P. 666

An Urban Experience
B.A. Niemiec1
1Southern Califormia Veterinary Dental Specialties, Dentistry, San Diego, USA
The basis of periodontal therapy today is plaque
control. This is accomplished via two to four components depending on the stage of the disease. These include
a thorough dental prophylaxis, periodontal surgery, homecare, and extraction. There are numerous variations and treatment options for therapy. This lecture will cover the basics and touch on the available options. The cornerstone of periodontal therapy is a thorough dental prophylaxis. This MUST be performed under general anaesthesia including a properly in ated endotracheal tube. The prophylaxis should include the following steps.
Step 1: Pre surgical exam and consultation
This is often a much neglected step of a professional dental prophylaxis. The veterinarian should perform
as complete as possible physical and oral exam. The physical exam (along with pre-operative testing) will
help ensure anesthetic safety. The oral examination will identify obvious pathology (fractured, intrinsically stained, or mobile teeth; oral masses; and resorptive lesions) as well as allow for a preliminary assessment of periodontal status. The veterinarian can then discuss the various disease processes found and the various available treatment options. Based on the physical  ndings, the practitioner can create a more accurate estimate (both  nancial and time). Both of which will decrease problems with over scheduling and client  nances during the anesthetic event. This small time investment will improve the experience of everyone involved (veterinarian, technician, receptionist, client, and patient).
Step 2: Chlorhexadine lavage
The oral cavity is a contaminated area and a dental cleaning is a mildly invasive procedure. In this way, it often results in a transient bacteremia. For this reason
it is recommended to rinse the mouth with a 0.12% solution of chlorhexadine gluconate prior to commencing the prophylaxis to decrease the bacterial load.
Step 3: Supragingival cleaning
This can be performed via mechanical or hand scaling. The mechanical scalars decrease anaesthetic time and include both sonic and ultrasonic types. The most common type of mechanical scaler in veterinary dentistry today is the ultrasonic scaler. There are two main types magnetorestrictive and piezoelectric). Both of these scalers vibrate at approximately 45,000 Hertz. They are very ef cient and have an additional
bene t of creating an antibacterial effect in the coolant spray (cavitation). They are however can be more damaging to the tooth, and may leave some calculus behind. Thus, it has been recommended that hand scaling be performed after ultrasonic scaling to ensure the complete removal of calculus. Sonic scalers run on compressed air and vibrate at 8-18,000 hertz. They are safer, but slower than sonic scalers and do not offer cavitation. The area of maximum vibration is 1-3 mm from the tip. Do not use the tip or back of the instrument as these are not effective for calculus removal and
can potentially damage the tooth. The instrument is placed on the tooth and LEFT on the tooth for up to 15 seconds. Once the instrument looses contact with the tooth, the scaler can no longer be effective. Run the instrument SLOWLY over the tooth surface in wide sweeping motions to cover every mm2 of every tooth surface.
Hand scaling is performed with a scaler. This is a triangular instrument with e sharp cutting edges. In addition, the tip is very sharp. Scalers are designed
for SUPRA-gingival use only. The scalers (as well as curettes below) are held with a modi ed pencil grip. The instrument is gently held at the gnarled or rubberized
end with the thumb and index  nger TIPS. The middle  nger is placed near the terminal end of the shaft and is used to feel for vibrations which signal residual calculus or diseased/rough tooth/root surface. Finally, the ring and pinkie  ngers are rested on a stable surface.
Hand instruments are used with a gentle touch and are run over the tooth numerous times in overlapping strokes until the tooth feels smooth. This step may be performed with a curette and combined with subgingival scaling (see below).
Step 4: Subgingival plaque and calculus scaling
This step is best performed by hand with a curette. A curette has 2 cutting edges and a blunted toe and bottom. In this way, it will not cut through the delicate periodontal attachment as long as excess force is not applied. The proper curette is selected based on its angulation. The lower the number (i.e. 1-2) the less the angle and the further rostral in the mouth the instrument is used. The face of the instrument is placed  at against the surface of the tooth and inserted gently to the base of the sulcus or pocket. Once there, the instrument
is rotated so that the shaft is parallel to the long axis
of the tooth. This will engage the calculus as well as place the instrument in the proper position for root surface and subgingival debridement. This is repeated with numerous overlapping strokes until the root feels smooth. Cleanliness can be further evaluated by gently directing compressed air into the sulcus. Any remaining

   664   665   666   667   668