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Dentistry
WK 17
| Question | Answer |
|---|---|
| Enamel | about 0.5mm thick & covers the entire crown is about the hardest substance in the body contains no blood vessels or nerves amplification is the process of the formation of enamel by ameloblast cells acellular & is unable to repair itself if damaged |
| if the smooth enamel surface is damaged, | it will retain plaque more easily |
| Dentine | is the hard dense body tissue & lies beneath enamel this makes up a large amount of the tooth it is sensitive to pain is able to repair itself & formed throughout an animals life |
| pulp cavity | the centre of the tooth & also known as the pulp chamber inside the root is referred to as the root canal contains nerves lymphatics & blood capillaries enters the root canal by fine canals known as the apical delta at the apex of the root |
| pulp cavity | when inflamed it will be painful overheating from either scaling or polishing can result in pulp necrosis |
| roots | there may be more than one root & the function angle is where they diverge 2 roots=Bifurcation 3 roots=Trifurication end of the root is known as the apex roots make up 60-70% of the tooth & generally one & a half time longer than the crown |
| periodontal ligament | made up of collagen fibres responsible for suspending the tooth in the sockets attaches the tooth to the alveolus allows movement of the tooth has both a good nerve and blood supply |
| cementum | softer than enamel and dentine covers the root surface & allows attachment of the periodontal ligament has no direct blood supply but can repair and be remodelled from vessels with the periodontal ligament |
| free gingiva | covers the alveolar bone and protects the nerve of each tooth |
| gingival sulcus | is the very shallow groove between the gingiva and tooth measured with periodontal probe small dog 1mmm depth is acceptable large dog 3mm depth is acceptable cats 1mm or less is normal |
| incisors | small with single root 6 maxilla and mandible used for grooming and shearing |
| canines | large with single root 2 maxilla & mandible used for tearing and grasping |
| premolars/molars | multiple roots premolars have shard edge and used for shearing molars large and used crushing |
| tooth clinical anatomy | Mesial: surface facing towards the sagittal midline. Distal: the surface facing towards the rear of the mouth. Buccal/Labial: surface facing cheek and/or lips. Lingual/Palatal: surface facing tongue (mandibular teeth) or the palate (maxillary teeth) |
| periodontal disease | occurs in all patients 9/10 adult dogs 7/10 adult cats risk factors include poor oral care breed/genetics age oral morphology nutritional factors |
| periodontal disease - risk in dogs = | dogs under 10kg have more than 3x the risk of periodontal disease increased genetic susceptibility brushing teeth in small dogs can be more challenging greater reluctance to accept dental chews a reputation of fussy eating habits |
| periodontal disease - risk in cats | is the most common specific disease in cats cats ages >9yrs had 6x risk of periodontal disease compared with cats <3yrs cats with periodontal disease where more likely to have co-morbidities such as kidney and heart disease |
| plaque | a clear sticky substance made of a bacterial microfilm it adheres to the enamel of the tooth above and below the gum line plaque is invisible to naked eye & forms within 24hrs of tooth brushing the microfilm is formed with the help of quorum sensing |
| calculus (Tartar) | plaque mineralises by naturally occurring minerals in the saliva and food the rough surface of tartar allows more plaque biofilm to build up which in turn will lead to an increase of the tartar |
| first stage of periodontal disease gingivitis - | inflammation of the gingiva can occur 2 weeks after plaque formation and with tartar formation its reversible with consistent home care |
| second stage of periodontal disease periodontitis - | occurs if gingivitis is left untreated inflammation resulting in loss of the supporting tissue of the teeth irreversible progressing to end stage disease requires dental treatment under ga |
| tooth resorption (TR) Resorptive lesions (FORLS) | aetiology currently unknown painful and common in both species may affect upto 30-60% cats in their life time teeth become destroyed as a result of resorption its not always apparent until dental radiographs are taken |
| tooth resorption types type 1 = inflammatory resorption = | often seen in cases of periodontitis ligament remains intact root density appears normal on Xray entire tooth extraction is required |
| type 2 = replacement resorption = | idiopathic tooth is resorbed and replaced by bone root dentistry increases amputation of the crown is required |
| other dental problems - periodontal pockets = | the attachment is destroyed at the alveolar margin and involves the periodontal ligament and alveolar bone if the pocket leads to the apex this can cause pulpitis |
| other dental problems - persistent Deciduous teeth | by 5 months of age all deciduous teeth should be lost if left, will cause malocclusion force the permanent tooth to lie in an incorrect position increase the risk of periodontal disease |
| other dental problems - bacteraemia | can be common in animals with chronic dental problems can aggravate preexisting conditions such as cardiac and renal disease in severe cases can become septicaemia |
| clinical signs = | facial swelling not eating, dropping food drooling bleeding gums favouring onside of mouth blood on toys loose teeth discoloured teeth turning of head bad breath red gums |
| the dental patient | often senior animals (+5yrs) owner often do not realise how bad the dental disease is informed consent can never give exact numbers of tooth extractions ASA score patient before anaesthesia commences |
| patient considerations | preoperative blood test IVFT from admit to discharge perioperative warming of patient pre-emptive analgesia throat pack the use of inco pads spring gags should be avoided in cats care with ET tube cuff inflation |
| patient position | commonly lateral recumbency patient needs turning halfway through can be difficult to visualise the teeth dorsal recumbency becoming popular head tilted to the side when water in use better visualisation of teeth no need to turn patient |
| Dorsal recumbency Care with obese patients as | can cause ventilation difficulties |
| the dental procedure | dental scale and polish - RVS dental extractions VS only |
| dental radiography | comes as standard in my practice owners can often opt in or out very useful for seeing TR shows health of jaw and teeth |
| dental kit - mouth gag | used to keep the mouth open and leave hands free for surgery care must be taken to use the appropriatley sized gag spring gags can cause blindness in cats due to cutting off blood supply |
| dental kit - periodontal probe | marking at either 1mm or 5mm used to assess pockets around teeth |
| Dental Kit - Scaler | Ultrasonic scalers most often used More proficient Better patient comfort Easier to use for staff Can be used subgingival – check head Must only be on tooth 20 seconds |
| Dental Kit – Gracey curette | A hand scaler designed to go beneath the gingival line |
| Dental Kit – Tartar Removing Forceps | Designed to pinch tartar off teeth Can either have a hooked side or both be straight Difference from extraction forceps as limbs do not meet in the middle |
| Dental Kit – Elevators | Used to put pressure on the periodontal ligament to cause it to break Winged tip designed to wrap around the tooth root Should be sharp to help with breaking the ligament |
| Dental Kit – Periosteal Elevator | Lift and reflect the periosteum, which is a thin layer of tissue that covers the bone Not be confused with orthopaedic periosteal elevators |
| Dental Kit – Extraction Forceps | Used to extract teeth from socket Usually, the last piece of kit used in tooth extraction Comes in many sizes and styles Standard extraction forceps Root extraction forceps Fragment extraction forceps |
| Dental Machine instruments include - | Ultrasonic Scaler – either separate unit or part of machine Drill head – used to drill between roots of multi-rooted teeth, can also drill roots out if crown fracture |
| Dental Machine instruments include - | Polisher – controversial to polish teeth now Water & air gun – used to clean surgical field so vs visualise Needs annual servicing and maintenance |
| Dental Kit – Sharpening Stone | Used to keep elevators sharp Should be used after every dental After cleaning and just before packing away Lubrication applied to stone then elevators run along it to grind sharp edge back on |
| Home care | Periodontal disease can be almost complete prevented by appropriate home care However, owner compliance is limited when supporting dental hygiene at home When advising products the owners' ability and willingness to complete need to be considered |
| Toothbrushing | The most effective way to reduce plaque build up Uses the mechanical action of the tooth bristles to hinder the microfilm Enzymatic toothpaste should also be recommended to further help break down of microfilm |
| Gum wipes | Often contain a chlorhexidine biased wash that is applied to the gums with a wipe Designed to again decrease microfilm – they do not work when tartar is present |
| Plaque-off | Veterinary Oral Health Council approved granular product Contains a specially selected seaweed Sustainably harvested from Norway & Iceland Dried granular form Contains 12 vit 13 minerals and trace elements Rich in natural iodine |
| Hexarinse | Contains 0.12% Chlorhexidine gluconate which can aid in the prevention of tooth and gum disease Provides temporary relief of minor gum irritation Inhibits plaque build-up Helps to eliminate bad breath |
| Water additives | Similar to human mouth wash Can help stop the build-up of plaque by removing the bacteria from the mouth Cannot dislodge already present biofilm Must be in fresh drinking water and replaced daily |
| Dental diets | Biscuits are designed to be fully punctured before crumbling Helps with tartar and plaque removal by mechanical removal Needs to make up 30% of daily diet to be effective |
| Chews | Care must be taken when advising dental chews! Commercial chews are very calorific Bones and Antlers can harm animals As with dental diets they work on the premises of mechanical removal of the microfilm/tartar |
| Lagomorph Dental | Aradicular hypsodont teeth Continuously growing roots cause problems in jaw bones as well as at the crown leave Blocked tear ducts Tooth root abscesses |
| Lagomorph Dental | Dentals normally to keep teeth in correct position / shape Rarely full tooth extraction CT advisable before preforming Scale and polish not performed in rabbits |
| Other Exotics | All rodents suffer with hypsodont teeth as with rabbits so often seen in general practice for tooth re-shaping Bearded Dragons suffer from dental disease and can have dental scale and polish surgery as with cats and dogs. |
Created by:
lucy.fox