periradicular tissues (round the roots)
what is endodontic therapy
indirect or direct pulp capping, or total pulpectomy (in preparation of root canal)Root canal therapy- a filling in the root.
what are the most common oral malignant tumors
Most common:squamous cell carcinoma fibrosarcomamalignant melanoma
describe an epulid or epulis
Epulid or epulis describes localized swelling of gingivaBenignTx : excisionRegrowth possible
what do you do if you see an oral tumor or growth
Radiographs important to show bony involvement and plan in tumor management
What is needed for the HIGHDENT power instrument
chlorexidine and water filled and pressurizedall appropriate tips put on + prophy anglescaler set
What is needed for the inovadent dental cart instrument
chlorex + water filled and pressurizedset piezo scalerput on prophy tip and cups
What is needed for the cavitron dental instrument
open handle (Water)fill handle with waterput in stacksset scaling water pressure
what is needed for the inovadent pet piezo plus
set tipsset piezo scalerpressurize water pumpset scaling water pressure
what power instrument do you put at low speed
the polisher
what power instrument do you put at high speed
the drill
for the cavitron what color does the blue stack need to be set to
grey
for the cavitron what color does the green stack need to be set to
blue
What is the curved beak instrument used to remove heavy gross calculus from the tooth surface
calculus removing forceps
to explore the depth of sulcus to determine periodontal probing depth and sub gingival calculus
dental probe
wide working tip, chisel like blade instrument used to remove supra gingival heavy gross calculus
dental hoe/chisel
very fine and sharp instrument with a flat tip used to break down the PL and expand the alveolus
dental luxator
to examine teeth for caries, calculi, furcations, resorptive lesions, calculus left behind
dental explorer
triangle pointed shaped instrument with a pointed toe and 2 parallel cutting edges (also: supra gingival or subgingivial)
supragingival - dental scaler
very thin delicate ends instrument used to lift the gingiva/mucosa away from the alveolar bone to prepare tooth for extractions
periosteal elevator
double ended instrument, rounded toe and back used to remove calculus (supra and/or subgingivally after power scaling)
both supra and sub - curette
thick working ends instrument used to stretch, cut, tear the PL and displace the tooth root from its socket during the extraction process
winged elevator
instrument used to grip the tooth or root for removal during extraction
extraction forceps
what type of scaler is the cavitron
magnetostrictive
where would the dial be placed in order to start scaling on the cavitron
in the blue
what needs to be done to the cavitron before inserting the stack
allow water to flow through it
what are the handpieces available for the inovadent big one
scaler, polisher, drill, water, air gun
what type of mechanical scaler is the inovadent big one
piezoelectric
what needs to be done for the inovadent big one before turning it on and using the machine
ensure proper oil level and fill water bottle
what are the two liquids in the hanging bottles for the highdent
distilled water, chlorexidine solution
what type of mechanical scaler is the highdent
piezoelectric
what type of mechanic scaler is in the pet piezo plus
piezoelectric
in addition to scaling what does the pet piezo plus
scaling, polishing, drilling
what is not recommended to do with the pet piezo plus unit
drilling. it does not run water through the drill so it heats up too quickly and can burn the tooth
what distinuishes the handheld unit from the rest.
handheld and wireless
what does the handheld unit do
it polishes
how do i know when the handheld unit needs to be charged
the light is orange
can we re-use the trophy angles for the handheld unit?
no it is disposable.
how do we verify the wear of a tip or a stack
compare to the tip cards
what are the first three steps when starting the dental prophy on the patients
put a towel under headpack the mouth chlorx- rinse
true/false: polishing is only done at the end when all four buccal quadrants have been scaled
false
fill in the blank: hand instruments and power instruments are held using the ________
modified pencil grip
true/false: the tip of the power instrument can be pointed at the tooth or held at a 90 degree angle to the tooth
false
fill in the blank: the correct positioning for the dental radiograph requires proper tube angulation, tube position and _____ position
film
what technique do you use for the mandibular PM and molars
parallel technique
what is the bisecting technique
when the film is placed parallel to the long axis of the tooth, and the central beam is directed perpendicular to the film
what happens when the beam is angled too vertically
the tooth will appear foreshortened
what happens when the beam is angled too low
the tooth will appear elongated
t/f: the dental film dot should face the beam
true
t/f: the dental film dot should be directed towards the inside of the patients throat
false
t/f: the white part of the dental film should face the opposite side of the x-ray beam
false
how long does the film need to remain in the water bath once it has been developed and fixed
1hour
How many teeth does a puppy have
28
how many teeth does an adult dog have
42
how many teeth does a kitten have
26
how many teeth does an adult cat have
30
what is the permanent canine dental formula
31423143
what is the permanent feline dental formula
31313121
towards the root
apical
towards the crown
coronal
surface towards front midline
mesial
surface away from midline
distal
4 parts of the periodontum
alveolar bonecementumgingivaPL
this structure is covered by enamel at the crown aspect
dentine
centre of tooth
pulp
hardest substance of the body
enamel
covers the root and provides a point of attachment for the PL
cementum
main supporting structure of the tooth
dentine
where the tooth sits in the alveolar bone
alveolar socket
what is a diphyodont
has 2 sets of teeth in a lifetime
what does the mucogingival line divide
junction of attached gingiva and oral mucosa
t/f: glycopyrrulate prevents bradycardia
true
what drug prevents bradycardia
atropine, glyco
a dog receives BAG and is induced with ket-val. give 2 reasons why we should put tear gel in his eyes
he isn’t blinking due to the ketamine, he got glyco so he is also producing less tears
which drug should be used in the pre-med to reduce salivation during a dental procedure
glyco
what does propofol do to the respiratory system
respiratory depression
how can you minimize the respiratory depression from propofol
pre-oxygenate for 5 mins
t/f: propofol is not considered safe for animals with liver or kidney dysfunction
false
what do you do if an animal is moving under anesthesia
stop scaling, increase iso and bag patient
what do you do if an animal regurgitates during the recovery period with the ET tube still in
place her head lower, ensure regurgitated material is not in mouth and clean mouth with gauze
what drug family will not slow down heart rate
anticholinergics
t/f: butorphanol is used for severe pain such as tooth extraction
false
t/f: the pulse oximeter of a patient reads 94%. this is normal
false
what drug is used first during cardiac arrest
epinepherine
what are the alpha 2 agonists
medetomidine, dexmeditomidine, xylazine
