Prophy or dental: The term "prophy" is often misunderstood; it does not equate to treating periodontal disease.
Prophylactic: Defined as prevention, particularly related to oral health.
Periodontal Therapy: Proper terminology for the treatment of periodontal disease which includes Professional Dental Cleaning (PRO) as described by the AVDC, which involves scaling under general anesthesia.
Equipment Needed for a Professional Dental Cleaning
Hand Instruments:
- Universal and area-specific hand scalers
- Universal and area-specific curettes
- Calculus removal forceps
- Periodontal probe/explorer
Powered Instruments:
- Ultrasonic scaler
- Low-speed handpiece
- Prophylaxis angle and cup
Client Discussion: Explain the procedure, estimated costs, and potential complications.
Consent: Obtain written consent from the client.
Veterinarian Responsibilities:
- Develop a plan for additional pathology detection, including options to proceed with recommended procedures, attempt to contact the client, or cease action if unreachable.
Anesthesia Education: Inform clients about anesthesia and monitoring procedures.
Health Assessment: Consider patient health status and necessary anesthetic protocols.
Step-by-Step Procedures for Professional Dental Cleaning
Preliminary Examination: Evaluate the patient's oral health before anesthesia.
Supragingival Gross Calculus Removal:
- Utilize hand scalers, calculus removal forceps, or ultrasonic/sonic scalers for effective removal.
Periodontal Probing:
- Use a periodontal probe to gauge sulcus depth and chart findings.
Subgingival Calculus Removal:
- Employ curette or ultrasonic tips for deeper cleaning, particularly in pockets larger than 6mm which may require surgical techniques.
Detection of Missed Plaque and Calculus:
- Use a disclosing solution and air-dry to highlight plaque on the tooth surfaces.
Polishing:
- Perform mechanical polishing using a prophy angle and abrasive paste to smooth surfaces and remove any residual plaque.
Sulcus Irrigation and Fluoride Treatment:
- Utilize saline or diluted chlorhexidine for rinsing, with options for fluoride application to inhibit plaque.
Application of a Sealer:
- Use sealers like Sanos or OraVet to prevent plaque accumulation; these products have specific application techniques.
Imaging:
- Conduct full mouth radiographs or cone beam CT for comprehensive diagnostics on dental and bony structures.
Final Charting: Review and document all findings and treatments performed during the procedure.
Home Care Instruction: Instruct clients on post-procedure home care techniques and provide resources for further education.
Additional Notes on Patient Care
Patient Positioning
Lateral Recumbency: Preferred for fluid control; however, visualization may be limited.
Dorsal Recumbency: Offers superior visualization but requires a draining structure to manage fluids. Disconnect anesthesia hoses before rotating patients.
Mouth Gags
Should be used minimally to avoid TMJ overextension. A hand can be used to keep the mouth open instead.
Additional Considerations
Antibiotics: Not typically necessary for healthy patients but may be required for those who are immunocompromised or presenting signs of systemic infection.
Documentation: Keeping accurate records of dental procedures is crucial for future evaluations and ensuring compliance with recommended treatments.
Ethical and Legal Considerations
Misleading practices such as Nonprofessional Dental Scaling (NPDS) may arise, which can jeopardize patient care and have legal implications in various states.
AVDC Position Statement indicates a commitment to maintaining high standards of care in veterinary dentistry.
Summary
The procedural steps and equipment outlined are crucial for effective dental cleaning and periodontal therapy in veterinary medicine. Proper methodology and documentation warrant successful outcomes in patient care and compliance with best practices.