Dentistry - Unit 4
Why would thermal bone injury be a complication of tooth extraction? a. The bur will overheat and damage the soft tissue and bone. b. Thermal injury is not a concern, as you are removing the tooth anyway. c. Tooth elevators cause excessive heat, which could injure the soft tissue around the tooth that is being extracted. d. Tooth extractors cause excessive heat, which could injure the remaining teeth.
a Adequate cooling of the bur by water (whether used in a high- or slow-speed handpiece) is mandatory. Overheating of the bur will result in damage to both the soft tissue and bone. Thermal necrosis of bone usually results in the development of a bone sequestrum that needs to be retrieved surgically as a second procedure. Elevators and extractors do not produce heat. Gorrel C, "Tooth extraction," Veterinary Dentistry for the General Practitioner, ed 2, Elsevier, 2013, p. 171-190.
Luxation of a tooth cannot be termed as: a. Attrition b. Intrusion c. Extrusion d. Avulsion
a Attrition is the normal or pathological wearing down of the tooth crown resulting from chewing, biting, and/or tooth on tooth. An intrusion occurs when the tooth is pushed apically into the alveolar bone. An extrusion occurs when a tooth is partially dislocated from the alveolar bone. An avulsion occurs when the tooth is completely luxated from the alveolus. Holmstrom SE, "The complete prophy," Veterinary Dentistry: A Team Approach, ed 2, Saunders, 2013, p. 167-193.
Removal of calculus and necrotic cementum from the tooth roots is called: a. Curettage b. Splinting c. Gingivoplasty d. Scaling
a Curettage is the removal of calculus and necrotic cementum from the root surface using a dental curette. A dental curette is an instrument that has a rounded back and a rounded toe to facilitate scaling subgingivally. Splinting is used as a treatment for periodontal disease. Splinting immobilizes a tooth that is mobile because of periodontal disease. Removal of all calculus and granulation tissue subgingivally treats the tooth using an open flap technique. The flap is then sutured closed and the tooth is immobilized during healing by splinting the treated tooth to a healthy tooth using dental acrylic. Gingivoplasty is the surgical recontouring of the gingival surface. This can also be called a gingivectomy, a treatment for gingival hyperplasia. Gingivoplasty is performed to treat gingival hyperplasia if there are no false pockets present. Scaling is the removal of plaque and calculus above the gum line or supragingivally. This procedure is undertaken using power equipment and/or hand instrumentation. Holmstrom SE, Frost P, Eisner ER, "Periodontal therapy and surgery," Veterinary Dental Techniques for the Small Animal Practitioner, ed 3, 2004, p. 233-290.
When assessing and quantifying gingivitis, the modified Löe and Silness index is often used. According to this index, a gingival index 0 indicates: a. Clinically healthy gingiva b. Mild gingivitis with slight reddening and swelling of the gingival margins c. Moderate gingivitis, with gentle probing resulting in bleeding d. Severe gingivitis, in which there is spontaneous hemorrhage and/or ulceration of the gingival margin
a Gingival index 0: Clinically healthy gingiva. Gingival index 1: Mild gingivitis: slight reddening and swelling of the gingival margin; no bleeding on gentle probing of the gingival sulcus. Gingival index 2: Moderate gingivitis: the gingival margin is red and swollen; gentle probing of the gingival sulcus results in bleeding. Gingival index 3: Severe gingivitis: the gingival margin is very swollen with a red or bluish-red color; there is spontaneous hemorrhage and/or ulceration of the gingival margin. Gorrel C, "Oral examination and recording" in Veterinary Dentistry for the General Practitioner, ed 2, Elsevier, 2013, p. 56-66.
The thin film covering a tooth that is composed of bacteria, saliva, and food particles is: a. Plaque b. Attrition c. Calculus d. Abrasion
a Plaque attaches to the biofilm on the tooth surface and is made up of bacteria, salivary glycoproteins, and extracellular polysaccharides. Attrition is the active or passive wear of the tooth surface either by chewing, by biting, or when there is close contact with another tooth. Calculus is mineralized dental plaque. Abrasion is wear to the tooth surface from an outside source such as a toy, cage door, or excessive grooming. Lobprise HB, "Glossary," Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal Dentistry, ed 2, Wiley-Blackwell, 2012, p. 467-482.
What stage of periodontal disease shows no change to the alveolar height but includes mild gingival inflammation? a. Stage I b. Stage II c. Stage III d. Stage IV
a Stage I periodontal disease shows no change to the alveolar height or architecture, but mild gingival inflammation is present. Stage II shows gingival inflammation and sometimes bleeding on probing. There is <25% bone loss or stage I furcation exposure. Stage III shows all of the signs of stage II but with 25%-50% bone loss, stage II furcation exposure, and possibly stage 1 mobility. Stage IV shows all the signs of stage III but with >50% bone loss, stage 3 furcation exposure, and stage II-III mobility. Perrone JR, "Common dental conditions and treatments: periodontal disease," Small Animal Dental Procedures for Veterinary Technicians and Nurses, Wiley-Blackwell, 2013, p. 105-115.
In general, most dental instruments should be held as you would hold a: a. Knife b. Pencil c. Hammer d. Toothbrush
b A modified pen grip is the preferred method of holding dental instruments. This technique involves holding the instrument as you would a pen or a pencil. The instrument should be grasped with a light grip to avoid stress to the hand or wrist. Hold the instrument with the thumb and index finger at the junction of the handle and the shank. The ring finger is allowed to rest on the patient. This creates a triangle of movement. The ring finger provides stability while the movement of the instrument is provided using the thumb and the index finger. Holmstrom SE, "The complete prophy," Veterinary Dentistry: A Team Approach, ed 2, Saunders, 2013, p. 167-193.
What term means the wearing away of enamel by tooth-against-tooth contact during mastication? a. Plaque b. Attrition c. Calculus d. Abrasion
b Attrition is the active or passive wear of the tooth surface either by chewing, by biting, or when there is close contact with another tooth. Plaque attaches to the biofilm on the tooth surface and is made up of bacteria, salivary glycoproteins, and extracellular polysaccharides. Calculus is mineralized dental plaque. Abrasion is wear to the tooth surface from an outside source such as a toy, cage door, or excessive grooming. Lobprise HB, "Glossary," Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal Dentistry, ed 2, Wiley-Blackwell, 2012, p. 467-482.
The normal adult canine mouth has how many permanent teeth? a. 40 b. 42 c. 48 d. 52
b Dogs normally have 42 teeth. Holzman G, "The basics," in Perrone JR, ed, Small Animal Dental Procedures for Veterinary Technicians and Nurses, Wiley-Blackwell, 2013, p. 3-22.
What drug should not be given to pregnant dogs because it may cause discoloration of the puppies' teeth? a. Amoxicillin b. Tetracycline c. Chloramphenicol d. Penicillin
b Enamel staining or intrinsic staining usually occurs secondary to tetracycline exposure of animals at a young age. Tetracycline binds to enamel and dentin, causing a dark yellow discoloration. Amoxicillin is a common antimicrobial given to dental patients either before or before and after periodontal therapy. Chloramphenicol, also an antimicrobial, is used mostly for tickborne illnesses such as Rocky Mountain spotted fever. Penicillin, although still used in veterinary medicine, is usually less preferred than amoxicillin because amoxicillin has fewer side effects. Dupont G, "Pathologies of the dental hard tissues," Niemiec BA, Small Animal Dental, Oral and Maxillofacial Disease, CRC Press, 2010, p. 127-157. http://www.petplace.com/article/drug-library/library/prescription/chloramphenicol-chloromycetin. Accessed 3/6.
Which of the following is a complication that might develop if a curette is used improperly? a. Etched tooth enamel b. Torn epithelial attachment c. Overheated tooth d. Bitten technician
b Excessive force using a dental curette may degrade the epithelial attachment. Another way to cause trauma to the gingival tissue is the improper sharpening of the instrument. It is important when sharpening a curette to sharpen the blade and to maintain the rounded toe. Finally, hold the instrument using the pen grasp and use proper angulation against the tooth surface so the instrument does not slide off the tooth, which could cause trauma. Overheating of the tooth is caused by excessive pressure on the tooth surface with a power scaler or prophy angle because these instruments generate heat. Dental patients need to be under general anesthesia for a dental procedure to allow the use of invasive instruments in the mouth without the risk of bites. McMahon J, "The dental cleaning," in Perrone JR, ed, Small Animal Dental Procedures for Veterinary Technicians and Nurses, Wiley-Blackwell, 2013, p. 59-85.
Prevention of periodontal disease involves all of the following except: a. Daily teeth brushing or mouth rinsing b. Full mouth extractions c. Routine professional scaling and polishing d. Proper diet
b Full-mouth extractions are performed to treat conditions in which patients are hypersensitized to the presence of plaque on the teeth such as stomatitis in dogs and cats. The condition causes inflammation and ulcerations that cause pain. Selective or full-mouth extractions are performed to remove the source of reaction. The only situations in which full-mouth extractions might be viewed as preventative medicine are patients with systemic diseases that make them a possible anesthetic risk. If these patients require extractions of most of their teeth, extractions of the remaining teeth can be performed to prevent the need for further anesthesia and further dental treatment. Lobprise HB, "Extraction technique," Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal Dentistry, ed 2, Wiley-Blackwell, 2012, p. 95-121; Peak M, "Chronic ulceration and chronic ulcerative paradental stomatitis," in Lobprise HB, Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal Dentistry, ed 2. Wiley-Blackwell, 2012, p. 243-250.
When grading furcation involvement, which of the following descriptions would be termed Grade 1? a. There is no furcation involvement. b. The furcation can be felt with the probe/explorer, but horizontal tissue destruction is <⅓ of the horizontal width. c. The furcation can be explored, but the probe cannot pass through it. d. The probe can be passed through the furcation from buccal to palatal/lingual.
b Grade 0: No furcation involvement. Grade 1: Initial furcation involvement: the furcation can be felt with the probe/explorer, but horizontal tissue destruction is less than ⅓ of the horizontal width of the furcation. Grade 2: Partial furcation involvement: it is possible to explore the furcation but the probe/explorer cannot be passed through it; horizontal tissue destruction is >⅓ of the horizontal width of the furcation. Grade 3: Total furcation involvement: the probe/explorer can be passed through the furcation from buccal to palatal/lingual. Gorrel C, "Oral examination and recording," Veterinary Dentistry for the General Practitioner, ed 2, Elsevier, 2013, p. 56-66.
Gingivoplasty is the: a. Addition of more gingiva to the site b. Binding of the loose teeth together to stabilize them during a healing process c. Removal of hyperplastic gingival tissue d. Removal of a portion of the tooth structure
c Gingivoplasty is the surgical contouring of the gingival tissues. This is performed to maintain tissue health and integrity. The suffix -plasty means formation or plastic repair. Gingival hyperplasia is treated using this method. Gingival hyperplasia is the excess growth of gingival tissue, causing a false pocket around the cementoenamel junction. Another condition for which gingivoplasty is performed is the suprabony pocket. The presence of a suprabony pocket means that the alveolar bone crest has decreased because of disease and will also cause a false pocket. The diseased gingiva is removed to eliminate suprabony pockets. The addition of more gingiva to a site is accomplished by performing flap surgery in which local gingiva is moved to cover a defect such as an oronasal fistula. If there are any exposed areas after the gingiva is removed, the tissue will granulate. The binding of loose teeth for stabilization is called periodontal splinting. Mosby's Dental Dictionary, ed 2, Mosby, 2008; Gorrel C, "Emergencies," Veterinary Dentistry for the General Practitioner, ed 1, 2004, Saunders, p. 131-155; Holmstrom SE, Frost P, Eisner ER, "Periodontal therapy and surgery," Veterinary Dental Techniques for the Small Animal Practitioner, ed 3, 2004, p. 233-290.
When grading tooth mobility, which of the following grades corresponds to a Grade 2? a. No mobility b. Horizontal movement of <1 mm c. Horizontal movement >1 mm d. Vertical and horizontal movement
c Grade 0: No mobility. Grade 1: Horizontal movement of ≤1 mm. Grade 2: Horizontal movement of >1 mm. Note that multi-rooted teeth are scored more severely and a horizontal mobility in excess of 1 mm is usually considered a Grade 3 even in the absence of vertical movement. Grade 3: Vertical as well as horizontal movement is possible. Gorrel C, "Oral examination and recording" in Veterinary Dentistry for the General Practitioner, ed 2, Elsevier, 2013, p. 56-66.
Which statement concerning the polishing aspect of dental prophylaxis is the least accurate? a. A slow speed should be used. b. Adequate prophy paste is needed for lubrication and polishing. c. The polisher should remain on the tooth for as long as is needed to polish the tooth. d. If teeth are not polished, the rough enamel will promote bacterial plaque formation.
c Prolonged application and/or excessive downward pressure of the prophy angle longer than 3-5 seconds on a tooth can cause overheating of the pulp, which could lead to pulpal death. When using the prophy angle, use a soft prophy cup and gently flange the edges of the cup to allow it to reach just under the gum line. McMahon J, "The dental cleaning," in Perrone JR, ed, Small Animal Dental Procedures for Veterinary Technicians and Nurses, Wiley-Blackwell, 2013, p. 59-85.
All of the following are complications that may result from extraction except: a. Hemorrhage b. Jaw fracture c. Stomatitis d. Oronasal fistula
c Stomatitis is not a complication of extraction. Extraction is performed as a treatment for stomatitis. Hemorrhage, jaw fracture, and oronasal fistulas are common complications. Clotting defects may not be apparent until after extraction. Advanced periodontal disease around the mandibular teeth will weaken the mandible itself. Advanced periodontal disease destroys the medial bony wall of the alveolus, resulting in an oral nasal fistula. Gorrel C, "Emergencies;" Veterinary Dentistry for the General Practitioner, ed 2, Elsevier, 2013, p. 141-170.
Between patients, it is best to maintain instruments in the following order: a. Use, sharpen, wash, and sterilize b. Use, wash, sterilize, and sharpen c. Use, wash, sharpen, and sterilize d. Wash, sterilize, use, and sharpen
c The steps for cleaning and care of dental hand instruments are: (1) After the procedure, the instrument should be washed in disinfectant. (2) The instrument should be dried. (3) The instrument should be sharpened. (4) The instrument should be sterilized. Holmstrom SE, Frost P, Eisner ER, "Dental equipment and care," Veterinary Dental Techniques for the Small Animal Practitioner, ed 2, Saunders, 1998, p. 31-106.
Which of the following correctly describes the puppy dental formula? a. 2 × {I 2/1:C 0/0:P 3/2:M 3/3} b. 2 × {I 3/3:C 1/1:P 4/4:M 2/3} c. 2 × {I 3/3:C 1/1:P 3/2:M 1/1} d. 2 × {I 3/3:C 1/1:P 3/3}
d 2 × {I 2/1:C 0/0:P 3/2:M 3/3} is the rabbit formula, 2 × {I 3/3:C 1/1:P 4/4:M 2/3} is the permanent formula for dogs, 2 × I 3/3:C 1/1:P 3/2:M 1/1} is the permanent formula for cats. 2 × {I 3/3:C 1/1:P 3/3} is the primary formula for puppies. Gorrel C, "Oral examination and recording" in Veterinary Dentistry for the General Practitioner, ed 2, Elsevier, 2013, p. 56-66.
What term identifies the loss of tooth structure by an outside cause? a. Plaque b. Attrition c. Calculus d. Abrasion
d Abrasion is wear to the tooth surface from an outside source such as a toy, cage door, or excessive grooming. Plaque attaches to the biofilm on the tooth surface and is made up of bacteria, salivary glycoproteins, and extracellular polysaccharides. Attrition is the active or passive wear of the tooth surface either by chewing, by biting, or when there is close contact with another tooth. Calculus is mineralized dental plaque. Lobprise HB, "Glossary," Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal Dentistry, ed 2, Wiley-Blackwell, 2012, p. 467-482.
Dry socket is more likely to occur if: a. An increased blood supply to the area is ensured. b. Good surgical technique is practiced. c. A blood clot is allowed to form to encourage fibroblasts. d. The tooth socket is overirrigated so that no clot can form.
d Dry socket or alveolar osteitis is a painful postoperative complication of extraction. It occurs mostly in humans but has occurred in dogs. It is thought to be a combination of trauma induced by the procedure, infection, loss of the primary clot, or a decreased blood supply to the alveolus. Palliative irrigation and pain management are used to treat this condition. Wiggs RB, Lobprise HB, "Oral surgery," in Veterinary Dentistry: Principles and Practices, Lippincott-Raven, 1997, p. 232-258.
To prep a patient for surgical tooth extraction, which of the following should occur? a. No prep is needed. It is best to extract, and then to clean the remaining teeth (this is a more efficient process, yielding a shorter anesthesia time). b. Rinse the mouth with chlorhexidine, then extract. c. Scale, polish, then extract. d. Scale, polish, rinse with chlorhexidine, then extract.
d Extraction of teeth is a surgical procedure. Although it is not possible to achieve a sterile environment in the oral cavity, the mouth should be clean before extraction is performed. All teeth should be scaled and polished and the mouth should be rinsed with a chlorhexidine solution. Gorrel C, "Tooth extraction," Veterinary Dentistry for the General Practitioner, ed 2, Elsevier, 2013, p. 171-191.
What is the most common dental disease found in dogs and cats? a. Endodontic disease b. Oral tumors c. Jaw fractures d. Periodontal disease
d Grade 1 periodontal disease is among the top 10 diagnoses in dogs and gingivitis is the top 10 diagnoses in cats. Banfield State of Pet Health 2011 Report http://www.banfield.com/getmedia/89cdf49c-67e7-41ba-865a-c2d6ab123720/State_of_Pet_Health_2011.pdf. Accessed 3.31.2015.
When performing a dental prophylaxis, minimal safety equipment includes: a. Gloves only b. Gloves and mask only c. Safety glasses only d. Safety glasses, mask, and gloves
d OSHA requires that veterinary employers provide hats, gloves, masks, and eye protection to members of staff who perform dental procedures. Dental procedures can aerosolize debris and oral bacteria, which could cause infection. Employees must take responsibility for their own safety by wearing said equipment. Holmstrom SE, Frost P, Eisner ER, "Personal safety and ergonomics," Veterinary Dental Techniques for the Small Animal Practitioner, ed 2, Saunders, 1998, p. 117-134; Cherry B, "Components of the dental operatory," in Perrone JR, ed, Small Animal Dental Procedures for Veterinary Technicians and Nurses, 2013, p. 29-44.
Ideally, the cutting edge of the scaler should be held at what angle to the tooth surface? a. 5-10 degrees b. 35-45 degrees c. 15-30 degrees d. 45-90 degrees
d When using a hand scaler, the blade angle ranges from 45 to 90 degrees depending on the job being performed and on the area of the tooth involved. When scaling developmental grooves where the tip of the instrument is used, a 45-degree angle is used. When scaling the interdental spaces, a 70-80-degree angle is used. When scaling the buccal or lingual/palatal aspects of the crown, the angle can go as high as 90 degrees. Miltex Veterinary Dental Prophylaxis and Periodontal Procedure for Routine Treatment. Package insert SH-6809C.
