1
Q
What is dentin?
A
- Majority of tooth
- Formed by odontoblasts at the periphery of the pulp
2
Q
Distinguish primary, secondary and tertiary dentin.
A
Primary dentin is formed during tooth development, while secondary dentin is laid down after root formation is complete and signifies normal aging of the tooth. Tertiary dentin is formed as an attempt at repair.
3
Q
What is in the central portion of the tooth?
A
Pulp cavity - is occupied by dental pulp. Dental pulp contains nerves, blood and lymphatic vessels, connective tissue and odontoblasts
4
Q
What does the dental pulp communicate with in dogs and cats?
A
The periodontal ligament at the apical delta and lateral canals in adult animals
5
Q
Describe the apical opening in young animals.
A
The apical opening is large and it closes into an apical delta in the process of apexogenesis.
6
Q
What is the coronal part of the tooth covered with?
A
Enamel, which is the hardest and most mineralized tissue in the body. Enamel is formed by ameloblasts only prior to the tooth eruption.
7
Q
What is the root of the tooth covered by?
A
Cementum, which is mineralised connective tissue similar to bone, formed by cementoblasts.
8
Q
What is the gingival sulcus?
A
The area between the tooth and the free gingiva. The floor of the gingival sulcus is formed by junctional epithelium. Below it lies the major connective tissue attachment of the tooth – the periodontal ligament
9
Q
What are the normal depths of the gingival sulcus in cats and dogs?
A
0 – 1 mm in cats
0 – 3 mm in dogs
10
Q
Where is the periodontal ligament anchored?
A
Into the cementum on one side and the alveolar bone on the other and thus holds the tooth in the alveolus
11
Q
Define dentine.
A
The bulk of the mature tooth, 70% inorganic material, a porous structure made of microscopic tubules
12
Q
Define enamel.
A
Hardest tissue in the body, covers the anatomical crown of the tooth, 0.1-0.5mm thick depending on species, 96% inorganic material
13
Q
Define cementum.
A
A bone like mineralised connective tissue covering the root of the tooth, part of periodontium, the anchoring system of the tooth within the alveolus
14
Q
Define pulp cavity.
A
Comprising the chamber and the root canal, this is a tissue made up of connective tissue, blood vessels, lymphatics and nervous tissue
15
Q
What is the term for the surface on the outside of the tooth, the side of the tooth against the cheek/lip?
A
Buccal/labial
16
Q
What attaches the tooth to the bone and acts as a shock absorber during mastication?
A
Periodontal ligament
17
Q
The dental formulae comprises incisors, canines, pre-molars and molars. Please fill in the correct number of each type of tooth in an adult dog in a single maxillary quadrant.
A
Incisors = 3, canines = 1, pre-molars = 4, molars = 2
18
Q
Number the arcades of the mouth.
A
Left maxillary/upper = 2
Right maxillary/upper = 1
Left mandibular/lower = 3
Right mandibular/lower = 4
19
Q
What is the Triadan number for a dog upper R canine tooth?
A
104
20
Q
List all the teeth that are normally present in the dog but absent in the cat.
A
105, 110, 205, 210, 305, 306, 310, 311, 405, 406, 410, 411
21
Q
What number are the upper and lower carnassials in dogs and cats?
A
Upper = 108/208 = last premolar. Lower = 309/409 = first molar
22
Q
Which jaw is more likely to contain triple rooted teeth?
A
Upper jaw/maxilla
23
Q
Why is dental radiography important?
A
- Allowing a higher standard of dental care
- Cannot provide complete/proper dental care without it
- Proper diagnosis and treatment of oral and dental disease. Without x-rays, painful and/or infectious pathology can be left behind
24
Q
List the possible pathologies hat can be seen on dental radiography.
A
Periodontal disease
Pulp necrosis
Dental fractures
Tooth resorption
Persistent deciduous teeth
Malocclusions
Supernumerary/malerupted/unerupted teeth/dentigerous cysts
Caries
Teeth associated with pathologic lesions
25
Describe the parallel technique of taking dental radiographs.
Can be used on the mandibular premolars and molars. The object is parallel to the image plate and the x-ray beam is at 90˚ to both. For the mandibular molars/premolars, you can position the tooth flat against the plate and shoot the x-ray from 90˚.
26
Describe the bisecting angle technique of taking dental radiographs.
Working out a specific angle to shoot the x-ray in order to create an accurate shadow of the tooth. Used for most dentition. The fixed angle or simplified technique relies on using just 3 approximate angles to allow images of most teeth, without actually calculating the bisecting angle. These angles are 90°, 45° and 20°
27
What can happen when imaging teeth with 3 roots?
Can be tricky to avoid the roots superimposing on each other, such as 4th maxillary pre-molar
28
How is root superimposition avoided?
Tube head may need slightly shifting in the horizontal plane in either direction to separate the roots.
S.L.O.B. rule – same lingual/opposite buccal. This means that the root that is more lingual will be imaged in the same direction as the tube is shifted and the buccal root will be imaged in the opposite direction.
29
What can appear as pathological on dental radiographs?
Canals and foraminae which show as lucency – do not mistake as pathology
30
Distinguish the appearance of permanent and deciduous teeth on dental radiographs.
Permanent teeth have wide pulp, narrow dentine and open apex. Deciduous teeth are smaller and have narrow roots. Apex may close from about 12 months. As teeth mature, the dentine gets thicker and thicker, the pulp narrows and the apex is closed.
31
What is periodontitis?
Periodontal ligament space widening. Bone loss – horizontal in recission, vertical in pocketing, at furcation. Periapical lucency can be a sign of various pathologies including apical periodontitis
32
What is the appearance of endodontitis?
Endodontium = pulp + dentine. Can’t see active pulpitis as soft tissue, but may see evidence it has been present. If the pulpitis was irreversible, the tooth may go on to die and then over time we can see radiographic sigs the tooth has died by compared to contralateral tooth. Wider pulp as it looks like a younger tooth.
33
What are some traumatic aetiologies for teeth?
- Fractured tooth
- Tooth dying after endodontitis if enough time has passed - tooth looks younger with a wider pulp compared to contralateral tooth
- Jaw damage
- Wear – checking the roots of teeth affected by attrition/abrasion
- Luxated teeth – pushed deeper into socket or to the side
34
List some other pathologies that could affect the teeth.
- Tooth reabsorption
- Missing teeth
- Extra teeth/supernumerary - genetic, retained deciduous teeth are especially common in canine
- Neoplasia
35
Why do we use local anaesthetics?
- Reduce the amount of inhalational anaesthetic required
- Provide peri-operative (and immediate post-operative) analgesia
- Blunt the initial surgical trauma, decreasing recovery times
- Reduce requirement for other immediate post-operative analgesia
36
What are the risks of using local anaesthesia?
- Damage to neurovascular bundles – direct contact with needle or neuropraxia if injected into bone canal under pressure
- Haematoma due to the injection
- Ocular trauma if an intraocular injection
- Accidental intra-venous injection
- Systemic toxic effects due to the agent – cardiotoxic (lidocaine is least cardiotoxic if particular concern about the heart)
37
Name 2 local anaesthetics used in dentistry.
Lidocaine
Bupivacaine
38
What are the doses of local anaesthetics for dentistry?
- Cats and dogs under 6kg = 0.1-0.3ml
- Dogs 6-25kg = 0.3-0.6ml
- Dogs 25-40kg = 0.6-0.8ml
- Dogs over 40kg = 0.8-1ml
39
What does a maxillary nerve block anaesthetise?
Completely anaesthetises the ipsilateral half of the maxilla, including the soft and hard palates, bone, mucosa and all the teeth
40
What are the 2 approaches for a maxillary nerve block?
Intraoral approach – risk of hitting the eye globe if you push the needle in too far
Transcutaneous approach – using a lateral approach, safest
41
Where does inferior alveolar nerve block anaesthetise?
Mandible including teeth, lower lip, part of the tongue, hard and soft tissues
42
Name the 2 different approaches to an inferior alveolar nerve block.
Intraoral approach
Transcutaneous approach
43
What is the risk of doing an inferior alveolar nerve block?
Hitting the lingual nerve causing temporary desensitisation of the tongue. Avoid by guiding the needle as close to the bone as possible
44
Where does a mental nerve block anaesthetise?
Mostly the lip and rostral soft tissues
45
Why is the mental nerve block not advised?
Due to risk of nerve damage. Not a particularly useful block and risk of damage if enter the foramen
46
What is periodontal disease?
Inflammation and infection of the periodontium by plaque bacteria and the host’s response to the bacterial insult.
47
Distinguish gingivitis and periodontitis.
Gingivitis = initial reversible stage
Periodontitis = later irreversible stage
48
What is calculus?
- Calculus is mineralised plaque and is important only due to its rough plaque retentive surface
- In itself, it is largely non-pathogenic and may just be irritant
- Calculus forms visibly supra-gingivally and also more dangerously for the periodontium subgingivally
- The calculus below the gum line and 2-3mm above it is a problem because it helps keep plaque there
49
What is plaque?
Plaque is a biofilm – an organic matrix of salivary glycoproteins, oral bacteria, lipids cellular debris and extracellular polysaccharides that adhere to the tooth surface. It eventually mineralises to form calculus
50
Why is plaque the key problem and not calculus?
- Plaque can form on a clean tooth within 24 hours if undisturbed
- The biofilm protects the bacteria from the host defences and antibiotics
- The composition of bacteria in plaque changes over time. This process is complex but ultimately it can trigger a host inflammatory response, leading to periodontal disease
51
How does gingivitis present?
Reddening and oedema of the tissue, starting at the gingival margin but progressing to visible ulceration and spontaneous bleeding
52
Does gingivitis lead to periodontitis?
Does not always lead to periodontitis but always precedes it: as the inflammation continues, the gingiva starts to detach from the tooth
53
How is gingivitis treated?
By plaque control – professional dental cleaning and home oral hygiene
54
Describe the gingival status scores.
0 = normal gingiva, natural coral pink gingival with no inflammation
1 = mild inflammation, slight changes in colour, slight oedema, no bleeding on probing
2 = moderate inflammation, redness, oedema, glazing, bleeding upon probing
3 = severe inflammation, marked redness and oedema, ulceration, tendency to bleed spontaneously
55
Describe the pathogenesis of periodontitis.
- Inflammatory process has extended to the deeper supporting structures of the tooth
- The inflammation produced by the combination of subgingival bacterial and the host response results in loss of attachment and recession of the gingiva, root exposure furcation exposure, formation of periodontal pockets, and the loss of alveolar bone
- The end stage is tooth loss.
56
What is the normal sulcal depths in cats and dogs?
Dog is 0-3mm
Cat is 0-0.5mm
57
Describe grades 1-3 of periodontitis functional involvement.
Grade 1 = periodontal probe extends less than half way under the crown from either side
Grade 2 = probe extends greater than halfway under the crown
Grade 3 = probe passes from one side to the other under the crown
58
Describe mobility as a factor for extraction.
Some mobility is normal in all teeth – the periodontal ligament acts as a shock absorber. Incisors are naturally more mobile, and mobility should be interpreted together with attachment loss before deciding on extraction.
59
Describe the classification of periodontal disease at stage 0.
Clinically normal. Healthy pink, non-inflamed periodontium, firmly attached to underlying bone wit a sharp margin where soft tissues meet the tooth. X-ray shows good bone height to CMJ
60
Describe the classification of periodontal disease at stage 1.
Gingivitis only without attachment loss. Plaque and calculus deposit on tooth, marginal gingivitis. Reversible.
61
Describe the classification of periodontal disease at stage 2.
Early periodontitis. Up to 25% attachment loss or stage 1 furcation involvement. Plaque and calculus extend down the root, pocket forms and bone recedes. X-rays show early signs of bone loss.
62
Describe the classification of periodontal disease at stage 3.
Moderate periodontitis. 25-50% attachment loss or stage 2 furcation involvement, plaque and calculus extend further down the root, pocket deepens, more extensive bone reduction. X-rays show moderate signs of bone loss.
63
Describe the classification of periodontal disease at stage 4.
Advanced periodontitis. More than 50% attachmnet loss or stage 3 furcation involvement, extensive plaque and calculus, severe inflammation, deep pocket, severe bone and gum loss. X-rays show advanced signs of bone loss. If generalised disease, see horizontal bone loss most likely, may present as vertical in pockets
64
How is periodontal disease managed?
- Scale and polish
- Subgingival curettage and root planing
- Open Periodontal surgery to clean tooth surfaces after making a flap
- Gingivectomy
- Extraction
- Homecare
65
What is root planing?
Removal of calculus and plaque from the tooth surface within the gingival sulcus
66
What is subgingival curettage?
Removal of granulation tissue and the gingival sulcar lining, from the gingival side of the sulcus
67
What is the purpose of polishing?
- Removes microscopic scratches on the enamel caused by wear and by scaling. The smoother the tooth surface the more difficult it is for plaque to stick
- Polishing also removes plaque better than scaling
68
What is open periodontal surgery?
- When deeper than 4-5mm
- Making a flap expose the subgingival surface/exposed root to allow thorough treatment
- Once scaling and polishing is complete, the site is lavaged and the flap is sewn back
69
What is a gingivectomy?
- Removal of excess gingiva surrounding a tooth
- For example, this can be used to eliminate pseudopockets in patients with gingival enlargement, or for localised pockets
70
What is the aim of dental homecare?
- To prevent the build-up of plaque, which leads to gingivitis and then periodontitis
- Daily tooth brushing is the gold standard
- The main value of brushing is the brush, not the paste
71
When should you extract a tooth?
If periodontal health cannot be restored, or if the client is unwilling to commit to ongoing homecare and periodic professional care.
If there is attachment loss greater than 25% of the root length, Grade 3 furcation involvement, or mobility, then it is likely you will need to extract the tooth.
72
What are the local consequences of periodontitis?
- Oro-nasal fistula – progression of periodontal disease
- Endodontic disease – periodontal loss progresses apically and gains access to endodontic system (pulp + dentine)
- Pathologic fracture – chronic periodontal loss weakens the bone. Typically occur in the mandible
- Ocular issues – severe inflammation close to the orbit
- Chronic osteomyelitis
73
What are the systemic consequences of periodontitis?
- Inflammation of the gingiva and periodontal tissues that allows the body’s defences to attack the invaders also allows these bacteria to gain access to the body
- Activation of patient’s own inflammatory mediators which have further damaging effects
74
How much do horse teeth erupt per year?
2-3mm/year
75
What is the equine dental formulae?
3 I 3-4 PM 3M
--------------------
3 I 3-4 PM 3M
76
Distinguish the eruption times in deciduous and permanent equine teeth.
Deciduous: central = 6 days, middle = 6 weeks, outer = 6 months
Permanent: 2.5 years and then annually. Central = 2.5y, middle = 3.5y, outer = 4.5y
77
How can equine teeth eruption be predicted?
If you know the premolar or molar number, then it is the same except that you add 6m to those on either end of the scale. If not, try to remember that they erupt in waves from mesial to distal/rostral to caudal for each type of tooth. The 08 is always the last.
78
What is eruption and shedding of deciduous equine teeth?
- Eruption by traction from periodontal ligaments or by pressure by underlying permanent tooth
- Shedding by apex resorption (immune mediated), grinding causing mobilisation of the crown, can have some remnants left in situ
79
When should deciduous teeth by removed?
If loose, impacted or causing trauma
80
What are embryonic molars in horses?
Form in jawbone (permanent). They develop within dental follicles which are embryonic dental tissue. Receive nutrition by diffusion.
81
How is dental examination done in horses?
1. Observation of eating
2. Facial symmetry – look and feel, don’t forget temporomandibular joint, nerve function
3. Eruption bumps – mandibular (lateral view)
4. Masseter muscle wastage – palpate
5. Draining tracts – nasal discharge
6. Submandibular lymph node
82
Describe the structure of the temporo-mandibular joint in horses.
- Articulation between the condylar process of the mandible and the zygomatic process of the squamous temporal bone
- Fibrocartilage cover articular surfaces
- Biconcave, fibrocartilaginous disc separates the joint
- Allows lateral movement
83
Distinguish the muscles of mastication in horses and carnivores.
Horses also have a lingual power stroke (transverse) unlike carnivores which have a vertical power stroke. Highly developed in horses
84
Name and describe the action of 2 muscles of mastication in the horse.
Masseter – provides adduction movement for stroke
Medial pterygoideus – provides initiation of lateral movement for stroke
85
What are lateral excursions in horse teeth?
- Horse can have incisors or molars in apposition at any one point of time, not both
- Normal = between ½-full width of corner incisor
- Abnormal = restriction may be unilateral or bilateral
86
How are lateral excursions in horses examined?
- Push down on nose and take to left, push up on jaw and take to right
- Until point where cheek teeth contact each other (the LE)
- Assess point of contact by looking at incisors
- Then assess that the slide is smooth
- Repeat in opposite direction
87
What is a horse's natural occlusions angle?
Approximately 15˚ at 06
88
How is a direct view examination done in horses?
- Without a gag
- Open both lips and look - age, mmbs colour and CRT, assess visible teeth (incisors, canines), assess soft tissues (bars, commissures, soft tissues), look for draining tracts
- Is it okay to place a gag?
- Use sense of smell
89
What pathologies can be identified from intraoral palpation of the equine teeth?
Sharp enamel points (SEP)
Displaced teeth
Mobile teeth
Excessive transverse ridges (ETRs)
Wave mouth
Ulceration
90
Describe enamel of equine teeth.
- Inert and translucent
- Covered by peripheral cement (less so in deciduous incisors)
- Encircles the infundibulum
- Toughest substance in body so slow to wear so remains prominent
- Infundibula (maxillary and incisors) or Invaginations (mandibular) increase surface area
91
Describe cementum in equine teeth.
- Similar histologically to bone
- Is the outer layer of the tooth- attach to the alveolar bone of skull via periodontal fibres called Sharpey’s fibres
92
What are the characteristics of the 3 types of dentine in horses?
Primary – translucent
Secondary – pigmented
Tertiary – direct response to local insult
93
Describe secondary dentine in equine teeth.
- Laid down at sub occlusal aspect of pulp and by pulp odontoblasts
- Reduced size of pulp cavity and eventually occludes it, prevents pulpal exposure with normal attrition
- Average depth 9-10mm, range 2-33mm
94
Why is the pulp vasculature essential in horses?
Vasculature is essential for continuous secondary dentine production. Therefore, apical foramina must remain open for a longer period while tooth continues to grow
95
When does the equine pulp lay down tertiary dentine?
In response to infection or trauma
96
Describe the structure of mandibular cheek teeth.
- No infundibulum
- Enamel infolding
- 2 roots
- Narrower crown
- Straight arcade
- Narrow jaw
- Smaller central vascular channels
97
Describe the structure of maxillary cheek teeth.
- 2 infundibula
- 3 roots
- Broader crown
- Curvilinear arcade
- Wider palate
98
What are the clinical signs of dental disease in horses?
- Asymptomatic – importance of regular routine checks
- Discharge – nasal/discharging sinus
- Dysphagia/quidding
- Facial asymmetry
- Headshaking
- Issues when ridden
- Muscular atrophy/hypertrophy
- Unable to prehend
- Weight loss
99
How is dental pathology in horses classified?
Stage - eruption, wear
Type - malocclusion (congenital, developmental, acquired), pathological
Location - endodontal, periodontal, soft tissue
100
Name 2 congenital craniofacial abnormalities in horses.
Malocclusion type 2-4 (MAL 2-4)
Cleft palate
101
What are 4 developmental dental pathologies in horses?
Hypodontia (missing)
Anodontia (all missing)
Polydontia (supernumerary – extra)
Dental dysplasia (abnormal form)
102
List the acquired dental pathologies in horses.
Malocclusion type 1 (MAL 1)
Apical infection
Diastemata
EOTRH
Neoplasia
Retained deciduous teeth
Temporal teratoma/dentigerous cyst
Trauma (fracture)
103
What are some possible eruption anomalies in horses?
Wrong number
Displacements
Rotations
Embrication (overcrowding)
Tilting
104
What are some possible wear anomalies in horses?
Incisors – smile, frown, slant, strep, irregular
Check teeth – sharp enamel points, hooks, wave, shear, excessive transverse ridges, focal overgrowths, strep
105
What should routine neonatal clinical examination of a foal include on oral assessment?
- Mucosal membrane colour and CRT
- Relative maxillary : mandibular length
- Intact palate
- Suck reflex
- Listen, look and feel
106
What is MAL 4 in horses?
Shortening unilateral premaxillary and maxillary bones causes lateral deviation towards affected side
107
What may severe cases of MAL 4 in horses have?
- Significant incisor malocclusion
- Cheek tooth malocclusion
- Nasal septum deviation obstructing breathing
108
What is MAL 2 in horses?
- Distocclusion or “Parrot Mouth”
- Mandible moves back as lift head so need to assess in neutral position
- Defect in shortened rostral mandible
109
What is the consequence of MAL 2 in horses?
- Short interdental space
- Possible genetic link
- Prone to excessive hooks on upper 06’s and lower 11’s
- All have overjet
- Severe ones develop overbite
110
What is MAL 3 in horses?
- Sow mouth
- Defect in shortened premaxilla and/or maxillary bones
111
What is the consequence of MAL 3 in horses?
- Short interdental space
- Possible genetic link
- Small horse breeds and miniature ponies predisposed
- Prone to excessive hooks on upper 06’s and lower 11’s
- Underbite
112
What is failure to erupt blind' in horses?
- Don’t penetrate oral mucosa
- Particularly wolf teeth (PM1)
113
What are retained deciduous incisors in horses?
- Permanent tooth usually erupts inside deciduous tooth pushing it up and out
- Some fail to shed
- May cause trauma to lips
114
What are retained deciduous premolars?
- Hard to tell if permanent or deciduous from oral exam unless both visible or not in full wear
- Permanent tooth displaces deciduous tooth from below
- Occasionally will find fragments of roots at routine examination
115
What is MAL1 polydontia/supernumerary teeth in horses?
- Always count all the teeth
- May be in usual alignment or displaced
- May facilitate food packing to cause gingivitis and subsequent periodontitis
- May be hard to identify the extra tooth
- Can be in usual mesiodistal orientation or displaced
- Often share a socket
- May require routine floating or extraction
116
How should incisors wear in horses?
Straight and horizontal
117
What is iatrogenic wear in horses?
- Horses grazing very short grass
- Those with a grazing muzzle
- Stable vices
- Over-rasping
118
What are sharp enamel points in horses?
- Maxillary – buccal
- Mandibular – lingual
- Created due to anisognathia
- Worsened if incomplete slide phase during power stroke – processed diets
- Cause buccal/lingual ulceration and pain
- Resolve with routine odotoplasty
119
What are hooks in horses?
- Usually form on the – mesial (rostral) maxillary 06s, distal (caudal) mandibular 11’s
- May have concurrent issues – supernumerary teeth, absent teeth
120
What are excessive transverse ridges in horses?
- Horses have variable transverse ridge heights with a couple of ridges per tooth
- Single ETR in a mouth are significant – often opposite a diastema
121
What are focal overgrowths/step mouth in horses?
- Loss of one tooth may, if unchecked, allow overgrowth of opposite tooth into gap
- This has serious impact for the opposite arcade
- Will obstruct the dental arcade dynamics and predispose to shear mouth too
122
What are shears in horses?
- Increased angulation of occlusal surface – normal range from 10 -35. Shear is >45˚ or asymmetry between sides
- Usually secondary to a limited lateral excursion, so narrow power stroke
123
What are waves in horses?
- Undulating pattern
- Secondary – opposite cupped out teeth, opposite missing/displaced teeth
- Enhanced eruption rate (x2-4) if tooth is not in wear
124
What are the clinical signs of periodontal disease in horses?
Quidding
Weight loss
Halitosis
Oral/facial pain (can change character)
125
How is periodontal disease examined in horses?
- Remove pocketed food to assess fully
- Use periodontal probe to measure pocket depth
126
What can severe periodontitis in horses lead to?
- Loss of periodontal attachment
- Apical and endodontic disease
- Oro sinus fistulation-sinusitis
- Osteomyelitis
- Majority of periodontal disease associated with diastema(ta)
127
What is a diastema in horses?
Means a space between 2 teeth, often used as a pathological term in horses. Mostly mandibular arcades but can affect maxillary arcade
128
How do diastema form in horses?
Food impaction > inflamed gingiva > bacterial growth > ulceration, cemental caries > more space for food to trap
Valve diastema most prevalent and associated with more severe disease – gap opens when in occlusion and food is forced in, then closed when not in contact trapping it there
129
What are the aetiologies of diastema in horses?
- Poor conformation – lack of dental angulation
- Dental drift – after loss of a tooth others no longer act as a functional unit and drift to fill hole
- Senile – crown is wider than root so as erupt and wear what is left of tooth is shorter and thus gaps arise. These naturally get wider as age progresses further
130
What are caries in horses?
- Visual appearance of dark and pitting on teeth
- Affects the cementum that lines the enamel – peripheral and infundibular
- Most prevalent in 09-11’s (cheek tooth problem)
131
Describe the pathologenesis of caries in horses.
1. Increase in high concentrate low fibre diets
2. Increase in those fed silage (acidic)
3. Bacterial fermentation of carbohydrates release acid
4. Acid breaks down (decalcifies) inorganic dental components
5. Tooth, CHO, plaque and bacteria all required
132
Describe infundibular caries in horses.
- Maxillary cheek teeth
- 09’s predisposed (75% of cases)
- Weakens tooth and predisposes for sagittal fracture down axis of tooth and apical infection
133
What is infundibular hypocementosis in horses?
- Vascular supply of 09 cut first as 1st permanent tooth in mouth – can be traumatised
- Possible risk by early removed caps?
- May predispose to infundibular caries?
134
What are the consequences of dental fissures?
- Defect in secondary dentine
- Single lesions may be inconsequential
- Multiple pulp exposure or >3mm deep when probe are suggestive of pulp death
135
What is a type 1a occlusal fissure in horses?
Involves the secondary dentine overlying the pulp cavity and runs from the secondary dentine perpendicular to the surrounding enamel fold
136
What is a type 1b occlusal fissure in horses?
Involves the secondary dentine overlying the pulp cavity but does not follow a perpendicular orientation in relation to one surrounding enamel fold. Often this orientation is more mesio-distal.
137
What is a type 2 occlusal fissure in horses?
Does not involve secondary dentine
138
What are buccal slab fractures in horses?
- Run through pulp chambers 1 and 2
- Exit close to gum line
- Buccal fragment often pokes into cheek causing trauma and is relatively easily removed
139
What are sagittal fractures in horses?
- Secondary to infundibular caries
- Often asymptomatic but some show pain
- Always involves pulp
- Extraction indicated
140
What is the route of infection for septic pulpitis in horses?
Most common route for infection is anachoresis
Blood borne
141
What could septic pulpitis be predisposed by in horses?
Vertical impaction
Hyperaemia of eruption cysts
142
What may septic pulpitis be secondary to in horses?
Deep periodontal disease
Severe wear disorders
Fractures
143
What anatomical structure makes the presentation of apical infection of 06-08 differ from 90-11?
Paranasal sinuses
144
How does apical infection in horses present?
06-08 roots in nasal passages – local swelling
09-11 roots in paranasal sinuses – CMS has wide opening into frontal sinus which drains out through the main sinus drainage angle
Mandibular apical infections have local mandibular swellings
145
What are the key radiographic signs of apical infections in horses?
- Periapical sclerosis
- Periapical halo formation
- Clubbing of root/apices
- Loss of lamina dura
- Widening of periodontal ligament
146
What is EORTH?
Equine odontoclastic tooth resorption and hypercementosis
147
What is the presentation of EORTH?
Asymptomatic
Loose incisors
Mandibular swelling
Discharging sinus tracts
Weight loss
Hypersalivation
Ridden issues? Bit? Headshaking?
148
What happens in EORTH?
- Resorption before or concurrent with hypocementosis
- Some may have cement replace periodontal ligaments
- Extraction required chiselling out
- Extensive resorption may predispose fracture on removal
- Some may have bulbous cementum mass wider than root at apex
149
How are tooth fractures classified?
The fracture location and whether the pulp is exposed (uncomplicated or complicated)
150
What are the phases of tooth damage?
1. Initial insult – very painful, the owner may or may not notice
2. Acute inflammation – acute pulpitis – may last days/weeks/months
3. Chronic inflammation – still painful but less obvious
4. Atrophy of pulp
5. Necrosis of pulp tissue
6. Death of canal – low grade pain or non-painful at this stage as it is dead
7. Abscess formation – painful again
151
What are the signs of a fractured tooth?
- Obvious pulp exposure
- Resistance to oral exam (pain)
- Chewing on one side more than the other
- Pawing at mouth
- Rubbing head on ground
- Reluctance to be patted on head
- Excessive salivation
- Irritability
- Decreased appetite
- Pain when chewing
- Reluctance to play with toys
- Fractures can be hidden with calculus
152
Describe an enamel infraction/enamel fracture/uncomplicated crown fracture.
If the defect is confined to the enamel or dentine, without radiographic signs of periapical pathology, then ensuring sharp edges are smooth is enough and you don’t need to extract. However this tooth must be monitored – there is still a risk bacteria can still enter through the exposed dental tubules
153
Describe uncomplicated crown-root fractures.
Provided the extension below the gumline is minimal (no more than 2-3mm) this may be treated as above, but must be monitored closely with careful owner homecare (brushing)
154
Describe complicated crown fracture/complicated crown-root fracture/root fractures.
Any tooth with direct pulp exposure or radiographic signs of tooth death/periapical inflammation needs either extraction or root canal therapy (referral)
155
What is done for vital teeth with direct pulp exposure?
Treated swiftly. If this is delayed, analgesia is provided. Antibiotics are not indicated
156
What are 2 complication of fractured teeth?
Chronic pain
Tooth root abscess – as the infection enters the periapical area
157
Distinguish abrasion and attrition in dentistry.
Abrasion – rubbing a tooth against an object
Attrition – wear from tooth on tooth due to malocclusion
158
When does the body produce tertiary dentine?
When the wear is slow enough the pulp isn’t exposed but is very close to being exposed
159
How is abrasion and attrition investigated?
- Probe these teeth with an explorer to ensure it can’t stick into the pulp
- Radiography to check the roots are normal (no sign periapical lucency)
160
How are teeth prone to abrasion and attrition managed?
- If the probe doesn’t stick into the pulp and the roots are normal it is ok to leave these teeth.
- If any problems > root canal or extraction
161
What can cause discolouration of the teeth?
The tooth may not be fractured but acute pulpitis has occurred which has caused bleeding into the dental tubules, causing the discolouration
162
What 2 ways might a discoloured tooth progress?
- The pulpitis may be temporary – it can subside and the tooth survives. This may happen if the discolouration is localised/minor
- The tooth dies due to disrupted blood supply – over time it goes grey/brown
163
You have diagnosed a complicated crown fracture on tooth 208/4th upper premolar. What should you do with this tooth?
Root canal treatment of extraction
164
You have a consultation with a dog presenting a large swelling on their cheek below their left eye, which is oozing a mucopurulent discharge. What should you do?
Check for a damaged or diseased tooth causing an abscess and recommend a full examination with dent radiographs under GA asap to explore the possibility of a dental cause.
165
Distinguish deciduous teeth from permanent teeth.
- Smaller, slimmer and sharper
- Proportionally longer roots
- Whiter as their enamel is less mineralised
166
How is the triadan system different for deciduous teeth?
Have different numbers – the quadrants are numbered 5-8 starting from upper right
167
Give the triadan dental formulae for dog deciduous teeth.
2 x ( I 3/3 C 1/1 PM 3/3) = 28
168
Give the triadan dental formulae for cat deciduous teeth.
2 x ( I 3/3 C 1/1 PM 3/2) = 26
169
Describe the crown morphology of deciduous teeth.
The crown morphology and number of roots are usually similar to the permanent tooth distal to it, rather than its true successor.
170
When are deciduous teeth a problem?
Retained/persistent deciduous teeth:
- May cause displacement of permanent successor, causing trauma
- Overcrowding greatly predisposes to periodontal disease
Fractured deciduous teeth - extracted
Malocclusions - painful, restricts normal jaw growth
171
What is tooth resorption?
Loss of dental hard tissue due to activation of odontoclasts
172
Describe stage 1 tooth resorption.
Mild dental hard tissue loss (cementum and enamel)
173
Describe stage 2 tooth resorption.
Moderate dental hard tissue loss (cementum and enamel with loss of dentine that does not extend to pulp)
174
Describe stage 3 tooth resorption.
Deep dental hard tissue loss (cementum and enamel with loss of dentine extending to pulp cavity), most of the tooth retains integrity
175
Describe stage 4 tooth resorption.
Extensive dental hard tissue loss (cementum and enamel with loss of dentine extending to pulp cavity), most of the tooth has lost integrity
176
Describe stage 5 tooth resorption.
Remnants of dental hard tissue visible only as irregular radiopacities; complete gingival covering
177
Describe type 1 tooth resorption.
Focal or multifocal radiolucency present in a tooth with otherwise normal radiopacity and normal PDL space. Also known as inflammatory resorption.
178
Describe type 2 tooth resorption.
Narrowing or disappearance of the PDL space in at least some areas and decreased radiopacity of the tooth. Also known as replacement resorption.
179
Describe type 3 tooth resorption.
Features of both type 1 and type 2 present in the same tooth. Areas of normal and narrow or lost PDL space, and focal or multifocal radiolucency in the tooth and decreased radiopacity in other areas.
180
What are the clinical signs of tooth resorption?
Decreased grooming, picking at/dropping food, pawing at mouth, lethargy, signs of oral discomfort, mucus on the lips/paws, head shaking, rubbing mouth on ground, tooth grinding
181
How can tooth resorption be diagnosed with tactile exploration?
Thorough exam of entire tooth surface, especially at the gingival margin, with a dental explorer. Intact enamel is very smooth. If there is a resorptive lesion present, the explorer catches.
182
How can tooth resorption be diagnosed with dental radiography?
These are essential to establish the type of TR present and therefore plan treatment. Ideally full mouth radiographs are taken in all feline dentals, to search for TR that may not be evident above the gumline
183
How does type of tooth resorption affect treatment?
Type 1 = extract whole root
Type 2 = extraction can be hard/impossible so can do crown amputation, partial root retention or complete extraction. Crown amputation = envelope gingival flap, removal of all tooth substance down 1-2 mm below bone level with a dental bur and suturing of the gingiva
Type 3 = type 2 root amputated, type 1 root extracted
184
What is essential to do when assessing tooth resorption?
Dental radiography
185
What is a key feature of type 1 tooth resorption?
Normal PDL space
186
You have diagnosed type 2 tooth resorption on 307. What is the appropriate treatment?
Crown amputation
187
What are the clinical signs of chronic gingostomatitis?
Moderate to severe oral pain
Depression, aggression, social withdrawal
Halitosis
Ptyalism
Dysphagia – not eating well
Decreased grooming
Weight loss
Oral bleeding
Pawing at the face/mouth
188
How is chronic gingivostomatitis diagnosed?
Primarily on clinical presentation. Histopathology may only be useful in ruling out other differentials such as neoplasia
189
What is the aetiology of chronic gingivostomatitis?
Believed to be multi-factorial involving viruses, bacteria and possibly other factors. Affected individuals may also have an inappropriate immune response to antigenic stimulation
Dental plaque may act as complicating or causative factors
190
What are the treatment aims of managing chronic gingivostomatitis?
- Modulate the immunological response
- Decrease inflammation
- Control plaque bacteria and treat secondary infections
- Control oral pain and discomfort
191
What is the aim of surgical therapy of chronic gingivostomatitis?
To eliminate any potentially inflammatory stimulus from the oral cavity
192
How is gingivostomatitis treated medically?
- Antibiotics/antimicrobials - only able to temporarily suppress not eliminate resident oral flora and cannot disrupt bacteria in plaque
- Anti-inflammatory, immunosuppressive or immunomodulatory drugs - immunosuppressive drugs carry a risk if used in cats carrying viruses
- Analgesics
193
What is feline eosinophilic granuloma complex?
Eosinophilic granulomas and indolent ulcers in the oral cavity
194
How is feline eosinophilic granuloma complex diagnosed and treated?
Diagnosis by cytology and histopathology
Lesions often wax and wane and may spontaneously regress, treatment of flare ups include immunosuppressive therapy at lowest possible doses
195
What is a malocclusion?
Upper and lower teeth do not align when you close your mouth, typically if teeth are crowded or are crooked, teeth are too large for the mouth or the lower and upper haws are not aligned
196
What are the common malocclusions?
Class 1 malocclusion is the most common. The bite is normal, but the upper teeth slightly overlap the lower teeth.
Class 2 malocclusion, called retrognathism or overbite, occurs when the upper jaw and teeth severely overlap the bottom jaw and teeth.
Class 3 malocclusion, called prognathism or underbite, occurs when the lower jaw protrudes or juts forward, causing the lower jaw and teeth to overlap the upper jaw and teeth.
197
What might be the clinical significance of malocclusion?
- Untreated can cause tooth loss or gum disease, damage enamel or cause jaw problems
- TMJ disorders
- Difficulty or discomfort biting or chewing
198
What are the possible treatment options for common malocclusions?
- Removing teeth to ease overcrowding
- Performing surgery on your jaw to correct issues you inherited or fix jaw fractures that didn’t heal properly
199
Define caries.
Demineralisation of the tooth resulting in loss of tooth structure
200
What causes caries?
- Poor oral hygiene
- Diets high in carbohydrates and sugars increase risk
- Breed predisposition due to shape and alignment of teeth
- Teeth formed abnormally close together
- Gaps between the teeth and gums
- Low salivary pH
- Poorly mineralised tooth enamel
201
What are the clinical signs of caries?
Pawing at the mouth, head shaking, jaw chattering, discomfort, quidding, drooling, difficulties swallowing, halitosis
202
How are caries diagnosed?
Dark brown spot and sticky or slightly soft when probed. Plug of plaque noted at the centre of discoloured groove or occlusal pit. Dental radiography to determine pulp involvement – periapical lucencies and an abnormal pulp canal.
203
What are the appropriate treatment options for caries?
Extraction or restoration of affected teeth
204
What is assessed on clinical exam for dental disease?
- Eyes, ears, nose, lips, any swellings, symmetry, lymph nodes
- Roof of the mouth and under the tongue if you can
- Missing/fractured/discoloured teeth, gingival inflammation, calculus deposits, gingival recession
- Oral mucosa, gingiva, palate, dorsal and ventral aspect of the tongue, tonsils, salivary glands. Check for masses, swelling, ulcerations, bleeding and inflammation
205
Describe dental health check under GA.
- Owner may have missed that there is pain
- Lymph nodes especially might be up if dental disease present
- Not every dog will allow a complete thorough conscious oral exam
- Concomitant disease/pre-dental diagnostic tests
206
Will the history and conscious oral exam tell us whether a dental procedure is required?
Can rule in for a dental procedure but not enough on its own
207
What are the possible complications/risks associated with dental procedures?
- Aspiration
- Death
- Jaw fracture
- Haemorrhage
- GA risks
- Leaving root behind
- Nerve damage
- Maxillary canine – risk of nasomaxillary fistula
208
Why is ultrasonic teeth cleaning by groomers not recommended?
- No medical benefit
- Dangerous for patient (periodontal damage, debris inhalation)
- Stressful
- Delaying effective treatment
- Miss chance to diagnose oral problems
209
What are the peri-operative considerations for dentals?
- Age – pre-GA bloods? Pre-med doses?
- Co-morbidities and how they might affect the GA
- IVFT – prophylactic antibiotics?
- Consider staging the procedure
- Wet procedure – we need to prevent hypothermia
- Care reuse of mouth gags
210
Are antibiotics given peri-operatively for periodontal disease?
- Antibiotics are ineffective against periodontal disease
- A bacteraemia occurs within 40 mins of the start of a dental procedure - antibiotics are not indicated in healthy patients
- Peri-operative prophylactic antibiotics maybe indicated for immunocompromised patients, those with underlying systemic disease, or where severe oral infection is present
211
When should peri-operative antibiotics be used in dentals?
Tooth root infection/abscess
212
How can we prevent Billy from aspirating the fluid generated in a dental procedure?
Intubated with a snuggly fitting ETT. Neck elevated and head positioned so that fluid drains out of the mouth. Throat pack does not achieve this as it is water permeable.
213
What are the steps for oral examination under GA?
1. Check occlusion before intubation
2. Check oropharynx/tonsils/epiglottis/fauces at intubation
3. Antiseptic rinse and scaling
4. Probe and chart
5. Dental radiography
6. Biopsies if needed
214
Why should scaling be performed before probing and charting?
Better visualisation, some teeth may be held in by calculus
215
What are the steps for a scale and polish?
1. Antiseptic lavage
2. Crack off the large chunks - never use on fragile teeth/cat teeth
3. Mechanical scaling - use an ultrasonic scaler at the lowest effective power
4. Hand scaling
5. Polishing - low speed (to avoid thermal damage) with a prophy paste
216
How can thermal damage by a scaler be alleviated?
- Water flowing through the tip to cool the scaler
- Using only the side of the tip
- Constantly moving
- Don’t scale any one tooth for more than a few seconds
217
Which instruments are used for probing and charting?
Periodontal explorer probe and curette (hand scaling)
218
What are the indications for extractions?
- Severe periodontal disease
- Fractured/worn teeth (with pulp exposure)
- Endodontic disease – think about how you can identify pulpitis/pulp necrosis)
- Traumatic malocclusion
- Persistent deciduous teeth
- Tooth resorption (FORLs)
- Infected teeth/abscesses
- Caudal stomatitis – if brushing and medical management failed)
- Unerupted teeth
- Supernumerary teeth
- Caries
219
What must be considered before extraction?
- Did you get consent to remove teeth if necessary?
- Pre-op radiographs - essential in cats
- Analgesia – wherever possible use nerve blocks
- Does this tooth need a closed or surgical extraction?
220
What is closed extraction?
An extraction without incising the gingiva, other than within the sulcus
221
What are the indications for closed extraction?
- Small single rooted teeth, or fused roots (incisors, 1st pre-molars, maxillary 2nd molars in dogs)
- Significant bone loss, resulting in increase in mobility
222
How is closed extraction done?
1. Cut the gingival attachment ad periodontal ligament fibres – use a luxating elevator/luxator
2. Elevate the tooth with an elevator. Apply 10-30secs moderate sustained, apical rotational pressure
3. Extract the tooth – use extraction forceps or fingers, only when very loose
223
What is open/surgical extraction?
An extraction after flap and creation and removal of alveolar bone
224
What are the indications for open/surgical extraction?
- Most multi-rooted teeth
- Canine teeth in most cases (non-surgical extraction may pre-dispose to oronasal fistula)
- Periodontally healthy teeth where resistance to closed extraction may be encountered
- If radiographs reveal abnormalities in the root
225
How is open/surgical extraction done?
1. Cut gingival attachment and raise a flap in the gingiva – scalpel and periosteal elevator
2. Remove alveolar bone that overlies the root – high speed drill and burr
3. Cut channels parallel to the root and elevate the tooth – elevator, luxator
4. Extract tooth and suture closed mucogingival flap – monofilament suture, needle holders
226
How are multi-rooted teeth roots extracted?
Multi-rooted teeth roots are divergent, so can’t be extracted in one piece. Multi-rooted teeth need to be split (sectioned) into individual single rooted pieces. Use high-speed drill on dental machine.
227
How is the site closed after open/surgical extraction?
- Once your tooth is out you need to suture the flap closed
- Burr down sharp alveolar bone edges
- Flush with saline
228
What at home ‘treatment’ should the owner give Billy for the first week after discharge?
Oral and soft food
229
What are the types of dental homecare?
- Active – gold standard, needs owner participation e.g. brushing, rinsing
- Passive – based on chewing behaviours via treats and diets, compliance is more likely
230
What are some examples of active dental homecare?
Tooth brushing
Antiseptic rinses
231
What are some examples of active passive homecare?
Dental diets
Dental chews
232
How do dental diets aid dental health?
Exercise the gums, promote gingival keratinisation and clean the teeth. Typically most effective on the areas around the cusp tips and not at the gingival margin
233
How do dental chews aid dental health?
- Minimal effects, won’t usually help with incisors or canines
- High calorie
- Risk of GI FB, tooth fracture
234
What are the pathologies in geriatric horses?
Cupping out
Wave mouth
Caries
EOTRH
Senile diastemata
Oral neoplasia
235
What is cupping out in old horses?
- Old mandibular teeth may reduce to just roots
- Teeth then lose periodontal ligament strength and fall out
- Not to remove too much tissue on dental care as they are already limited to the amount of tissue they have left
- Slower
236
How can horses with EORTH be tested if they are painful?
Generally painful – carrot test, gag pain likely
237
Which teeth in EORTH are affected first?
Affected 03’s 1st – caudal incisors affected first
238
What is the presentation of EORTH?
Asymptomatic
Loose incisors
Mandibular swelling
Discharging sinus tracts
Weight loss
Hypersalivation
Ridden issues – bit, headshaking
239
What are draining tracts in horses?
Look for little spots/holes in the mouth, as these could be the start of these discharging tract
240
What is the ideal angle for bisecting angle intraoral radiographs in horses?
Perpendicular to plate, perpendicular to teeth, estimate and mid-way between
241
Distinguish category 1, 2 and 3 dental procedures in horses.
Category 1 – procedures that are not acts of veterinary surgery
Category 2 – qualified EDTs/equine dental technicians. WWAED Cat 2 or BEVA/BVDA qualified
Category 3 – anything else in horses mouth is an act of veterinary surgery
242
List the category 1 procedures in equine dentistry.
- Examination of teeth
- Removal of sharp enamel points using manual (hand) floats only
- Removal of small dental overgrowths (maximum 4mm reductions) using manual rasps only
- Rostral profiling of the first cheek teeth (maximum 4mm reductions), previously termed ‘bit seat shaping’
- Removal of loose deciduous caps
- Removal of supragingival calculus
243
List the category 2 procedures in equine dentistry.
- Examination, evaluation and recording of dental abnormalities
- The extraction of teeth or dental fragments with negligible periodontal attachment.
- The removal of erupted, non-displaced wolf teeth in the upper or lower jaw under direct and continuous veterinary supervision
- Palliative rasping of fractured and adjacent teeth
- The use of motorised dental instruments where these are used to reduce dental overgrowths and remove sharp enamel points only. Horses should be sedated unless it is deemed safe to undertake any proposed procedure without sedation, with full informed consent of the owner.
244
What indicates an oronasal fissure?
Flush into the mouth coming out of nose is not normal
245
What are the limitations of hand and motorised rasping in equine dentistry?
Both can cause dmage, including pulp exposure when used inappropriately
246
What are the disadvantages of hand rasping in equine dentistry?
- Time taken
- Harder skill to learn
- Harder to visualise when rasping
- Harder to work on overgrowths at back of mouth
247
What are the disadvantages of motorised rasping in equine dentistry?
- Expensive
- Maintenance essential
- Significant heat generation
- Minimum contact time on single tooth
248
Where to sharp enamel point from?
Lingual aspect of mandible CT and buccal aspect of the maxillary CT
249
When should you stop rasping in horses?
Stop when light brown/dark cream else expose pulp
Return in 3-6m when more secondary dentine laid down
Beige is already too far, pink is into live tissues. Stop at light brown.
250
How should you hold the rasp in equine dentistry?
If you can hold in right hand and overhand for right side, you can visualise teeth and make sure they are not wonky, flip for lower/upper. Do the same for left side with left overhand
251
Where are wolf teeth (the first premolars) most commonly located in horses?
Just rostral to maxillary cheek teeth. But can be found on the lower jaw but more commonly on upper.
252
What is used to extract wolf teeth in horses?
- Sedation
- LA into palatal fold, through lateral mucosa to periodontal ligament
- Using elevators
- Then forceps
- Not burgess elevators – wrong shape and risks breaking
253
What post-operative care is used post wolf tooth extraction in horses?
- Curette socket if palpably rough
- NSAIDs
- Oral Rest <10days without bit
- Diet – grass, haylage, soften hay
- If leave root tip in situ, curette and reexamine in 1 month
254
How is periodontal disease prevented in horses?
General health PPID
Diligent odontoplasty to remove overgrowths
Diet – avoid short chop
255
What is the treatment for periodontal disease in horses?
- General health –PPID
- Remove food material – picks and forceps, flush – allows for healing time
- Widen diastema – occlusal relief cuts, groove at the occlusal surface so less food can become impacted in there and can get out
- Temporary bridge to prevent re-impaction
- Permanent bridge
- May need serial treatments
256
What are the steps used for equine dental extractions?
1. Sedation and regional anaesthesia.
2. Elevate gingiva
3. Molar separators(with serial increasing size) to loosen mesial and distal periodontal ligaments
4. Forceps to stretch medial and lateral periodontal ligaments - constant force to stretch instead of repeated oscillations
5. Elevate with fulcrum
6. Check tooth and socket
257
When are minimally invasive trans buccal screw extractor used in equine dentistry?
When simple oral extraction not possible
258
What are the other more invasive methods for extraction in equine dentistry?
- Intraoral tooth segmentation – if divergent roots
- Lateral buccotomywith alveolar bone flap –cases with cementoma
- Minimally invasive trephine and repulsion
- Repulsion – outdated
259
What are the increased risk of complications with these more invasive techniques in equine dentistry?
Tooth
Bone (sequestrum or major)
Persistent sinus or oroantral fistula
Infection
Dehiscence
Dry socket
260
How do infundibular restorations treat caries in horses?
- Reduce risk of sagittal fracture
- Reduce risk of periapical infection
CVSOH 4
flashcards
Decks in class (35)
# Cards
-
Ophthalmology403
-
Dermatology267
-
Dentistry260
-
Ears36
-
Surgery156
-
Practicals42
-
Diagnostic Imaging140
-
Small Animal Gastrointestinal210
-
Equine Gastrointestinal235
-
Bovine and Ovine Gastrointestinal235
-
Gastrointestinal Pathology187
-
Liver235
-
Gastrointestinal Surgery236
-
Nephrology and Urology348
-
Urinary Tract Surgery83
-
Bovine Clinical Nutrition210
-
Small Animal and Equine Clinical Nutrition60
-
Endocrinology285
-
Avian Medicine438
-
Rabbit, Rodent and Ferret Medicine316
-
Fish Medicine89
-
Reptile Medicine91
-
Pig Health238
-
Shelter Medicine31
-
Bees16
-
Small Animal Musculoskeletal618
-
Bovine Musculoskeletal242
-
Equine Musculoskeletal450
-
Musculoskeletal Pathology81
-
Nervous System Pathology129
-
Neurology386
-
VPH and Abattoir Welfare215
-
Behaviour109
-
Goats, Deer, Donkey and Camelid Medicine183
-
Therapeutics28
