Week 1 - Dentistry Flashcards
What is the purpose of an awake oral exam?
- estimate extent of oral dz to make a treatment plan and a cost estimate
- to evaluate occlusion
What is periodontal disease?
disruption of the equilibrium between the bacteria in subgingival plaque and the host’s immune response at the dent-gingival junction
What are contributing intrinsic factors for periodontal dz?
-endocrinopathy
-metabolic dz
-debilitating dz
-corticosteroid therapy
-nutritional deficiency
-immune-mediated dz
What are some systemic dz concerns?
-contributing intrinsic factors (ex. dry mouth)
-oral manifestations of systemic dz (ex. uremic dz)
-systemic manifestations of oral dz
-pre-anesthetic work-up
Anesthesia is an important consideration with dental dz patients. Why?
-not a single protocol will work for all
-avoid gas induction
-inhalation anesthesia
–cuffed e-tube – bc a lot of fluid is used in the oral cavity during procedures
-duration unpredictable
-prevent hypothermia
-monitor
What two reason would you use abx for?
- Prophylaxis
-important bc could be very dangerous if oral bacteria could get into different areas (from where you’re conducting surgery) - Therapeutic (ex. stomatitis, osteomyelitis, severe refractory periodontitis)
What to consider when choosing an abx?
-known susceptibility of oral bacteria
-high concentration in oral tissues
-narrow spectrum preferred
-bactericidal preferred
-lack of side-effects
-cost
What is the dose of ampicillin for dentistry?
20mg/kg IV at time of catheter placement for anesthesia
repeated after 6 hours if indicated and if catheter is still in place
Dose for clindamycin?
Dogs 5-10mg/kg PO BID
Cats 10-20mg/kg PO QD
Dose for amoxicillin-clavulanate?
20mg/kg PO BID or TID
Dose for Cephalexin or Cefradoxil?
10-30mg/kg PO BID or TID
Dose for Metronidazole?
20mg/kg PO BID
What is an example of an antiseptic? (it is considered another form of antimicrobials)
Chlorhex - decrease load of bacteremia and aerosolization of bacteria
so rinse mouth before scaling with Chlorhex (0.12%) - 0.05% used in OR
CHLORHEX GLUCONATE - mouthwash
DIACETATE - surface disinfectant
-use non-alcohol solution
Why is patient positioning important?
-dorsal recumbancy, see things well and no need to flip
avoid tracheal ruptures in a cat
What are the important considerations when conducing oral surgery?
-pre-op work-up and systemic disease concerns
-anesthesia
-use of antibiotics
-use of antiseptics
-patient positioning
-organizing the workplace
-personal protection (eye protection, sx cap, gloves)
What do you consider with Diagnostic Charting?
-extraoral findings and intraoral soft tissue lesions
–neck, head, ears, eyes - retro pulse, salivary glands, mandible/maxilla, palate, cheek tissues, teeth
-exam each individual tooth
What examination instruments are used?
Periodontal probe
-determines mobility of the tooth
-the amount of plaque/calculus on tooth
-degree of gingivitis
-determine furcation/exposure
Explorer Probe
-23 shepherd’s hook
-pulp exposure
-fractures
-cavities
Dental Mirror
-hard to see areas
Everything gets recorded on the __________
DENTAL CHART
What is a dental index/indices? Used per tooth
-a numerical value reflecting the presence and/or severity of a pathological conditions using predefined diagnostic criteria
What is a dental stage? Used per tooth
-assessment of the extent of a pathological lesion in the course of a disease that is likely to be progressive
Example of Plaque and Calculus Index
Indices of 0-4
0 - no plaque detected
1-4 divided into quarters
Stages of mobility (mobility is something that progresses and cat get worse)
Stages 0-3
0 - physiologic mobility up to 0.2mm
3 - increased mobility >1mm or any axial movement
Example of Gingivitis Index
Indices 0-3
0 - normal gingiva
3 - severe inflammation, severe erythema and swelling (bleed immediately)
Stages of furcation involvement
Stages 0-3
0 - no furcation, can’t get probe in
3 - furcation exposure extending through and through
The gingiva can do two things when there is a pocket:
Gingival enlargement - pocket may look worse, but pocked it the same, just gingiva is large
Gingival recession > attachment loss, pocket may look better, but bad attachment loss
WE CARE ABOUT ATTACHMENT LOSS - not influenced by gingival enlargement or recession
Check Lecture 3-4, slide 49 for probing depth of attachment loss
Remember, true attachment loss is from CEJ to bottom of probe
Radiography is important in periodontal disease. It’s very valuable - why?
-additional radiological info 92% of time
-unexpected amount of bone loss in 25% of cases
-increased odds ratios of rinding root resorption, endodontal lesions and root fragments
What are the radiological signs of periodontitis?
-rounding of alveolar margin at the cemento-enamel junction
-widening of periodontal space
-loss of integrity of the lamina dura
-osteolysis of the supporting bone
-resorption of the alveolar margin
What’s the difference between horizontal and vertical bone loss?
Horizontal
-receding line of bone loss across multiple roots
Vertical
-wedge of bone loss around surface of a root
Stages of Periodontal Dz
Stages 0-4
NEED DENTAL CHARTING and RADS
Stage 1 - gingivitis
Stage 2 - attachment loss <25%, stage 1 furcation involvement
Stage 3 - attachment loss 25-50%, stage 2 furcation involvement
Stage 4 - attachment loss >50%, stage 3, furcation involvement
What are the parts of the Periodontal Healing?
-epithelial re-attachment - dose not occur
-epithelial regneration - main component
-connective tissue re-attachment -very limited
-connective tissue regeneration - difficult to achieve
-when dental cleaning, goal is for periodontium to regenerate
-epithelium does not reattach and it’s very limited in the connective tissue
-want regeneration - easier said than done
-issue: epithelium wants to heal first, but you want periodontal ligament to heal first – so need guided healing/advanced periodontal surgery
What are Periodontal treatment objectives?
-complete regeneration
-healing of the pockets
-cessation of attachment loss
-elimination of active inflammation
-establishing conditions conductive to periodontal health
What factors are important to consider with periodontal treatment planning?
-attachment loss: mobility, furcation involvement, pockets >4mm – is tooth salvageable?
-home care possible?
-other health issues?
-practice philopshy
What is your periodontal treatment while patient is under anesthesia?
oral exam
irrigation
charting
dental rads
periodontal debridement
extractions
disclosing solution
polishing
irrigation
What is your periodontal treatment plan for aftercare?
-short term post op treatment - pain meds
-long term aftercare - home care
-re-evaluation
What is scaling?
-removal of plaque and calculus from supra gingival and sub gingival tooth surfaces
removal of plotting calculus
What is root planing?
removal of residual calculus and contaminated cementum from the scaled root surface
removal of calculus at root level, and removal of cementum
What is periodontal debridement?
removal of plaque from the root surface without removing cementum
There has bene a paradigm shift in treatment endpoint with teeth cleaning. What is it?
The idea that you shouldn’t leave the tooth “squeaky clean”
-try not to remove cementum, but remove all calculus and surface irregularities at the dentogivignal interface
-remove plaque and calculus, not tooth structure
What equipment can you use to scale, root plane, and periodontal debride?
- power scalers
-ultrasonic scalers - higher freq
–piezoelectric US scalers - only lateral side of tip is active, linear movement, usually only water
–magnetostrictive US scalers - all sides of tip is active, elliptical/rotational movement, can use other than water
-sonic scalers - elliptical movement, only water
don’t spend more than 5 sec on a tooth
don’t stay static
What are scalers and curettes?
scalers
-pointed at tip
-above gumline
-curved sickle scaler
-straight sickle scaler
curettes
-round
-use with gumline
-universal curette - 90 degree angle toe, 2 cutting edges
-gracey curette - 70 degree angle toe, lower angle is cutting edges
What can you use with the power scaler to go under the gumline/subgingival?
Power scaler with periodontal debridement tip
What is disclosing solution?
test work!
make sure work is done, if tooth is still dirty, then tooth will stain
Is polishing really needed?
Old paradigm - scaling caused surface irregularities, so polishing was a must
New paradigm - does not seem to be clinically relevant, selective polishing to remove residual plaque is indicated
use a cup and pumice polishing - awkward to use in animals
also air polishing - easy to use, no thermal damage, can be used with periodontal debridement, may traumatize unkeratinzed tissues
