Download Applied Dentistry for the Veterinary Technician

Periodontal Debridement
Routine Prevention or Necessary Treatment?
 Dental prophylaxis OR periodontal therapy
 Both involve removal of deposits from supragingival and
subgingival surfaces of the teeth
 Uses nonsurgical OR surgical instrumentation
 To prevent OR arrest infection
 General anesthesia for both
 What does that entail?

Risks?

Cost?
Explore the Teeth
Dental explorer – has a slender, wire-like working
end that tapers to a sharp point and is used to explore
the topography of the tooth surface
 Explore for _________
Acid producing bacteria demineralization of
enamel and dentin
 Most common surface affected?

 Test for attrition vs. pulp exposure
Check for Attachment Loss
Periodontal probe
• Round, blunt working end
• Intraoral ruler that measures ____________ levels:
1. Gingival recession
2. Sulcus depth
3. Loss of bone in furcation areas
• Used to assess mobility of teeth and the presence of
gingival bleeding
Periodontal Probe
 ________________
have millimeter
increments at 1,2,3,5,7,8,9
and 10mm.
Gingival Sulcus and Recession
Calculus Removing Forceps
Removes gross calculus,
supragingivally
Which teeth do you think need this tool the most?
Scaling Above the Gingiva
 Hand scaler – used to remove tartar / calculus
supragingivally
 Modified pen grasp technique


Gives precise control of the instrument; limits wrist motion
Where should all of your fingers be?
Scaling Below the Gingiva
 Curette-used to remove tartar subgingivally
 Modified Pen Grasp
*Tip is more round/dull than the hand scaler.
Periodontal Debridement Using Machines
 Ultrasonic scaler- uses vibrations and irrigation to
remove tartar from surface of tooth.

Steady stream of water (strong mist) flushes out the sulcus
AND can disrupt bacterial cell walls
Ultrasonic Scaler
 Water through the tip also acts as a coolant; this
machine can get very hot!
 Move tip from the sulcus, coronally, away from the
root’s apex.
 Time line/tooth?
Ultrasonic Scalers: Two Options
Magnetostrictive- magnetic field in the hand piece
is created by a zinc and nickel __________, sends
vibrations to the tip in an elliptical pattern
1.

All surfaces of the tip vibrate!
 Most vibrations are on the ____

Use least amount of vibrations
 Found on the lateral surfaces

Modified Pen grasp
Magnetostrictive Scaler
 Hand piece
 Contains the stack, which is replaceable
 Stack is delicate and should not be bent or twisted!
 Tip
 Stainless steel instrument
 Attaches to hand piece and secured in place with the
_____ _____.
 Many sizes available, specific to each patient
 Removed with the ______ (VERY IMPORTANT)
Magnetostrictive Scaler Use
INCORRECT
Distal third of tip should be
held at 0-15° from long axis of
the tooth.
Ultrasonic Scalers: Two Options
2. Piezoelectric- ceramic discs or crystal that produces liner
movements



Only lateral surfaces vibrate
More fragile, more skill required
More expensive, growing in popularity
Polishing –IMPORTANT
 The scaler microscopically scratches the tooth
surface and creates more surface area  quicker
bacterial build up

Scratches must be smoothed
 Polish- use moderate pressure on every surface of
tooth that was scaled

Much quicker than scaling
 Modified pen grasp
Parts of the Polisher
 Prophy angle- attachment that is connected to the
hand piece
 Prophy cup- disposable rubber piece attached to the
prophy angle


This part actually touches the tooth
Cup holds the polish, or prophy ___________
Polishing
Patient Position/Safety
Comfortable for you and the patient
 Plenty of light
 Elevate neck; nose down

Why?
 Opening of mouth
 Oral speculum
 Suction/gauze
 Preemptive rinse?
 PPE
Oral Speculum Use
 Cornell Feline Health Center study
 Maxillary artery blocked
Exodontics
 Extraction of the tooth
 Malocclusion
 Prognosis of tooth is grave
 Client prefers low cost method
 Multiple anesthesias are contraindicated in patient
 Complications:
 Anesthetic factors
 Hemorrhage
 Iatrogenic trauma
Instruments: Periosteal Elevators and Luxators
 Goal is to ________ the PDL



Elevator is placed in between tooth and bone
Tool is rotated slightly, held, and then rotated
in the opposite direction and held
Tooth is separated from its gingival attachments
 Index finger is extended to working end
 Minimizes iatrogenic soft tissue trauma
Winged Elevators
Extraction Prep
 Pre and post _____________
 Regional nerve block


Delivered to specific nerves to block an entire region of mouth
Bupivacaine 0.5% and lidocaine 2%
 Instruments:





Dental luxator/Periosteal elevators
Scalpels  gingival flap
Extraction forceps
Small suture
Sx: High speed hand piece/burs, scissors, curettes, dilute
chlorhexidine, and root tip elevators if fx
 Client instruction: no hard food or toys for 14 days

Bupivicaine used in mandibular block?
Endodontics
 Disease of the pulp
 Pulp is the vital part of the tooth, should not be exposed to
bacteria of the mouth

Can lead to infection and abscesses
 Commonly indication is fx
 More invasive and expensive than extraction

Which teeth are commonly fractured?

Why is this painful?

What instrument can determine exposure vs. attrition?
Endodontics
Endodontic disease requires treatment
1. Root canal therapy


Removal of pulp with a dental bur, shape with H-files or Kfiles, disinfect with sodium hypochlorite or bleach, dry with
paper points, fill canal with Gutta Percha, and place protective
seal.
Require pre and post radiographs
2. Vital pulp therapy


When tooth is alive and can be saved
Immature teeth
Oronasal Fistulas (ONF)
 Holes formed between mouth and nasal cavity,
usually secondary to PDL destruction.
 Tooth becomes mobile and eventually falls out,
leaving a communication between oral and nasal
cavities.

Which teeth commonly affected?
 CS: sneezing, and persistent, usually single sided,
nasal discharge (with or without bleeding).
 Treatment includes surgery to close fistula.
Oronasal Fistula
Tooth Resorption
 Destruction of tooth structures
 Lesions usually found clinically in the
cervical region


Easily hidden by gingiva
Which instruments help find these lesions?
 Actually begin break down in the root structures…
 How can we find this earlier?
 Idiopathic
 Vitamin D levels?
 Extraction required
“Cervical neck lesions”
Gingival Hyperplasia
 Thickening or over growth of gingival tissue.
 Not a malignant condition.
 How do we confirm this?
 May be caused by periodontal disease.
 Overgrowth of gingiva can increase sulcus depths,
forming pseudopockets.
 Treatment:


Remove tissue if needed
More prophylactic cleanings
Trauma
 Jaw Fractures
 Most common type is symphyseal separation
 Left and right mandibles separate from each other at
the symphysis
 Require rigid fixation for ~3-4 weeks
 Ex. Cerclage wire, tape (puppies)
Tape muzzles- stabilize fracture until Sx
Adhesive side up!
 Loose enough to allow tongue to move
between incisors  allows eating of slurry

Client Education
 Start young!
 Inform client of periodontal disease during vaccination process
 Explain home care oral hygiene techniques
 Brushing with dentrifices, rinses/wipes, water additives
 Mention acceptable bones and chews
Home Care
 BRUSH, BRUSH,BRUSH!
 Start with water, then dentrifice
 Begin caudal and buccal
Brushing Techniques
Stillman Technique:
Sweep in a coronal direction
*When is this used?
Bass Technique:
Bristles go into the
sulcus
Client Education
Once routine dental cleanings begin: (1 -2 years of age)
 Discuss the procedures actually performed and:



Possible complications
Medications
Diet changes (temp. or long term)

Prescription needed?
 Discuss any follow up procedures needed

Prepare estimates
 Helpful websites:
https://www.aaha.org/
http://vohc.org/index.htm