1887

Dentistry

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Abstract

Dentistry is one of the most important aspects of veterinary healthcare alongside vaccination and medical care. Routine veterinary dentistry treatment is not only prophylactic but also involves treating existing disease and stopping or slowing down the progression of periodontal disease. In other cases, painful conditions can be alleviated which may not have been noticed by the owner and/or may have been mistaken as a ‘normal’ ageing process. It is no longer acceptable to ignore these problems or to treat them as minor or secondary problems to be dealt with at the same time as other surgical procedures. The Royal College of Veterinary Surgeons (RCVS) advises that veterinary nurses should be able to perform a thorough oral examination, record the findings on a dental chart, take intraoral dental radiographs, perform periodontal therapy (excluding periodontal surgery) and offer instruction in homecare and ongoing oral hygiene. The chapter covers Dental anatomy; Instrumentation; Dental examination; Dental radiography; Common dental pathology; Dental treatment; and Dental homecare and owner compliance.

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Figures

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9.3 Incisor tooth structure. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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9.4 Skull showing important anatomical features. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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9.5 Instruments used for an oral examination (left to right): explorer probe; periodontal probe; and periodontal teaching probe.
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9.6 A modified pen grip is used to hold dental instruments correctly.
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9.7 Hand scaler (left) and curette (right) showing different working tips.
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9.8 Cross-section of a scaler and curette showing the difference in the working tips. (Courtesy of J Robinson)
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9.9 Instruments required for extraction (left to right): elevators; extraction forceps; periosteal elevator; and a basic surgical kit.
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9.10 Luxator (top) and elevator (bottom). Note the differences: the luxator is a flatter, sharper instrument, whilst the tip of the elevator is more robust.
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9.11 Goldman–Fox periosteal elevators.
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9.12 Compressed air-driven dental unit. The unit has a slow-speed handpiece, water-cooled high-speed handpiece and a three-way air/water syringe. Some machines have fibreoptic handpieces or suction as extra features.
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9.13 Burs (left to right): FG tapered fissure; round; diamond; and RA round bur.
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9.14 Polishing cups.
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9.15 Sharpening a subgingival curette on an Arkansas stone.
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9.16 Oiling the air-turbine.
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9.20 Feline dental chart. Canine dental chart. An example of a completed canine dental chart. (© DentaLabels, J Robinson)
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9.22 Missing first mandibular premolar. Intraoral radiograph showing an unerupted premolar (radiodense area surrounded by a radiolucent halo) and the formation of a dentigerous cyst (radiolucent area) as a result. Resorptive lesion (arrowed) affecting the crown of 304. The true extent of the resorptive process can only be assessed by intraoral radiography. The tooth shows no normal root anatomy: no periodontal ligament, dentine or root canal (bottom arrow) can be identified. The area of crown resorption (top arrow) is seen clinically. The right canine tooth is also undergoing resorption.
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9.23 Dental film. An open film packet showing the paper covering the film, the film and the foil backing, all enclosed within a water-resistant envelope.
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9.24 Radiograph showing an accurate representation of the teeth, proving that the dental film was correctly positioned. Foreshortened image: the X-ray beam was directed perpendicular to the film. Elongated image: the X-ray beam was directed perpendicular to the long-axis of the tooth.
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9.25 Incident beam perpendicular to the tooth results in elongation of the image. Incident beam perpendicular to the film results in foreshortening of the image. Incident beam perpendicular to the bisecting line results in a life-size image. (© D Crossley)
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9.26 Malocclusion: the lower canine is occluding distally and palatally to the correct position, causing trauma to the palate. This malocclusion needs treatment as the bite is not functional or comfortable. Enamel dysplasia affecting the canine and incisors. Normal enamel should be smooth and not pitted or discoloured. Persistent deciduous teeth, resulting in a malocclusion.
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9.27 Gingivitis. Gingival recession. Grade 3 furcation exposure. Gingivitis with gingival recession: established periodontitis. Significant gingival recession with furcation exposure. Severe periodontitis. Periodontal probe inserted into the gingival sulcus of the upper canine. Periodontal probe showing loss of attachment of the upper canine.
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9.28 Complicated crown fracture with a visible necrotic pulp (black spot). Slab fracture of the carnassial tooth, exposing the pulp and extending subgingivally. Upper molar affected by caries.
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9.29 Lower premolar affected by a FORL. The gingiva has grown over the defect in the crown of the tooth. Radiograph of the affected tooth showing resorption of the roots and crown.
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9.30 Removing supragingival calculus using an ultrasonic scaler with a fine tip. The fine water spray generated by the machine helps cool the tip and dislodge calculus. Polishing helps smooth the tooth surface and remove any remaining plaque. The cup can be flared by applying gentle pressure to clean subgingivally.
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9.32 Surgical extraction of a canine tooth. Vertical releasing incisions are made mesially and distally to the tooth. A mucoperiosteal flap is raised. Grooves are made along the mesial and distal aspects of the tooth root to facilitate placement of the dental elevators. The grooves are connected across the buccal surface of the root. Following extraction of the tooth, the flap is replaced and sutured using a simple interrupted suture pattern.
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9.34 Fractured tooth repaired through root canal treatment.
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9.35 Dog held across the muzzle. Brushing should be started at the back of the mouth and worked forwards. The bristles of the toothbrush should be angled towards the gingival margin. Cat with head held firmly and rotated to the side. Brushing should be started at the back of the mouth as with dogs.

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