Terms in this set (83)
1) retained deciduous teeth
2) supernumerary teeth when crowded or causing interference
3) advanced periodontal disease
4) tooth resorption
5) impacted or embedded teeth
6) caudal mucositis/stomatitis
7) non-vital teeth or complicated fractures WHEN owner decline endodontic tx to sae tooth
8) mal-positioned teeth when other intervention (referral) is not possible
9) retained tooth root tips
10) teeth in fractured jaw sites
11) teeth associated with neoplasia
What are indications for tooth extraction?
- bone loss on both roots
- lucencies
- thin mandible
what is seen in this image?
Image: - bone loss on both roots - lucencies - thin mandible
bone loss (blue indicates where bone should be)
what is seen in this image?
Image: bone loss (blue indicates where bone should be)
- What is biofilm in the mouth? Where does it reside?
Plaque is a biofilm and the sulcus/pocket is the most favorable environment

- What are periodontal pathogens?
1) starts with G+ cocci aerobic, non motile bacteria
2) As biofilm progresses, becomes G - rod ANaerobic, motile bacteria
- What is biofilm in the mouth? Where does it reside?
- What are periodontal pathogens?
Normal (PD 0): Clinically normal - no gingival inflammation or periodontitis clinically evident. up to 3 mm sulcus in canine & 1 mm sulcus in feline

Stage 1 (PD 1): Gingivitis only without attachment loss or bone destruction. The height and architecture of the alveolar margin are normal. REVERSIBLE

Stage 2 (PD 2): Early periodontitis - gingivitis + less than 25% of attachment loss or at most, there is a stage 1 furcation involvement in multirooted teeth.

Stage 3 (PD 3): Moderate periodontitis - gingivitis + 25-50% of attachment loss. Stage 2 furcation involvement in multirooted teeth. These teeth often require extraction or other advanced intervention.

Stage 4 (PD 4): Advanced/Severe periodontitis - gingivitis + more than 50% of attachment loss stage 3 furcation involvement in multirooted teeth. Often mobile & will require extraction. teeth with no structural attachment are useless
What are the stages of periodontal disease?
use fine explorer on every tooth

may be subgingival vs supragingival lesions
How do you check for tooth resorptions?
left: normal
right: resorption
Image: left: normal right: resorption
persistent deciduous teeth
Image: persistent deciduous teeth
stomatitis + periodontal dz
Image: stomatitis + periodontal dz
stomatitis + periodontal dz
Image: stomatitis + periodontal dz
malocclusions causing trauma in the mouth --> pyogenic granulomasfractured tooth tx: - root canal & crown restoration - extractionwhat is shown? tx?jaw fracture (note: teeth in fracture must be removed)teeth associated with neoplasiacrowding of the 3rd-4th PMcrowding of 2-3-4 PMretained tooth root + draining tract needs to be extractedretained rootscarries/decay- P's in poor health that are NOT good anesthetic candidates - P's undergoing radiation tx or chemotherapy (delayed healing) - Bleeding disorders that are not well-managed - if pathology can be treated via referral and specialized txwhen do you NOT extract teeth?pulpitisexodonticsWhat is removal of teeth called?rootapexincisorspremolarsmolarscrownmolarspremolarscanine- intra-oral dental x-ray unit - local anesthesia - dental unit with water cooled high-speed handpiece - carbide cutting burs - oral sx pack - SHARP - absorbable suture with cutting needle (4-0 or 5-0)Equipment for exodonticsair-driven dental unit left = high speed to section teeth & remove bone right = low speed to clean & polish teethtools?dental BURS- scalpel handle and 11, 15, or 15c blade - small brown adson thumb forceps (rat tooth forceps can be too traumatic) - small needle driver - mosquito hemostats - sharp scissors for cutting gingiva and dissecting tissue - gauzeWhat is in an oral sx pack?- sharp periosteal elevators (lift & reflect gingiva off bone) - sharp dental luxators (sharp & straight instruments ~ used to shear periodontal ligament) - sharp dental elevators (breaks down periodontal ligament) - small extraction forcepsinstruments for extractionsdental elevators (breaks down periodontal ligament) & luxatorsperiosteal elevators (lift & reflect gingiva off bone) EX-8 & EX-9elevators (breaks down periodontal ligament)luxators (sharp & straight instruments ~ used to shear periodontal ligament) & winged elevator (elevate tooth out of socket)left = luxators (shear periodontal ligament) right = winged elevators (elevate tooth out of socket)scalpel handlesneedle driversthumb forcepsperiosteal elevatorsextraction forcepsleft - hemostat middle - gauze right - suture scissors- keep instruments SHARP - clean well - store properlyinstrument care- monocryl (lasts long) - vicryl (absorbs quick) - chromic gut (absorbs very quick) - PDS (lasts very long)suture optionspersonal choice consider: - absorbable - how long will it last? - what are you using it for? - needle size - handling characteristics typically use: - 4-0 monocryl dogs - 5-0 monocryl catswhat sutures should be used? (considerations & what is normally used)loupes - allows for better visualization - allows for better posture - improves efficiency and safetyPurpose decreases amount of required: - anesthetics - other analgesics + eases transition to administering post-op oral pain meds at home Procedure - preemptive (5 minutes prior to extraction) - usually use Bupivacaine 0.5% (5mg/mL) --> onset of action = 6-10 minutes --> duration = 2-10 hours --> use 1 cc or 3 cc syringes w/ 25 g 1 inch needle --> total dose dog = 2 mg/kg --> total dose cat = 1-2 mg/kg - can use lidocaine 2% (20mg/mL) --> short duration of action --> total dose dog = 5 mg/kg --> total dose cat = 1 mg/kg total meaning in all 4 quadrants... start low, can always increase Length of action - 24+ hours - drug & pH dependent ~ decreasing pH will decrease duration - increase vascular = decrease duration MOA - membrane stabilizing drugs - water soluble - bind to Na channels and inhibit depolarization --> no action potential- What is purpose of local anesthetics for dentistry? - Procedure? (including drugs used & dosages) - What affects length of action? - MOA?3kg * 2 mg/kg = 6 mg 6mg/ 5mg/ mL = 1.2 mL/4 quadrants --> 0.3 mL/site maximumwhat is appropriate 0.5% Bupivacaine dose for a 3 kg Yorkie?extended release bupivacaine can be used post extraction but block lasts 3 days!!YESare extractions considered sx?NEVER suture under tension tension = failurewhen suturing after tooth extraction, should you suture under tension? why or why not?- no flap required - no alveolar bone removed - no sectioning of teeth needed - minimal trauma to surrounding oral structures ex's include: - incisors - first premolars - mandibular 3rd molarsDefine closed/"simple" extractions1) pre-extraction radiographs - diagnose pathology - plan technique for extraction (extra roots, proximity of other teeth, condition of surrounding bone) 2) incise gingival attachment all the way around tooth with a scalpel blade - (#11 or #15) - position blade to sever attachment at the level of the gingival sulcus to minimize soft tissue trauma when the tooth is extracted 3) loosen periodontal ligament - place a dental elevator or luxators btwn the tooth and alveolar crest - elevators should be rotated w/in the alveolus to stretch the periodontal ligament. stretch and hold. - a luxator acts to sever the periodontal ligament and as a wedge to expand the periodontal ligament space. Not intended to be rotated - often used to create space for elevators - apply apical pressure on the elevator and rotate slightly until tension is felt from the periodontal ligament. Hold 10 seconds - move elevator around the tooth in a circular fashion with apical pressure and rotation... hemorrhage from ligament aids in this process 4) remove the tooth - once tooth is loose, use small extraction forceps to grasp the tooth - grasp as apically as possible and rotate while applying traction - do NOT use extraction forceps until the tooth is loose, or root fracture will occur 5) examine & radiograph 6) the empty alveolus - alveolus should be debrided IF there is obvious debris after extraction (use curette) otherwise don't 7) suture place several sutures to close the defect and secure blood clot (1 suture may suffice) Important note - have "short finger stop" i.e., place index finger towards working end of elevator to give more control = less likely to over torque and fracture roots + helps prevent trauma if instrument slips during extractionWhat are steps to closed/simple extractions?- mucoperiosteal flap created - alveolar bone removed - multi-rooted teeth sectioned ex's used for: - larger, solid single or multi-rooted teeth - removal of fractured roots involve more trauma compared to simple extractions BUT when performed properly, should have similar healing timeDefine open/surgical extractionenvelope flap1) pre-extraction radiographs - diagnose pathology - plan technique for extraction (extra roots, proximity of other teeth, condition of surrounding bone) 2) create mucoperiosteal flap a - envelope flap: cut across sulcus only b - triangle flap: 1 releasing incision along with sulcular incision c - pedicle flap: 2 releasing incisions followed by sulcular incision *most often used 3) elevate the flap - use periosteal elevator to raise flap from its attachment to the underlying buccal bone - angle elevator into the bone to ensure the periosteum and mucosa is included with the flap - dull or damaged periosteal elevators will tear tissue and delay healing 4) Buccal bone removal - A cutting Burr is used to remove buccal bone mesial, distal, and buccal to the root - use a gently back and forth motion to paint away the bone to avoid damage to the root - keep cutting surface of bur parallel to the root to avoid cutting into the root - try to be conservative with bone removal, but remove enough to effectively extract the tooth - gently keep flap out of the way and be aware of surrounding teeth and other structures - don't be shy, remove 50-70% of bone if you need 5) Section multi-rooted teeth - all teeth with multiple roots should be sectioned - use a cutting burr on a water-cooled high speed handpick - work from the furcation towards the crown 6) elevation - loosen the PDL of each indv. root (similar to simple extraction) - each root should move independently when elevating - if not, then sectioning = incomplete - remove each root indv. and debride the alveolus if necessary 7) post x-rays REQUIRED 8) Alveoloplasty - the process of smoothing any sharp bony projections of alveolar bone at/around the extraction site - use a round or football shaped diamond burr on a water-cooled high speed handpiece - digital palpation should not reveal any sharp projections or catches - prevents trauma to flapr once it is sutured over the extraction site 9) Bone grafts - can be placed in empty alveolus but is RARELY indicated b/c w/o graft the natural blood clot in alveolus leads to bone growth w/in alveolus - consider when extraction greatly weakens jaw but note it can result in delayed healing or infection 10) suture - allows primary healing and reduces hemorrhage - be sure flap is tension FREE before suturing - to relieve tension, fenestrate/release the periosteum using a scalpel blade or sharp scissors - use an absorbable suture with reverse cutting needle - suture corners of flap to ensure proper coverage - suture over bone to support suture lineWhat are steps to open/surgical extractions?triangle flappedicle flapmaxillary molars - section all the way throughCASE EXAMPLESmandibular 1st molar pedicle flap with draining tract (note the bright red) once tooth is removed, the draining tracts should resolvedraining tracts with flap pulled backremoved buccal bone & sectioning of tooth- can alter occlusion/bite which can cause oral trauma to tongue, gingiva of opposing arcade, & cheek - fracture roots or root tips - mandibular or infraorbital artery laceration - pushing roots or root tips into the maxillary sinus or mandibular canal - jaw fracture - perforation or contusion of the eye - oronasal fistulaWhat are exodontic complications?upper tooth cleans lower tooth (when absent calcular accumulation occurs ~ see next card)increased calculus accumulation due to absence of upper toothmandibular fracture due to extractioncalmly re-asses another plan ("CRAP") - create good visualization of the retained root - remove enough buccal bone to safely visualize the root - take as many radiographs as needed - use a small bur to make a ring around root to allow for instrument placement - gently elevate the root coronally to avoid pushing into the maxillary sinus or mandibular canal - if you don't feel you can remove the tooth w/o further complication or trauma DO NOT PROCEED. inform client & consider referral - do NOT pulverize or drill out roots with your high speed handpiecewhat do you do if you have a broken root?retained rootretained root- 10-14 days of soft foods only (soak regular food) - 1 week abx +/- amoxicillin, clavamox, clindamycin, doxycycline (controversial ~ mainly sent if have other diseases) - pain control - recheck in 2-3 weekspost-op instruction following extractionsfull quadrant flap common for cats with stomatitislingual molar gland in cat = normal1 - focal or multifocal radiolucency with normal periodontal ligament space 2 - no root at all + disappearance of periodontal ligament space & decreased radiopacity 3 - features of 1 and 2types of resorptionsshows types of resorptions- type 2 tooth resorption - absence of periodontal dz - no x-ray evidence of endodontic disease or periapical pathological findings - no clinical evidence of stomatitis - negative for FIV, FeLV, caliciviruswhen is crown amputation indicated?oronasal fistula closure - direct appositional closure: elevate gingival margins, undermine mucosa, remove gingival collar, tension free position and simple interrupted sutures - simple buccal flap: elevate a partial thickness flap from the buccal mucosa, debride margins, tension-free position flap and suture