dent 3 oral exam

extraoral exam

access

• facial symmetry

• oral or nasal discharge

• muscle mass

• lumps/bumps

• pain

• odour

• patient demeanour

normal bite

scissor bite

pedodontics

• Treatment of dental disease

• exhibit both genetic and acquired conditions

adontia

absence of teeth

missing teeth cause

• never developed

• slow to erupt

• fell out

charting missing tooth

circle around the tooth indicated its missing

persistent primary teeth

(retained deciduous teeth)

• can lead to orthodontic problems and may require extraction if they interfere with the eruption of permanent teeth.

• lead to periodontal disease, due to plaque accumulation

• rule of thumb NEVER should both sets of teeth be visible at same time

interceptive orthodontics

process of removing primary (or adult) teeth to prevent malocclusions

effective to be done before patient is 12 wks

fractured primary teeth

• occurs fairly frequently

• if left can lead to an abcess or possible fistula formation

• can cause enamel hypoplasia in underlying adult

supernumerary teeth

• commonly found in incisors or first premolars in dogs

• causes overcrowding

• charting “SN” with an additional tooth drawn

• third set “shark teeth” requires extractions

fusion

joining of 2 developing teeth that have different tooth buds

• on radiographs 2 separate roots

gemini tooth

A single tooth bud that has partially divided

-on radiographs, there will be one root with split crowth

dilacerated roots

abnormally formed/ curved roots

important to know about before extractions

orthodontic disease

• Oral disease caused by the malalignment of teeth

can be due to dental or skeletal abnormalities

malocclusion

-Incorrect relationship between the teeth of 2 dental arches when the jaw opens and closes

class I,II,III,IV

Class I occlusion

Overall normal bite except one or more teeth out of alignment

• due to dental malalignment (not skeletal)

• charting “MAL 1”

Lance canines (spearing canines)

Rostral cross bite (CB/R)

caudal crossbite (CB/C)

base narrow canines

rotated P3

Class II malocclusion

mandibular distoclusion aka short mandible “overbite”

• overshot or parrot mouth

• due to skull configuration

• Lower canines and incisors may cause trauma

• charting MAL2

Class III malocclusion

mandibular malocclusion “underbite’

• due to skull configuration

• charting MAL3

• results in undershot of the lower jaw leading to trauma of lower

mandibular prognathism

mandible too short

maxillary brachygnathism

maxilla to short

class 4 malocclusions

maxillomandibular asymmetry “Cross bite”

charting MAL4

level bite

incisors meet exactly, surface to surface

• causes teeth to wear against eachother

stains

• form from wear and exposure of dentin- brown colour that can’t be removed

• some drugs can also cause staining (tetracycline)

• need to differentiate from dead teeth

abrasions

• worn faucets or cusps from an external source

• tennis balls, bones

• charting AB

attrition

wearing of teeth caused by friction against each other

• charting AT

• level bite

enamel hypoplasia

• caused by trauma or high fever that can temporarily prevent enamel production

• tooth surface rough, flaky, brown with dentin exposure

• charting E/H

caries (cavities)

Most common on the occlusal surface of dogs

defect in the enamel ± dentin

requires extraction

Charting CA

uncomplicated fracture

enamel and dentin

compicated fracture

enamel, dentin and pulp

chroic fracture

present for a preiod of time

• pulp apperars black/ brown

acute fracture

fresh injury

• pulp appears as red

enamel fracture

• chip fracture

• loss of enamel only

• charting EF

• draw a jagged line ove area of fracture

uncomplicated crown fracture

• involves both enamel and dentin but has not entered the pulp chamber

• may or mayy not require treatment

• charting “UCF”

• draw jaggd line over area of fracture

compicated crown- root fracture

• enamel and dentin are involved but not pulp chamber

• fracture extends below the gumline

• may or may not require treatmnet

• Charting “UCRF”

• draw jagged line over fracture area

complicated crowth fracture

• penetrates enamel and dentin and exposes pulp cavity

• requires extractions or endodontic treatment

• Charting “CCF”

• draw jagged line over the fracture area

• Complicated it enters pulp cavity

• Endodontic treatment = treating the pulp cavity (root canal)

complicated crown root fracture

• involves enamel and dentin and exposes pulp chamber

• extends below gum line

• requires extraction or endodontic possibly peridontal treatmnet

• charting “CCRF”

• draw a jagged line over the fracture area

root fracture

• involves root

• tooth often mobile

• usually requires extraction

• Charting “RF”

• draw jagged line over fracture area

endodontic disease

• disease of the pulp chamber “inside the tooth “

• can be due to trauma or iatrogenic (heating up tooth during prophy)

• may have external evidence on exam

• may only be evident on rads

tooth discoluration

a normal healthy tooth is white

• brown if wear has exposed dentin

• black of pulp has been exposed (extract or root canal)

• purple, pink, tan, and grey indicates pulpal hemorrhage and tooth death

luxation

partial displacement of tooth from socket

tooth may be viable and immediate repositioning and splinting is recommended

Avulsion

• complete displacement of tooth from the socket

• must be replaced immediatly to be saved

• special solutions or milk to preserve

• if cant save tooth clean socket and suture gingiva

tooth resorption

• common in cats

• Resorption of the hard structures of the tooth into the pulp chamber is exposed and eventually crown of the tooth is lost

• charting “TR”

Gingivitis

• inflammation of gingiva

• can progress until attached gingiva becomes involved

• marginal gingiva becomes swollen, edematous, and encroaches on crown of the tooth

• considered reversible

Periodontitis

• common in dogs and cats

• result

stomatitis

• infammation/ infection of the mucous lining of the mouth

• more extensive than gingivitis

• typically see extremely red and inflamed tissues in the oral cavity

• often underlying cause

• cats have an immune response to components of plaque

• requires full mouth extractions

uremic ulceratiobn

seen in patients with advanced renal disease

Clinical signs include

• ulceration on tip of tongue

• increased calculus formation

• periodontal disease

one reason pre op blood is important

oronasal fistula

• result from advanced periodontal disease

• often deep pockets on the palpatal aspect of canines

• inflammation and infection has eroded bone between teeth and nasal cavity

• often present but not diagnosed until extraction

• need to be closed carefully

• Charting “ONF”

granulomas

• common

• result from periodontal disease, irritation, or foreign body

• can be part of eosinophilic granuloma complex in cat

• biopsy to be sure

gingival hyperplasia

• gums grow over teeth

• often secondary to plaque accumulation

• create pseudopockets

• can trap food

• common in brachycephalics esp boxers

• treatment gingivectomy - removal of excess gingiva

oral papillomas

• common in young dogs <2yrs

• warty growth on oral mucosa/ lips

• caused by papillomavirus

• usually resolves on own

fibromatous Epulis

• Gingival tumour made of fibrous tissue

• generally responds well to excision

• need biopsy to confirm

ossifying epulis

• similar to fibromatous epulis but contains bone

• usually needs wide excision including part of jaw

• needs a biopsy to confirm

acanthomatous epulis

• primarily composed of epithelial cells

• tumour of the gums

• tends to invade bone

malignant melanoma

• found on any site within the oral cavity

• locally invasive and highly metastatic

• poor prognosis as recurrence is common

fibrosarcoma

• create fleshy, protruding firm masses

• as grow become ulcerated and infected

• more problems with local growth rather then metastasis

squamous cell carcinoma

• found on any site within oral cavity

• epithelial cell type