Oral medicine Flashcards

Question

Trigeminal Neuropathy

Answer 1

Other names: mandibular neuropraxia Occurrence: dogs Cause: idiopathic, based on resolution of clinical signs and lack of long-term neuropathy Features: open mouth that can be closed passively with little effort Treatment: Recovery in idiopathic cases usually occurs in two to four weeks with rest and conservative support **Use of corticosteroids had no effect on the clinical course of the disease**

Answer 2

Occurrence: common site in the mandible Cause: Usually bacterial infection, but fungi can also be responsible Bone infections can result from three possible routes of inoculation – hematogenous, implantation, or local extension. Infectious agents include: Staphylococcus spp., Streptococcus sp., Fusobacterium necrophorum, Truperella pyogenes, Nocardia spp., and several different fungal agents including Coccidioides immitis (cats, and dogs), Cryptococcus neoformans (cats), Aspergillus spp., Candida spp. and occasionally Pythium insidiosum. The most common form of bacterial inoculation is via local extension from an infection of the tooth or periodontal tissues. Clinical presentation: large and firm swelling, often painful on palpation Radiographically there may be a zone of bony destruction surrounded by a region of increased density or sclerosis. sequestration may be present proliferative reaction of the periosteum at the periphery of the lesion with lysis of the associated cortical and alveolar bone. Endosteal or periosteal scalloping of the cortex, or a moth-eaten pattern of bone destruction is often evident.

Answer 3

Attachment loss exposes the periodontal apparatus to the plaque-associated microflora, resulting in bacterial periodontitis. The presence of microorganisms stimulates osteoblasts and inflammatory cells to produce inflammatory cytokines like TNF alpha, IL1, and IL6. These mediators stimulate osteoclasts, resulting in bone and tooth root resorption.

Answer 4

Definitions: exposed necrotic bone in the maxillofacial region that fails to heal after 6 to 8 weeks (up to 44 days before noticing) Subtypes: Radiation induced: Predisposed to breakdown and delayed healing. Risk of dehiscence and progressive extension of the osteonecrosis. Difficult to differentiate from recurrent malignant disease. Risk of recurrence is higher. Prognosis is fair to guarded. Traumatic: treat by localization and surgical removal of the bone sequestrum. Prognosis is excellent. Non-traumatic (infectious): removal of the bone sequestrum, appropriate bone debridement and long-term appropriate medical therapy. Idiopathic: A disproportionate number of cocker spaniels have been reported. May recur at the same location or other sites. Prognosis is fair to good.

Answer 5

1. Nutritional secondary hyperparathyroidism can occur as a result of diets with a low calcium-to-phosphorous ratio, such as all meat. This leads to a transient hypocalcemia, which stimulates the secretion of parathyroid hormone. 2. In renal secondary hyperparathyroidism, the reabsorption of phosphate is impaired, which results in hyperphosphatemia. This in turn leads to a lower blood calcium concentration, which stimulates parathyroid gland activity. Concurrent with secondary hyperparathyroidism, the synthesis of 1,25-dihydroxyvitamin D in the kidney is also decreased. This leads to a decrease in intestinal calcium absorption and impaired mineralization of osteoid. The combined effect of renal secondary hyperparathyroidism and the decreased 1,25-dihydroxyvitamin D is often referred to as renal osteodystrophy.

Answer 6

Features: The first radiographic sign is loss of the lamina dura, followed by loss of density of mandibular trabecular and cortical bone. Teeth may appear almost unsupported by bone. most likely to become clinically evident in growing dogs but rarely in cats. The first bone affected is the mandible, followed by the maxilla, then the other bones of the skull, and finally the long bones. the bones of the jaws may become swollen and malleable. Histo: Histologically, bone resorption and replacement with fibrous tissue is seen, which is often referred to as osteitis fibrosa cystica. In addition, osteomalacia, or poorly mineralized osteoid, may be seen.

Answer 7

1. The root, attached to the basihyoid bones by the extrinsic muscles 2. The body, the middle portion, attached to the floor of the mouth by the lingual frenulum 3. The apex, which is the rostral, unattached, and mobile portion of the tongue.

Answer 8

Electrocution: Non-cardiogenic pulmonary edema also possible, must be addressed first. Then, wait till necrosis is over to debride (days to weeks) + same supportive tx as above. Chewing lesions: sx, may recur Glossitis 2ndry to plant FB (e.g. burdock plant): Prevention, otherwise anti-inflammatory and pain control, removal of burs if able to visualize Ranula: Sialoadenectomy, can attempt marsupialization first Linear FB: Trim + GI sx Canine eosinophilic granuloma: a rare idiopathic condition that causes plaques or proliferative masses on the lateral or ventral aspects of the tongue. alcinosis circumscripta: idiopathic deposition of calcium salts into soft tissues. Most commonly found in young, large-breed dogs. Slightly raised, nodular, white-to-grey areas on the lingual and/or buccal tissues. TX: excision Papilloma virus Calicivirus Neoplasia -- Melanoma>SSC

Answer 9

Occurrence: rare, middle-aged dogs, severe. Features: Affect keratinized oral epithelium (hard palate, gingiva, dorsal tongue). The majority of cases have oral involvement (up to 90% of patients, frequently at the mucocutaneous junctions, with some mucous membrane ulceration). Oral lesions occur before skin lesions in about 50 % of cases. Fragile vesicles. Patchy areas of ulceration, crusting and inflammation quickly follow when vesicles rupture and slough.

Answer 10

OF: Other names: cementifying fibroma Features: local asympotomatic swellings of the jaw generally with distinct margins. A predilection for the mandible appears to be present in dogs. FD: Other names: craniofacial FD Features: dysplastic rather than neoplastic process can be locally destructive, generally self-limiting. May present in the canine zygomatic bone.

Answer 11

Supernumerary teeth (twinning). Develop from continued proliferation of permanent or deciduous dental lamina to form a third tooth germ or from disturbances during tooth development More common in permanent teeth, maxilla>mandible. Usually incisors, PMs. Common in Greyhound, Boxer, Bulldog, Rottie, dolichocephalic breeds. More than 1/3 Greyhounds had T/SN, usually PM1 Boxer and Bulldogs: supernum incisors

Answer 12

Failure to develop

Answer 13

hypodontia: absence of 1-6 teeth

Answer 14

absence of >6 teeth

Answer 15

all teeth missing

Answer 16

More common in permanent dentition, however, if deciduous absent, permanent likely to be absent also. Cats: MxPM2 freq absent (incidence 3-28%) Dogs: assoc w Kerry Blue, Affenpinscher, hairless dogs, large dolico, small breed, mini poodle

Answer 17

crown as abnormal conical shape

Answer 18

Gemination (aka schizodontism) Single tooth germ attempted to divide into two separate teeth. Increased frequency in boxers No tmt required except if grooves extends subgingivally (gingivoplasty, sealant/resin) Fusion Clinical appearance similar to germination but one tooth is missing from dental arch Concrescence Union of two fully formed teeth by only their cementum (no involvement of dentin/enamel) From trauma/inflammation. Developmental (trauma/crowding) vs acquired (inflammation-induced HC)

Answer 19

Dysplasia = Congenital. Hypoplasia = Environmental

Answer 20

Often accompanies enamel hypoplasia/dysplasia Environmental etiology- seen in dogs with distemper and other unknown causes vitamin D deficiency, phosphorus deficiency Infectious, traumatic No tmt necessary if tooth not mobile, monitor for endodontic pathology

Answer 21

Sharp bend/curve along the root or crown of a formed tooth (20-90°). Root > crown

Answer 22

dogs MxPM2, MxPM3 cats MxPM3

Answer 23

Teeth change spots

Answer 24

2 normally shaped roots fused

Answer 25

Hereditary, deciduous and permanent dentitions are affected. Recessive in Border Collies. DSPP gene implicated in humans C/S: Characterized by a blue/brown discoloration and translucent/opalescent appearance Enamel can separate from dentin easily, exposing dentin → rapid attrition Rads: bulbous crowns, thin roots, possible/early obliteration of the root canals and pulp chambers. Histopath: short misshapen tubules course through an atypical granular dentin matrix Multiple types of this **See MACK PAPER**

Answer 26

Systemic hereditary disease of bone that can also affect dentin, COL1A1 mutation affecting type 1 collagen production Changes in dentition are clinically and radiographically similar to DI

Answer 27

Rare genetic defect of dentin formation, autosomal dominant inheritance in humans, should be monitored for PA/P. Fairly normal enamel and primary dentin development, with significantly abnormal development of secondary dentin (conglomeration of disorganized tubular dentin and atubular osteodentin that resembles cementum). Usually results in tooth discoloration that is described as opalescent or pearlescent, discolored light grey to brown

Answer 28

Shortened roots with pulp cavities completely obliterated by the abnormal secondary dentin, often resulting in periapical granulomas due to nonvitality.

Answer 29

Normal root length with widened coronal pulp cavity (underproduction of primary dentin) with amorphous globules of abnormal secondary dentin within the root. Teeth usually remain vital.

Answer 30

Tooth or teeth are abnormally shaped, rough surface with yellow to brown discoloration MX>MN Permanent teeth, C/I

Answer 31

Disrupted deposition of enamel matrix Results in normal density or mineralization but enamel is thinner than normal Can be focal or multifocal May see yellow-brown dentin underneath (if enamel still in tact), borders regular and smooth (where the enamel has chipped off) ex; distemper

Answer 32

Inadequate mineralization of enamel matrix Enamel difficult to distinguish from dentin on radiographs, same radiopacity Affects several or all teeth White yellow brown spots in enamel, enamel edges are initially sharp and irregular where the enamel has chipped off (later being smoothed by wear) Crowns soft and wear faster

Answer 33

Most common type of dog abnormality seen by the authors Clinical tooth defect areas of opaque white, yellow or brown discoloration of visibly abnormal enamel to grossly abnormal tooth morphology Often only one tooth affected Environmental factors are responsible (trauma to the dental germ in the 1st 8-10wks of life): Trauma #1 anecdotally

Answer 34

nvolvement of much of the dentition; in the author’s experience often present present as areas with circumferential involvement of the entire crown vs pits or lines Result of systemic diseases Pyrexia Canine Distemper Virus: Epitheliotropic nature of the virus causes direct infection and destruction of the ABs, in addition to pyrexia

Answer 35

Type of hereditary EH with genetic basis, results from a disturbance in ectodermal layers of developing teeth Affects teeth in a more uniform fashion than environmental EH Italian Greyhound - Hypoplastic type, autosomal recessive ENAM gene1 Samoyed - autosomal recessive SLC24A4 gene2 Standard Poodle - Hypocalcified type, mode of inheritance/gene not investigated3

Answer 36

Metabolic: Fluorosis Congenital: Congenital erythropoietic porphyria (deposition of byproducts of hemolysis), AI, dentinogensis imperfecta Drug-related: Pregnant mothers or young animals given tetracycline, severity based on dosage and duration of administration, does not cause weakness Pulpal necrosis and intrapulpal hemorrhage: Grayish black discoloration Nerve of tooth undergoes necrosis-->tissue disintegration byproducts are released -->byproducts penetrate dentinal tubules and cause discoloration of surrounding dentin Trauma to tooth-->intrapulpal hemorrahge-->release iron sulfides into tooth and discolor dentin

Answer 37

Developmental abnormality that results when the developing tooth crown surface invaginates into the developing tooth pulp before mineralization has occurred

Answer 38

Type I: invagination in the crown only, which does not extend beyond the cementoenamel junction Type II: invagination extends beyond the cementoenamel junction into the root canal and ends as a blind sac Type III: invagination extends through the root or lateral surface to form an additional opening or foramen but with no direct communication with the existing pulp canal

Answer 39

mall nodules of enamel <4mm located on the root surface of the tooth close to or at the cementoenamel junction, most commonly at the bi/trifurcation of molar (MNM1)

Answer 40

Molar malformation Usually bilaterally symmetrical defect in enamel leading to periapical infection, PA/P necessitating extraction in a majority of cases

Answer 41

MX canine and MXPM3

Answer 42

MPO: Non-neoplastic proliferative bone dz of young large-breed dogs (3-5 mo), during MnM1 eruption Sex/breed predilection: All dogs in this case series were large breed and male C/S: Non-painful firm swelling usually centered around M1. May be fluctuant orally. Usually unilateral (L>R). Dx: Rad: Double mandibular cortex Tx: Usually self-resolving in weeks t

Answer 43

CMO AKA Lion jaw, Westie Jaw, Scottie Jaw. Non-neoplastic, non-inflammatory proliferative bone disease, onset at 3-6mos old and continues until 12mos old (when growth ceases) Breed/Sex Predilection: West Highland white terriers, Scottish terriers, and Cairn terriers. Inheritance: Terrier breeds: Autosomal dominant, incomplete penetrance. Monogenic mutation in chromosome 5 Gene SLC37A2, a glucose phosphate transporter in osteoclasts. C/S: PAIN when opening mouth, systemic signs (fever, lymphadenopathy). Masticatory muscle atrophy. TMJ restriction in severe cases. Usually bilaterally symmetric though can be unilateral. Mandibles and tympanic bullae are most commonly affected. Tx (Wiggs and Verstraete): usually self-limiting;

Answer 44

Calvarial hyperostotic syndrome CHS: Non-neoplastic proliferative bone disease usually affecting bull mastiffs (+ pitbulls?). Onset at 5-10mos old and continues until growth ceases. No known causes or associations other than possibly familial predisposition. In this case report, only MALE bull mastiffs were affected C/S: PAIN when opening mouth or palpating head, fever, lymphadenopathy Dx: CT = cortical thickening of the calvarium and frontal sinus w irregular, bony proliferation over the frontal, temporal, and occipital bones, tending to be unilateral Tx: Self-resolving about 80% of the time, supportive NSAIDs if needed

Answer 45

Feline patellar fractures are rare and most commonly occur spontaneously/atraumatically at the mean age of 28 months, and are postulated to be caused from a primary bone disorder. They most commonly occur at the level of the mid to proximal third of the patella. 50% of cats fracture contralateral patella within 3 months of first fracture, and often sustain fractures of other bones. Persistent deciduous teeth, hypodontia, root resorption, root malformation and unerupted teeth. Swellings of the jaw (mimicking neoplasia), osteonecoris/myelitis surgical extraction of persistent deciduous and unerupted permanent teeth, and debridement of proliferative and necrotic bone appear to be necessary for an improved outcome Generalised increased bone density in some cases supports that the underlying bone disease in these cats is a form of osteopetrosis

Answer 46

abyssinian

Answer 47

Dogs with true congenital macroglossia: decreased function and ROM, increased susceptibility to lingual trauma Resection of traumatized tongue = good px Giant Schnauzers with congenital hypothyroid. All had dwarfism, some had macroglossia and delayed tooth eruption 7 dachshunds with nasopharyngeal dysgenesis (abnormally thickened palatopharyngeal muscles +/- hypertrophic geniohyoid and genioglossus muscles). Tmt - Surgical removal of excessive soft tissue, however POOR PX if macroglossia/dysphagia present

Answer 48

Bird tongue short narrow pointed upward curled recessive autosomal Miniature schnauzers, Basset Hound Inability to suckle, looks like fading puppy syndrome (poor px)

Answer 49

Very rare, only reported in Anatolian Shepherd dogs* (Kangal dog) Most cases no other abnormalities difficulty suckling, licking, swallowing, vocalizing; difficulty with thermoregulation; difficult prehension, Excessive drooling Treatment: frenuloplasty (excellent PX)

Answer 50

hair on media sulcus of tongue not treated unless causes glossitis can remove but will grow back

Answer 51

CPV-1, -2, -6, -7

Answer 52

Italian Greyhound - Hypoplastic type, autosomal recessive ENAM gene1 Samoyed - autosomal recessive SLC24A4 gene2 Standard Poodle - Hypocalcified type, mode of inheritance/gene not investigated3

Answer 53

poodle, akitas

Answer 54

Collagen 1 COL1A1 or COL1A2

Answer 55

dentin sialophosphoprotein (DSPP) gene ECM important in the mineralization of predentin into dentin.

Answer 56

inhibits bacteria

Answer 57

Impedes viral replication

Answer 58

removes proliferative tissue and stimulates fibrosis;

Answer 59

~70% demonstrate substantial improvement or resolution, ~20% of cats benefiting minimally or not at all No significant difference in response to treatment between PM/M vs. Full mouth extractions

Answer 60

~50% achieved clinical remission, remaining showed 40-77% improvement 45% clinically cured on long-term after >3m

Answer 61

42.8% clinical remission, 28.6% substantial improvement, 28.6% did not response Arzi 2020- 71% positive response on 6-24m o

Answer 62

patients receiving both 77% substantial improvement or clinical remission after 12wks

Answer 63

treatment group got 45% substantially improved or clinical remission (10%)

Answer 64

lower clinical efficacy with 28.6% achieved clinical remission, 28.6% achieved substantial improvement, and 42.8% were nonresponders

Answer 65

For all ages, cats with periodontitis and stomatitis had a significantly higher risk than orally healthy cats of being seropositive for FIV. In particular, stomatitis was associated with the highest risk of FIV seropositivity Inflammatory oral disease was associated with an increased risk of seropositivity for retroviruses in naturally infected cats.

Answer 66

15% (4/26) of the cases were positive for FIV, and 34.6% (9/26) were positive for FeLV FCG cases analyzed could not be correlated with FCV. It is possible that FeLV plays a role as a causal agent of lesions in cases where the presence of the virus has been confirmed by immunohistochemistry in epithelial samples.

Answer 67

1 - focal or multifocal radiolucency affecting the tooth with normal PDL 2- narrowing or disappearing of the PDL 3- combination of 1 and 2

Answer 68

Not always visible radiographically lesions along the latreal margins of the roo and the PDL/lamina dura are not affected Trauma- self limiting

Answer 69

RAD- gradual disappearance of PDL with progressive replacement of root tissues surround alveolar bone Leads to necrosis od PDL fibers

Answer 70

RAD- loss of dental tissue adjacent to areas of loss of alveolar bone secondary to inflammation (pero/endo diz) All endodontically compromised teeth are considered to have this

Answer 71

RAD- oval shaped enlargement located in the apical third of the root canal From trauma - self limiting

Answer 72

RAD - irregular enlargement with a tunnel like appearance adjacent to the root canal Located on the coronal fragment of root fractures or seen during luxation injury

Answer 73

RAD - oval shaped enlargement found in the cervical third of the root canal Inflammatory conditions

Oral medicine Flashcards

(106 cards)