Dentistry

Question 1

List at least 3 clinical signs of oral pain

Answer 1

Pytalism; Dropping food; Jaw chattering; Bruxism; Head shaking; Face-rubbing; Sneezing; Inappetance; Excessive licking; Depression; Weight loss

Question 2

What is the most common “clinical sign” of oral/dental pain?

Answer 2

No clinical signs at all

Question 3

Four most common causes of oral pain in dogs and cats

Answer 3

Periodontal disease; Fractured teeth; Tooth resorption; Malocclusion

Question 4

What are the 4 layers of tissue that hold the teeth in their sockets, from most external to most internal?

Answer 4

Alveolar bone and gingiva –> periodontal ligament –> cementum

Question 5

What are the two steps required to properly assess periodontal disease?

Answer 5

Dental probing; Intraoral radiographs

Question 6

Periodontium

Answer 6

Supporting structures of the teeth

Question 7

Cementoenamel junction

Answer 7

Transition between cementum which lines the root and enamel which lines the crown –> site of gingival attachment in healthy mouths

Question 8

When probing for pockets, what are you actually probing for?

Answer 8

Probing from the free gingiva to where the gingiva attaches

Question 9

Normal, acceptable pocket size in dogs

Answer 9

0-3 mm

Question 10

Normal, acceptable pocket size in cats

Answer 10

0-1 mm

Question 11

How many places should your probe the teeth?

Answer 11

1-2 regions on each side of the tooth, depending on its size

Question 12

Is stippling around the tooth normal, or a sign of gingivitis?

Answer 12

Stippling is normal to some degree as it indicates the presence of blood vessels. With gingitivitis you’re looking for a more uniform redness

Question 13

Total attachment loss =

Answer 13

Distance of gingival recession from the margin (mm) + size of periodontal pocket (mm)

Question 14

How do you measure gingival recession?

Answer 14

Measure the distance from the cementoenamel junction to the gingiva (mm)

Question 15

In healthy mouths, the height of alveolar bone should go from what region/structure to what region/structure?

Answer 15

Should go from the root to the cementoenamel junction

Question 16

How do we measure bone loss?

Answer 16

Bone loss is measured as a percent of the normal total height of bone from the cementoenamel junction to the root

Question 17

How many stages of periodontal disease are there?

Answer 17

Four stages

Question 18

Stage 1 Periodontal disease

Answer 18

Gingivitis w/o attachement loss

Question 19

Treatment for Stage 1 Periodontal disease

Answer 19

Dental cleaning

Question 20

Stage 2 Periodontal disease

Answer 20

There is <25% attachment loss

Question 21

Treatment for Stage 2 Periodontal Disease

Answer 21

Dental cleaning and root planing

Question 22

What is root planing?

Answer 22

Cleaning out periodontal pockets associated with the tooth

Question 23

Stage 3 Periodontal Disease

Answer 23

25-50% attachment loss +/- presence of furcation

Question 24

Treatment for Stage 3 Periodontal Disease

Answer 24

Dental cleaning and root planing OR Extraction; Or referral for gingival tissue regeneration

Question 25

What are the strategic teeth in dogs and cats?

Answer 25

Canines and carnassials

Question 26

Normal dental formula for a dog

Answer 26

I(3/3); C(1/1); P(4/4); M(2/3)

Question 27

Total number of teeth in the average dog

Answer 27

42

Question 28

Normal dental formula for a cat

Answer 28

I(3/3); C(1/1); P(3/2); M(1/1)

Question 29

Total number of teeth in the average cat

Answer 29

30

Question 30

Stage 4 Periodontal disease

Answer 30

>50% attachement loss

Question 31

Treatment for Stage 4 Periodontal disease

Answer 31

Extraction

Question 32

You do an xray of the incisors and note that in addition to ~40% bone loss, one of the teeth has a significantly wider pulp cavity than the others. What does this mean?

Answer 32

Wide pulp cavity --> tooth is likely dead

Question 33

Pathognomonic sign for tooth resorption

Answer 33

Gingiva growing over the tooth

Question 34

What species is commonly affected by tooth resorption?

Answer 34

Cats

Question 35

An owner comes to you and tells you that her cat seems to be having trouble eating her food as of late. Her cat will start to eat and then jump back, almost as if she was startled, and may return to eating. The owner has also noticed that her cat is barely eating her wet food nowadays, but will still finish her dry food. What should be your primary differential based on this history?

Answer 35

Tooth resorption

Question 36

Why do some cats with tooth resorption prefer hard kibble over wet food?

Answer 36

They can yeet the hard kibble into their esophaguses

Question 37

With cases of suspected tooth resorption, how should you perform your oral exam?

Answer 37

Use a dental explorer to examine the lesion as it tends to develop at the neck of the tooth

Question 38

What diagnostic is required to classify tooth resorption?

Answer 38

Intraoral radiographs

Question 39

How do we characterize and classify tooth resorption?

Answer 39

We stage it, according to how deeply the lesion penetrates the tooth, and type it, based on whether the root is intact or actively being resorbed

Question 40

Stage 1 Tooth Resorption

Answer 40

Loss of cementum or cementum and enamel, typically at the cemento-enamel junction

Question 41

Stage 2 Tooth resorption

Answer 41

Penetration of dentin, and possible formation of a furcation

Question 42

Stage 3 Tooth Resorption

Answer 42

Involvement of the pulp cavity

Question 43

Stage 4 Tooth Resorption

Answer 43

Extrensive loss of tooth structure

Question 44

Stage 5 Tooth Resorption

Answer 44

Complete loss of the crown

Question 45

What is the proposed pathophysiological mechanism of tooth resorption?

Answer 45

Odontoblasts get exposed to alveolar bone and start degrading both alveolar bone and tooth; Odontoblasts are unable to properly remodel teeth or bone, unlike osteoblasts and osteoclasts

Question 46

Type 1 Tooth Resorption

Answer 46

Roots are intact

Question 47

Type 2 Tooth Resorption

Answer 47

Roots are actively resorbing

Question 48

Type 3 Tooth Resorption

Answer 48

(In two-rooted tooth), one root is resorbed while the other is intact

Question 49

Extraction is a viable treatment option for which stages of tooth resorption?

Answer 49

Stages 2 to 4 (assuming Type 1)

Question 50

Treatment for Type 1 Tooth Resorption

Answer 50

Surgical extraction

Question 51

Treatment for Type 2 Tooth Resorption

Answer 51

Crown amputation

Question 52

Treatment for Type 3 Tooth resorption

Answer 52

Combination of surgical extraction and crown amputation

Question 53

Before performing a crown amputation, what 4 criteria should be met?

Answer 53

Presence of root resorption on radiograph; No oropharyngeal inflammation (stomatitis); No endodontic disease; No advanced periodontal disease

Question 54

What should a proper dental radiograp include?

Answer 54

Crown; Root; and surrounding supportive structures

Question 55

List 4 benefits of intraoral radiographs

Answer 55

Allows for visualization of the entire tooth; facilitates diagnosis and treatment plan; monitors treatment progression; allows us to better educate clients

Question 56

Ideally, full mouth radiographs should be done fro every patient. However, if you can't do full mouth rads, always obtain rads for:

Answer 56

Teeth with abnormal findings on probing; Areas where teeth are missing (e.g. retained roots? impacted teeth?); If resorption is seen, do the entire mouth!!!

Question 57

Dentigerous cyst

Answer 57

Cyst which forms in areas where gingiva has grown over a retained root; This leads to erosion of surrounding bone and pain

Question 58

What are the two types of sensors we can use for dental radiographs, and the benefits and drawbacks of each?

Answer 58

Digital sensor (benefit: quick to process; con: only comes in one size); Digital phosphor plates (benefit: comes in various sizes

Question 59

What groups of teeth can we use parallel technique on?

Answer 59

Mandibular premolars and molars

Question 60

What does the parallel imaging technique consist of?

Answer 60

You place the plate or sensor parallel to the roots of the teeth, and place the xray cylinder along the parallel axis

Question 61

What groups of teeth can we use the bisecting angle technique for?

Answer 61

Canines; Incisors; Maxillary premolars and molars (areas where plate cannot be placed parallel)

Question 62

Describe how to properly set up a dental radiograph using the bisecting angle technique

Answer 62

Basically, you place the plate off-parallel to the tooth root. This forms an angle between the tooth root and the plate. You then imagine a line that bisects the angle that the root and plate make. You adjust your xray cylinder so it lies parallel to that bisecting line.

Question 63

For the 4th maxillary premolar, you have three roots, the distal root, the mesial palatal root, and the mesial buccal root. If you were to do a bisecting angle, you would have superimposition of the mesial roots. Therefore, what radiographic technique can we use to separate out those mesial roots?

Answer 63

Beam shift technique

Question 64

SLOB

Answer 64

Describes the underlying principle of how the beam shift technique works. Basically, the roots closest to the plate (lingual or palatal aspect), the mesial roots, will shift in the same direction as the xray; whereas, the distal root, which is closest to the buccal side, will move opposite of the xray

Question 65

Describe how you would obtain a proper beam shift for the maxillary 4th premolar?

Answer 65

You determine the bisecting angle, and then move the machine (not by the head) slightly posterior (posterior oblique shift) or anterior (anterior oblique shift) to separate out the roots

Question 66

Which root will be most anterior with the anterior oblique shift?

Answer 66

Lingual mesial root will be most anterior

Question 67

Which root will be most posterior with the posterior oblique shift?

Answer 67

Lingual mesial root will be most posterior