Zuku: Dentistry

Answer is E: Dogs should have 42 teeth by 7 months of age. Ruminants have 32 by 4 years, horses 36-44 by 5 years, cats 30 by 7 months, and pigs 44 by 20 months. Eruption times used to estimate ages are important to study--follow this link to a Merck Manual tooth eruption table.

By what age should a dog have all its permanent teeth, and how many teeth are in the canine adult dental formula? (A) 32 by 4 years (B) 36-44 by 5 years (C) 44 by 20 months (D) 30 by 7 months (E) 42 by 7 months

Answer is E: This is a normal finding. Further evaluation should be performed to determine the source of the weight loss and intermittent diarrhea in this cow. Ruminants do not have upper incisors and instead have a dental pad.

During a farm call, the vet asks you to evaluate a 5-year-old dairy cow that has been losing weight and having some intermittent diarrhea in spite of a good appetite. A brief oral examination reveals that there are no upper incisors. What should the owner be told? (A) This is very common abnormality in older cows; periodontal disease should be treated with parenteral antibiotics (B) This cow cannot properly chew food; should be culled (C) This cow has had significant oral trauma; radiographs are necessary (D) This cow cannot properly chew food; should be fed chopped silage (E) Normal finding; continue exam for source of weight loss

Answer is D: Normal depth of the gingival sulcus in cats is less than 1 mm, in dogs 1-3 mm. The gingival sulcus is the crevice between the tooth and the gumline where plaque collects. It is important to know that this crevice is not very deep in normal cats when you are cleaning teeth.

Normal gingival sulcus in a cat is? (A) 1-3 mm (B) 2-5 mm (C) 4-6 mm (D) 0.5-1 mm

Answer is A: The dog will likely be started on corticosteroids. Masticatory myositis is an immune-mediated disease. If caught in the acute phase, long-term immunosuppressive doses of steroids can lead to resolution. Once chronic, there is muscle atrophy and severe scar tissue within the muscle. Chronic cases respond poorly to treatment. Muscle and serum samples are sent to a neuromuscular lab for antibody analysis to confirm the diagnosis.

A 5-year-old male neutered retriever mix presents with a recent history of poor appetite and dropping food. He is very painful when you try to open his mouth and there is periorbital swelling. It is suspected that he has masticatory myositis. What specific treatment do you expect the vet will start him on while awaiting confirmatory results from the lab? (A) Corticosteroids (B) Omega-3 fatty acids (C) Aspirin or Ibuprofen group NSAIDs (D) Broad-spectrum antibiotics (E) There is no treatment

Answer is A: It is best to remove the retained deciduous tooth as soon as possible to prevent periodontal disease, malocclusion, and trauma to the lips. Since it does not feel loose, an open approach is recommended, as root fracture and retained root tips are possible complications.

A 6 month old mixed breed dog is presented with a retained deciduous canine tooth. It does not feel loose. Which one of the following choices is the best recommendation? (A) Remove the tooth now using an open approach (B) Any of these will be fine (C) Wait until the dog is at least a year old then remove the tooth (D) Tie a suture to the tooth and pull hard (E) Leave it alone, it is too early to tell if it won't fall out on its own

Answer is A: The vet is likely to recommend a cerclage wire behind the canine teeth for 4 weeks. Mandibular symphyseal separation is the most common type of jaw fracture in cats and dogs. A cerclage wire placed behind the canine teeth for 4 weeks can provide stability while the symphysis heals. Tape muzzles can be useful to stabilize acute mandibular fractures prior to surgical fixation OR in very young patients in which rigid fixation might inhibit mandibular growth.

A 7-year-old female spayed Persian cat fell out of the window of her owner's 3rd floor apartment. A mandibular symphyseal separation is diagnosed. What treatment is the vet likely to recommend? (A) Cerclage wire behind canine teeth for 4 weeks (B) A tape muzzle for 2 weeks (C) Plate and screw fixation (D) No treatment needed; offer only soft foods for 6 weeks (E) Acrylic bonding of maxillary 104, 204 and mandibular 304, 404

Answer is A: She should have the mouth evaluated ASAP because of likely pulp exposure. Dogs are prone to tooth fractures because of how they play. Canines and the 4th maxillary premolar teeth are the most commonly fractured. Hemorrhage may be noted with acute fractures in which there is pulp exposure. Vital pulp therapy may be able to save the tooth if it is initiated within the first 48 hours. Periapical abscesses can develop if left untreated. Conventional root canals or tooth extraction are the necessary treatment for this development. All the teeth should be permanent tooth in a 2-year-old dog.

A client calls because her 2-year-old male neutered Labrador retriever was playing in the back yard and came in with blood dripping from the mouth. She thinks it is coming from one of the teeth. What do you tell her (A) Have mouth evaluated ASAP, likely pulp exposure (B) Schedule appointment for tooth extraction (C) This is not a problem because it's a deciduous tooth (D) Rinse mouth with water, bring into clinic if still bleeding (E) Rinse mouth with water, bring into clinic if still bleedingMonitor closely for any swelling or discomfort

Answer is D: It does not matter that this is a baboon- this is gingival hyperplasia between the lower incisors. The treatment of choice is to remove the hyperplastic gingiva. Hyperplastic gingiva can be idiopathic or medication induced (cyclosporine, anticonvulsants).

A five-year-old baboon is presented for an oral examination. If there is a problem here, what is it? (A) Displacement and possible abscess of lower incisors (B) Displacement and possible abscess of lower left canine (behind tubing) (C) Recessed gums (D) Gingival hyperplasia (E) This is normal in mature-adult primates

Answer is C: Lower left canine. There are two slightly different tooth numbering systems, the anatomical and the Triadan systems, but they both number the canines and incisors the same way. The upper right canine is 104. The lower right canine is 404. The upper left canine is 204. The lower left canine is 304. The first upper left premolar is 205.

After a routine spay, the vet asks you to clean up a cat's teeth, with special attention to tooth 304. Which tooth is that? (A) Upper left canine (B) Lower right canine (C) Lower left canine (D) Upper right canine

Answer is E: Conventional root canals can be performed on dogs and cats over 12 months of age. This procedure involves removing any dying or dead pulp tissue, disinfecting the root canal, shaping the root canal, and filling the canal to seal the apex.

After what age can conventional root canals be performed on dogs and cats with endodontic disease? (A) 6 months (B) 9 months (C) 15 months (D) 18 months (E) 12 months

Answer is D: Triangular, more acute. When equine incisors first erupt, their occlusal surfaces are elliptical, then subsequently become trapezoid, round, and then triangular with the apex toward the lingual side. Click here to see the incisors of a 6 year-old horse. The angle between the upper and lower incisors also becomes more acute with age. Click here to see a diagram of equine dentition.

As horses age, the occlusal surfaces of the incisors become more ____________ and the angle between the upper and lower incisors becomes ______________. (A) Elliptical, less acute (B) Elliptical, more acute (C) Triangular, less acute (D) Triangular, more acute (E) Elliptical, closer to 90 degrees

Answer is E: This is a trick question, but one you should know: Cows and other ruminants do NOT HAVE UPPER INCISORS- They have a thick dental pad, against which the lower incisors pull and cut forage. Follow this link to a ruminant dental formula from Merck. Follow this link to a Merck Manual tooth eruption table.

At what age do a cow's first permanent upper incisor teeth (I1) begin to erupt? (A) 1 year (B) 4 years (C) 3 years (D) 2 years (E) Cows don't have upper incisor teeth

Answer is B: 5-6 months of age Eruption of the teeth. Remember that wolf teeth are little first premolars in the upper jaw (maxilla) that sometimes get removed because they interfere with a bit around 12-18 mos. Follow this link to see pictures of Equine dental anatomy

At what age do wolf teeth are normally erupt in horses? (A) 4-5 years of age (B) 5-6 months of age (C) 9-12 months of age (D) Does not erupt

Answer is C: The ultrasonic scaler tip should be angulated at 0-15 degrees from the long axis of the tooth. A 90-degree angle will damage the tooth enamel.

At what angle should the ultrasonic scaler tip be directed in relation to the long axis of a dog or cat's tooth in order to perform periodontal debridement? (A) It does not matter (B) 45-70 degrees (C) 0-15 degrees (D) 70-90 degrees (E) 15-45 degrees

Answer is B: Dental caries (cavities) are UNcommon in dogs and RARE in cats. This may be due to differences from humans in oral flora and diets that are mostly free of easily fermentable carbohydrates (ie: pets don't drink soda pop every day). Also, dogs have slightly alkaline saliva. In cats there is a poorly understood problem called Feline odontoclastic resorptive lesions, (FORL, or "neck lesions") where tooth material is resorbed around the "neck" of a tooth. Possibly infectious, but the actual cause is not yet known. Follow these links to see a radiograph of a severe neck lesion and a photo of the same tooth.

How common are dental caries (cavities) in cats? (A) Seen in 85% of adults older than 5 years (B) Rare (C) Seen in 25% of adults older than 5 years (D) Common

Answer is A: Dental caries (cavities) are UNcommon in dogs and RARE in cats. This may be due to differences from humans in oral flora and diets that are mostly free of easily fermentable carbohydrates (ie: pets don't drink soda pop every day). Also, dogs have slightly alkaline saliva. In cats there is a poorly understood problem called Feline odontoclastic resorptive lesions, (FORL, or "neck lesions") where tooth material is resorbed around the "neck" of a tooth. Possibly infectious, but the actual cause is not yet known. Follow these links to see a radiograph of a severe neck lesion and a photo of the same tooth.

How common are dental caries (cavities) in dogs? (A) Uncommon (B) Seen in 75% of adults older than 5 years (C) Common (D) Seen in 35% of adults older than 5 years

Answer is A: A dental explorer will "fall into a hole" where there is pulp exposure. Conversely, it will slide smoothly over an area with tertiary dentin and discoloration. It is critical to distinguish between these two conditions because treatment of the former is usually necessary

How do you distinguish between pulp exposure and tertiary dentin in a tooth of a dog or cat? (A) Dental explorer (B) Oral radiographs (C) It is not possible to distinguish (D) Scaler (E) Periodontal probe

Answer is E: Alginate sets in about 5 minutes from when mixing is initiated. Using cold water increases this time interval and using warm water decreases it.

How long does it typically take alginate impression material to set when making a dental impression, and what can affect the set time? (A) 3 minutes; longer with ice water (B) 5 minutes; longer with warm water (C) 10 minutes; water temperature has no effect (D) 3 minutes; longer with hot water (E) 5 minutes; longer with cold water

Answer is A: Ruminants (cows, sheep, goats) are in the middle between cats and dogs with 32. In cats there are 30 permanent teeth. Dogs have 42 permanent teeth. Food-loving pigs have the most teeth at 44. Horses vary by age between 24-42.

How many permanent teeth are found in a normal adult cow (A) 32 (B) 42 (C) 40 (D) 30

Answer is A: Ruminants (cows, sheep, goats) are in the middle between cats and dogs with 32. In cats there are 30 permanent teeth. Dogs have 42 permanent teeth. Food-loving pigs have the most teeth at 44. Horses vary by age between 24-42. Follow these links to see a diagram of normal sheep and goat dentition and a Dental formula table for large and small animals.

How many permanent teeth are found in a normal adult goat? (A) 32 (B) 40 (C) 30 (D) 42

Answer is B: Adult horses vary between 36 and 44 permanent teeth, depending upon whether they have canines and/or wolf teeth. Cats have 30 permanent teeth. Ruminants are in the middle between cats and dogs with 32. Dogs have 42 permanent teeth. Food-loving pigs have the most teeth at 44.

How many permanent teeth are found in a normal horse? (A) 28-48 (B) 36-44 (C) 20-30 (D) 28-32

Answer is B: Food-loving pigs have the most teeth at 44. In cats there are 30 permanent teeth. Ruminants are in the middle between cats and dogs with 32. Dogs have 42 permanent teeth. Horses vary by age between 24-42. Follow these links to see a diagram of normal pig dentition and a Dental formula table for large and small animals.

How many permanent teeth are found in a normal pig? (A) 32 (B) 42 (C) 44 (D) 48

Answer is A: In cats there are 30 permanent teeth. Ruminants are in the middle with 32. Dogs have 42 permanent teeth. Food-loving pigs have the most teeth at 44. Horses vary by age between 24-42.

How many permanent teeth are found in normal cats? (A) 30 (B) 32 (C) 42 (D) 40

Answer is B: Dogs have 42 permanent teeth. In cats there are 30 permanent teeth. Ruminants are in the middle between cats and dogs with 32. Food-loving pigs have the most teeth at 44. Horses vary by age between 24-42.

How many permanent teeth are found in normal dog? (A) 44 (B) 42 (C) 30 (D) 32

Answer is B: Radiographs should be used to evaluate endodontic work at least once yearly. In addition, a good history should be taken to help determine how the animal damaged the affected tooth in the first place. Animals should be denied access to inappropriate chew toys to minimize the risk of future tooth damage.

How often should endodontically treated teeth in dogs and cats be re-evaluated? (A) Every 2 years (B) Once yearly (C) In 3 months, then annually (D) It's unnecessary (E) Every 6 months

Answer is A: Llamas and alpacas have "fighting teeth"; i.e., the upper 3rd incisor and upper and lower canine teeth, which can grow to over 3 cm in length and cause severe trauma. These are usually ground down or removed upon eruption at 18-24 months. Anesthesia should be used for this procedure as it is quite painful. It must be repeated at intervals as these teeth continue to grow. When only the tips are cut off, this can be done without anesthesia and may be performed by the breeder. When the crown is removed, the root will be exposed. The stub of the crown can be covered with a gingival flap. However, this is not commonly done and complications are rarely seen. The canine teeth can also be completely extracted under general anesthesia. This is a fairly extensive procedure and is not often performed. Canine teeth in females are poorly developed. After castration, the canines of males will stop growing.

In what animals are the "fighting teeth" (i.e., upper and lower canines) routinely ground down as needed in intact males? (A) Llamas (B) Horses (C) Cattle (D) Cats (E) Dogs

Answer is B: Horses have hypsodont dentition, so age can be estimated pretty accurately by tooth eruption time and then the appearance of the lower incisors as the horses age. Dogs and pigs have brachydont dentition, and cows have hypsodont dentition. Age determination by tooth eruption is less accurate in these species.

In which animal can age be best estimated by tooth eruption times? (A) Cats (B) Horses (C) Cattle (D) Pigs (E) Dogs

Answer is D: This dog has prognathia (under-bite), which is considered normal in brachycephalic dogs. The mandible is longer than the maxilla

In which breeds is the problem seen here considered to be normal? (A) Toy breeds (B) None. This is always abnormal (C) Collies (D) Brachycephalics (E) Chondrodystrophics

Answer is C: The roots of the four caudal maxillary cheek teeth (4th premolar; 1st, 2nd, and 3rd molar) extend into the ventral aspect of the maxillary sinuses. Sinusitis can develop secondary to infection of these teeth. Sinusitis secondary to tooth root abscess often necessitates tooth extraction and sinus lavage for permanent resolution.

Infection of the roots of which teeth in a horse can lead to sinusitis and chronic unilateral nasal discharge? (A) The rostral 2 mandibular molars (B) The central upper and lower incisors (C) The caudal 4 maxillary cheek teeth (D) The upper wolf teeth (E) None can do this

Answer is A: Curettes are designed for subgingival scaling. They can also be used for supragingival scaling and root planing. Sickle scalers were designed for use on the tooth crown. The shank of an instrument extends from the handle to the working end. Straight-shanked instruments are designed to scale teeth in the rostral aspect of the mouth. Bent-shanked instruments are designed to scale teeth in the caudal aspect of the mouth.

Match the instrument with its most correct use: (A) Curette and subgingival scaling (B) Sickle scaler and subgingival scaling (C) Straight-shanked instrument and molar (D) Bent-shanked instrument and incisors (E) Periodontal probe and crown

Answer is D: Gingivitis is inflammation of the gums. Look for reddening at the base of the teeth. Follow these links to see gingivitis in a dog .

The veterinarian assigns you a dog with a case of gingivitis. What is the health problem? (A) Inflamed eyes (B) Tooth root infection (C) Epiglottal inflammation (D) Inflamed gums

Answer is C: Piezoelectric scalers are the least traumatic. Sonic dental scalers do not build up heat like the other 2 kinds of scalers. In order to avoid overheating or pitting damage to the tooth and enamel, do not apply ultrasonic scalers more than 5 sec. This is a general rule, and may depend on the kind of machine you use.

There are three kinds of ultrasonic scaler: magnetorestrictive, piezoelectric and sonic. What is the advantage of a piezoelectric scaler over the other two kinds? (A) Quieter (B) QuieterNo heat build-up (C) Least traumatic (D) No pitting of enamel

Answer is A: Sonic dental scalers do NOT build up heat like the other 2 kinds of scalers. Piezoelectric scalers are the least traumatic. In order to avoid overheating or pitting damage to the tooth and enamel, do not apply ultrasonic scalers more than 5 sec. This is a general rule, and may depend on the kind of machine you use.

There are three kinds of ultrasonic scaler: magnetorestrictive, piezoelectric and sonic. What is the advantage of a sonic scaler over the other two kinds? (A) No heat build-up (B) No pitting of enamel (C) It is the easiest one to spell (D) Least traumatic

Answer is B: According to the modified Triadan system, tooth 109 (first molar) erupts between 9-12 months and is the first permanent tooth to erupt in the 100 arcade. Tooth 105 (the wolf tooth) erupts sooner, but it is a premolar. Click here to see a diagram of equine dentition

This tooth is the first permanent molar to erupt in the horse's 100 arcade (right maxilla, as numbered by the modified Triadan system): (A) 105 (B) 109 (C) 107 (D) 106 (E) 103

Answer is D: This is Stage 1 (M1). The Mobility Scoring Index goes from 0 to 3 (M0 to M3). Stage 0 is normal physiologic mobility up to 0.2 mm. Stage 1 is 0.2-0.5 mm, Stage 2 is 0.5-1.0 mm, and Stage 3 is >1.0 mm in any direction other than axial.

Using the Mobility Scoring Index, how would you score a tooth with mobility that was increased between 0.2 and 0.5 mm in any direction other than axial? (A) Stage 3 (M3) (B) Stage 4 (M4) (C) Stage 2 (M2) (D) Stage 1 (M1) (E) Stage 0 (M0)

Answer is A: The right maxillary quadrant is the 100-series, the left maxillary quadrant is the 200-series, the left mandibular quadrant is the 300-series, and the right mandibular quadrant is the 400-series. The Triadan numbering system is used in veterinary medicine as a universal way to rapidly and consistently identify teeth in all species. Each tooth has a 3-digit number that starts at -01 increases as you move caudally. For example, the first right maxillary incisor is 101 and the left mandibular canine is 304.

Using the Triadan system for numbering teeth, which quadrant of teeth is the 100-series? (A) Right maxillary quadrant (B) Right mandibular quadrant (C) Left mandibular quadrant (D) Left maxillary quadrant (E) This system is not used in veterinary medicine

Answer is E: These markings denote the maxillary sinus, which is commonly affected by sinusitis. In horses, sinusitis is most often due to tooth root infections, since the roots of the four caudal-most cheek teeth extend into the maxillary sinus cavity. Horses have six pairs of paranasal sinuses. Clinical signs of sinusitis include unilateral mucopurulent or bloody nasal discharge (often malodorous if associated with a tooth root infection) and facial deformity. Dx: Skull radiographs, sinoscopy, additional imaging modalities (e.g., CT or MRI). Rx: Trephination and lavage of the sinus cavity with systemic antimicrobial therapy. If sinusitis is secondary to a confirmed tooth root infection or mass (e.g., cyst) within the sinus, sinus flap with tooth repulsion or removal of abnormal material is indicated. Ethmoid hematomas are less commonly found in the paranasal sinuses than in the nasal passages but can be found in the conchofrontal sinus. Rx: Either intralesional injection of formalin or surgical excision via a frontal bone flap. Nasofrontal suture periostitis (or exostosis) is characterized by bony, nonpainful swelling over the nasofrontal suture, thought to be secondary to trauma. Rx: topical and systemic antiinflammatories, time.

What condition commonly occurs in this demarcated area that can be treated with trephination and lavage? (A) Guttural pouch empyema (B) Blocked nasolacrimal duct (C) Conchofrontal ethmoid hematoma (D) Nasofrontal suture periostitis (E) Maxillary sinusitis

Answer is E: Extraction forceps are best to remove teeth or heavy calculus. A hand scaler can be used to remove supragingival calculus and a curette for subgingival calculus. Ultrasonic scaler is used to remove light to moderate calculus above the gum line.

What dental instrument is best to remove heavy calculus? (A) Subgingival elevator (B) Forklift (C) Hand scaler (D) Ultrasonic scaler (E) Extraction forceps

Answer is D: The bisecting radiograph technique minimizes the image distortion that occurs because of an inability to place x-ray film parallel to the central axis of a tooth. If you do not use the bisecting angle technique, a tooth may appear artificially foreshortened or elongated. The bisecting radiograph technique for generally preferred for maxillary teeth and mandibular canines and incisors (the rostral mandibular teeth). Bisecting radiograph technique minimizes the image distortion that occurs because of an inability to place x-ray film parallel to the central axis of a tooth. If you do not use the bisecting angle technique, a tooth may appear artificially foreshortened or elongated.

What image problems are avoided with proper bisecting radiograph technique of teeth? (A) Increased scatter (B) Decreased contrast (C) Overlap of soft tissue (D) Elongation

Answer is B: An epulis (plural = epulides) is a general term for a gingival mass. In the veterinary nomenclature, a Canine ameloblastoma (formerly called acanthomatous epulis) is the most common benign oral tumor of dogs. Ameloblastomas are tumors of the peridontal ligament that often aggressively invade local tissues, including bone, but generally do not metastasize. Surgical excision is curative but must include a full 1-cm margin of clinically normal tissue (including bone and teeth) to prevent recurrence. Dogs with large tumors may benefit from radiation treatment to minimize disfigurement.

What is an epulis? (A) Intestinal polyp (B) Gingival mass (C) Ear tumor (D) Nasal diverticulum (E) Nonfunctioning teat

Answer is D: Dental calculus is mineralized plaque. Plaque is the whitish-yellow film that accumulates in the gingival sulcus (the cleft between the gums and the tooth), and is made up of food debris, saliva glycoproteins, exfoliated cells and bacteria. As time goes by, plaque builds up and then mineralizes into calculus.

What is dental calculus made of? (A) Chewed up math homework (B) Sloughed tooth fragments (C) Calcified food debris (D) Mineralized plaque

Answer is B: Doxycycline is the most popular antibiotic for this purpose, and it is sold in a pre-mixed combination with a slowly absorbable polymer. It is a broad-spectrum antimicrobial that also has anti-inflammatory effects. The polymer fills the pocket, preventing further food accumulation and allowing the pocket to heal from the most apical site in a coronal direction. There is a similar product made with clindamycin.

What is the antibiotic of choice for packing freshly debrided periodontal pockets in small animals? (A) Trimethoprim-sulfa (B) Doxycycline (C) Ampicillin (D) AmpicillinMetronidazole (E) Enrofloxacin

Answer is C: Normal depth of the gingival sulcus in cats is less than 1 mm, in dogs 1-3 mm. The gingival sulcus is the crevice between the tooth and the gumline where plaque collects. It is important to know that this crevice is not very deep in normal cats when you are cleaning teeth.

What is the depth of the gingival sulcus in normal dogs? (A) 4-7 mm (B) 0.5-1 mm (C) 1-3 mm (D) Normal dogs do not have a gingival sulcus

Answer is C: Molars grind food. Incisors are for cutting, nibbling food. Canines grip and tear food.

What is the function of molar teeth? (A) Cutting (B) Holding (C) Grinding (D) Nibbling

Answer is D: The main concern regarding dental malocclusion in dogs and cats is pain from soft tissue impingement. Aesthetics may be of concern in some cases. There is no known association between malocclusion and caries or periodontal disease.

What is the main concern regarding dental malocclusion in dogs and cats? (A) Increased risk of dental caries (B) Increased risk of periodontal disease (C) Poor aesthetics (D) Pain from soft tissue impingement (E) There is no reason for concern

Answer is A: In order to avoid overheating or pitting damage to the tooth and enamel, do not apply ultrasonic scalers more than 5 sec. This is a general rule, and may depend on the kind of machine you use. There are three kinds ultrasonic scalers. Magnetorestrictive, piezoelectric and sonic. One advantage of sonic units is that they do NOT build up heat like the other 2 kinds of scalers. Piezoelectric scalers are the least traumatic.

What is the maximum time an ultrasonic scaler should be applied on each tooth? (A) 5 sec (B) 30 sec (C) 10 sec (D) 3 min

Answer is A: Lymphocytic-plasmacytic stomatitis in cats is most often immune-mediated. Cats' immune systems may over-react to plaque accumulation. While many cats with this disorder do shed herpesvirus and calicivirus, they are not thought to be causative. The other answers listed can cause stomatitis, but not as commonly. Therapy may include increased home care and frequent dental cleanings, immunosuppressive therapy, or full-mouth tooth extraction

What is the most common cause of lymphocytic-plasmacytic stomatitis in cats? (A) Immune-mediated (B) Uremic toxicosis (C) Foreign body (D) Reaction to a drug (E) Viral exposure

Answer is C: Squamous cell carcinoma is by far the most common oral malignant tumor in cats and second most common in dogs. You can never tell simply by looking at the animal what kind of growth it may be. It takes a biopsy to confirm the diagnosis. Follow this link to see a Squamous cell carcinoma. Malignant melanoma is the most common oral malignant tumor in dogs. Follow this link to see a malignant melanoma on a dog's lip and a cat's radiograph of malignant melanoma. (note the jaw bone and teeth are dissolved away!)

What is the most common malignant oral tumor in cats? (A) Fibrosarcoma (B) Osteosarcoma (C) Squamous cell carcinoma (D) Melanoma

Answer is D: Malignant melanoma is the most common oral malignant tumor in dogs, but you can never tell simply by looking at the animal what kind of growth it may be. It takes a biopsy to confirm the diagnosis. Follow this link to see a malignant melanoma on a dog's lip and a cat's radiograph of malignant melanoma. (note the jaw bone and teeth are dissolved away!) Squamous cell carcinoma is by far the most common oral malignant tumor in cats and second most common in dog

What is the most common malignant oral tumor in dogs? (A) Squamous cell carcinoma (B) Osteosarcoma (C) Fibrosarcoma (D) Melanoma

Answer is C: The cervical part of the tooth where the crown meets the root (also known as the neck) is the most common location. Tooth resorption occurs in up to 70% of cats. These lesions may begin at the root, and can often be seen radiographically before they can be seen clinically. This condition may be associated with vitamin D levels in cat food.

What is the most common site of feline tooth resorption? (A) Root surface (B) Occlusal crown (C) Cervical region (D) Does not occur in cats (E) Apex

Answer is C: Sodium hypochlorite is the most common irrigant because it is a good disinfectant and can break down organic matter such as pulp. However, it can be irritating to the soft tissues so contact with soft tissues and forceful irrigation should be avoided.

What is the most common solution to use as an irrigator during a root canal in a dog or cat? (A) Hydrogen peroxide (B) 0.12% chlorhexidine (C) Sodium hypochlorite (D) 1.0% povidone iodine (E) Lactated Ringer's solution

Answer is A: Polishing smooths down small pits and scratches left after scaling procedure and from routine chewing. Polishing slows the return of plaque, by decreasing the available surface area created by scratches.

What is the most important reason to polish an animal's teeth after a dental cleaning? (A) Smooth small scratches on the tooth surface (B) Remove big pieces of calculus (C) Scale tooth roots (D) Scale tooth rootsScale the crowns of the teeth

Answer is A: There are two slightly different tooth numbering systems, the anatomical and the Triadan systems, but they both number the canines and incisors the same way. The upper right canine is 104. The lower right canine is 404. The upper left canine is 204. The lower left canine is 304. The first upper left premolar is 205.

What is the numerical classification for the canine tooth in the right maxilla in dog? (A) 104 (B) 205 (C) 404 (D) 305

Answer is A: The peridontium is another name for all the structures that SUPPORT a tooth. These include the gums, the tooth root cementum, the periodontal ligament and the alveolar bone of the jaw to which the ligaments attaches.

What is the peridontium? (A) The structures that support the tooth (B) The part of the teeth below the gumline (C) The periodontal ligament and alveolar bone beneath it (D) The part of the teeth visible above the gumline

Answer is B: This is dental plaque. Plaque can mineralize within 24 hours and form dental calculus (also known as "tartar"). Calculus is yellow to light brown, raised, and adhered to the teeth surfaces and roots. Cementum is a hard normal tissue that covers the root of brachyodont teeth and some of the crowns of hypsodont teeth. Caries are tooth decay.

What is the white-tan substance, composed of bacteria, food, cells, and salivary glycoproteins, that accumulates around and within the gingival sulcus? (A) Calculus (B) Plaque (C) Cementum (D) Tartar (E) Caries

Answer is D: This is malocclusion of the incisors and they need to be carefully trimmed. Malocclusion is a common problem in animals whose teeth grow continuously throughout life, like rabbits and small rodents. Dental trimming in rabbits is done under anesthesia with bone or wire cutters, or with a grinding tool or dental burr (safer). Dental trimming in small rodents like mice, hamsters and gerbils can often be done with nail clippers or small scissors.

What is wrong with this rabbit? (A) Broken mandible, poorly healed (B) Chronic calcium-phosphorus imbalance (C) Diet too high in roughage (D) Malocclusion (E) Oral damage from excessive cage chewing

Answer is A: When the maxilla (upper jaw) is longer than mandible, you have mandibular brachygnathism. Another name would be overbite, or overshot jaw. Mandibular prognathism is an elongated lower jaw (think of a bulldog, for example). Polydontia is more teeth than normal.

What kind of problem does a dog with mandibular brachygnathism have? (A) Maxilla is longer than mandible (B) Mandible is torsed (C) Undershot jaw with exaggerated incisor wear (D) Polydontia (E) Dangling participles

Answer is B: When the mandible is longer than the maxilla, you have mandibular prognathism (projecting lower jaw--think of a bulldog, for example). When the maxilla (upper jaw) is longer than mandible, you have mandibular brachygnathism. Wry mouth is malocclusion when one segment of the jaw is disproportionately sized relatively to the other half. Polydontia means having more teeth than normal

What kind of problem does a dog with mandibular prognathism have? (A) Polydontia (B) Mandible is longer than maxilla (C) Irregular tooth wear causing wave mouth (D) Wry mouth

Answer is D: Approximately 80% of dogs and 70% cats will have periodontal disease (around="peri", "dontal"=teeth) by 3 years of age. The point is that this is a COMMON problem Periodontal disease is a general term that includes gingivitis (gum inflammation) and peridontitis (more chronic, severe damage from bacterial plaque that involves gingiva, periodontal ligament, alveolar bone, root cementum). Periodontal disease is caused by accumulation of bacterial plaque at the gingival margin (gumline) due partly to lack of adequate oral hygiene. Follow these links to see gingivitis in a dog, a radiograph of peridontitis with bone loss and Peridontitis in a dog.

What percentage of cats will have periodontal disease by 3 years of age? (A) 55% (B) 30% (C) 95% (D) 70%

Answer is D: Approximately 80% of dogs and 70% cats will have periodontal disease (around="peri", "dontal"=teeth) by 3 years of age. The point is that this is a COMMON problem Periodontal disease is a general term that includes gingivitis (gum inflammation) and peridontitis (more chronic, severe damage from bacterial plaque that involves gingiva, periodontal ligament, alveolar bone, root cementum). Periodontal disease is caused by accumulation bacterial plaque at the gingival margin (gumline) due partly to lack of adequate oral hygiene. Follow these links to see gingivitis in a dog, a radiograph of peridontitis with bone loss and Peridontitis in a dog.

What percentage of dogs will have periodontal disease by 3 years of age? (A) 50% (B) 25% (C) 12% (D) 80%

Answer is B: The peridontium is another name for all the structures that SUPPORT a tooth. These include the gums, the tooth root cementum, the periodontal ligament and the alveolar bone of the jaw to which the ligaments attaches.

What structures make up the peridontium? (A) Cheeks, tongue, nasopharynx, soft palate (B) Gums, tooth root cementum, periodontal ligament, alveolar bone of jaw (C) The part of the teeth below the gumline (D) Tooth root, alveolar and cancellous bone of jaw, sinuses

Answer is D: The peridontium is another name for all the structures that SUPPORT a tooth. These include the gums, the tooth root cementum, the periodontal ligament and the alveolar bone of the jaw to which the ligaments attaches.

What structures make up the peridontium? (A) Tooth root, alveolar and cancellous bone of jaw, sinuses (B) Cheeks, tongue, nasopharynx, soft palate (C) The part of the teeth below the gumline (D) Gums, tooth root cementum, periodontal ligament, alveolar bone of jaw

Answer is C: The most commonly abscessed teeth in dogs are the upper fourth premolars.

What teeth are most commonly abscessed in dogs? (A) Upper canines (B) Lower molars (C) Upper premolars (D) Lower incisors

Answer is C: The buccal side of the tooth faces the cheek. Lingual side faces the tongue. Labial surface of the tooth is nearest the lips. Gingival is the area of the tooth toward gums.

Which choice describes the buccal side of a tooth? (A) Closest to gums (B) Grinding face (C) Faces the cheek (D) Faces tongue

Answer is A: The buccal side of the tooth faces the cheek. Lingual side faces the tongue. Labial surface of the tooth is nearest the lips. Gingival is the area of the tooth toward gums.

Which choice describes the side of the tooth that faces the cheek? (A) Buccal (B) Lingual (C) Gingival (D) Labial

Answer is E: Mixed metal crowns are stronger and require less tooth removal than porcelain, zirconium, or mixed porcelain-metal crowns. Crowns are not made out of carbon alloy or ceramic. Crowns are most frequently placed on the canine and maxillary 4th premolar teeth in dogs.

Which dental crown material is the strongest and requires the least removal of tooth in dogs and cats? (A) Zirconium (B) Carbon alloy (C) Carbon alloyCeramic (D) Porcelain (E) Mixed metal

Answer is A: These are attributes of the occlusal technique, in which the film is placed on the occlusal plane and the beam is directed at a right angle towards it. The paralleling technique directs the beam at a right angle to a film that is placed intraorally parallel to the long axis of the tooth. It can only be used on mandibular teeth due to the rostral symphysis of the mandible and the maxilla's adjacent palate. The bisecting angle technique is used when paralleling is not possible. This technique directs the beam at a right angle to an imaginary line that bisects the angle formed by the long axis of the tooth and the plane of the film.

Which dental radiographic technique maximizes the area shown on the film, helps evaluate nasal disease, and is useful in identifying tooth remnants? (A) Occlusal (B) Bisecting angle (C) Paralleling (D) Reverse (E) Long axis

Answer is A: Typically, peridontitis is a more chronic and severe problem. Periodontal disease is a general term that includes gingivitis (gum inflammation) and peridontitis (more chronic, severe damage from bacterial plaque that involves gingiva, periodontal ligament, alveolar bone, root cementum). Periodontal disease is caused by accumulation bacterial plaque at the gingival margin (gumline) due partly to lack of adequate oral hygiene. Follow these links to see: gingivitis in a dog, a radiograph of peridontitis with bone loss and Peridontitis in a dog.

Which is more severe, periodontitis or gingivitis? (A) Periodontitis (B) No difference in severity (C) Depends on patient (D) Gingivitis

Answer is C: Lagomorphs (rabbits) have aradicular hypsodont teeth. Aradicular hypsodont (elodont) teeth do not have a true root structure and grow throughout the animal's life. Rabbits and some rodents have elodont cheek teeth and incisors. Horses have radicular hypsodont teeth, in which the apices remain open for a long time but then close late in life and the continual growth of the teeth stops.

Which of the following animals has aradicular hypsodont (also known as elodont) cheek teeth and incisors? (A) Feline (B) Canine (C) Lagomorph (D) Porcine (E) Equine

Answer is B: Class I malocclusions are very common and include lingually displaced mandibular canines, lance canine teeth, and rostral and caudal cross-bites. Class II malocclusions include maxillary prognathism and mandibular brachygnathism. Class III malocclusions include mandibular prognathism and maxillary brachygnathism (also known as mandibular mesioclusion). Class III malocclusions are accepted breed standards in brachycephalic breeds.

Which of the following is an example of a Class II malocclusion? (A) Mandibular mesioclusion (B) Maxillary prognathism (C) Rostral cross-bite (D) Caudal cross-bite (E) Lingually displaced canines

Answer is E: It is best to: use adequate paste, use a low rpm, make sure the handpiece is at full speed prior to touching the tooth, and to only polish each tooth surface for 1-3 seconds. The mouth should be rinsed at the end of the procedure. It is possible to damage the pulp with the heat created by the rotating rubber cup used for polishing teeth.

Which of the following is the best way to minimize damage when polishing the teeth of a dog or cat? (A) Polish each tooth for 3-4 seconds (B) Employ frequent rinsing (C) Apply cup to tooth before starting motor (D) Maintain a high rpm (E) Use adequate paste

Answer is B: Aspiration can be minimized by using a cuffed endotracheal tube and tipping the nose DOWN (using gravity to the patient's advantage). Ultrasonic power scalers are the primary instrument used to perform periodontal debridement in small animal veterinary dentistry.

Which of the following techniques should be employed to help prevent aspiration of fluids and debris during periodontal debridement? (A) Using a hand scaler (B) Cuffed endotracheal tube (C) Application of continuous suction (D) Using an ultrasonic scaler (E) Tipping the nose up

Answer is A: A periodontal probe is blunt, and is used to gently measure the depth of the gingival sulcus. Scalers have two parallel sharp sides, used for supragingival calculus removal. A Curette scaler has one sharp side and is used for subgingival calculus removal. A Shepherd's hook has a sharp tip and is used to detect cavities and broken teeth.

Which of these dental instruments is blunt? (A) Periodontal probe (B) Curette scaler (C) Sickle scaler (D) Shepherd's hook

Answer is C: Bone-like enamel and dentin are physical bacterial barriers. Sulcular fluid flushes the sulcus (crevice area between gumline and neck of a tooth) with substances with antimicrobial functions, like immunoglobulins (antibodies). Pulp does not have particular antibacterial properties.

Which of these protect teeth from bacteria? (A) Dentin and pulp (B) Enamel and cementum (C) Enamel and dentin (D) Sulcular fluids and pulp

Answer is C: Distemper virus. Enamel hypoplasia is the incomplete or defective formation of tooth enamel. Causes include trauma, systemic (fever, distemper), nutritional deficiencies (hypocalcemia), fluorosis, tetracyclines), and hereditary (rare). Click here to see a dog with enamel hypoplasia. Enamel hypoplasia occurs only during the formative stage of enamel development (amelogenesis), before tooth eruption into the oral cavity. Here are crown formation dates for dogs and cats Primary teeth- Day 42 gestation - day 15 postpartum Permanent teeth-Week 2 to 3rd month postpartum.

Which one of the following choices can cause enamel hypoplasia in the dog? (A) Heartworm infection (B) Severe giardiasis (C) Distemper (D) Canine adenovirus-1 vaccination (E) Neosporosis

Answer is A: Fluorosis. Chronic excessive ingestion of fluoride by cattle during the critical periods of tooth development, amelogenesis (enamel formation) and dentinogenesis (dentin formation) causes enamel hypoplasia. Dental fluorosis is commonly diagnosed by examining the incisiors, although all teeth may be affected. Osteofluorosis and lameness may also be observed. Dental lesions observed: staining, mottling, excessive erosion, hypoplasia, hypocalcification. Exposure to excessive fluoride after teeth are fully formed does not result in dental lesions.

Which one of the following choices is the most common cause of enamel hypoplasia in cattle? (A) Fluorosis (B) Distemper virus (C) Hypermagnesemia (D) Copper toxicosis (E) Copper toxicosisFescue poisoning

Answer is B: The crown is the visible tooth above the gum line. The chewing surface of a tooth is occlusal. Buccal means the surface toward the cheek. Lingual is surface toward the tongue.

Which part of a tooth is the crown? (A) Chewing surface (B) Above the gum line (C) Toward the cheek (D) Toward the tongue

Answer is D: The chewing surface of a tooth is occlusal. The crown is the visible tooth above the gum line. Buccal means the surface toward the cheek. Lingual is surface toward the tongue.

Which part of a tooth is the occlusal surface? (A) Above the gum line (B) Toward the tongue (C) Toward the cheek (D) Chewing surface

Answer is C: Dentin and pulp are living tissue. Dentin is formed by odontoblasts. Pulp is composed of odontoblasts and fibroblasts and is supplied by blood vessels, nerves and lymphatics. Enamel is acellular and considered nonliving tissue.

Which part of the tooth is considered to be living tissue? (A) Enamel and Dura mater (B) Enamel and dentin (C) Dentin and Pulp (D) Lignum and Cementum

Answer is D: The mandibular salivary gland is easily palpable subcutaneously in the neck. It is larger and softer than the nearby and rostrolateral mandibular lymph nodes. The sublingual and parotid salivary glands are diffusely located. The zygomatic gland is too deep to be easily palpated. There is no maxillary salivary gland.

Which salivary gland is readily palpable in a dog's neck? (A) Maxillary (B) Zygomatic (C) Sublingual (D) Mandibular (E) Parotid

Answer is A: The bisecting radiograph technique for generally preferred for maxillary teeth and mandibular canines and incisors (the rostral mandibular teeth). Bisecting radiograph technique minimizes the image distortion that occurs because of an inability to place x-ray film parallel to the central axis of a tooth. If you do not use the bisecting angle technique, a tooth may appear artificially foreshortened or elongated. The idea is easier to understand with a picture. Click here to see a good summary article with images of bisecting technique, courtesy of the Veterinary Dentistry website from Dr. Norman Johnston and the Royal Veterinary College of London.

Which teeth are best x-rayed using the bisecting radiograph technique? (A) Maxillary incisors (B) Temporomandibular joint (TMJ) (C) Mandibular premolars (D) Mandibular molars

Answer is A: Use the parallel radiograph technique for mandibular premolars and molars.

Which teeth are x-rayed using the parallel radiograph technique? (A) Mandibular premolars (B) Mandibular incisors (C) Maxillary premolars (D) Maxillary incisors

Answer is D: Chlorhexidine has cytotoxic effects so tissues must be rinsed after its use.

Why is it necessary to rinse with lactated Ringer's solution after lavaging a periodontal surgical site with 0.12% chlorhexidine in dogs and cats? (A) Gastrointestinal upset (B) Oral ulceration (C) Hepatotoxcity (D) Cytotoxicity (E) Bad flavor

Answer is B: A thorough oral examination requires sedation, an oral speculum, and a light source. Some veterinarians may choose to wear gloves. A head stand can be helpful. It may be beneficial to rinse out the mouth after initial evaluation (once the vet sees where food may be packing) with an oral syringe (NOT a hose). A dental mirror and long-handled dental picks can be useful. A twitch is not routinely used to facilitate oral examinations in horses. Endoscopy and ultrasound are not used for routine oral evaluation. An elevator and float might be used during a dental float, but not during an evaluation.

You are called out to a stable to assist in the evaluation of a 22-year-old Thoroughbred gelding that has been losing weight and dropping feed. Which of the following sets of equipment will the vet need to perform a thorough dental evaluation? (A) Twitch, elevator, hose (B) Sedation, speculum, light (C) Head stand, twitch, endoscope (D) Sedation, float, gloves (E) Twitch, ultrasound, hose

Answer is A: The diastema is the safest place to put your hand when you work inside a horse's mouth. The diastema is the gap between the canines and the premolars and there are no teeth there.

You are called to a farm to help do a routine dental exam and float the teeth of a 5-year old Quarter horse gelding. If you needed to put your hand into the horse's mouth, where is the best place to grip a horse? (A) Diastema (B) Tongue (C) Lower incisors (D) Nasal planum

Answer is C: Use your rasp to blunt the OUTSIDE of the UPPERS (buccal/cheek) side and the INSIDE of the LOWERS (Lingual/tongue side). Horses are "anisognathic" which is a fancy way to say the lower jaw is NARROWER than the UPPER jaw.

You are called to a farm to help do a routine dental exam and float the teeth of an 8-year old Standardbred mare. What parts get filed down with the rasp when a horse gets its teeth floated? (A) Buccal aspect-upper molar arcade, Buccal aspect-lower molar arcade (B) Lingual aspect-upper molar arcade, Lingual aspect-lower molar arcade (C) Buccal aspect-upper molar arcade, Lingual aspect-lower molar arcade (D) Lingual aspect-upper molar arcade, Buccal aspect-lower molar arca (E) Buccal aspect-upper molar arcade, rostral points of wolf teeth

Answer is B: Most horses that work with a bit in their mouth benefit from having the wolf teeth removed. Do not confuse canines (near the incisors, rostrally) with the WOLF teeth, which are permanent FIRST PREMOLARS (P1) further back, abutting the cheek teeth (molars). Equine permanent canines are typically unopposed in the diastema and cause few problems. These teeth have long roots and are EXTREMELY DIFFICULT to extract

You are called to a farm to help float the teeth of a 5-year old Quarter horse gelding. The owner is a trail rider who uses a standard metal bit when out riding. Inside the horse's mouth, you find a pair of wolf teeth in the upper arcades. The horse has been having problems with headshaking. What should you help the vet do? (A) Nothing (B) Remove them (C) Trim the buccal points (D) Float them

Answer is D: Wolf teeth are permanent FIRST PREMOLARS (P1) seen in the upper arcade of 20-60% of horses. Wolf teeth (P1) are caniform (ie: canine-like) and erupt at around 5-6 months. Rarely occur in the lower arcade. Most horses that work with a bit in their mouth benefit from having the wolf teeth removed. Because the wolf-tooth looks like a little canine tooth, the first so-called "cheek tooth" in horses is actually the SECOND premolar (P2). Follow this link to a Merck Manual tooth eruption table. References vary by about 6 months, but here is a good rule of thumb for permanent tooth eruption in horses: I1-2.5 yr, I2-3.5 yr, I3-4.5 yr, C-4-5 yr.

You are called to help examine a 6-year old Appaloosa gelding. The owner is worried because the horse seems sensitive and head-shy when he has a bit in his mouth. On physical exam you note a prominent pair of wolf teeth. What, anatomically is an equine wolf tooth? (A) Deciduous canine (Dc) (B) Permanent canine (C) (C) Permanent incisor 3 (I3) (D) Permanent premolar 1 (P1) (E) Deciduous premolar 1 (Dp1)

Answer is B: These are the normal openings of the zygomatic and parotid salivary gland ducts. Rugae are the mucosa of the hard palate where it is arranged in prominent ridges. The incisive papilla is a raised, round structure on the midline just behind the maxillary incisors. The incisive duct to the vomeronasal organ is just lateral to this papilla bilaterally. The tonsils are located in the tonsillar crypts, at the caudal aspect of the tongue. Vallate papillae are the large, distinctive papillae at the caudal third of the tongue. Abrasians would be very unlikely to be so focal and bilaterally symmetrical.

You are performing a routine dental examination on a 3-year-old intact female mixed breed dog. There are a couple of bilaterally symmetrical bumps on the alveolar mucosa just dorsal to the 4th maxillary premolar and 1st molar teeth. What are these structures? (A) Tonsils (B) Salivary duct openings (C) Palatal rugae (D) Abrasions from dietary indiscretion (E) Vallate papillae

Answer is A: This is a normal finding in this breed. Brachycephalic dogs and cats have less caudal movement of the globe in response to retropulsion. The bilateral nature of the decrease in this patient makes a retrobulbar mass or infection very unlikely, as that would usually be unilateral. There are no lymph nodes in the retrobulbar space. Blocked nasolacrimal ducts result in ocular discharge, not decreased retropulsion.

You are performing a routine dental examination on a 7-year-old female spayed Bulldog prior to anesthesia for routine dental cleaning. Bilateral retropulsion of the eyes reveals decreased movement of the globe. What do you suspect? (A) Normal in this breed (B) Blocked nasolacrimal ducts (C) Retrobulbar neoplasia (D) Lymphadenopathy (E) Retrobulbar abscess

Answer is D: Root debridement and/or subgingival curettage would be appropriate. Periodontal disease (PD) is classified into four stages. PD0 is clinically normal, PD1 is gingivitis with no attachment loss, PD2 is less than 25% attachment loss and mild periodontitis, PD3 is 25-50% attachment loss and moderate periodontitis, and PD4 is greater than 50% attachment loss and advanced periodontitis. PD1 requires routine dental cleaning and increased dental care at home. PD2 requires root debridement or subgingival curettage. PD3 requires root debridement, gingival curettage, and periodontal surgery. PD4 often requires tooth extraction.

You perform a routine dental examination on a 7-year-old male neutered German Shepherd and he is diagnosed with grade 2 periodontal disease. On consultation with the vet, what would be the appropriate course of action? (A) Closed root planing (B) Routine dental cleaning and increased owner home care (C) Extraction of the affected teeth (D) Root debridement and/or subgingival curettage (E) Extensive cleaning and gingival scaling