L25: Clinical Approach To Oral Disease (Stone)

Question 1

Canine permanent dental formula**

Answer 1

I 3/3 C 1/1 P 4/4 M 2/3 = 42

Question 2

Feline deciduous dental formula**

Answer 2

I 3/3 C 1/1 P 3/2 = 26

Question 3

Feline permanent dental formula**

Answer 3

I 3/3 C 1/1 P 3/2 M 1/1 = 30

Question 4

Periodontum

Answer 4

Tissues that hold the tooth in the mouth (alveolar bone, periodontal ligament, gingiva)

Question 5

No 2 teeth should occupy the same space!**

Answer 5

:)

Question 6

All dogs and cats should have adult teeth by what age?

Answer 6

6-7 months

Question 7

Components of normal occlusion**

Answer 7

1) maxillary incisors fit in front of mandibular incisors
2) mandibular canine fit between maxillary 3rd incisor and canine
3) space between premolars should be zig-zag shape (scissors bite)
4) upper 4th premolar fits lateral to lower 1st molar

Question 8

Caries are most common on what teeth?**

Answer 8

Maxillary molars

Question 9

Abrasion vs. attrition**

Answer 9

Abrasion = wear from external source
Attrition = wear from occluding tooth source

Question 10

Approach for discolored teeth**

Answer 10

1) Rads
2) Extract if disease visible on rads
3) rads again in 6 mo- 1 yr if no dz visible

Question 11

When do deciduous premolars erupt in dogs?

Answer 11

4-12 wks

Question 12

3 primary patterns of canine tooth resorption**

Answer 12

1) internal resorption - starts in root canal, tooth may turn pink
2) idiopathic bony replacement (external) resorption - starts apically, common in premolars
3) osteoclastic resorption - like cats, uncommon

-trauma, orthodontic tx, malocclusion can incite

Question 13

When must action be taken against tooth resorption?***

Answer 13

When it enters the oral cavity (above the gum line)

• this is when it becomes painful
• must be extracted

Question 14

2 types of tooth resorption. In which can a crown amputation be performed?**

Answer 14

Type 1: crown affected but periodontal ligament intact

Type 2: crown and periodontal ligament affected (crown amputation possible**)

Question 15

Chars. Of tooth resorption in CATS**

Answer 15

• odontoclasts resorb cementum
• mandibular 3rd premolar first involved in 80% of cases
• can cause ankylosis and tooth destruction as alveolar bone fuses to cementum, periodontal ligament lost
• crown amputation possible if there is ankylosis and NO stomatitis

Question 16

Grades of periodontal disease***

Answer 16

0 (Normal): clinically normal, no gingivitis

Stage 1: gingivitis without attachment loss, normal alveolar bone (ONLY REVERSIBLE STAGE***)

Stage 2: early periodontitis, 50% attachment loss, or in multirooted teeth a stage 3 furcation involvement; tooth should come out***

Question 17

Steps of a dental prophylaxis

Answer 17

**only called a prophy if done in a mouth free of disease

1) complete oral exam
2) supra gingival scaling
3) sub gingival scaling or curettage
4) polish (with fluoride)
5) flush
6) repeat oral exam

Question 18

Indications for use of antibiotics in periodontal disease***

Answer 18

Oral ulceration
Severe periodontitis +/- osteomyelitis
Systemic dz (renal, cardiac, diabetes, Cushing’s)
Additional sx being performed
Bone implants
Pulp capping, vital pulp therapy or root canal (5-7 days)

Question 19

Oral medicine case process**

Answer 19

Hx
Conscious oral exam
Full PE and anesthetic work up
Exam under anesthesia
Tx
Follow up
Home care

Question 20

Causes of enamel hypoplasia/hypocalcification

Answer 20

Hereditary
Systemic infection causing high fever
Viral infection during tooth formation
Enamel organ damage during early extraction of deciduous tooth
Other trauma during formation

*rapidly accumulates plaque and calculus

Question 21

2 types of enamel staining

Answer 21

1) intrinsic (ie. Abx use)

2) extrinsic (ie. Metal from objects)

Question 22

92% of discolored teeth are non-vital or dying

Answer 22

:)

Question 23

Periodontal disease/stomatitis can cause what bloodwork abnormalities?**

Answer 23

ALT, AST, ALP 1.5-2x normal
Globulins and TP mild to severely elevated
BUN mildly elevated

Question 24

Therapy process for stomatitis in cats**

Answer 24

• thorough prophy
• abx, analgesics, and anti-inflammatories
• extractions (distal to canine first, or full mouth)
• home care
• continue w/ anti-inflammatories and/or adjunctive laser tx for proliferative tissues
• stem cell therapy is coming about
• always potential for tx failure and possible euthanasia

Question 25

Sentinel tooth for tooth resorption in the cat**

Answer 25

Mandibular 3rd premolar (80% of the time it's this one affected!)

Question 26

Most common tooth to get fractured

Answer 26

4th premolar

Question 27

Canine deciduous dental formula**

Answer 27

I 3/3 C 1/1 P 3/3 = 28

Question 28

Classes of malocclusion

Answer 28

0: normal 1: jaw normal, but at least one tooth out of position 2: mandible shorter than maxilla - brachygnathic (overbite) 3: maxilla shorter than mandible - prognathic (under bite)

Question 29

Which classes of malocclusion are more likely to be genetic/hereditary?***

Answer 29

Class 2 and 3 occlusions

Question 30

Even bite

Answer 30

Malocclusion occurs in such a way that there is constant attrition of teeth

Question 31

Tx for tight lip

Answer 31

(Frenulum is too far over so teeth ram into it --> oral trauma and malocclusions) -requires early aggressive sx correction

Question 32

Pedodontic (pediatric) abnormalities

Answer 32

``` Missing teeth Supernumerary teeth Malocclusion Palatal and lip defects Odontoma Hairy tongue Papillomatosis Juvenile gingivitis (feline) Enamel problems Lack of teeth Germination (fusion of two teeth) Retained or persistent deciduous teeth Fractured deciduous teeth ```

Question 33

Adontia

Answer 33

Missing all teeth

Question 34

Oligodontia

Answer 34

Missing one or more teeth (never developed, never erupted, or due to trauma)

Question 35

Dentigerous cyst

Answer 35

Fluid-filled cyst surrounding the crown of an unerupted tooth leading to pressure atrophy of the surrounding bone

Question 36

Odontoma

Answer 36

Odontogenic tumor that contains both epithelial and mesenchymal cells

Question 37

2 types of odontomas**

Answer 37

Compound: tooth-like structure present Complex: conglomerate of dental tissue

Question 38

Oral papillomatosis

Answer 38

- self-limiting viral dz of young dogs - affects tongue, lips, oral mucosa - causes salivation, dysphagia, hemorrhage - sx excision is necessary

Question 39

Cranial mandibular osteodystrophy

Answer 39

- inherited condition in Westies - non-cancerous bone formation at the TMJ and spreads to the mandible - CS: pain, fever, reluctance to eat or open jaw

Question 40

Diseases of the gingiva and buccal mucosa

Answer 40

"Cheek-Chewers" or "gum-chewers" syndrome (buccal granulomas) Gingival enlargement (ie. Boxers)

Question 41

Gingival trauma most common where?

Answer 41

Palatal side of 4th premolar

Question 42

Neoplastic tumors of gingiva

Answer 42

Malignant melanoma (dogs most common) SCC (cats most common) Fibrosarcoma Osteosarcoma

Question 43

Feline juvenile gingivitis

Answer 43

8-18 mo. Cats Purebreds most common Requires early and aggressive tx (plaque removal) Can be proliferative

Question 44

Endodontic vs. periodontal disease

Answer 44

Endodontic: dz of tooth itself Periodontal: dz of structures holding tooth in

Question 45

Effects of periodontal dz

Answer 45

``` ST loss Deep gingival pocket formation Tooth attachment loss Periodontal bone resorption Ultimately, tooth LOSS ```

Question 46

Indications of the use of abx to treat periodontal disease***

Answer 46

Oral ulceration Severe periodontitis including purulent discharge Additional surgery being performed Bone implants Pulp capping (pulpotomy) or vital pulp therapy

Question 47

Canine chronic ulcerative stomatitis (Trench Mouth) + CS

Answer 47

- an immune mediated rxn to bacteria - mostly a CANINE disease - CS: halitosis, oral pain, inappetence, anorexia, ptyalism

Question 48

Canine chronic ulcerative stomatitis (Trench Mouth) Ddx

Answer 48

- severe periodontal dz - bullous autoimmune skin disease - contact dermatitis - systemic lupus erythmatosus - discoid lupus erythmatosus - 2ary immune complex dz - drug eruptions - immunodeficiency dz

Question 49

Tx of Canine chronic ulcerative stomatitis (Trench Mouth)

Answer 49

``` Symptomatic (anti-inflammatory) Prophy Extractions PRN Broad spec abx Tube feeding PRN ```

Question 50

Tx for eosinophilic granuloma complex

Answer 50

Immunomodulators (ie. Cyclosporine, steroids) Requires life-long therapy

Question 51

Lesions assoc. with mycotic stomatitis

Answer 51

Obvious white, plaque-like lesions at the mucocutaneous jxs Caused by overgrowth of Candida albicans (assoc. with long-term abx therapy)

Question 52

Causes of feline viral respiratory dz that causes oral changes***

Answer 52

Feline rhinotracheitis Calicivirus*** (may have ulcers on tongue and hard palate FHV

Question 53

Oral lesions assoc. with blastomycosis

Answer 53

Granulomatous yellow-white, up to 1.5 cm lesions

Question 54

Oral CS and PE findings assoc. with hypoparathyroidism

Answer 54

``` Oral ulcers Necrosis* Halitosis Pryalism Swollen lips and tongue Osteoporosis 2ary infections ```

Question 55

Oral CS and PE findings assoc. with uremia (uremic stomatitis)

Answer 55

- ulceration at pressure points of tongue/oral cavity** - occasional hemorrhage - stomatitis - necrosis of tip of the tongue

Question 56

Differential for uremic stomatitis

Answer 56

Lepto

Question 57

Many IM disorders cause erythema and ulceration of the oral mucous membranes. They present similarly and must do a biopsy or test of immune function to differentiate

Answer 57

:)

Question 58

Pathologies of the salivary system and pharynx

Answer 58

Sialoceles Salivary gland tumors Sialoliths Tonsilitis

Question 59

Which animals get tonsilitis most commonly

Answer 59

Tonsilitis

Question 60

Causes of tonsilitis

Answer 60

``` Predisposing factors (ear or anal gland dz) Unknown ```

Question 61

Tx for tonsilitis

Answer 61

Symptomatic - tonsillectomy is NOT indicated and won't cure symptoms -most resolve on their own

Question 62

Cause of secondary tonsilitis

Answer 62

2ary to diseases causing chronic vomiting, coughing, or regurge -assoc. with ears and anal glands

Question 63

Tx for secondary tonsilitis

Answer 63

- symptomatic - remove underlying cause - tonsillectomy CAN be successful and curative

Question 64

Causes of severe feline stomatitis

Answer 64

``` Neoplasia Immune-mediated Toxic Infectious Periodontal dz Idiopathic (likely genetic) ```

Question 65

Only virus that has proven association with stomatitis in cats***

Answer 65

FCV | FeLV, FIV, FHV, FIP are suspected only but not associated

Question 66

Fauces

Answer 66

Lateral walls of the oropharynx medial to the palatoglossal folds

Question 67

Hx and CS assoc. with stomatitis

Answer 67

``` Difficulty eating and drinking Grinding teeth/tooth chattering Facial rubbing Halitosis Facial hair loss Encrusted lips Swollen eyes Cachexia ```

Question 68

Diagnostics for stomatitis***

Answer 68

``` Histopath is CRITICAL** CBC normal Chem: hypergammaglobulinemia FeLV/FIV test UA Oral rads (to differentiate other things) Culture NOT helpful! ```

Question 69

Therapy for stomatitis

Answer 69

``` Abx (Anaerobic spectrum) Analgesics Anti-inflammatories Extractions (all teeth with severe dz --> premolars and molars --> full mouth extractions) Home care Adjunctive therapy ``` *all root fragments must be removed (don't just do a crown amputation)

Question 70

Problems with the muscles, bones, and joints

Answer 70

``` Masticatory myositis Craniomandibular osteopathy Idiopathic trigeminal neuritis TMJ luxation TMJ dysplasia Fxs Osteomyelitis Hyperparathyroidism Tumors and cysts Tooth avulsion Tetanus and botulism ```