Why are dental radiographs an integral part of a COHAT?
it allows you to detect hidden pathologies (unerupted/retained roots, abnormal roots, bone loss, endodontic disease)
What determines how many radiographs are needed in a COHAT?
Though all COHATS should consist of a full mouth suite, the number of rads it takes to get a full suite is dependent on the size of the patient’s mouth and the pathologies at play (some teeth may require more views than typical)
What is the only parameter that needs to be imputted in most modern dental xray machines?
Time. KVP and mA are already set and programmed in these machines
What radiographic technique is used for mandibular premolars and molars?
parallel
what radiographic technique is used for mandibular incisors, maxillary incisors, and maxillary premolars and molars?
bisecting angle
one of your rads shows elongation of tooth roots. How can you correct this?
angle tube more perpendicular to the sensor
one of your rads has shortened roots. How can you fix it to better represent real-life conformation?
angle the tube more parallel to the sensor
What is involved in the “bisecting angle” technique?
The angle between the tooth and the sensor is bisected, and the xray tube is aligned parallel to this bisecting line
You take a rad and the mesiolingual and mesiobuccal tooth roots of your molar are superimposed. This is problematic, as it appears one of the roots has a pathology, but you cannot tell which root it is affecting. What can you do to determine this?
Take another rad, with the tube angled slightly mesially to the first. Then use the SLOB rule to differentiate the roots (the Lingual root will shift to the Same direction as you moved the tube (mesially) and the Buccal root will move in the Opposite direction of the tube (distally))
What is the SLOB rule?
When roots are superimposed, move the tube either mesially or distally and take another rad. lingual (palatal) roots will move in the same direction as the tube, while buccal tubes will move in the opposite direction.
(Same Lingual/palatal, Opposite Buccal)
What are some things to look for on dental rads?
Missing teeth
Abnormal roots
Pulp width
alveolar bone height
Resorptive lesions
Periapical pathology
How do you determine periodontal ligament pathology?
in a normal tooth, you should be able to trace the periodontal ligament around the entire tooth root. It appears radiolucent. If you can’t do this, it means there is something wrong with the ligament, or there is alveolar bone loss around the ligament
How do teeth change radiographically with age?
When teeth are young: the dentin is thin, the apex is open, and the pulp chamber is very large. As the tooth ages, dentin is continuously laid down, the apex closes, and the pulp chamber progressively gets smaller
An 11 yo dog gets dental rads. 205 has a wide pulp chamber, while 105 has a very narrow pulp chamber. Which is more likely to be pathologic? Why?
- by 11 years, the pulp chambers in all teeth should be quite narrow due to natural age progression. A wide pulp chamber in 205 indicates that the tooth was devitalized before this process could occur, which in this case was a VERY long time.
A radiolucent oval is found below the apex of a premolar. When you redirect the xray tube mesially, the oval appears to shift slightly away from the root apex. Is this pathologic?
The mental foramens on the mandible can overlap apices of teeth, giving the appearance of a pathology. Shifting the beam allows us to determine if the lucency is associated with the tooth root, which would indicate a pathology. In this case, the oval did not seem associated (it shifted away from the root), and is therefore likely to be the mental foramen
What is a Chevron sign?
The appearance of a triangular shadow/lucency below the apices of tooth roots. This is a normal finding that is commonly mistaken as pathologic.
How can you differentiate a normal chevron sign from pathology?
Chevron signs are triangular, and will not have additional signs of periodontal disease. Pathologic radiolucency below root apices will be rounded, and have other signs of periodontal disease (changes in radiolucency of the root, incomplete periodontal ligament, etc)
What is the most common oral disease of dogs and cats?
Periodontal disease
Periodontal disease is a progressive inflammatory disease of what structures?
Gingiva, periodontal ligament, cementum, and alveolar bone. Together, these are the components of the periodontium.
What are the two stages of periodontal disease?
stage 1: gingivitis
Stage 2: periodontitis
which stage of periodontal disease is reversible, and which is irreversible?
stage 1 (gingivitis) is reversible, stage 2 (periodontitis) is not.
Describe the pathogenesis of periodontal disease
oral bacteria creates biofilm on tooth (plaque) -> plaque is mineralized, becomes calculus -> calculus accumulation leads to subgingival proliferation of bacteria -> shifts from mainly gram + to gram - bacteria -> endotoxins and proteolytic enzymes are released, triggering host release of pro-inflammatory cytokines -> cytokines cause osteoclast activation -> alveolar bone resorption
What are four factors affecting periodontal disease?
Genetics
Teeth crowding
Diet and chewing behaviour
Systemic disease (diabetes especially)
What are the clinical signs of periodontal disease
halitosis
gingival redness, swelling and bleeding
tooth mobility
tooth loss
drooling, pawing at mouth, reluctance to eat
asymmetrical accumulation of calculus
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