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An Urban Experience
performed or completely omitted. The entire oral cavity must be systematically evaluated using both visual and tactile senses.
The only accurate method for detecting and
measuring periodontal pockets is with a periodontal probe, as pockets are not accurately diagnosed by radiographs. Periodontal probing is performed by gently inserting the probe into the pocket until it stops and then “walking” the instrument around the tooth. Depth measurements should be taken at six spots around EVERY tooth. The normal sulcal depth a cats is 0-0.5 mm. All abnormal  ndings must be recorded on the dental chart. Using the modi ed Triadan system will also greatly increase ef ciency of this step. It is important that dental charts be of suf cient size to allow for accurate placement of pathology. The minimum size for an acceptable dental chart is 1/3 of a page, however veterinary dentists use full page charts.
Step 6: Dental radiographs: Dental radiographs should be taken of every area of pathology noted on dental exam. Dental radiographs are a critical aid in the evaluation of dental pathology, however they are NOT a substitute for the clinical exam.
Step 9: Treatment planning: In this step, the practitioner uses all available information (visual, tactile, and radiographic) to determine appropriate therapy. It is important to consider overall patient health, the owner’s interest and willingness to perform homecare, and all necessary follow-up. After forming an appropriate dental treatment plan for the patient, an estimate should be created and the client contacted for consent.
Home care: Home care is a critical part of periodontal therapy. A recent study found that periodontal pockets are reinfected within 2 weeks of a prophylaxis if homecare is not performed. Therefore, the bene ts of regular brushing and homecare must be discussed with each client following a prophylaxis.
There are two major divisions of dental homecare, active and passive methods. Both types can be effective if performed correctly, however active homecare is certainly the gold standard.
Active homecare consists primarily of tooth brushing. There are numerous veterinary brushes available, but a soft child’s toothbrush is also effective. There are also
a number of veterinary toothpastes available. These products increase the palatability of the toothbrush, and many add a cleaning aid. Human tooth pastes are not recommended because they can cause gastric upset if swallowed. Antimicrobial preparations are also available and can be used instead of toothpaste in cases of established periodontal disease.
Proper brushing technique is a circular motion with the brush at a 45-degree angle to the gingival margin. Once
a day is the ideal frequency, as this is required to stay ahead of plaque formation, but this is unrealistic for most owners. Three days a week is considered the minimum frequency for patients in good oral health. For patients with established periodontal disease, daily brushing is necessary.
Passive homecare is an alternative for minimizing periodontal disease, and is achieved with special diets and treats. Since this method requires no effort by the owner, compliance is more likely. There are currently several available diets that decrease tartar and plaque build-up. Of the available diets, only one has been clinically proven to decrease gingivitis.
The downfall of all passive homecare products involves the fact that the patient is not likely to chew with all teeth equally and therefore areas will be missed. Passive homecare is most effective on the carnassial teeth; in contrast, active homecare is superior for the incisor and canine teeth. Therefore, a combination of active and passive homecare is best.
Periodontal Surgery: Any pockets with depths
greater than 0.5 mm are pathologic and in need of therapy. Periodontal therapy involves removing the infection from the root (i.e. plaque, calculus, and granulation tissue), as well as smoothing the diseased root surface. These steps allow for gingival reattachment leading to a decrease in pocket depth.
In cats, pockets up to approximately 3-5 mm which are not associated with tooth mobility, furcation exposure, or other issues are best treated with closed root planing and subgingival curettage. This step is performed in a similar manner to subgingival scaling described above, with a combination of mechanical and hand scaling.
Pockets greater than 5-mm require advanced procedures for effective cleaning, owing to the fact
that residual calculus is seen with regularity in pockets greater than 6-mm. In humans this is known as the 5-mm standard. In addition, periodontal surgery is also indicated for teeth with moderate bone loss, furcation level II and III, and inaccessible areas. Visualization is best accomplished via periodontal  ap procedures, which should be offered if the clients are interested in salvaging the teeth. These are advanced procedures, but can be learned by general practitioners.
The  nal modality for the therapy of periodontal disease is extraction. While extreme, it is the only true cure. Without a commitment to homecare or routine professional cleanings, advanced periodontal surgery should not be attempted. Furthermore, leaving periodontally diseased teeth in the mouth simply because “they are not loose” is not acceptable, as re-infection is imminent.

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