Download What is provided during a dental prophylaxis at PetCare?

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What is provided during a dental prophylaxis at PetCare?
Dental disease is the number one disease of our patients, affecting 70 to 80% of the population. If left
untreated, it is often painful, results in infections, and can contribute to other systemic diseases. A complete
dental prophylaxis (cleaning) is performed not only to clean the teeth, but also to examine the oral cavity
for any other problems that might be present. The cleaning not only includes what you can see, but also the
area under the gumline, which is the most important part. For this reason, “Non-anesthetic” cleaning is not
a viable option. In addition, without anesthesia the teeth cannot be polished. Without polishing, the cleaned
surface is rough and increases the adherence of plaque bacteria and hastens dental disease. At PetCare, all
of our patients are given an eight-step prophylaxis to give them the maximum benefit available.
8 STEP PROPHYLAXIS:
(1) Supragingival cleaning: This is cleaning the area above the gum line. It is usually accomplished by
mechanical scalers in our animal patients. This increases the speed that the cleaning can be performed,
which decreases anesthetic time.
(2) Subgingival cleaning: This is cleaning the area under the gum line. In our animal patients, this is one
of the most important steps. The subgingival plaque and calculus is what causes periodontal disease.
This is the most common ailment diagnosed in ALL animal patients. Without this step, the teeth will
look nice, but the cleaning will have done little medically for the patient.
(3) Polishing: Cleaning the teeth causes microscopic roughening of the tooth surface. This roughening
makes is easier for plaque and calculus to stick to the teeth. Polishing smoothes the surface and
reduces future build-up of plaque and tartar.
(4) Sucal Lavage: The scaling and polishing of the teeth will cause a lot of debris to become trapped under
the gums. This will cause local inflammation, as well as increase the chance of future periodontal
disease. For this reason we gently flush the gingiva with an antibacterial solution.
(5) Dental Radiographs: A digital dental X-ray machine is utilized to take full mouth dental radiographs.
Up to 50% of dental disease cannot be identified without this essential step.
(6) Treatment planning: This step is where the teeth and entire oral cavity are evaluated. Results of the
visual exam, periodontal probing, and dental radiographs are used to determine the extent of the disease
process present. Using all of these modalities, a plan is developed (with the owners input) to reestablish
the patient’s oral health.
(7) Dental Charting: All of the pertinent oral findings and treatment rendered and planned in the future is
placed on a dental chart in the patient’s permanent medical record. This will allow the veterinarian to
follow the patient’s progress (or regression) through the years.
(8) Dental sealer: While still under anesthesia a plaque barrier sealant is applied to the teeth. This sealant
will help prevent plaque from bonding to the teeth. A home care version of this same sealant will be
sent home so the benefits of the dental cleaning will be long-lasting.
ANESTHETIC SAFETY:
Before the prophylaxis can begin, the patient must be placed under general anesthesia. This will greatly
increase patient comfort and effectiveness of cleaning. In addition, it allows us to place a tube in the
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patient’s airway. This will protect the lungs from the bacteria that are being removed from the teeth. General
anesthesia is required to obtain intra-oral radiographs, achieve thorough periodontal treatment, and to
perform any oral surgical procedures which might be indicated. We understand your concerns for your pet’s
safety, and in order to minimize the risk of anesthetic complications, we provide the following:
 Pre-surgical Assessment: Pre-surgical blood tests and physical examination enable us to assess and
minimize the risk of anesthesia for your pet.
 Monitoring: A veterinary nurse is present throughout the procedure, monitoring heart rate and rhythm,
respiration rate and quality, body temperature, and blood pressure. This allows us to detect and address
potential problems before they become life-threatening.
 IV Catheterization: For all procedures requiring general anesthesia, an intravenous catheter is placed to
provide us with an easy route to administer medications and fluids (which support blood pressure and
kidney function) during the procedure.
 Pain Management: We will pro-actively manage pain associated with any oral surgical procedure by
administering pain medications before and/or after the procedure. As with any drug, side effects may be
associated with administration of pain medications and local anesthetic agents.
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Dental Home Care
Dental care does not end with the prophylaxis. Within 24 hours, plaque has already started to form on
the teeth, and the periodontal disease process starts over. This is where home care comes in. Imagine what
would happen in you mouth if you never brushed your teeth, all the cleanings in the world won’t keep your
mouth healthy.
Dental disease is the number one diagnosed disease in our patients, more than skin allergies, ear
problems, lameness, etc. In animals over 6 years of age it is even more common. You may say, “I’ve had
pets all my life, and no one has told me about this before.” There are a few reasons for that. First, our pets,
like us, are living longer, which allows the bacteria in the plaque to work longer, and cause more disease.
Second, many purebred dogs and cats are predisposed to dental disease. Finally, in the not too distant past, we
as veterinarians did not know that this caused a problem in our patients. For these reasons, you likely did not
appreciate the importance of oral health in our animal friends.
The “Gold Standard” of home care is tooth brushing. This is the most effective means of controlling
plaque and the associated diseases that affect both our patients as well as ourselves. The following is a guide
to starting to brush your pet’s teeth.
START YOUNG
The sooner you start your pet on its oral health care, the easier it will be to do. We recommend that all
pet’s have their mouths handled from a young age (as young as possible) to get them used to it. You can start
brushing their teeth as young as 2-3 months of age, but it really isn’t necessary until they are about 5 months.
This is when they have most of their adult teeth in.
GO SLOW
Don’t push the procedure on your pet. Make the experience as positive as possible. If you force this
on your pet, they will resent it, and the brushing will probably not happen. Start with simply handling the
mouth for a short period. Then get your fingers in the mouth, and even try to open it. Then start by wiping the
outside surface of the teeth with a soft cloth wrapped around your finger. Finally, introduce the brush. These
steps may take weeks to accomplish, but it WILL be worth it. Start with a few teeth, and then slowly progress
to the entire mouth as your pet gets more comfortable and allows you to brush without much resistance.
MAKE IT FUN
If you link this behavior to positive things like walks, playtime, and especially FOOD (either dinner
or a favorite treat), you will greatly increase the likelihood of patient acceptance. This will take a while, but
again, it WILL be worth it.
TOOLS
All you need to get started is a toothbrush. There are various brushes designed for pets. Buy one
appropriately sized for your pet’s mouth. If you prefer, a soft child’s toothbrush will also work well. There
are many options for toothpaste. You CANNOT use a human toothpaste, because they contain ingredients
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that can make your pet sick if swallowed (and it will be swallowed). There are numerous veterinary products
available, and they come in various flavors such as chicken, seafood and beef.
TECHNIQUES
Use a circular motion with the brush at a 45 degree angle to the gum line. Use a small amount of
veterinary toothpaste, but replace it often. Brush all of your pet’s teeth in succession. For the rear teeth, you
can usually just place the brush in under the lips. The rear lower teeth present a small problem since the upper
teeth cover them. If your pet is very good, you can try to open his or her mouth slightly (1/2” or so) by placing
a finger between the jaws in the area just behind the upper canine. There are only a few very small teeth in
this area. The insides of the teeth are a little bit more tricky. Most patients will not accept brushing this area.
Try to open the mouth slightly and brush the inside of the teeth. If you can’t do it, it’s ok, as most periodontal
disease occurs on the outside surface of the teeth. One exception to this is on the inside surface of the upper
canines in small breed dogs (especially dachshunds, Yorkshire terriers, Maltese, and poodles. They can get
very bad periodontal disease in this area for some reason.
FREQUENCY
Once a day would be ideal, but for most owners this is unrealistic.
It has been reported that if you brush your pet’s teeth 3 times a week you will reduce plaque by 90%, and if
you can only manage once a week by 75%. We ask most clients to try for three days a week, unless we are
treating periodontal disease.
WHAT TO LOOK FOR
Just like you, even though brushing greatly improves periodontal health, it does not completely eliminate
the need for professional cleanings. However, it should decrease the frequency necessary to maintain oral
health. When you brush your pet’s teeth, you can catch potential problems early. If you start seeing blood on
the toothbrush, this means that there is some periodontal disease starting, and your pet is due for a cleaning. If
you start seeing tan/brown buildup on the teeth, this is calculus, and again your pet is likely due for a cleaning.
If you notice any loose teeth, swellings or growths, broken teeth, or anything else that you don’t like, it is time
to visit your veterinarian for an evaluation. In addition, if a pet who is normally tolerant of brushing stops
allowing it, it may be a sign of oral pain, and you should see your veterinarian for an evaluation. Regardless,
an oral exam should be part of an annual physical exam performed regularly by your veterinarian.
OTHER OPTIONS
If your pet just won’t allow the brushing, or if you don’t have time, there are some other methods. There
are special foods available that will help clean the teeth. Hills T/D is a food available through veterinarians.
It comes in a cat form, as well as 2 sizes for dogs. This is balanced enough to be the sole food for your pet (as
long as your pet has no other healthy problems that require a special diet, please consult your veterinarian). It
can also be used as part of the pet’s food, or even as a treat. In addition, there are various tartar control chews
and biscuits that have varying levels of effectiveness.
Avoid hard treats such as real bones and hooves which can break teeth.
DENTAL SEALANTS
Oravet Gel is a plaque prevention barrier that is first applied as the last step of a professional cleaning.
The gel provides a barrier film on the teeth which prevents plaque from building up on the teeth. At home, the
product is easily applied once weekly to maintain this barrier. For a video demonstration of how to use the gel
visit the company’s web site at www.oravet.us.merial.com.
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Extractions
Extractions are by far the most common oral surgery performed in animals. However, to a veterinary
dentist, extraction is often viewed as a defeat. Most teeth are salvageable, but sometimes the degree of
disease, health status of the patient, inability of the owner to perform homecare and financial constraints
make extraction the best option. Indications include: advanced periodontal disease, fractured teeth,
supranumery (extra) or crowded teeth, feline oral restorative lesions, inflammatory disease, and orthodontic
disease that is causing oral trauma.
For fractured teeth we would generally prefer to refer the patient to a specialist for a root canal
procedure and save the tooth. This is especially true of the canines, upper fourth premolars, and lower first
molars. These teeth are very important to the patient, and the large size of the roots makes extraction very
difficult if the tooth is periodontally healthy. Based on the severity of the disease, periodontal disease can
be treated with surgery; however, the owner must be willing and able to perform home care if this avenue is
to be explored.
The first step we perform is to take a dental radiograph of the tooth to ensure that there is no root
pathology or aberrant anatomy that would effect the extraction. Extractions are performed by using a dental
elevator to fatigue the periodontal ligament enough so that the tooth can be removed easily with extraction
forceps. For teeth with more than one root, the tooth is sectioned into single root segments and each root
removed as a single root entity. The veterinarian may or may not suture closed the extraction site depending
on the size of the hole. Dissolvable suture is typically used so the patient does not need to be sedated for
suture removal. We generally recheck all extraction sites two weeks post operatively to ensure that they are
healing well.
Canines, upper forth premolars and large molars that are broken but are periodontally healthy are a
very different matter. The roots on these teeth are very large. The root is approximately twice the length of
the crown (the area you can see) and sometimes larger in diameter. This makes standard extractions very
difficult, however not impossible. Generally, we will perform a surgical extraction to save time, effort, and
animal discomfort. This procedure entails creating a flap in the gingival tissue on the outside of the tooth
to expose the underlying bone. Using a high-speed dental bur, the bone on the outside of the tooth root is
removed. Then, the tooth is luxated out of the socket. Finally, the harvested flap of gum tissue is sutured
over the extraction site to cover the defect.
All patients undergoing extractions are treated pro-actively with antibiotics, narcotic analgesics and/
or local anesthetics before and after the procedure. The patients are also sent home with pain medications as
needed to keep them comfortable and eating. Most patients, even those with multiple large extractions, are
eating within hours of surgery.
1370 Fulton Road
Santa Rosa, California 95401
www.pcvh.com
P 707 579 5900
F 707 579 9512
PC#118