Maxillary & Mandibular Nerve Blocks in Veterinary Dentistry
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Questions and Answers

Which of the following structures does the maxillary nerve NOT provide sensory innervation to?

  • Mandibular teeth (correct)
  • Lower eyelids
  • Hard palate
  • Maxillary teeth

What is the primary advantage of using the infraorbital approach for maxillary nerve blocks in veterinary dentistry?

  • Requires patient to open mouth
  • May block more caudally than other approaches
  • Minimal risk of puncturing important structures in pterygopalatine fossa (correct)
  • Technically easy to perform

Which of the following is a disadvantage of the lateral approach for maxillary nerve blocks?

  • Potential for damage to the zygomatic salivary gland (correct)
  • Low risk of nerve injury
  • High accuracy in local anesthetic placement
  • Technically difficult to perform

During an intra-oral approach for a maxillary nerve block, where should the needle be advanced?

<p>Dorsally, just caudal to the maxillary tuberosity (C)</p> Signup and view all the answers

What is a potential complication associated with the intra-oral approach to maxillary nerve blocks?

<p>Penetration of the orbit (B)</p> Signup and view all the answers

The mandibular nerve exits the cranium via which foramen?

<p>Oval foramen (D)</p> Signup and view all the answers

Which nerve branches off the mandibular nerve?

<p>Lingual nerve (B)</p> Signup and view all the answers

What anatomical landmark is crucial for both intra-oral and extra-oral approaches to the inferior alveolar nerve block?

<p>Mandibular foramen (A)</p> Signup and view all the answers

A veterinarian chooses to perform an extra-oral approach to an inferior alveolar nerve block. What is the primary advantage of this approach compared to the intra-oral approach?

<p>The patient's mouth can remain closed (C)</p> Signup and view all the answers

During the intra-oral approach to an inferior alveolar nerve block, what is the primary method for ensuring proper needle placement?

<p>Palpation of the mandibular nerve on the ramus of the mandible (C)</p> Signup and view all the answers

A dog presents with inflamed gingiva, bleeding on probing, and plaque accumulation but no attachment loss. According to the periodontal disease staging, what stage is this?

<p>Stage 1 (PD1): Gingivitis only (A)</p> Signup and view all the answers

In Stage 2 periodontitis (PD2), what is the maximum percentage of attachment loss observed, as measured by either probing or radiographically?

<p>Less than 25% (B)</p> Signup and view all the answers

Which of the following is a characteristic typically associated with Stage 3 periodontitis (PD3)?

<p>Stage 2 furcation involvement (D)</p> Signup and view all the answers

What treatment is MOST appropriate for a patient diagnosed with Stage 4 periodontitis (PD4)?

<p>Extraction (C)</p> Signup and view all the answers

In which stage of periodontal disease is hematogenous spread of bacteria a potential concern?

<p>Stage 4 (PD4) (C)</p> Signup and view all the answers

A multi-rooted tooth exhibits Stage 3 furcation involvement. Which stage of periodontitis is MOST likely present?

<p>Stage 4 (PD4) (A)</p> Signup and view all the answers

What clinical sign differentiates Stage 1 periodontitis (PD1) from a healthy periodontium?

<p>Inflamed and swollen gingiva (A)</p> Signup and view all the answers

Which of the following stages of periodontal disease is determined using radiographic findings?

<p>Staging periodontal disease is a radiographic diagnosis! (D)</p> Signup and view all the answers

What is the primary recommendation for treating significant gingival hyperplasia?

<p>Gingivectomy (C)</p> Signup and view all the answers

Which of the following is a typical presenting complaint associated with Chronic Ulcerative Paradental Stomatitis (CUPS) in dogs?

<p>Severe halitosis (D)</p> Signup and view all the answers

What is the current thinking regarding the underlying cause of Canine Chronic Ulcerative Stomatitis (CCUS)?

<p>A hypersensitivity response to bacteria and plaque (B)</p> Signup and view all the answers

Which breed is predisposed to Canine Chronic Ulcerative Stomatitis (CCUS)?

<p>Maltese (C)</p> Signup and view all the answers

What is the significance of biopsy in the context of Canine Chronic Ulcerative Stomatitis (CCUS)?

<p>To rule out systemic autoimmune conditions presenting with similar oral lesions (A)</p> Signup and view all the answers

What is the primary surgical approach in treating severe cases of Canine Chronic Ulcerative Stomatitis (CCUS)?

<p>Full mouth extractions (D)</p> Signup and view all the answers

How long does it typically take for oral papillomas to resolve in young dogs with healthy immune systems?

<p>8-12 weeks (C)</p> Signup and view all the answers

What is the most important consideration when evaluating malocclusion in growing animals?

<p>The alignment of teeth in opposing dental arches (D)</p> Signup and view all the answers

In the context of malocclusion, what characterizes a Class II malocclusion?

<p>Mandibular premolars/molars positioned caudal to the normal relationship (D)</p> Signup and view all the answers

Where are retained deciduous teeth most commonly found in small breed dogs? (MC = most common)

<p>Canines (C)</p> Signup and view all the answers

What is a primary concern when examining radiographs of a young dog with deciduous dentition?

<p>Retained deciduous teeth interfering with permanent teeth eruption (C)</p> Signup and view all the answers

Why should radiographs be taken when a horse has a long-standing oral foreign body?

<p>To evaluate for potential bone involvement or infection. (C)</p> Signup and view all the answers

What is the MOST critical next step when unexplained bone loss is observed during an oral examination?

<p>Perform a biopsy of the affected area. (C)</p> Signup and view all the answers

Why are regular dental exams a good 'practice builder' in equine veterinary practice?

<p>They often lead to the discovery of other health issues. (B)</p> Signup and view all the answers

How do modern feeding practices alter mastication in horses, potentially leading to dental problems?

<p>They reduce the natural wear of teeth due to softer feed. (B)</p> Signup and view all the answers

Which characteristic defines hypsodont teeth, as found in horses?

<p>Continual eruption and attrition throughout life (D)</p> Signup and view all the answers

A horse's reserve crown is approximately 100mm and it erupts 2-4mm per year. Approximately how long will it take for the reserve crown to expire?

<p>25-30 years (C)</p> Signup and view all the answers

What does the term 'Diphyodont' describe in the context of equine dentition?

<p>The presence of deciduous and permanent teeth (D)</p> Signup and view all the answers

What is the primary function of incisors in equine dentition?

<p>Grasping and cutting food (B)</p> Signup and view all the answers

Which of the following best describes the arrangement of premolars and molars that optimizes their grinding function?

<p>Spaced very closely together to act as one individual grinding surface (B)</p> Signup and view all the answers

The dental formula for permanent teeth in horses is 2 (I 3/3, C* 1(0)/1(0), PM* 3(4)/3(4), M 3/3)=36-44. What does the asterisk next to the Canine (C*) indicate?

<p>The presence of canines is sexually dimorphic. (D)</p> Signup and view all the answers

Approximately when do horses shed their third incisor (I3)?

<p>4.5 years (B)</p> Signup and view all the answers

Which of the following structures is NOT a component of the periodontium?

<p>Enamel (A)</p> Signup and view all the answers

Which of the following scenarios would be the MOST appropriate indication for antibiotic use in conjunction with a dental procedure?

<p>A geriatric dog with a known heart murmur undergoing a COHAT with multiple extractions. (A)</p> Signup and view all the answers

Why is calculus considered relatively non-pathogenic despite its association with periodontal disease?

<p>Calculus acts primarily as a surface for plaque accumulation, which directly causes periodontal disease. (C)</p> Signup and view all the answers

Which of the following represents the correct order of events in a normal equine chewing cycle?

<p>Open stroke, closing stroke, power stroke (A)</p> Signup and view all the answers

During a COHAT, a veterinary technician notes that a dog has a pocket depth of 4mm. What does this indicate?

<p>Periodontal disease. (A)</p> Signup and view all the answers

What term describes the chewing surface of a tooth?

<p>Occlusal (D)</p> Signup and view all the answers

A veterinarian notes the presence of sharp enamel points on the outer edge of a horse's maxillary cheek teeth. Where are these points located?

<p>Along the buccal edge (C)</p> Signup and view all the answers

A patient presents with mild inflammation of the gingiva, slight color change, and edema, but no bleeding on probing. According to the Gingivitis Scoring Index, how would you score this?

<p>GI 1 (A)</p> Signup and view all the answers

You are using a periodontal probe on a multi-rooted tooth and can extend less than halfway under the crown. How would you classify this furcation involvement?

<p>F1 (D)</p> Signup and view all the answers

Which branch of cranial nerve innervates the facial soft tissues?

<p>Facial nerve (CN VII) (D)</p> Signup and view all the answers

What is the Anatomical Abbreviation of the third incisor?

<p>I3 (C)</p> Signup and view all the answers

When evaluating tooth mobility, what does Stage 2 (M2) indicate?

<p>Mobility is increased in any direction other than axial over a distance of more than 0.5mm and up to 1.0mm (C)</p> Signup and view all the answers

A dog is diagnosed with Stage 1 periodontal disease. What is the significance of this diagnosis?

<p>This stage is characterized by gingivitis and is the only reversible stage of periodontal disease. (B)</p> Signup and view all the answers

Which of the following antibiotics is LEAST likely to be prescribed for treating periodontal disease, according to the provided information?

<p>Convenia (C)</p> Signup and view all the answers

Why does calculus tend to accumulate more rapidly on the buccal surface of maxillary teeth, particularly the maxillary PM4?

<p>The proximity to the salivary duct predisposes to increased mineral deposition in this area. (D)</p> Signup and view all the answers

A veterinary dentist identifies Stage 3 furcation involvement on a mandibular molar of a canine patient. What does this finding indicate?

<p>A periodontal probe extends under the crown, through and through from one side of the furcation out the other. (B)</p> Signup and view all the answers

Flashcards

Maxillary Nerve Function

Sensory innervation to maxillary teeth, hard/soft palate, nose, and lower eyelids.

Maxillary Nerve Path

Round foramen to pterygopalatine fossa, then infraorbital canal via maxillary foramen.

Maxillary Nerve Block - Infraorbital Approach

Catheter through infraorbital canal, depositing anesthetic on the opposite side.

Maxillary Nerve Block - Lateral Approach

Needle inserted on ventral aspect of rostral zygomatic arch, directed rostrally into pterygopalatine fossa.

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Maxillary Nerve Block - Intra-oral Approach

Short needle advanced dorsally just caudal to the maxillary tuberosity.

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Mandibular Nerve Function

Sensory innervation to the mandibular teeth.

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Mandibular Nerve Path

Oval foramen, courses over temporomandibular joint, becomes inferior alveolar nerve.

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Inferior Alveolar Nerve Block - Intra-oral Approach

Palpate on medial aspect of ventral ramus, direct needle to mandibular foramen.

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Inferior Alveolar Nerve Block - Extra-oral Approach

Needle inserted on medial mandible, advanced dorsally toward mandibular foramen.

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Regional Anesthesia for Dentistry

Mental and Infraorbital.

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Gingivitis (Stage 1 PD)

Inflammation of the gums without attachment loss; alveolar margins are normal.

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Stage 1 Periodontal Disease (PD1)

Gums bleed, inflamed, swollen, plaque present; treated with prophy and homecare.

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Stage 2 Periodontal Disease (PD2)

Early periodontitis with less than 25% attachment loss.

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Treatment for Stage 2 PD

Plaque removal and diligent homecare.

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Stage 3 Periodontal Disease (PD3)

Moderate periodontitis with possible stage 2 furcation; increased sulcus depth.

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Clinical signs of Stage 3 PD

Increased sulcus depth, gingival hyperplasia/recession, significant attachment loss.

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Stage 4 Periodontal Disease (PD4)

Advanced periodontitis with >50% bone loss; stage 3 furcation common.

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Treatment for Stage 4 PD

Extraction; hematogenous spread of bacteria is possible.

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Osteomyelitis

Infection of the bone. Antibiotics are indicated in some dental cases.

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Antibiotics for Periodontal Disease

Common antibiotics used in periodontal disease. Examples: Amoxicillin-clavulanate, Clindamycin, Doxycycline, Metronidazole

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Calculus (Tartar)

Calcified plaque, composed of 70-90% inorganic calcium salts (hydroxyapatite).

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COHAT

Procedure including anesthetized oral exam, radiographs, scaling/polishing +/- extractions.

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Normal Pocket Depth

Cats 0.5-1.0 mm and Dogs 1.0-3.0 mm

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Gingivitis Index

0: normal gingiva; 1: mild inflammation, no bleeding; 2: moderate inflammation, bleeding; 3: severe inflammation, ulceration, spontaneous bleeding.

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Furcation Involvement

Extent of exposure to a furcation. F0: no exposure; F1: probe extends less than halfway; F2: probe extends greater than halfway, but not through; F3: probe extends through and through.

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Tooth Mobility Index

Index for assessing the degree of tooth movement. M0: normal; M1: 0.2-0.5mm; M2: 0.5-1.0mm; M3: >1.0mm or axial movement.

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Periodontal Stages

Stage 0: healthy; Stage 1: gingivitis only; Stage 2: <25% bone loss

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Reversible Stage of Periodontal Disease

Gingivitis, characterized by inflammation of the gums without bone loss.

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Gingival Hyperplasia

Overgrowth of gingival tissue, may require gingivectomy.

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CCUS (Canine Chronic Ulcerative Stomatitis)

Painful, immune-mediated condition with oral ulceration, often a hypersensitivity to plaque.

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Gingivectomy

Removal of gingival tissue. Used to remove excessive gums.

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Oral Papillomas

Caused by papilloma virus, usually in young or immunocompromised dogs. Resolves in 8-12 weeks.

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Malocclusion

Misalignment of teeth when the mouth is closed, affecting dental arches.

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Class 0 Malocclusion

Normal occlusion, scissor bite, symmetrical arches.

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Class 1 Malocclusion

Normal occlusion, but one or more teeth are misplaced or rotated.

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Class II Malocclusion

Mandibular premolars/molars positioned caudal to normal.

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Class III Malocclusion

Mandibular premolars/molars positioned rostral to normal.

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Retained Deciduous Teeth

Deciduous teeth that have not fallen out, potentially damaging adult teeth.

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Equine dental care benefits

Routine check-ups can identify weight loss causes or lameness.

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Hypsodont

Hypsodont teeth have continuous eruption and wear.

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Diphyodont

Replacement of deciduous teeth by permanent teeth.

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Lophodont

Teeth with ridges on the chewing surfaces.

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Medical and Preventative Care

Establish annual dental exams to identify other conditions for weight loss or lameness and behavioral changes. Practice builder allows for other services and client education.

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Prevention

Oral ulcers, abscesses, inflammation, fractures, and pain. Weight loss. Esophageal obstruction (choke). Colic. Bit Problems.

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Hypsodont teeth:

Continual eruption and attrition. Erupt 2-4 mm per year. Reserve crown is ~ 100mm, expires 25-30 years

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Diphyodont:

deciduous + permanent teeth

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Incisors

Grasp and cut food. Sharp teeth at the front of the mouth

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Canines

Teeth used for fighting.

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Deciduous Dental Formula (Equine)

The dental formula for deciduous teeth in horses is 2 (DI 3/3, DPM 3/3) = 24 teeth.

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Permanent Dental Formula (Equine)

The dental formula for permanent teeth in horses is 2 (I 3/3, C* 1(0)/1(0), PM* 3(4)/3(4), M 3/3)=36-44.

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Maxilla

Upper jaw bone.

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Mandible

Lower jaw bone.

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Anisognathia

Unequal jaw length between upper and lower.

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Buccal

Toward the cheek, refers to premolars and molars.

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Occlusal

The chewing surface of the tooth.

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Study Notes

Dysphagia

  • Dysphagia is defined as difficulty swallowing

Anatomic Classification

  • Anatomic classification is a method for categorizing dysphagia
  • Dysphagia can be classified as acute vs. chronic
  • Dysphagia can be classified as mechanical vs. functional
  • Dysphagia can be classified as painful vs. not painful
  • Dysphagia can be classified by type of food: liquid vs. solid
  • Dysphagia can affect different regions: oral, pharyngeal, esophageal, or oral preparatory

Stages of Swallowing

  • Swallowing involves four stages: oral preparatory, oral, pharyngeal, and esophageal
  • The oral preparatory and oral stages are considered voluntary
  • The pharyngeal and esophageal stages are involuntary

Clinical Signs of Dysphagia

  • Clinical signs vary depending on the location of the dysphagia

  • Oral dysphagia can manifest as:

    • Inability to prehend food
    • Trouble chewing
    • Food falling out of the mouth
    • Inability to close the mouth
    • Inability to form a bolus
    • Pain

  • Pharyngeal dysphagia can manifest as:

    • Inability to move the bolus
    • Repeated attempts to swallow
    • Throwing the head back
    • Gagging or retching
    • Dyspnea
    • Aspiration

  • Esophageal dysphagia can manifest as:

    • Regurgitation
    • Coughing
    • Gagging or retching

  • A decreased or absent appetite can be a general sign of dysphagia

Diagnosing Dysphagia

  • Diagnosing dysphagia involves a systematic approach
  • The steps are taking a thorough history, performing a physical examination, conducing initial diagnostics, doing advanced diagnostics, and then formulating a diagnosis, management, and prognosis

History and Signalment for Diagnosis

  • Important details include:
  • Onset (acute vs chronic)
  • Phase of eating that is difficult
  • Presence of coughing, gagging, sneezing, nasal discharge
  • Previous illnesses
  • Changes in diet
  • Types of food (food, water, or both) that cause difficulty
  • Current treatments, including over-the counter medications and supplements
  • Other clinical signs

Physical Exam for Diagnosis

  • A complete physical examination should be performed
  • Include a general assessment, neurological examination, paying attention to cranial nerves
  • Include an oral examination, palpating the neck, and thoracic auscultation

Initial Diagnostics

  • Initial diagnostics may include:
  • Complete blood count (CBC)
  • Biochemistry profile
  • Urinalysis
  • Radiographs of the cervical and thoracic regions to evaluate for foreign bodies, masses, esophageal dilation, aspiration pneumonia, or metastatic disease

D-A-M-N-I-T-V scheme

  • Use the D-A-M-N-I-T-V scheme as a mental framework for identifying potential causes of dysphagia
    • Degenerative
    • Anatomic
    • Metabolic
    • Neoplastic/Nutritional
    • Infectious/Inflammatory/Immune-mediated/Iatrogenic/Idiopathic
    • Toxic/Traumatic
    • Vascular

Advanced Diagnostic Testing

  • Advanced diagnostics may include:
    • Laboratory testing (endocrine function, Type 2M antibody, acetylcholine receptor antibody)
    • Non-sedation/anesthesia visualization (contrast videofluoroscopy)
    • Sedation/anesthesia visualization (oropharyngeal exam, endoscopy, neuromuscular testing with muscle/nerve biopsy)

Dysphagia-Anatomic/obstructive

Oral

  • Dental diseas or abscess
  • Soft tissue swelling due to trauma or foreign body
  • Bone or tooth fracture
  • Mucositis or pharygitis

Pharyngeal

  • Soft tissue swelling due to trauma or foreign body
  • Neoplasia
  • Nasopharyngeal polyp or stenosis
  • Sialocele/sialoadenitis
  • Granuloma
  • Temporomandibular Joint Disease

Dysphagia-Functional/dysmotility

  • Masticatory myositis
  • Myasthenia gravis
  • Pharyngeal Dysphagia
  • Cricopharyngeal achalasia
  • Polyneuropathy conditions: Tick paralysis, tetanus, botulism, rabies, or neoplasia

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Description

This lesson covers nerve blocks in veterinary dentistry, focusing on the maxillary and mandibular nerves. It explores the sensory innervation, approaches (infraorbital, lateral, intra-oral, extra-oral), and potential complications. Anatomical landmarks and nerve branches are also discussed.

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