1. Veterinary Dentistry
CTVT: Chapter 34
DRG:

2. Objectives Recognize a patient’s overall dental health status
Perform routine dental prophylaxis safely and efficiently
Recognize, describe, and use common dental instruments
Understand client education regarding home care

3. Dental Tasks for Veterinary Technicians
Oral examination and charting
Professional dental cleaning “Dental prophylaxis”
Taking and developing dental radiographs
Taking impressions and making models
Performing nonsurgical, subgingival root planning
Assisting with exodontics and endodontics
Client education
*Procedures performed by veterinary technicians must not result in alterations in the shape, structure, or positional location of teeth in the dental arch.

4. History and Extraoral Examination
Dental procedures require general anesthesia
Before animal is anesthetized:
Obtain a proper history
Ask about general medical info, medications, nutrition/treats, toys, etc.
Perform an extraoral exam
Palpate muscles of the face
Retropulse the eyelids
Look for symmetric depth and firmness
Look for ocular and nasal discharge
Palpate mandibular salivary glands
Palpate submandibular lymph nodes

5. Intraoral Examination- Awake
The entire mouth should be evaluated, however we do only a quick exam while awake:
Access patient’s occlusion
Check for retained deciduous teeth or missing teeth
Evaluate overall appearance of soft tissue
Goal is to inform owner of the
procedure their pet needs and give
an estimate of cost.

6. Intraoral Examination- Anesthetized
Once anesthetized, a more thorough exam can be done:
1. Soft tissue
Mucosa- should be pink or pigmented; no lesions seen
Pharynx- evaluate for inflammation/neoplasia/lesions
Tongue- chewing lesions present?

7. Know What’s Normal! Hard palate- covered in rugae
Examine closely in brachycephalic breeds
Incisive papilla- bump that is midline, caudal to maxillary incisors
Two salivary ducts on quadrants 1 &2
Bumps buccal to maxillary 4th PM and 1st M

8. Intraoral Examination- Anesthetized
2. Teeth
Number, fractures, mobility, etc
3. Periodontium
Inflammation, periodontal pockets, bone loss, etc.
*Radiographs are often necessary
to access the oral health status

9. The Periodontum The periodontum is the area that surrounds the tooth.
Purpose: to attach the tooth to the jaw and provide support, & resistance to normal, functional forces.
It includes:
Gingiva
Periodontal ligament
Cementum
Alveolar bone

10. The Periodontum Gingiva = gum tissue surrounding teeth
Healthy gingiva can be pink or pigmented
The margin lies closely against the crown of the tooth
Gingival sulcus is the shallow groove between the tooth and the gingiva.
Normal depth is 0-3 mm in canines; up to 1 mm in felines
Called a periodontal pocket when deeper.

11. The Periodontium
Cementum is a bone-like tissue that covers the root surface.
It is stronger than bone but not as strong as enamel.
It is capable of repairing itself.
Alveolar bone forms the tooth socket.
Blood vessels and nerves run through the alveolar bone
Periodontal ligament attaches cementum to the alveolar bone.

12. Scissor Bite Evaluation
Scissors bite is evaluated in three locations:
1. The mandibular canine tooth resides in the interdental space of the upper third incisor and the upper canine tooth.
2. The upper fourth premolar is labial to the lower first molar, which together, constitute the carnassial teeth.
3. Maxillary incisors are slightly rostral to the mandibular incisors.

13. Normal Scissors Occlusion: When all three locations are normal- the premolars interdigitate toward the opposing interdental space.

14. Malocclusion
Malocclusion is an abnormality in the position of the teeth.
It can occur in any of the three skull shapes, but is more common in brachycephalic breeds.
There are four classes of malocclusions.
(Class I, II, III, and IV)
Class I- easily fixed with orthodontic correction OR not needed
Class II-IV are skeletal malocclusions due to differing jaw length

15. Class I: Rostral Cross-bite
Maxillary incisors are caudal to the mandibular incisors.
Canines are in normal position
Very common malocclusion in veterinary dentistry.
Thought to occur secondary to retained deciduous incisors.
Could also occur due to trauma
Treatment:
Orthodontic movement or extraction of the abnormal teeth.
Treat vs. not treat?

16. Rostral Cross-bite

17. Class I: Caudal Cross-bite
Maxillary premolars/molars are positioned lingual to the mandibular opposing premolars/molars
Occurs occasionally in dolichocephalic breeds.
Treatment:
Extractions or more frequent professional prophylaxis will be needed for these pets.

18. Caudal Cross-bite
The maxillary fourth premolar is positioned abnormally inside of the mandibular first molar. 
This condition did not require treatment as the pet had a comfortable and functional occlusion.

19. Class II: Mandibular Distoclusion
Appears as mandibular brachygnathism-
abnormally short mandible, normal maxilla
Referred to as “overshot”
Problems:
Lack of self-cleaning ability
Can create painful hard palate abrasions
Never an accepted standard

20. Class III: Mandibular Mesioclusion
Appears as mandibular prognathism-
abnormally long mandible, normal length maxilla
Referred to as “undershot”
Problems:
These dogs will lose some of their self-cleaning ability and trap plaque and debris more easily
Maxillary incisors can traumatize the mandible
*Accepted as normal in brachycephalic breeds such as Bulldogs, Pekingese, Boston terriers, Pugs, and Persian cats.

21. Mandibular Mesioclusion

22. Persistent Deciduous Teeth
A deciduous tooth that remains after the adult tooth has already erupted
Can occur in any animal, but most common in small breed dogs
Problems:
1. Interfere with normal eruption pathway of permanent teeth  malocclusion
Early detection is key!
2. Are a reservoir for debris  dental disease
Extraction is almost always necessary

23. *Note: deciduous teeth are numbered differently in the Triadan system
(500, 600, 700, 800)

24. Polydontia
Supernumerary teeth should not be confused with retained deciduous teeth.
These are extra permanent/adult teeth
Unless extra tooth causes crowding, no treatment is necessary.
Occasionally the extra teeth will erupt in an abnormal angle or be impacted.
If crowding: increased chance of periodontal disease. (Extraction necessary)

25. Hypodontia One or more teeth do not form in the dental arcade.
Un-errupted permanent tooth or hypodontia?
How do you confirm?
If permanent tooth is absent, a deciduous tooth can remain in the arch for months to years.
No treatment necessary

26. Periodontitis
Periodontitis is one of the most common diseases of dogs and cats.
It’s caused by subgingival plaque, and the body’s response to it
Periodontitis exists in most pets over five years of age that have not received home care, but can be seen as early as six months of age.
There are four stages of periodontitis.

27. The Culprit: Plaque
Plaque is a white, slippery film that collects around the gingival sulcus of the tooth.
Composed of bacteria, food debris, exfoliated cells, and salivary glycoproteins.
Over time, plaque will
mineralize on the teeth to
form dental calculus
(tartar), a brown/yellow
deposit that contributes
to periodontal disease.

28. It’s only a matter of time…
Saliva + plaque +
24 hours = calculus.
Calculus and plaque
deposits on these teeth
have caused gingivitis.

29. Your calculus has plaque!
As plaque and tartar collect around the tooth, they damage the gingival tissues by releasing bacterial by- products.
Shift to gram negative bacteria (anaerobic)
Breakdown of cementum and eventually PDL
The animal’s immune system further damages these tissues through the release of harmful by-products from white blood cells as they attempt to destroy the bacteria.

30. *Attachment loss refers to gingival recession and pocket depth
Periodontitis
Once present, destruction of the periodontal tissues has begun and will continue if not treated.
As a tooth loses its periodontal attachment increased mobility
Timeline=months to years before the tooth actually falls out.
Bacteremia liver, kidneys, heart, and lungs effected.
*Attachment loss refers to gingival recession and pocket depth

31. Stage I Periodontitis Also referred to as gingivitis.
Animal presents with reddened gingival tissues.
First thing that owners notice is halitosis.
Time of onset depends on diet and home care
Canned food promotes gum disease.
Hard, dry food generally better for gingival health.
Can be treated/cured with a professional dental cleaning.

32. Stage I Periodontitis
(Stage 2)

33. Stage II Periodontitis
Stage II can also be called advanced gingivitis.
Examination will reveal inflammation and plaque at free gingival margin with edema present.
Halitosis is very apparent.
Most dogs between 1 – 4 years of age when stage II occurs.
With scaling, polishing, and home care this stage is treatable and usually curable.

34. Stage II Periodontitis