Veterinary Dentistry CTVT: Chapter 34 DRG: 692-704

Objectives Recognize a patient’s overall dental health status Perform routine dental prophylaxis safely and efficiently Recognize, describe, and use common dental instruments Understand client education regarding home care

Dental Tasks for Veterinary Technicians Oral examination and charting Professional dental cleaning “Dental prophylaxis” Taking and developing dental radiographs Taking impressions and making models Performing nonsurgical, subgingival root planning Assisting with exodontics and endodontics Client education *Procedures performed by veterinary technicians must not result in alterations in the shape, structure, or positional location of teeth in the dental arch.

History and Extraoral Examination Dental procedures require general anesthesia Before animal is anesthetized: Obtain a proper history Ask about general medical info, medications, nutrition/treats, toys, etc. Perform an extraoral exam Palpate muscles of the face Retropulse the eyelids Look for symmetric depth and firmness Look for ocular and nasal discharge Palpate mandibular salivary glands Palpate submandibular lymph nodes

Intraoral Examination- Awake The entire mouth should be evaluated, however we do only a quick exam while awake: Access patient’s occlusion Check for retained deciduous teeth or missing teeth Evaluate overall appearance of soft tissue Goal is to inform owner of the procedure their pet needs and give an estimate of cost.

Intraoral Examination- Anesthetized Once anesthetized, a more thorough exam can be done: 1. Soft tissue Mucosa- should be pink or pigmented; no lesions seen Pharynx- evaluate for inflammation/neoplasia/lesions Tongue- chewing lesions present?

Know What’s Normal! Hard palate- covered in rugae Examine closely in brachycephalic breeds Incisive papilla- bump that is midline, caudal to maxillary incisors Two salivary ducts on quadrants 1 &2 Bumps buccal to maxillary 4th PM and 1st M

Intraoral Examination- Anesthetized 2. Teeth Number, fractures, mobility, etc 3. Periodontium Inflammation, periodontal pockets, bone loss, etc. *Radiographs are often necessary to access the oral health status

The Periodontum The periodontum is the area that surrounds the tooth. Purpose: to attach the tooth to the jaw and provide support, & resistance to normal, functional forces. It includes: Gingiva Periodontal ligament Cementum Alveolar bone

The Periodontum Gingiva = gum tissue surrounding teeth Healthy gingiva can be pink or pigmented The margin lies closely against the crown of the tooth Gingival sulcus is the shallow groove between the tooth and the gingiva. Normal depth is 0-3 mm in canines; up to 1 mm in felines Called a periodontal pocket when deeper.

The Periodontium Cementum is a bone-like tissue that covers the root surface. It is stronger than bone but not as strong as enamel. It is capable of repairing itself. Alveolar bone forms the tooth socket. Blood vessels and nerves run through the alveolar bone Periodontal ligament attaches cementum to the alveolar bone.

Scissor Bite Evaluation Scissors bite is evaluated in three locations: 1. The mandibular canine tooth resides in the interdental space of the upper third incisor and the upper canine tooth. 2. The upper fourth premolar is labial to the lower first molar, which together, constitute the carnassial teeth. 3. Maxillary incisors are slightly rostral to the mandibular incisors.

Normal Scissors Occlusion: When all three locations are normal- the premolars interdigitate toward the opposing interdental space.

Malocclusion Malocclusion is an abnormality in the position of the teeth. It can occur in any of the three skull shapes, but is more common in brachycephalic breeds. There are four classes of malocclusions. (Class I, II, III, and IV) Class I- easily fixed with orthodontic correction OR not needed Class II-IV are skeletal malocclusions due to differing jaw length

Class I: Rostral Cross-bite Maxillary incisors are caudal to the mandibular incisors. Canines are in normal position Very common malocclusion in veterinary dentistry. Thought to occur secondary to retained deciduous incisors. Could also occur due to trauma Treatment: Orthodontic movement or extraction of the abnormal teeth. Treat vs. not treat?

Rostral Cross-bite

Class I: Caudal Cross-bite Maxillary premolars/molars are positioned lingual to the mandibular opposing premolars/molars Occurs occasionally in dolichocephalic breeds. Treatment: Extractions or more frequent professional prophylaxis will be needed for these pets.

Caudal Cross-bite The maxillary fourth premolar is positioned abnormally inside of the mandibular first molar.  This condition did not require treatment as the pet had a comfortable and functional occlusion.

Class II: Mandibular Distoclusion Appears as mandibular brachygnathism- abnormally short mandible, normal maxilla Referred to as “overshot” Problems: Lack of self-cleaning ability Can create painful hard palate abrasions Never an accepted standard

Class III: Mandibular Mesioclusion Appears as mandibular prognathism- abnormally long mandible, normal length maxilla Referred to as “undershot” Problems: These dogs will lose some of their self-cleaning ability and trap plaque and debris more easily Maxillary incisors can traumatize the mandible *Accepted as normal in brachycephalic breeds such as Bulldogs, Pekingese, Boston terriers, Pugs, and Persian cats.

Mandibular Mesioclusion

Persistent Deciduous Teeth A deciduous tooth that remains after the adult tooth has already erupted Can occur in any animal, but most common in small breed dogs Problems: 1. Interfere with normal eruption pathway of permanent teeth  malocclusion Early detection is key! 2. Are a reservoir for debris  dental disease Extraction is almost always necessary

*Note: deciduous teeth are numbered differently in the Triadan system (500, 600, 700, 800)

Polydontia Supernumerary teeth should not be confused with retained deciduous teeth. These are extra permanent/adult teeth Unless extra tooth causes crowding, no treatment is necessary. Occasionally the extra teeth will erupt in an abnormal angle or be impacted. If crowding: increased chance of periodontal disease. (Extraction necessary)

Hypodontia One or more teeth do not form in the dental arcade. Un-errupted permanent tooth or hypodontia? How do you confirm? If permanent tooth is absent, a deciduous tooth can remain in the arch for months to years. No treatment necessary

Periodontitis Periodontitis is one of the most common diseases of dogs and cats. It’s caused by subgingival plaque, and the body’s response to it Periodontitis exists in most pets over five years of age that have not received home care, but can be seen as early as six months of age. There are four stages of periodontitis.

The Culprit: Plaque Plaque is a white, slippery film that collects around the gingival sulcus of the tooth. Composed of bacteria, food debris, exfoliated cells, and salivary glycoproteins. Over time, plaque will mineralize on the teeth to form dental calculus (tartar), a brown/yellow deposit that contributes to periodontal disease.

It’s only a matter of time… Saliva + plaque + 24 hours = calculus. Calculus and plaque deposits on these teeth have caused gingivitis.

Your calculus has plaque! As plaque and tartar collect around the tooth, they damage the gingival tissues by releasing bacterial by- products. Shift to gram negative bacteria (anaerobic) Breakdown of cementum and eventually PDL The animal’s immune system further damages these tissues through the release of harmful by-products from white blood cells as they attempt to destroy the bacteria.

*Attachment loss refers to gingival recession and pocket depth Periodontitis Once present, destruction of the periodontal tissues has begun and will continue if not treated. As a tooth loses its periodontal attachment increased mobility Timeline=months to years before the tooth actually falls out. Bacteremia liver, kidneys, heart, and lungs effected. *Attachment loss refers to gingival recession and pocket depth

Stage I Periodontitis Also referred to as gingivitis. Animal presents with reddened gingival tissues. First thing that owners notice is halitosis. Time of onset depends on diet and home care Canned food promotes gum disease. Hard, dry food generally better for gingival health. Can be treated/cured with a professional dental cleaning.

Stage I Periodontitis (Stage 2)

Stage II Periodontitis Stage II can also be called advanced gingivitis. Examination will reveal inflammation and plaque at free gingival margin with edema present. Halitosis is very apparent. Most dogs between 1 – 4 years of age when stage II occurs. With scaling, polishing, and home care this stage is treatable and usually curable.

Stage II Periodontitis