QUESTIONS

1. Periodontal pockets deeper than ____ mm cannot be effectively cleaned. What is the magic depth?
    
2. How deep is the normal periodontal sulcus in the dog?  In the cat?
    
3. At what grade of periodontal disease does  irreversible periordontal ligament damage occur?
    
4. The following are all techniques used in advanced periodontal disease. Describe what they are:
   
   a) odontoplasty
   
   b) frenectomy
   
   c) gingivectomy
    
5. What is periodontal splinting?
    
6. The general rule for vital pulpotomy is that you must see the fxed tooth within 4-6 hours (otherwise you gotta do a root canal).  This time limit is extended greatly for dogs < 1.5 years of age.  How is this possible?
    
7. What can you do it a dog is < 1.5 years old but the tooth fx is several months old?
    
8. What do you do if during a root canal, a file breaks off inside the tooth?
    
9. Is a feline neck lesion an example of dental caries?
    
10. There are 5 classes of feline neck lesions:
    
    Class 1- lesion extends < 1/2 mm into the neck
    
    Class 2 - Signif erosions present but the endodontic system has not been invaded
    
    Class 3 - Signif erosions & the endodontic system has been invaded
    
    Class 4 - deep involvement
    
    Class 5 - Coronal loss & gingival overgrowth hiding the retained root
    
    In Class 1 lesions, fluoride treatments are often used.  What are the benefits of fluoride?
     
11. At what Class is restoration recommended?
     
12. Traditional fillers = composite & amalgam.  Currently glass ionomer is considered filler of choice.  What are the advantages of glass ionomer?

Thanks Tooth60808 for your comments and help for those of us who are dentally ignorant.  I wish I could actually do some of the techniques in these questions.



 

ANSWERS

1. 5mm is the magic number because tooth brush bristles cannot go deeper than this.
   
   
   
   
    
2. K9- 1-3 mm
   Feline- 1 mm
   
   
   
   
    
3. At Grade 3 periodontal disease, ligament damage has become irreversible.
   
   
   
   
    
4. Odontoplasty - removal of a plaque-retaining area of a tooth.  This is hard to describe without a picture.  Imagine a molar with a periodontal pocket. Can you picture how broad the tooth is at the gum line?  The tooth sort of makes an over hanging (like a cave) over the pocket.  Shaving off the over-hanging so that the pocket is more pit-like & less cave-like would be an example of odontoplasty.
   
   Frenectomy -  The dog has 3 frenula:  one between the upper lip & central incisors & 2  (right & left) between the labial surface of the canine tooth & the flews of the mandible.  In little tiny dogs, junk can get stuck in the frenula  promote periodontal disease.  Removing the frenula removes these junk-collecting areas.
   
   Gingivectomy - Say you have a pocket > 5mm.  You can't clean it out.  Trim off the top  layer of gingiva - hell, it's not attached anyway - now you only have a 2mm pocket & you can clean it out.  ALWAYS LEAVE AT LEAST 2 MM OF ATTACHED GINGIVA!  You  can do sliding flaps to cover up the exposed root.
   
   
   
   
    
5. Periodontal splinting is very cool.  Think of all the decrepit mouths where every single incisor is loose.  But wait!  Don't extract them!  Splint them!   A splint is a support  (generally easily put together out of acrylic powder) that connects unstable
   teeth to adjacent stable ones (like the canines).  splints can stay on short term or for life & they make mandibular symphyseal fractures a breeze.
   
   
   
   
    
6. We aren't sure why the young dog's tooth doesn't get as easily infected after fx but we think the tremendous blood circulation is simply really efficient at removing pathogens.
   
   
   
   
    
7. OK, the tooth is dead but not apexified. Debride the canal, fill with CaOH & saline paste, & after apexification is over take the seal out & root canal it.  There is something about the alkaline nature of the CaOH that stimulates the closure of the apex.
   
   
   
   
    
8. Don't tell me you broke off a file ?!
   
   First, swear really loud.
   
   Next, try to fish it out with another file.
   
   Next, try a magnate to get it out (doesn't usually work but worth a try)
   
   Next, use a needle & squirt in really thin ZOE (zinc oxide/eugenol) & close the access hole.
   
   Take an x-ray.  If the seal is good, you're done. If the seal is bad, swear some more & do a retrograde rooth canal through the apex of the tooth.:(
   
   
   
   
    
9. Feline neck lesions are not carious.
   
   
   
   
    
10. Fluoride desensitizes pulp, hardens enamel, & has antibacterial action.
    
    
    
    
     
11. Class 2 lesions can be restored.  Class 1 = treat with fluoride or
    varnish.  Class 3 & up, extract.
    
    
    
    
     
12. Advantages of glass ionomer = ease of use,  bonds directly to dentin so no need for invasive prepping, contains fluoride which it releases slowly (over years).