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Equine michaelmas 23 > Dentistry > Flashcards

Dentistry Flashcards

1
Q

Quidding

A

Abnormal dropping of food from the mouth

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2
Q

On the bit

A

term used to describe position of horses head in relation to bridle - often the position riders want to achieve during work

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3
Q

Lateral radiograph use

A

To assess sinuses
Head up to stop fluid accumulation

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4
Q

Dorsoventral radiograph use

A

Ventral conchal sinus

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5
Q

Latero-30degree-dorsolateroventral oblique radiograph use

A

For maxillary

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6
Q

Latero-35-40 degree venterolaterodorsal oblique view radiograph use

A

For mandibular

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7
Q

Open mouthed obliques radiograph use

A

For clinical crowns and diastemata

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8
Q

How to radiograph maxillary incisors

A

plate in mouth - vertical
60-80 degrees from dorsal plane
Rostrodorsal-caudoventral oblique

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9
Q

How to radiograph mandibular incisors

A

60-80 degrees
Rostroventral-caudodorsal
Centre beam on central incisors

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10
Q

How to radiograph canines and wolf teeth

A

Lateral projection 15-20º rostrocaudal or dorsoventral to prevent superimposition

Highlight reserve crown and roots of canines and wolf teeth (04s/05s)

Blind wolf teeth

Intraoral view (as for incisors) occasionally useful

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11
Q

How to radiograph maxillary arcade

A

Lateral view

Shows fluid lines (nose pointed at floor) and abnormalities in paranasal sinuses

Cannot evaluate individual teeth apices due to superimposition of teeth

Position horse with lesion to cassette

Use cassette holder, in vertical plane, parallel to head as close to possible to the horse

Beam directed horizontal to long axis of the head

Collimate to caudal aspect of interdental space, eye caudally and dorsal aspect of the skull

Maxillary teeth-center dorsal to rostral aspect of the facial crest to evaluate cheek teeth and paranasal sinuses

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12
Q

Sinus anatomy

A

Maxillary sinus divided into rostral and caudal compartments

Apices of maxillary 08+09’s in rostral maxillary sinus (RMS)

Apices of 10+11’s in caudal maxillary sinus(CMS) Conchofrontal sinus drains into CMS

Ventral conchal sinus communicates with RMS

Frontal sinus

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13
Q

Maxilla and sinuses radiography

A

DV view

Occasionally used

Deviation of medial septum

Soft tissue masses or sinusitis

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14
Q

Radiographing maxilla and paranasal sinuses

A

Latero 30 degree dorsal-lateroventral oblique view

Latero 10-30 degree ventral-laterodorsal

LEARN THESE TWO WELL

Lateral

Latero 10-45 degree ventral-laterodorsal oblique

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15
Q

Latero 30 degree dorsal-lateroventral oblique view for imaging maxilla and paranasal sinuses

A

Separates structures on the left and right size

Affected side next to the cassette

30 degree from dorsal plane, parallel to palate and centred 3-5cm dorsal to the rostral aspect of the facial crest

Include maxillary cheek teeth row and paranasal sinuses

Avoid rostro-caudal angulation

Higher exposure for cheek teeth apices compared to sinus

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16
Q

Latero 10-30 degree ventral-laterodorsal open mouthed oblique view for imaging maxilla and paranasal sinuses

A

Use hollow PVC tubing

Lesion/area of interest next to the plate

Beam directed in opposite direction to closed mouth oblique views

Latero15 degree-ventral-laterodorsal for maxillary

Centre beam on rostral aspect of facial crest

Erupted crowns of cheek teeth and occlusal aspect of alveolus (alveolar crest)

Also useful for imaging Tridan 05’s or wolf teeth

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17
Q

Lateral view of maxilla and paranasal sinuses

A

not usually indicated, but centre over area of interest

Collimate rostrocaudally to include centre cheek teeth row

Higher exposures needed to image apices of three most caudal teeth due to masseter and pterygoideus muscles

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18
Q

Latero 10-45 degree ventral-laterodorsal oblique view for imaging

A

Cassette next to lesion

Centre on rostral aspect of facial crest and include all erupted crowns in the arcade

As for maxillary open-mouthed oblique, reverse direction of closed-mouth oblique

Used to image mandibular erupted crowns

Diastemata, clinical crown fractures and abnormalities of wear can be assessed

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19
Q

Structure of teeth

A

Enamel, cementum and dentine.

All three visible on the occlusal surface.

Enamel arranged in folds in teeth to increase the surface area for chewing.

Maxillary cheek teeth- two additional concentric cup like infoldings of enamel - infundibular enamel folds- involved infundibular caries.

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20
Q

Infundibula

A

Infolding of occlusal surface to increase surface area available for mastication.

Incisors have one infundibulum.

Each maxillary tooth (aside from wolf tooth 05) has 2 infundibulae.

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21
Q

Pulp cavities

A

Pulp is innermost layer of the tooth.

Contains nerves, blood supply, lymphatics and odontoblasts.

Number of pulp horns varies according to tooth.

Care when rasping teeth, over-rasping can cause thermal necrosis of pulp

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22
Q

Periodontum

A

Dynamic structure

4 components
- Gingiva,
- Peripheral cementum,
- Periodontal ligament
- alveolar bone

Protects and supports tooth

Secures tooth in alvelous

Copes with chewing

Goes all round the root of the tooth not just the very bottom

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23
Q

Peripheral cementum

A

Unique to hypsodont periodontum

Produced continuously by cementoblasts

Deposited at apex and periphery of reserve crown

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24
Q

Gingiva

A

Covers the alveolar bone, periodontal ligament and reserve crown

Acts as a barrier to prevent bacteria entering the periodontal tissues.

Composed of keratinised epithelium

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25
Q

Periodontal ligament

A

Purpose is to relay vasculature to tooth

Supports tooth and keeps it stable during chewing

26
Q

Diastemata

A

Pathological space between teeth

‘open’ or ‘valve’

Older horses usually

Easily missed

Food packing and rotting food will cause periodontal disease which is incredibly painful

Up to 50% in general population.

Good prognosis if treated early - if it gets to about 3mm it is going to be much harder to treat

May progress to tooth loss

Excessive transverse ridge (ETR) in teeth opposing diastema causes or worsens condition

27
Q

Clinical signs of diastemata

A

Quidding
Dysphagia
Anorexia
Or none!

28
Q

Diastema drilling

A

Creates open space to reduce valve effect

Periodontitis

Care to avoid pulp chambers

Try conservative management first

29
Q

Management of diastema

A

2-3 times annual rasping

Replace long fibre food e.g. hay with grass, or short chopped foods e.g. grass or alfalfa

Monitor carefully for progression

30
Q

Periodontal disease

A

Painful

Very common (>75%) esp > 10 yrs

Small animals-periodontitis due to bacteria in plaque

Equine- due to entrapment of feed between teeth>bacterial infection of PD tissue> inflammation and pain

Early recognition key to treatment

Check for underlying cause eg displacement, dental overgrowth of opposing tooth

Severe cases will lead to disruption of periodontum-periodontal ligaments and can lead to periapical infection and tooth loss

31
Q

Treatment of periodontal disease

A

Check for underlying cause eg displacement, dental overgrowth of opposing tooth

Severe cases will lead to disruption of periodontum-periodontal ligaments and can lead to periapical infection and tooth loss

Mild cases can be managed with routine dental floating

Remove any ETR

Balance the mouth

Can use antiseptic flushes

Recheck case in 3 months to reassess

Severe cases may need analgesia and nerve block to evaluate

If pocketing very deep-extraction may be warranted
If PAI, extraction only option

32
Q

Dental caries

A

Two types of caries-

Infundibular caries- occlusal surface of maxillary cheek teeth or peripheral-any of the dental calcified tissue ie cementum, enamel and dentine.

Infundibular caries vary in significance, but deep pockets may predispose to fractures.

More prevalent in older animals.

Peripheral caries more common in more caudal cheek teeth (? Less buffering effect of saliva).

? Link between diastemata and peripheral caries

33
Q

Pulpar exposure in dental caries

A

Cheek teeth have between 5 and 9 pulp chambers depending on tooth.

Often no obvious clinical signs of disease.

Flush mouth well and use mirror and probe to examine.

Early cases may benefit from filling.

In advanced cases, radiographs or CT warranted to investigate.

Occlusal pulpar exposure-black area around pulp horn

Fissure in occlusal 2 dentine

Can get probe into pulp horn

Tooth likely dead

Can wall off damaged pulp with 3 dentine

34
Q

Infundibular caries

A

Caries affect the cementum of the maxillary infundibula.

Caries usually marked on chart as IC.

Can use IC followed by the grade of caries as described by BEVA.

A probe can be very useful to assess the depth.

Grading system 0 degree to 4th degree

35
Q

Peripheral cemental caries

A

Can affect any tooth

Grading system described can be used on chart.

Erosion of edges of teeth

Rough surface that food adheres to

Discoloured teeth

Often improve with regular dental care

Food stasis in mouth is implicated

Can lead to fractures

36
Q

Tooth fractures

A

Can be idiopathic

Rarely iatrogenic

Traumatic fractures rare-usually limited to incisors following kick or injury (often haynet).

Cheek teeth fractures usually secondary to pulpar disease or caries.

May be incidental finding on examination.

Fractures usually lead to pulpar exposure, but not all fractures will lead to periapical infection…some cases will wall off infection before abscessation occurs.

Pulp exposed in fractures, does not always lead to infection-can wall off

Fragment can be removed if pulp walled off

Will grow out given time

CT ideal to evaluate

37
Q

Clinical signs of tooth fracture

A

Quidding
Halitosis
Sinusitis
Facial swelling
Can be asymptomatic

38
Q

Sites of fractures

A

Lingual slab fractures not often associated with PI

Maxillary teeth most commonly suffer midline sagittal fracture-through infundibulae-often associated with PI

Mandibular teeth- Buccal sagittal fractures most common

39
Q

Apical/periapical infections (tooth root infections

A

Infections of cheek teeth

Can involve mandibular, max bones or paranasal sinus

Draining tract or swelling in mandible

Extension of periodontal dz (diastema etc)

Pulpar exposure

Anachoresis→blood/ lymph bourne to devitalised pulp

Can occur with # tooth

Caries- rare

40
Q

Clinical signs of apical/periapical infections

A

Nasal discharge (malodorous)
Dysphagia
Anorexia

41
Q

Diagnosis of apical/periapical infections

A

Radiography
□ Limitations
- Low sensitivity so it is possible to miss early infections
- Warn owner may need repeat x-ray
- ?refer for CT…cheaper than 2 sets of radiographs?
□ What do you see?
- Periapical sclerosis
- Periapical halo formation
- Clubbing of root apices
- Widening of periodontal space and loss of lamina dura indicative, but less reliable
- Low false negatives

CT, almost 100% sensitive

Scintigraphy (56% sensitivity) rarely used for this anymore

42
Q

Treatment of apical/periapical infections

A

Radiography/CT to assess

Long term (4-6 wks) abs –not often curative

Tooth removal most often indicated

Endodontics?

Curettage of root?

43
Q

Missing teeth

A

Common

Teeth need opposing surface to grind against

Grow approx. 4mm/yr, more in unopposed

Tooth will grow into space

Causes reduced range of motion of jaw

Dental drift occurs post tooth loss

Usually minimal and uncomplicated

In severe cases can lead to diastema or further tooth loss

Regular rasping needed.

If corresponding overgrowths large, need staged reduction.

In cases with severe dental drift, further extraction may be needed.

44
Q

EOTRH

A

Equine Odontoclastic Tooth Resorption and Hypercementosis

45
Q

Equine Odontoclastic Tooth Resorption and Hypercementosis

A

Older horses

Incisors/canines-not cheek teeth

? Immune mediated

Painful-will not eat carrot with incisors

Rapidly progressive

Odontoclasts absorb tooth and body responds by laying down tissue

Diagnosed based on clinical signs and radiography

Treatment is extraction of affected teeth - can be extraction of all incisors so can be a difficult sell to owners but they often do much better after this

46
Q

Oral extraction of cheek teeth

A

Oral extraction has lower complication rate than surgical techniques

Usually performed under standing sedation

Nerve blocks

Domosedan drip

Preparation
○ Excellent sedation vital
○ Detomidine drip
○ Analgesia (NSAIDs Paracetamol)
○ ?Antibiotics, don’t need to usually unless it is immunocompromised or particularly nasty infection
○ Tetanus antitoxin

47
Q

Nerve blocks

A

Ipsilateral infraorbital nerve block for maxillary 06/07 and incisors

Maxillary nerve block for maxillary arcade

Mandibular nerve block for mandibular cheek teeth

Mental nerve block for lower incisors

48
Q

Ipsilateral infraorbital nerve block

A

For maxillary 06/07 and incisors

Analgesia of the nostrils and lip

Infraorbital foramen

If anaesthetised up into infraorbital canal, can get desenstisation of 101-107 and 201-207

Locate infraorbital foramen

Push levator nasolabialis m. dorsally

21G needle

4-5ml local

49
Q

Maxillary nerve block

A

For maxillary arcade

Entire upper arcade de-sensitized, including incisors.

22G spinal needle

10-15ml mepivicaine

Skin bleb may be useful

Insert needle just below zygomatic bone at level of posterior third of eye

Insert needle at 90 degree angle to skin

Advance needle into periorbital fat pad

Withdraw needle slightly before infiltrating local

If needle hits ramus of mandible, re-direct

Can cause exophthalmos (temporary) if blood vessel traumatised

50
Q

Mandibular nerve block

A

For mandibular cheek teeth

Desensitises all mandibular arcade

Used for extraction or severe PD disease

Mandibular nerve enters mandibular canal on the dorso-medial aspect of the horizontal ramus of the mandible

Mandibular foramen-at intersection of vertical line at the caudal limit of the orbit with a line parallel to the occlusal surface of the rostral 4 CT

15cm 18G spinal needle

Walk up medial aspect of the mandible

20-30ml mepivicaine deposited at and 1-3cm dorsocaudally

Don’t do both at the same time as they could chew their tongue off

51
Q

Mental nerve block

A

For lower incisors

Blocks lower lip and mandible up to 306 and 406

Sometimes called mandibulo-alveolar nerve

Site: mental foramen

22 G 1 ½ inch for lower lip

5-10ml local

If caudal anaesthesia required, use 3 inch needle inserted into canal

52
Q

Dental pick

A

Dental pick used to expose crown on side of tooth.

Local infiltration of lidocaine useful

Expose as much crown as possible- tooth like an iceberg, can be quite brutal with the gum

Oral endoscopy may facilitate

To minimise the risk of the tooth breaking, get the forceps as far down as possible

53
Q

Molar separators

A

Narrow blade CT separator inserted into interdental space rostral and caudal to tooth

Kept in place for circa 5 mins to excessively stretch and damage the periodontal ligaments

Can use series of wider separators

Do not use between 06/07 when extracting 07 as will loosen 06

54
Q

Extractors

A

Appropriate CT extractor then applied

Extractor forceps kept tightly shut using bungee cord

Verify correct position visually Extractors then moved gently sideways in a horizontal plane

Care must be taken to avoid fracturing the crown

Ensure the extractor forceps are in place tightly at all times as if loose will only excoriate the crown increasing risk of fracture

Success is close once a “squelching” sound is heard and foamy blood is visible

Greater movement can then be applied

Fulcrum used to aid extraction once tooth digitally loose or can be removed by hand

55
Q

Retained fragments

A

If fragments of tooth remain, horse may still show clinical signs

May be clinically silent but will not heal

? Significance

Should always be removed if possible

56
Q

Post oral extraction

A

Check for root fragments or alveolar bone

Alveolus plugged with honey soaked swabs - 24 hrs →avoids food impacting alveolus before granulation tissue has formed

Pack with dental acrylic

If <5cm deep (old horses) then no need to pack

Should have smooth outline- rough areas usually due to sequestra- removed digitally or curretted

57
Q

Post dental op care

A

When first pack removed, check alveolus

Rough areas curetted and lavaged

Smaller sequestra may be removed by granulation tissue

Larger sequestra removed with forceps

If granulation tissue not forming in first few days suspect problem

58
Q

Sinus lavage

A

In cases with sinusitus, the ipsilateral sinus often be trephined and irrigated daily for 5-7 days

Sinoscopy helpful, particularly in refractory cases

Frontal sinus trephined and flushed in all extractions involving a sinus

In cases where RMS involved, this must be flushed separately
BID 5-7 days

59
Q

Wolf teeth

A

Vestigial premolar

Brachyodont teeth- no deciduous precursor

Erupt at 6-18 months old

Mandibular wolf teeth-rare (standardbreds)

Blind wolf teeth occasionally- 1-2cm rostral to 06, under the mucosa, →poor performance.

Radiography used to evaluate blind or displaced teeth- need extraction

Erupted and non-displaced classed as Cat 2. Can be removed by EDT under direct and continuous VS supervision

Blind/unerupted/displaced classed as Cat 3 - incision into vital tissue. VS only.

Local anaesthetic into palatine ridge

NSAIDs and TAT/toxoid

Elevation of gingiva and breakdown of the periodontal ligaments

Avoid Palatine Artery!
If palatine artery lacerated, insert towel or cotton wool roll in horse’s mouth, shut mouth, keep head (not nose) elevated (head up so pressure reduced but nose pointing down so that the blood runs out and doesn’t drown them.

60
Q

Methods of extractions

A

Oral extraction

Invasive transbuccal screw technique

Repulsion under GA

Endodontic techniques

61
Q

Oral extraction

A

Oral extraction has lowest complication rate

Method of choice where possible

Always have back up plan

Be aware of complications

62
Q

When is oral extraction less successful

A

Clinical crown cannot be grasped

Reserve crown fracture

If the apex is bigger than alveolus eg dental tumour/reactive hyperplasia of cementum

Equine michaelmas 23 (17 decks)

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