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VET433B > Week 1 - Dentistry > Flashcards

Week 1 - Dentistry Flashcards

1
Q

What is the purpose of an awake oral exam?

A
  1. estimate extent of oral dz to make a treatment plan and a cost estimate
  2. to evaluate occlusion
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2
Q

What is periodontal disease?

A

disruption of the equilibrium between the bacteria in subgingival plaque and the host’s immune response at the dent-gingival junction

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3
Q

What are contributing intrinsic factors for periodontal dz?

A

-endocrinopathy
-metabolic dz
-debilitating dz
-corticosteroid therapy
-nutritional deficiency
-immune-mediated dz

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4
Q

What are some systemic dz concerns?

A

-contributing intrinsic factors (ex. dry mouth)
-oral manifestations of systemic dz (ex. uremic dz)
-systemic manifestations of oral dz
-pre-anesthetic work-up

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5
Q

Anesthesia is an important consideration with dental dz patients. Why?

A

-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

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6
Q

What two reason would you use abx for?

A
  1. Prophylaxis
    -important bc could be very dangerous if oral bacteria could get into different areas (from where you’re conducting surgery)
  2. Therapeutic (ex. stomatitis, osteomyelitis, severe refractory periodontitis)
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7
Q

What to consider when choosing an abx?

A

-known susceptibility of oral bacteria
-high concentration in oral tissues
-narrow spectrum preferred
-bactericidal preferred
-lack of side-effects
-cost

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8
Q

What is the dose of ampicillin for dentistry?

A

20mg/kg IV at time of catheter placement for anesthesia

repeated after 6 hours if indicated and if catheter is still in place

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9
Q

Dose for clindamycin?

A

Dogs 5-10mg/kg PO BID
Cats 10-20mg/kg PO QD

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10
Q

Dose for amoxicillin-clavulanate?

A

20mg/kg PO BID or TID

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11
Q

Dose for Cephalexin or Cefradoxil?

A

10-30mg/kg PO BID or TID

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12
Q

Dose for Metronidazole?

A

20mg/kg PO BID

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13
Q

What is an example of an antiseptic? (it is considered another form of antimicrobials)

A

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

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14
Q

Why is patient positioning important?

A

-dorsal recumbancy, see things well and no need to flip

avoid tracheal ruptures in a cat

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15
Q

What are the important considerations when conducing oral surgery?

A

-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)

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16
Q

What do you consider with Diagnostic Charting?

A

-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

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17
Q

What examination instruments are used?

A

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

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18
Q

Everything gets recorded on the __________

A

DENTAL CHART

19
Q

What is a dental index/indices? Used per tooth

A

-a numerical value reflecting the presence and/or severity of a pathological conditions using predefined diagnostic criteria

20
Q

What is a dental stage? Used per tooth

A

-assessment of the extent of a pathological lesion in the course of a disease that is likely to be progressive

21
Q

Example of Plaque and Calculus Index

A

Indices of 0-4

0 - no plaque detected
1-4 divided into quarters

22
Q

Stages of mobility (mobility is something that progresses and cat get worse)

A

Stages 0-3

0 - physiologic mobility up to 0.2mm
3 - increased mobility >1mm or any axial movement

23
Q

Example of Gingivitis Index

A

Indices 0-3

0 - normal gingiva
3 - severe inflammation, severe erythema and swelling (bleed immediately)

24
Q

Stages of furcation involvement

A

Stages 0-3

0 - no furcation, can’t get probe in
3 - furcation exposure extending through and through

25
Q

The gingiva can do two things when there is a pocket:

A

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

26
Q

Check Lecture 3-4, slide 49 for probing depth of attachment loss

A

Remember, true attachment loss is from CEJ to bottom of probe

27
Q

Radiography is important in periodontal disease. It’s very valuable - why?

A

-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

28
Q

What are the radiological signs of periodontitis?

A

-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

29
Q

What’s the difference between horizontal and vertical bone loss?

A

Horizontal
-receding line of bone loss across multiple roots

Vertical
-wedge of bone loss around surface of a root

30
Q

Stages of Periodontal Dz

A

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

31
Q

What are the parts of the Periodontal Healing?

A

-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

32
Q

What are Periodontal treatment objectives?

A

-complete regeneration
-healing of the pockets
-cessation of attachment loss
-elimination of active inflammation
-establishing conditions conductive to periodontal health

33
Q

What factors are important to consider with periodontal treatment planning?

A

-attachment loss: mobility, furcation involvement, pockets >4mm – is tooth salvageable?

-home care possible?

-other health issues?

-practice philopshy

34
Q

What is your periodontal treatment while patient is under anesthesia?

A

oral exam
irrigation
charting
dental rads
periodontal debridement
extractions
disclosing solution
polishing
irrigation

35
Q

What is your periodontal treatment plan for aftercare?

A

-short term post op treatment - pain meds
-long term aftercare - home care
-re-evaluation

36
Q

What is scaling?

A

-removal of plaque and calculus from supra gingival and sub gingival tooth surfaces

removal of plotting calculus

37
Q

What is root planing?

A

removal of residual calculus and contaminated cementum from the scaled root surface

removal of calculus at root level, and removal of cementum

38
Q

What is periodontal debridement?

A

removal of plaque from the root surface without removing cementum

39
Q

There has bene a paradigm shift in treatment endpoint with teeth cleaning. What is it?

A

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

40
Q

What equipment can you use to scale, root plane, and periodontal debride?

A
  1. 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

41
Q

What are scalers and curettes?

A

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

42
Q

What can you use with the power scaler to go under the gumline/subgingival?

A

Power scaler with periodontal debridement tip

43
Q

What is disclosing solution?

A

test work!

make sure work is done, if tooth is still dirty, then tooth will stain

44
Q

Is polishing really needed?

A

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

VET433B (8 decks)

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