Оглавление
Jan Bellows. Feline Dentistry
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Feline Dentistry
Dedication
About the Author
Forewords
Acknowledgments
Introduction. First Do Good
1 Anatomy. Tooth Nomenclature
1.1 Oral Cavity
1.2 Mucosa
1.3 Muscles
1.4 Tongue
1.5 Innervation
1.6 Blood Supply and Lymphatic Drainage
1.7 Salivary Glands
1.8 Periodontium
1.9 Gingiva
1.9.1 Marginal Gingiva
1.9.2 Free Gingival Margin
1.9.3 Attached Gingiva
1.9.4 Gingival Sulcus
1.10 Periodontal Ligament
1.11 Cementum
1.12 Alveolar Bone
1.13 Bones and Joints. 1.13.1 Cranium
1.13.2 Facium
1.13.3 Maxillae and Mandibles
1.14 Maxillary Region
1.15 Mandibles
1.16 Temporomandibular Joint
Temporomandibular Joint Nomenclature
1.17 Teeth
1.17.1 Dental Formula
1.17.2 Tooth Types
1.18 Variation in Tooth Number and Morphology
1.19 Composition. 1.19.1 Enamel
1.19.2 Dentin
1.19.3 Pulp
1.20 Tooth Eruption
Surfaces of Teeth and Directions in the Mouth
Further Reading
2 The Feline Dental Operatory – Equipment, Instruments, and Materials
2.1 Space
2.2 Electricity, Water, and Drainage
2.3 Ergonomics
2.4 The Operatory
2.5 Adjustable Stools/Chairs
2.6 Built‐in Desk
2.7 Powered Dental Delivery Systems. 2.7.1 Electric
2.7.2 Air/Gas‐Driven
2.7.3 Compressor
2.7.4 Storage Tank
2.7.5 Assembly Delivery System
2.7.5.1 Suction
2.8 Storage
2.9 Lighting
2.10 Dental Loupes (Telescopes)
2.11 Radiography
2.11.1CR (Computed Radiography) Technology
2.11.2DR (Digital Radiography) Technology
2.12 General Anesthesia
2.13 Patient Monitoring Devices
2.14 Dental Charts
2.15 Dental Explorer
2.16 Periodontal Probe
2.16.1 Dental Mirror
2.16.2 Mouth Props
2.17 Operator Safety Equipment
2.18 Dental Scaling, Irrigation and Polishing Equipment, Instruments, and Techniques
2.18.1 Hand Instruments (Scalers and Curettes) for Plaque and Calculus Removal. 2.18.1.1 Sickle Scaler
2.18.1.2 Curettes
2.18.1.3 Powered Dental Scaling
2.18.2 Sonic‐ and Ultrasonic‐Assisted Dental Scaling. 2.18.2.1 Sonic Scaling
2.18.2.2 Ultrasonic Scaling
2.18.2.3 Replacing Worn or Broken Tips
2.18.3 Dental Polishing Equipment and Materials
2.18.3.1 Sealants
2.18.3.2 Locally Administered Antimicrobials (LAA)
2.19 Extraction Instruments and Materials. 2.19.1 Oral Surgery Instruments
2.19.2 Periotome
2.19.2.1 Mechanical Periotome
2.19.2.2 Periosteal Elevators
2.19.3 Dental Luxators and Dental Elevators for Extractions
2.19.3.1 Luxators
2.19.3.2 Elevators
2.19.3.3 Extraction Forceps
2.19.3.4 Root Tip Pick
2.19.3.5 Hand Instrument Sharpening
2.19.3.6 Materials for Sharpening Instruments
2.19.3.7 Instrument Cassette
2.20 Dental Handpieces
2.20.1 Low‐Speed Handpiece
2.20.2 Contra‐Angle Attachment
2.20.3 High‐Speed Handpiece
2.20.4 Burs
2.20.4.1 The Bur Shank
2.20.5 Bur Storage
2.20.5.1 Bur Head Bur Types
2.21 Maintenance of Dental Equipment. 2.21.1 Handpiece Maintenance
2.21.1.1 Replacing the High‐Speed Turbine
2.21.1.2 Low‐Speed Handpiece Cleaning Steps
2.21.1.3 Bur Maintenance
2.21.1.4 Compressor Maintenance
2.22 Homecare Products to Reduce the Accumulation of Plaque and Tartar (Calculus)
2.23 Equipment and Materials for Advanced Dental Care
2.23.1 Endodontic Instruments and Materials. 2.23.1.1 Canal Preparation. Barbed Broach
2.23.1.2 Debriding the Canal. Root Canal Conditioner
2.23.1.3 Endodontic Files. K‐Files
Hedstrom Files
2.23.1.4 Canal Irrigation
2.23.1.5 Drying the Prepared Irrigated Canal
2.24 Obturating the Canal. 2.24.1 Filling the Prepared and Cleaned Root Canal. 2.24.1.1 Gutta Percha
2.24.1.2 Retrograde Amalgam Carrier (1 mm)
Pluggers
MTA
Light‐Cured Glass Ionomer Liner/Base
2.25 ADVANCED PROCEDURES. 2.25.1 Adhesives
2.25.2 Composite Resins
2.25.3 Polishing the Restoration
2.26 Lasers
2.26.1 Carbon Dioxide Laser (10 600 nm)
2.26.2 Diode Laser
2.26.3 Therapy Lasers (Low‐Level Laser Therapy – LLLT)
2.26.4 Laser Safety
2.26.5 Patient and Operator Infection Control
Further Reading
3 Anesthesia and Analgesia for Feline Dental Patients
3.1 Non‐Professional Dental Scaling (NPDS)
3.1.1 Anesthesia Risk
3.1.2 ASA Scoring
3.2 Preanesthetic Evaluation
3.3 Anesthesia Protocols
3.4 Premedication
3.4.1 Induction
3.4.2 Chamber or Mask Induction
3.4.3 Propofol
3.4.4 Etomidate
3.4.5 Alfaxalone
3.4.6 Preemptive Pain Control
3.4.7 Methadone
3.5 Medical Conditions Requiring Tailored Protocols. 3.5.1 Renal Disease
3.5.2 Hyperthyroidism
3.5.3 Diabetes Mellitus
3.6 Feline Hypertrophic Cardiomyopathy
3.6.1 Intravenous Fluids
3.6.2 Checklist Before the Patient Is Anesthetized
3.6.3 Preparation of the Anesthetized Dental Patient
3.6.4 Intubation
3.6.5 Endotracheal Tube Inflation
3.7 Maintenance
3.8 Monitoring
3.9 Blood Pressure (BP)
3.10 End‐Tidal Carbon Dioxide (ETCO2)
3.11 Pulse Oximetry (SpO2)
3.12 Electrocardiography (EKG)
3.12.1 Respiration
3.12.2Temperature
3.12.3 Local/Regional (Locoregional) Analgesia
3.12.4 Benefits of Local and Regional Analgesia
3.12.5 Indications for Local and Regional Analgesia
3.12.6 Contraindications for Local and Regional Anesthesia
3.12.7 Duration
3.12.8 Local and Regional (Locoregional) Analgesia Medications and Equipment
3.13 Maxillae. 3.13.1 Infraorbital Nerve Block
3.13.2 Maxillary Nerve Block
3.14 Mandibles. 3.14.1 Middle Mental Nerve Block
3.14.2 Mandibular Nerve Block
3.15 Constant Rate Infusion (CRI)
3.16 Transdermal Pain Patch
3.17 Opioids and Hyperthermia
3.18 Postoperative Analgesia
3.19 Meloxicam
3.20 Decreasing Fear, Anxiety, and Stress
3.20.1 Gabapentin
3.20.2 Trazodone
3.21 Music
3.22 Feline Facial Pheromones
3.23 In the Reception Area and Examination Room
3.24 Feline Orofacial Pain Syndrome (FOPS)
Further Reading
4 The Oral Disease Prevention, Assessment, and Prevention Visit
4.1 The Oral Disease Prevention, Assessment, and Prevention Visit. 4.1.1 Prevention
4.2 Assessment
4.3 Treatment
4.4 Case Volume
4.5 Workflow
4.6 Workflow Example
4.6.1 Common Basic and Advanced Treatment and Follow‐up Plans
4.6.2 Scheduling the Next Professional Oral Hygiene Visit
4.7 Workflow Timeline. 4.7.1 Charting
4.7.2 Charting Steps
4.8 Two‐/Four‐Handed Charting
4.9 Step‐By‐Step Charting. 4.9.1 The Conscious Exam
4.9.2 Incisor Relationship
4.9.3 Canine Relationship
4.9.4 Premolar and Molar Relationship
4.9.5 Temporomandibular Joints
4.9.6 Anesthetized Examination
4.9.7 Tooth‐by‐Tooth Examination
4.9.8 Deciduous, Retained, Missing, and Supernumerary Teeth
4.9.9 Hyperdontia or Supernumerary Teeth
4.10 Periodontal Indices
4.10.1 Gingiva
4.11 Diagnostic Hand Instruments Used to Aid Charting. 4.11.1 The Periodontal Probe
4.11.2 Clinical Probing Depth
4.12 Dental Explorer
4.13 Furcation Disease
4.14 Bleeding on Probing
4.15 Gingivitis Index
4.16 Tooth Mobility
4.16.1 Plaque and Calculus Accumulation
4.17 Crown Pathology. 4.17.1 Trauma
4.17.2 Resorption
Further Reading
5 Dental Radiography
5.1 Workflow – Incorporating Dental Radiography into General Practice
5.1.1 Radiograph Equipment
5.1.2 X‐ray Generator
5.1.3 Image Archiving
5.1.4 Intraoral Radiograph Digital Software
5.2 Radiation Safety. 5.2.1 ALARA
5.2.2 Personnel Monitoring
5.3 Radiograph Image Troubleshooting. 5.3.1 Foreshortened Image
5.3.2 Elongated Image
5.4 Positioning
5.4.1 Parallel and Bisecting Angle Techniques
5.4.2 Vertical and Horizontal Angulation
5.4.3 Positioning for the Maxillary Arch
5.4.4 SLOB Rule
5.4.5 Extraoral Technique to Remove Superimposition of the Zygomatic Arch
5.4.6 Positioning for the Mandibles
5.4.7 Temporomandibular Joint
5.5 Radiograph Interpretation. 5.5.1 Radiographic Terminology
5.5.2 Radiographic Landmarks
5.5.3 Maxillary Sinus Radiolucencies and Densities
5.5.4 Mental Foramina and Mandibular Canal
5.5.5 The Mandibular Symphysis
5.5.6 The Mandibular Canal
5.6 Radiographic Interpretation of Periodontal Disease
5.6.1 Stages of Periodontal Disease
5.6.2 Horizontal Bone Loss
5.6.3 Vertical Bone Loss
5.6.4 Furcation Involvement and Exposure
5.6.5 Alveolar Bone Expansion (Chronic Alveolar Osteitis)
5.6.6 Tooth Extrusion
5.7 Endodontic Disease
5.7.1 Radiograph Evaluation for Endodontic Disease
5.7.2 Internal Resorption
5.8 External Root Resorption
5.8.1 Classification of Tooth Resorption by Stages and Types
5.8.2 Tooth Resorption Anatomic Classification by Types
5.8.3 Neoplastic Disease
5.8.4 Computed Tomography (CT) and Cone Beam Computed Tomography (CBCT) Imaging
Further Reading
6 Tooth Resorption
6.1 Prevalence
6.2 Terminology
6.3 Etiology
6.4 Clinical Signs
6.5 Classification
6.5.1 Classification by Anatomical Location – Internal and External Resorption
6.5.1.1 Internal Resorption
6.5.1.2 External Resorption
6.5.1.3 External Cervical Root Surface Resorption
6.5.1.4 External Inflammatory Resorption
6.5.1.5 External Noninflammatory Replacement Resorption
6.5.2 Stages of External Root Resorption Classified According to Dental Tissue Involvement
6.5.3 Radiographic Appearance Classification – Tooth Resorption Types
6.6 Clinical Examination Findings
6.7 Pathogenesis
6.8 Histology
6.9 Treatment of Tooth Resorption
6.10 Monitoring Without Immediate Care
6.11 Crown/Root Atomization
6.12 Tooth Extraction
6.12.1 Instruments and Materials for Extraction of Teeth Affected by Tooth Resorption
6.12.2 Step‐by‐Step Extraction Technique
6.13 Crown Amputation with Intentional Partial Root Retention Followed by Gingival Closure
6.14 Crown Amputation with Intentional Root Retention and Gingival Closure (Crown Removal with Retention of Resorbing Root Tissue)
Further Reading
7 Oropharyngeal Inflammation
Oral Inflammation Nomenclature
7.1 Gingival and Periodontal Diseases
7.1.1 Pathogenesis of Gingival and Periodontal Disease
Periodontal Nomenclature
Nomenclature of Periodontal Procedures
Tooth Extraction Nomenclature
7.2 Clinical Approach to Periodontal Disease. 7.2.1 Dental Scaling, Irrigation, and Polishing
7.2.2 Dental Scaling – Plaque and Calculus Removal
7.2.2.1 Supragingival (Above the Gum Line) Scaling Procedure
7.2.2.2 Subgingival (Below the Gum Line) Scaling and Root Planing
7.2.2.3 Ultrasonic Scaling Subgingivally
7.2.2.4 Curette‐Assisted Root Planing
7.2.3 Tooth Polishing
7.2.4 Periodontal Diagnostics – Probing and Intraoral Radiography. 7.2.4.1 Periodontal Probing
7.2.4.2 Bleeding on Probing
7.2.4.3 Intraoral Radiography
7.2.5 Periodontal Disease Stages. 7.2.5.1 Stage 1 (PD1) Periodontal Disease – Gingivitis‐Inflammation of the Gingiva Without Support Loss
7.2.5.2 Stage 2 (PD2) Periodontal Disease – Early Periodontitis
7.2.6 Suprabony and Infrabony Pockets
7.2.7 Gingival Recession – Periodontal Disease Without Pockets
7.3 Treatment of Minimal Gingival Recession
7.3.1 Furcation Involvement and Exposure
7.3.2 Tooth Mobility
7.3.2.1 Stage 3 (PD3) Periodontal Disease – Moderate Periodontitis
7.3.2.2 Stage 4 Periodontal Disease (PD4) – Advanced Periodontitis
7.3.3 Canine Tooth Extrusion (Super Eruption)
7.3.3.1 Juvenile Onset Gingivitis/Hyperplastic Gingivitis/Periodontitis
7.3.3.2 Proliferative Gingival Enlargement
7.3.4 Alveolar Bone Expansion (Chronic Alveolar Osteitis)
7.3.5 Periodontal Regeneration
7.4 Technique for Placing a Bone Graft into a Palatal Defect
7.4.1 Canine Palatal Periodontal Pockets
7.5 Scheduling the Next Oral Disease Assessment Treatment and Prevention Visit
7.5.1 Preventing the Progression of Periodontal Disease After Initial Treatment
7.6 Efficacy of Homecare Products Purported to Decrease the Accumulation of Plaque and Tartar
7.6.1 The Veterinary Oral Health Council
7.6.2 Efficacy Through Mechanical Action. 7.6.2.1 Tooth Brushing
7.7 Cotton Swabbed Applicators Rubbed Along the Gingival Margin
7.7.1 Oral Rinses/Gels/Toothpaste
7.7.2 Plaque Barrier Gel
7.7.3 Diet
7.7.4 Treats
7.8 Dental Treats. 7.8.1 Diseases of the Oral Mucosa. 7.8.1.1 Mucositis
7.8.2 Treatment for Mucositis
7.8.3 CO2 Laser
7.8.4 Stomatitis (Feline Chronic Gingivitis Stomatitis)
7.8.5 Feline Chronic Gingivitis Stomatitis
7.8.6 Etiology of Feline Chronic Gingivitis Stomatitis
7.8.7 History and Clinical Signs and Symptoms
7.8.7.1 Histopathology
7.8.7.2 FCGS Histopathology Grades
7.8.8 Radiography
7.8.9 Medical Management of Feline Chronic Gingivitis Stomatitis
7.8.10 Antimicrobials
7.9 Anti‐Inflammatory Medication. 7.9.1 Corticosteroids
7.9.2 Meloxicam
7.9.3 Cyclosporine
7.9.4 Interferon
7.10 Protocols for Intralesional Use of Interferon
7.10.1 Bovine Lactoferrin and Stem Cell Therapy
7.10.2 Pain Relief
7.10.3 Surgical Management of FCGS
7.10.4 Extraction of Selective Teeth or Full Mouth Extraction
7.10.4.1 Technique for Placement of Esophagostomy Feeding Tube in the Anesthetized Cat (Figure 7.38a–i)
7.10.4.2 Dental Extractions to Treat Oropharyngeal Inflammation
7.10.5 Pre/Post‐Extraction Radiographs
7.10.6 Equipment for Extractions
7.10.7 Flap Design, Procedure, and Closure
Flap Nomenclature
7.10.8 Extraction of Incisor Teeth
7.10.9 Technique for Incisor Extraction
7.10.10 Maxillary Canine Tooth Extraction Technique
7.10.11 Mandibular Canine Extraction Technique – Facial Exposure
7.10.12 Premolar Tooth Extraction Technique
7.10.12.1 Step‐by‐step Premolar Extraction
7.10.13 Molar Extraction
7.10.14 Technique for Extracting Several Teeth (Figure 7.44a‐m)
7.10.15 Root Fragment Retrieval
7.10.15.1 Technique for Root Fragment Retrieval (Figure 7.46a‐c)
7.10.15.2 Feline Immunodeficiency Virus (FIV)‐Positive Cats with Feline Chronic Gingivitis Stomatitis
7.10.16 Treatment for Refractory Cases of Inflammation After Extraction
7.10.17 Adjunct Therapy Using Carbon Dioxide Laser
7.10.18 The Therapeutic Laser
7.10.19 Other Before and After FCGS Surgical Case Examples (Figures 7.52, 7.53 and 7.54) 7.10.19.1 Targeted Pulsed Electromagnetic Fields (tPEMF)
Further Reading
8 Oral Masses. Neoplasia Nomenclature
Oral Swellings – Diagnostic and Treatment Nomenclature
Salivary Gland Pathology/Treatment Nomenclature
8.1 Visual Examination Findings
8.1.1 Diagnostics
8.1.2 Tissue Sampling
8.1.2.1 Cytology
8.1.2.2 Histopathology
8.2 Benign Neoplasia. 8.2.1 Gingival Enlargement
8.2.2 Peripheral Odontogenic Fibroma (Fibromatous Epulis and Ossifying Epulis)
8.2.3 Feline Inductive Odontogenic Tumor (FIOT)
8.2.4 Cystic Enlargement
8.2.5 Dentigerous/Eruption Cysts
8.2.6 Salivary Gland Pathology
8.2.7 Osteomyelitis
8.2.8 Alveolar Bone Expansion (Periodontal Osteomyelitis)
8.2.9 Eosinophilic Granuloma Complex
8.2.10 Amyloid‐Producing Odontogenic Tumor
8.2.11 Feline Pyogenic Granuloma
8.3 Oral Malignancy
8.3.1 Squamous Cell Carcinoma
8.3.1.1 Common Oral Locations
8.3.1.2 Squamous Cell Carcinoma Diagnostics
8.3.1.3 Treatment of Oral Squamous Cell Carcinoma
8.3.1.3.1 Surgery
8.3.1.3.2 Radiation Therapy for Squamous Cell Carcinoma
8.3.1.3.3 Microbrachytherapy
8.3.1.3.4 Chemotherapy for Feline Squamous Cell Carcinoma
8.3.2 Fibrosarcoma
8.3.3 Oral Malignant Melanoma
8.3.4 Feline Oral Lymphoma
8.3.5 Mast Cell Tumor
8.3.6 Osteosarcoma
8.4 Surgical Options to Treat Oral Swellings
ADVANCED PROCEDURE
8.5 General Principles
Maxillectomy and Mandibulectomy Nomenclature
Further Reading
9 Oral Cavity Trauma
Dental Trauma Nomenclature
Crown Nomenclature
9.1 Signs and Symptoms of Dental Trauma
9.2 Physical Examination Signs of Endodontic Disease
9.3 Dental Trauma Location. 9.3.1 Pulpitis
9.3.2 Abrasion and Attrition
9.3.3 Uncomplicated Crown Fractures
9.3.4 Complicated Crown Fractures
9.4 Endodontic Therapy
9.4.1 Age of the Patient. 9.4.1.1 Pediatric Patients
9.4.1.2 Mature Patients
9.4.1.3 Age of the Fracture
9.4.2 Consumable Materials for Endodontic Therapy. 9.4.2.1 Paper Points
9.4.2.2 Gutta Percha
9.4.3 Endodontic (Rubber) Stop
9.4.4 Spreaders and Pluggers
9.4.5 Zinc Oxide–Eugenol
9.4.6 Mineral Trioxide Aggregate (MTA)
9.4.7 Calcium Hydroxide
9.4.8 Sodium Hypochlorite (Bleach)
9.4.9 Ethylenediaminetetraacetic Acid (EDTA)
9.4.10 Instruments for Endodontic Therapy
9.4.11 Barbed Broach
9.4.12 Endodontic Files
9.5 The International Standards Organization (ISO)
9.5.1 College Pliers
9.5.2 Retrograde Amalgam Carriers
9.5.2.1 Spatulas
9.5.2.2 Irrigation Needles
9.6 Fundamental Endodontic Procedures. 9.6.1 Vital Pulp Therapy
9.6.2 Instruments and Materials
9.6.3 Technique
9.7 Standard (Conventional) Root Canal Therapy
9.7.1 Instruments and Materials
9.7.2 Accessing the Pulp Chamber and Root Canal. 9.7.2.1 Canines
9.7.2.2 Preparing the Root Canal – Debridement and Shaping
9.7.3 Vertical Reciprocation Handpiece Debridement
9.7.4 Obturation
9.7.5 Restoring Fracture and Access Sites
9.7.6 Oral Cavity Trauma
9.7.6.1 Tooth Luxation
9.7.6.2 Avulsion
9.7.6.3 Trauma to the Maxilla
9.7.6.4 Mandibular Trauma
9.8 Mandibular Symphysis Separation
9.9 Mandibular Fractures
9.9.1 Temporomandibular Joint (TMJ) Trauma
9.9.1.1 TMJ Luxation
9.9.1.2 Multiple Areas of Trauma
9.10 Temporomandibular Joint Ankylosis
9.11 Open‐Mouth Jaw Locking
Further Reading
10 Occlusal Disorders
10.1 Normal Occlusion in the Mesaticephalic Cat
Occlusion Nomenclature
Symmetrical Skeletal Malocclusions
10.2 Malocclusion
10.3 Angle Classification
10.4 Skeletal Malocclusions
10.5 Dental Malocclusion
10.6 Treatment of Occlusal Disorders
10.6.1 Extraction of Malpositioned Teeth
10.6.2 Crown Reduction with Vital Pulp Therapy and Restoration
10.6.3 Gingivoplasty
10.7 Moving Teeth into Functional Positions
10.7.1 Ethics of Performing Veterinary Orthodontics
10.7.2 Principles of Orthodontic Tooth Movement
10.7.3 Types of Forces
10.8 Orthodontic Buttons and Elastics
10.8.1 Additional Instruments and Materials
10.8.2 Technique for Button Placement and Force Activation
10.9 Specific Occlusal Disorders. 10.9.1 Persistent Deciduous (Primary) Teeth
10.9.2 Supernumerary (Extra) Teeth
10.9.3 Missing Teeth
10.9.4 Mandibular Canine Linguoversion
10.9.5 Maxillary Fourth Premolar/Mandibular First Molar Interference
10.9.6 Feline Knees and Teeth Syndrome
Further Reading
Index
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
r
s
t
u
v
w
x
z
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