Dental Prophylaxis + Equipment

What is the most common oral disease?

• Periodontal disease

What is a common process Periodontal disease can cause?

• Common infectious process in body, it can spread to other organ systems like cardiovascular + respiratory systems

What causes periodontal disease?

• Plaque build up

What is plaque made up of?

• Bacteria component + mucopolysaccharides

What is the process of plaque build up?

• plaque adheres to the tooth + initiates inflammatory process in gingival tissue

• causes gingivitis

Can periodontal disease be in different stages in different areas in the mouth?

• Yes, it can be in different stages in different areas in the mouth

What is the supragingival area?

• area above gum line

What is considered “reversible gingivitis”?

• Bacteria located above gum line

How does periodontal disease progress?

• plaque build up, periodontal pockets enlarge, bacteria work up into deeper structures

What are the 3 primary goals for periodontal disease treatment?

• Control bacteria growth

• Minimizing pocket depth

• Maintaining healthy attached gingiva

What are 5 severe implications of untreated periodontal disease?

• Halitosis (bad breath)

• unpleasant appearance of teeth

• tooth loss

• loss of appetite / weight loss

• affects liver, kidneys + heart (less common: lungs + nervous system)

What is gingival sulcus?

• space between tooth + free gingiva

What is tartar?

• hardened plaque build up

What does tartar begin to do to the tooth if not removed?

• It begins to break down the tooth

What is normal gingival sulcus depth for dogs?

• 2-3 mm

What is normal gingival sulcus depth for cats?

• 0.5 - 1 mm

Stage 1 Periodontal Disease

• Starts with mild gingivitis

• edema + redness

• slight increase in sulcus depth from swollen gingival margins

  • subsides when edema is gone

• can be reverse with therapy

Stage 2 Periodontal Disease

• Caused by no intervention from stage 1

• periodontitis

• subsequent attachment loss

• increase pocket depth

• Bone loss

• 25% attachment loss

What is gingival sulcus depth for dogs with Stage 2 PD?

• 5 mm

What is gingival sulcus depth for cats with Stage 2 PD?

• 1 mm

Stage 3 Periodontal Disease

• increased plaque build up

  • becomes tartar

• Halitosis may begin at this stage

What is gingival sulcus depth for dogs with Stage 3 PD?

• up to 9 mm

What is gingival sulcus depth for cats with Stage 3 PD?

• 1.5 mm

Stage 4 Periodontal Disease

• severe periodontitis

• gingivitis present

• halitosis detected by clients

• reluctance to eat due to pain

• over 50% attachment loss

• teeth become mobile

What is gingival sulcus depth for dogs with Stage 4 PD?

• > 9 mm

What is gingival sulcus depth for cats with Stage 4 PD?

• > 1.5 mm

Are all pets at risk for periodontal disease?

• yes all pets are at risk but several factors can increase it

What increases periodontal disease?

• no home care

• smaller breeds + pure breed cats

• supernumerary or missing teeth

• diet

What is prophylaxis?

• process in which teeth are cleaned

Why do we practice dental prophylaxis?

• prevents/protects the teeth from disease

• removes plaque/tartar/bacteria/minerals

• reduces health risks (gingivitis, decaying tooth/bone + periodontal disease)

What is required to perform dental prophylaxis?

• anesthesia

• warming devices

• keep patient dry as possible

• place IVC

• Pain management

• Local anesthesia block is critical

Is it ethical to perform dental prophylaxis with only sedation?

• NO, not ethical, sedation is not effective for this procedure

What will warrant splitting into 2 dental appointments?

• Time to perform prophylaxis

• patient condition

  • geriatric patients

  • heart murmurs

  • kidney patients

  • etc.

Body temperature can affect what on the patient?

• Body temperature can affect the body’s response to anesthesia

• make sure to provide adequate warming equipment

Is it okay to leave a patient wet from the procedure?

• no, keep patient as dry as possible

Why do we place IVC?

• in case of emergencies

• quick venous access

• fluid therapy

• medication administration

What are the steps for dental cleaning?

1. Examine mouth both when patient is awake/under anesthesia

2. ultrasonic scaling of teeth to remove plaque/tartar

3. hand scaling for tough tartar that ultrasonic scale won’t remove

4. subgingival curette to get under gingiva to remover tartar/bacteria

5. Diluted chlorhex rinse in mouth to kill bacteria

6. probe/explore teeth

7. take radiographs (preventative/diagnostic)

8. perform extractions if needed

9. polish teeth

10. apply sealant

11. chart + record treatment

What is needed for dental prophylaxis set up?

• prep anesthesia monitoring / ready to use

• lay out dental equipment

• sterile dental equipment between patients

What is in a dental pack?

• hand scaler

• dental probe/explorer

• dental mirror

• subgingival curette

• hand scaler

• different size elevators

• calculus removers

• gauze pads

• thumb forceps

• iris scissors

• needle drivers

What equipment is needed for prophylaxis?

• absorbable sutures

• gauze/cotton tipped applicators/tongue depressor

• prophy paste / prophy head

• fluoride gel or foam

• Diluted chlorhex rinse

• Oravet or Sanos sealant

• Photos for before/after

• Dental probe

• Dental chart

What is absorbable suture used for?

• for gingival flaps

• extractions

What is gauze/cotton tipped applicators used for?

• holding tongue for intubation

• drying mouth

• cleaning socket

What is the contact time for fluoride gel/foam?

• 1-4 min

What PPE must you wear for dental cleanings?

• goggles

• gloves

• mask

• face shields

• long sleeves

• radiographic PPE for x-rays

How does the ultrasonic scaler work?

• It uses vibrations from scaler to remove tartar or calculus

What does improper use of the ultrasonic scaler cause?

• excessive heat even with adequate water flow

• Tooth damage

What part of the ultrasonic scaler can damage the enamel?

• Using the tip or point of scaler on tooth. DO NOT USE

How do you use an ultrasonic scaler?

• use side of the tip

• Sweeping motion of the tooth

What must you adjust to avoid injury to the patient?

• adjust water and power

Should you touch the ultrasonic scaler?

• no it will cause harm

Describe Scaler

• removes supragingival hard deposits

• Can be used 1-2 mm below gingival

• Two cutting edges come together into a point

Describe Curette

• most versatile removal instrument that is supra + subgingivally

• Two cutting edges come together as a rounded tip

Describe Universal curettes

• lower shank needs to be tilted towards the tooth for correct angulation

• Allows hard deposits to be easily removed

• Tip is rounder + wider

Describe Gracy curettes

• area specific

• Use sub + supragingivally

Describe Probe

• no cutting edges

• Evaluates periodontium health by measuring pocket depth in mm

Explorer (Shepherd’s hook)

• has one sharp tip

• Used to see & feel for calculus, furcation

Describe Mirror

• Helps with visual inspection of distal surfaces of teeth

• Assists in holding back tissue

Describe Dental Elevator

• Place between root + bone to stretch the periodontal ligaments

• Winged elevator wrap around tooth

• Helpful to retrieve root tips

Describe Periosteal Elevators

• elevate + reflect tissue flaps

Describe Extraction Forceps

• removes teeth + heavy calculus

Describe Calculus Removing Forceps

• Similar to extraction forceps but have a “hook” to help elevate calculus from crown

What is this dental tool?

Dental Scaler

What is this dental tool?

Curette

What is this dental tool?

Universal curettes

What is this dental tool?

Gracey curettes

What is this dental tool?

Probe

What is this dental tool?

Explorer (Shepard hook)

What is this tool?

Dental Mirror

What is this tool?

Dental elevator

What is this tool?

Periosteal Elevators

What is this tool?

Extraction Forceps

What is this tool?

Calculus Removing forceps

What is the function of subgingival curette?

• remove any plaque/ calculus/ foreign material + diseased tissue below the gumline

How do you use a subgingival curette?

• inserted to bottom of sulcus with curved side directed toward gingiva = rounded tip aimed toward root

What must you do after scaling?

• flush entire mouth to make sure all large chunks of plaque are out so patient does not swallow

What happens if you do not flush the mouth after scaling?

• Loose debris can settle back in to the pockets + cause irritation/ infection

How do you use a dental probe / explorer?

• run along gingiva to check for pockets/ bone loss/ inflammation

• measure sulcus depth around entire tooth

• Explorers detect subtle defects on tooth surface

What must you do with all your findings?

• chart ALL findings

Why must you do dental radiographs?

• preventative reasons: can spot fractures/ abscesses + anything underneath the gingiva that may be seen during cleaning

What can radiographs be used for by the DVM?

• prior to extracts DVM can diagnosis + extract teeth

Can you radiograph after polishing + sealing?

• No must be taken BEFORE

What does polish do?

• smooths out the tooth surface after rough scaling from tartar removal

• Must rinse it all out after

What must you apply after applying polish?

• Fluoride foam + finish with sealant

Can Fluoride foam + sealant be applied on a wet tooth?

• No, completely dry tooth with gauze before applying sealant

What are home care owners can do?

• brush daily or once a week

• Dental treats

• dental wipes

• water additives

What signs should owners look out for after dental cleanings?

• vomiting, diarrhea, extreme lethargy

• frank amount of blood (minimal bleeding is normal)

Should food be given after the procedure?

• no, wait 4-6 hours after and feed small amounts after