Download Surgery Dentistry 2017- KJT part 2

Stage III Periodontitis
 The established stage; 25-50% attachment loss
 Swelling, inflammation, and pocket formation (from
attachment loss) are present.
 Bone loss may be seen on dental x-rays.
*Note: this stage is the change from gingivitis, which is
reversible with treatment, to true periodontitis, which is only
controllable with therapy.
 Animals that suffer from stage III disease usually
have owners who are not educated on, cannot, or do
not wish to perform home care.
Stage III Periodontitis
*Visualization of the cemento-enamel junction
Furcations
 Furcations are areas between the roots of multi-
rooted teeth and are indicative of stage 3 periodontal
disease.
 Gum tissue recedes with advanced periodontal
disease and bone supporting the tooth is “eaten
away”, exposing the area where the roots come
together.
 Exposed section appears as a hole at the gingival
margin.
Stage IV Periodontitis
 Advanced Periodontal Disease
 May appear as any or all of the following forms of
pathology: severe inflammation, attachment loss
with deep pocket formation, gum recession, bone
loss, pustular discharge, or tooth mobility.
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Spontaneously bleeding gums.
 Signs: animals will paw at their face, drop food while
eating, and drool excessively.
 Treatment consists of scaling, root planing, and
surgical extraction of affected teeth.
Stage IV Periodontitis
Note- these teeth appear to have been cleaned already:
Stage IV Periodontal Disease
 Periodontal disease has
destroyed a significant
portion of the alveolar
bone and PDL of these
incisor teeth.
 The gingiva has receded
from the crowns of these
teeth, and the tooth roots
are now exposed.
This is an irreversible stage of periodontal disease!
Routine Prevention or Necessary Treatment?
 Dental prophylaxis OR periodontal therapy
 Both = removal of deposits from supragingival and
subgingival surfaces of the teeth
 Prophylaxis uses non-surgical instrumentation to
prevent infection
 Periodontal therapy is provided when
disease/infection already exists
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This will be a longer procedure with
higher cost to the client
Usually due to no previous prevention
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
1. Confirm dental caries (not common)
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Demineralization of enamel and dentin due to bacteria
Appears as a dark spot on the tooth
Most common found on the occlusal surface
Will feel “sticky”
2. Test for pulp exposure
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Due to attrition or trauma
Appears as discoloration on the tooth
Check for Attachment Loss
Periodontal probe
• Round, blunt working end
• Intraoral ruler that measures attachment levels by
measuring:
1. Gingival recession
2. Sulcus depth
3. Loss of bone in furcation areas
Periodontal Probe
 Williams’ markings
have millimeter
increments at 1,2,3,5,7,8,9
and 10mm.
Calculus Removing Forceps
 Removes gross calculus, supragingivally
 Curved jaw is used on buccal aspect of tooth
 Usually reserved for molars and premolars
 This instrument has the potential to cause trauma
 Use with caution!
Scaling Above the Gingiva
 Hand scaler – used to remove tartar/calculus
supragingivally
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Use Modified pen grasp technique
Gives precise control of the instrument; limits wrist motion
Know where all of your fingers should be
Working end
Shank
Handle
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.
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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 w/o adequate water supply!
 Move tip from the sulcus, coronally, away from the
root’s apex.
 Time line/tooth = < 10 seconds (use common sense)
Ultrasonic Scaler
Magnetostrictive- a magnetic field is created
by a zinc and nickel stack in the hand piece,
which sends vibrations to the tip in an elliptical
pattern
Two Parts:
1. Hand piece
Contains the stack, which is replaceable
 Stack is delicate and should not be bent or twisted!
 Modified Pen grasp
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Magnetostrictive Scaler Parts
2. Tip
Stainless steel instrument
 Many sizes available, specific to each patient
 All surfaces of the tip vibrate!
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Most vibrations are on the toe
Use the least amount of vibrations!
Found on the lateral surfaces
 Should be used subgingivally! (into sulcus)
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Secured onto the hand piece via the
nose cone- no instrument is used to put
the tip on
Removed with the key
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VERY IMPORTANT TO USE THE KEY
Using the Ultrasonic Scaler
 Machine must be plugged in & then turned on
 Must have a water source
1. Sink- machine attaches to the sink nozzle; use cold water
2. Distilled water tank- must be pressureized and locked into
place
 Amount of water used to scale is adjustable with a dial
 Machine is operated via foot pedal
 To scale, set dial to “scale”
 Select desired tip- place on the hand piece until “hand tight”
 Start power around 5, increase if needed
Using the Ultrasonic Scaler
 If takes practice to become an efficient scaler
 Goal is to remove all evidence of plaque and tartar
 Use lateral surfaces of tip only
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Distal aspects of teeth can be difficult to see
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Use all instruments!
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Work efficiently- animal is under anesthesia!
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Be aware of tip placement at all times
Try not to touch cheeks or tongue
 Check for over heating
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Dental Mirror
Oral Speculum
 Instrument used to hold the patient’s mouth open
 Placement:
 Compress springs together
 Place the black rubber cups on the patient’s canines
 Let the mouth open into a natural position
 Disadvantage:
 Exerts pressure on the patient’s TMJ
 Not used on cats
*Should be used at a minimum
Patient Position/Safety
Comfortable for you and the patient
 Lateral or dorsal is most common
 Elevate patient neck with towels
 Point nose down
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Water used will run into the sink
Prevents aspiration
 Set up a light source
 Head lamp or standing floor lamp
 Provide warmth for the patient
 PPE required- gloves, mask, eye protection
Ultrasonic Scaler Complications/Risks
 Soft tissue burns
 Trauma to the teeth
 Aspiration
Polishing –IMPORTANT STEP
 The scaler microscopically scratches the tooth
surface and creates more surface area  quicker
bacterial build up
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Scratches must be smoothed, or polished
 Use moderate pressure on every surface of tooth that
was scaled
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Much quicker than scaling!
 Modified pen grasp
Parts of the Polisher
 Prophy angle- attachment that is connected to the
hand piece
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Slides onto hand piece and then locked into place
Ensure hand piece is UNLOCKED before inserting
prophy angle!
 Prophy cup- disposable rubber piece; attaches to the
prophy angle
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This part actually touches the tooth
Holds the polish, or prophy paste
Exodontics
Extraction of the tooth
 Indications:
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Persistent deciduous teeth
Prognosis of a tooth is grave
Client prefers low cost method of treatment
Anesthesia is contraindicated in patient
 Possible complications:
 Anesthetic factors
 Hemorrhage
 Iatrogenic trauma
Instruments: Periosteal Elevators and Luxators
 Goal is to weaken the PDL (done by a veterinarian)
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Instrument 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 and is removed in
one piece
 Index finger is extended to working end
 Minimizes iatrogenic soft tissue trauma
Winged Elevators
Extraction Prep
 Pre and post radiographs
 Regional nerve block
 Delivered to specific nerves to block an entire region of mouth
 Bupivacaine and/or lidocaine
 Time of effect?
 Instruments needed:
 Dental luxator/elevators
 Extraction forceps
 Small suture and needle drivers
Tooth Resorption
 Idiopathic destruction of tooth structures
 Break down begins in the root
 Lesions usually found clinically in the cervical region
 Easily hidden by gingiva
 Periodontal probe and explorer will help find these lesions during
a dental cleaning
 Can be found earlier with radiographs
 Extraction required
“Cervical neck lesions”
Client Education
 Start young!
 Inform client of periodontal disease during vaccination process
 Distribute pamphlets or brochures
 Explain home care oral hygiene techniques
 Brushing
 Rinses/wipes
 Water additives
 Dental treats
 Mention acceptable bones and chews
Home Care Instructions
 BRUSH, BRUSH,BRUSH!
 Start with water, work towards dentrifice
 Begin caudal and buccal, work towards incisors
Client Education
Once routine dental cleanings begin: (2-3 years of age)
 Discuss the procedures actually performed and:
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Any complications
Medications given or needed
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Ex. Local anesthetics, antibiotic, etc
Diet changes (temp. or long term)
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Prescription needed?
 Any follow-up procedures needed
 Prepare estimates
 Give date of return
 Helpful websites:
https://www.aaha.org/ www.vohc.org