Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Public health genomics wikipedia , lookup
Dental degree wikipedia , lookup
Infection control wikipedia , lookup
Special needs dentistry wikipedia , lookup
Dental implant wikipedia , lookup
Focal infection theory wikipedia , lookup
Remineralisation of teeth wikipedia , lookup
Tooth whitening wikipedia , lookup
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. 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 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) 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 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 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. 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 Magnetostrictive Scaler Parts 2. Tip Stainless steel instrument Many sizes available, specific to each patient All surfaces of the tip vibrate! Most vibrations are on the toe Use the least amount of vibrations! Found on the lateral surfaces Should be used subgingivally! (into sulcus) Secured onto the hand piece via the nose cone- no instrument is used to put the tip on Removed with the key 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 Distal aspects of teeth can be difficult to see Use all instruments! Work efficiently- animal is under anesthesia! Be aware of tip placement at all times Try not to touch cheeks or tongue Check for over heating 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 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 Scratches must be smoothed, or polished 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 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 This part actually touches the tooth Holds the polish, or prophy paste Exodontics Extraction of the tooth Indications: 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) 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: Any complications Medications given or needed Ex. Local anesthetics, antibiotic, etc Diet changes (temp. or long term) Prescription needed? Any follow-up procedures needed Prepare estimates Give date of return Helpful websites: https://www.aaha.org/ www.vohc.org