Vet and Nurse dentistry pocket guides

Dentistry
Pocket
Guide
Vet and Vet Nurse
1

Tooth Structure
and anatomy
Enamel 1
Dentine
2
Pulp
3
Gingival Sucus
4
Gingiva
5
Alveolar Bone
7
Lateral Canal
6
Periodontal Ligament
8
Cementum
9
2

Canine Dentition
101
102
103
201
202
203
104
105
205
106 206
107 207
108 208
109 209
110 210
R
204
L
411 311
410 310
409 309
Incisors
Canine
Premolars
Molars
408 308
407 307
406 306
405 305
404 304
403 303
402 401 301 302
3

Feline Dentition
101
102
103
201
202
203
104 204
106 206
107 207
108 208
109 209
R
L
409 309
408 308
407 307
Incisors
Canine
Premolars
Molars
404 304
403 303
402 401 301 302
4

Dental formulas
• Puppy
2(I 3/3 C 1/1 P 3/3 M 0/0) =
28
• Kitten
2(I 3/3 C 1/1 P 2/3 M 0/0) =
26
• Adult dog
2(I 3/3 C 1/1 P 4/4 M 2/3) =
42
• Adult cat
2(I 3/3 C 1/1 P 3/2 M 1/1) =
30
• Rabbit
I2/1 C0/0 P3/2 M3/3 =
28
5

Key to abbreviations
used on a dental chart
#
+
m
→
|→|
A
C
G
M
P
Pn
R
Rn
S
W
X
Fracture
Severity + to ++++
Missing tooth
Tipping/positioning
Length relationship
Abscess
Cavity
Gingivitis
Mobility
Periodontitis
Pocket depth, mm
Recession
Depth in mm
Supernumerary
Wear
Extracted
6

Charting Terminology
• Apical - toward the apex of the tooth
• Buccal - surface of tooth toward
cheeks
• Labial - the surface toward the lips
(applies to incisors, canines)
• Coronal - toward the crown
• Incisal - toward the tip of the tooth
(for incisors, canines)
• Distal - surface away from midline of
animal
• Facial - can be labial or buccal
surface
• Interproximal - surface between two
teeth
• Lingual - surface of tooth toward
tongue
• Mesial - surface toward rostral
midline of animal
7

• Occlusal - biting surface of tooth
(applies to maxillary molar 1 and 2
in dogs)
• Palatal - surface of tooth toward
hard palate
• Supragingival - above the free
gingival margin (gum line)
• Subgingival - below the free gingival
margin (gum line)
• Uncomplicated crown fracture -
fracture of crown of tooth not
involving the pulp
• Complicated crown fracture -
fracture of crown of tooth involving
the pulp
• BOP - bleeding on probing with
light pressure with a blunt
periodontal probe
8

Procedures
Performed
Required
Pre-anaesthetic checks
General anaesthesia
Radiography
Occlusal assessment
Supra-gingival scaling
Subgingival scaling
Root planing
Polishing
Gingival lavage
Gingival surgery
Extraction
Periodontal splinting
Crown height reduction
Endodontic therapy
Restoration
Orthodontic treatment
Oro-facial surgery
Homecare program
9

Ways in which the safety
and comfort of both operator
and patient can be ensured
during dental prophylaxis
` The operator should wear protective
apron, gloves, mask and goggles.
` The patient should be anaesthetised
with an endotracheal tube in place
and the cuff inflated.
` The patient’s head should be rested
on a foam wedge keeping the rostral
head downmost enabling good
drainage of debris and water out of
the mouth, ideally through a grid and
into a collecting tray.
` Assistance must be enlisted when
turning a large patient. The animal
should never be turned over dorsally
since debris may be ingested.
10

` A gag of an appropriate size should
be used to keep the patient’s mouth
open.
` The pharynx should be packed with
loose weave surgical swabs in order
to prevent accumulation of debris
that may later become respiratory
foreign bodies. These must be
carefully counted and removed
following the procedure.
` The designated area for dental
procedures should be well
ventilated and ideally possess an air
conditioning or air filtering system
in order to reduce aerosol spread of
debris and pathogens.
` A well-designed, supportive chair, of
adjustable height will minimise neck
and back strain.
` Good lighting will facilitate efficient
oral examination.
11

Tooth resorption stages
(No longer known as FORLS - feline
Odontoclastic Resorptive Lesions)
• Stage 1 (TR 1):
Mild dental hard tissue loss
(cementum or cementum and
enamel).
• Stage 2 (TR 2):
Moderate dental hard tissue loss
(cementum or cementum and enamel
with loss of dentin that does not
extend to the pulp cavity).
• Stage 3 (TR 3):
Deep dental hard tissue loss
(cementum or cementum and enamel
with loss of dentin that extends to
the pulp cavity); most of the tooth
retains its integrity.
12

• Stage 4 (TR 4):
Extensive dental hard tissue loss
(cementum or cementum and enamel
with loss of dentin that extends to
the pulp cavity); most of the tooth
has lost its integrity.
(TR4a)- Crown and root are equally
affected;
(TR4b)- Crown is more severely
affected than the root;
(TR4c)- Root is more severely
affected than the crown.
• Stage 5 (TR 5):
Remnants of dental hard tissue are
visible only as irregular radiopacities,
and gingival covering is complete.
13

For Vets:
• Sectioning Teeth
Upper PM4
Occlusal View
Lateral view
Upper M1
Occlusal View
Lateral view
14

For Vets:
• Extraction
A. Incise
attached
gingiva
B. Vertical
releasing
incisions
C. Elevate
gingival
tissues
D. Removing
cortical bone
iver the roots
E. Tooth ready
for elevation
15

Common Oral Conditions
• Lingually Displaced
Mandibular Canines
• Fractured Teeth
• Canine Chronic Ulcerative
Stomatitis in dogs
• Feline Oral Cavity Conditions
• Trauma to Jaws
• Enamel Dysplasia in dogs
• Pulp Damage
• Orthodontics & Bite Defects
• Dental Caries in dogs
• Prosthodontics: Crowns
• Eruption Cysts in Jaws
• Oronasal & Oroantral Fistulae
• Exotic & Zoo Animal Surgery
• Periodontal Disease
• Avulsion of Teeth
16

Periodontal Disease Index
Can be generalised or localised
Stage
0
No disease
1
(PD1) Gingivitis - reversible,
no attachment loss (AL*)
2
(PD2) AL < 25% or furcation
1 exposure
3
(PD3) AL 25%–50% or furcation
2 exposure
4
(PD4) AL > 50% or furcation
3 exposure
*AL is usually best based on
measurements with a periodontal
probe and intraoral radiographs.
17

Calculus Index (CI)
Usually used as a whole mouth score
Stage
0
No calculus
1
Some supragingival calculus
covering < 1/3 buccal tooth
surface
2
Moderate calculus covering
1/3 to 2/3 buccal tooth surface
with minimal subgingival deposit
3
Heavy calculus covering
> 2/3 of buccal tooth surface
and extending subgingivally
18

Gingival Index (GI)
Usually used as a whole mouth score
Stage
0
Normal gingiva
1
Marginal gingivitis, mild swelling,
some colour change, no BOP
2
Moderate swelling and
inflammation of gingiva, BOP
3
Marked swelling and
inflammation, spontaneous
bleeding
19

Plaque Index (PI)
Usually used as a whole mouth score
Stage
0
No plaque
1
Thin film along gingival margin
covering < 1/3 of buccal tooth
surface
2
Moderate accumulation of plaque
covering 1/3 to 2/3 of buccal tooth
surface
3
Abundant soft plaque covering
> 2/3 buccal tooth surface
20

Furcation (F)
Used for each multirooted tooth
Stage
F1
Probe goes into furcation and up
to 1/3 buccolingual crown width
of multirooted tooth
F2
Probe goes up to 2/3 buccolingual
crown width of multirooted tooth
F3
Probe goes all the way through
buccolingual crown width of
multirooted tooth
21

Tooth Mobility (M)
Used for each tooth
Stage
M1
Slight mobility > 0.2 mm,
less than 0.5 mm
M2
Moderate mobility, > 0.5,
less than 1 mm in any lateral
direction
M3
Severe mobility > 1 mm
or intruded into socket or
can be extruded out of socket
22

Intra- and Extraoral
Radiography
Some of the indications for dental
radiography include:
1. Periodontal disease - assessment
of bone levels, type of bone loss,
combined periodontal-endodontic
lesions, success or failure of
periodontal therapy
2. Endodontic disease including apical
pathology, pulp exposures, and
draining fistulae
3. Pathology of the oral soft and hard
tissues, including tumours and
fractures
4. Temporomandibular joint dysfunction
5. Crown/root pathology including tooth
resorption lesions, crown or root
fractures, extra roots, dilacerated
roots
23

6. Pre/post tooth extraction
7. Root canal therapy
8. Oligodontia/supernumerary teeth,
especially in breeds with a family
history of missing or extra permanent
teeth
9. An assessment of tooth development
and chronological dental age of the
animal
24

Additional resources
Download canine dental chart
Download feline dental chart
Download puppy dental chart
Download kitten dental chart