Page 667 - ONLINE PROCEEDING BOOK WSAVA 2017
P. 667

calculus will appear chalky. This is a very technically demanding procedure and the practitioner is directed to continuing education programs to hone their skills.
Traditional ultrasonic scalers should not be used subgingivally due to thermal damage to the gingiva and pulp. This occurs because the water coolant cannot reach the tip of the instrument. However sonic and ultrasonic scalers with specialized periodontal tips have been developed for subgingival use. These are much easier to use and therefore will likely result in superior cleaning in the hands of novices. Like supragingival scaling, it is recommended to perform mechanical scaling  rst to remove the majority of the plaque and calculus  rst, and then follow up with hand scaling.
Step 5: Polishing
Scaling (especially mechanical) leaves the tooth surface (and especially the root) rough, which increases plaque attachment. Polishing will smooth the surface of the teeth which will retard plaque attachment. Polishing
is typically performed with a prophy cup on a slow- speed hand-piece with a 90 degree angle. The hand- piece should be run at a slow rate and no greater than 3,000 RPM. Ensure that adequate polish is used at all times. Running the prophy cup dry is not only inef cient, it may also overheat the tooth. Just like with scaling, every mm2 of tooth surface should be polished. In addition, slight pressure should be placed down onto the tooth to  are the edges of the prophy cup so as to polish the subgingival areas. One tooth may be polished for a maximum of  ve seconds at a time to avoid overheating. The tooth can be further polished after a short break (while other teeth are polished).
Step 6: Sulcal lavage
The cleaning and polishing steps will result in debris such as calculus and prophy paste (some of which is bacteria laden) to accumulate in the gingival sulcus. In some cases there are visible deposits, but in all cases there
is microscopic debris. These substances will allow for continued infection and in ammation. Therefore a gentle lavage of the sulcus is strongly recommended. The lavage is performed with a blunt ended cannula which is placed gently into the sulcus and the solution is injected while slowly moving along the arcades. The typical lavage solution is sterile saline, although some authors favor a 0.12% Chlorhexadine solution.
Step 6 (a): Fluoride therapy (optional)
This is a controversial step with some dentists recommending that it be performed in all cases and some that it never be done. The positive aspects of  uoride include antiplaque and antibacterial activities, hardening tooth structure, and decreases tooth sensitivity. The latter activity is most important in patients with gingival recession and secondary root
An Urban Experience
exposure. When root planing is performed, cementum
is removed which may expose underlying dentin. In this case, sensitivity may result from the hydrodynamic theory of tooth sensitivity. Application of  uoride should help decrease this sensitivity.
Step 7: Periodontal probing, oral evaluation, and dental charting
This is a critical, however often poorly performed and underappreciated step. The entire oral cavity must be systematically evaluated using both visual and tactile senses. Careful visual examination should be performed during the periodontal evaluation. The periodontal probe should be inserted at six spots around EVERY tooth
to identify periodontal pockets. This is performed by gently inserting the probe into the pocket until it stops and then “walking” the instrument around the tooth. The normal sulcal depth in a dog is 0-3 mm, and a cat is 0-0.5 mm. All abnormal  ndings must be recorded on the dental chart. Dental charting should be performed 4-handed. This means that one person evaluates the mouth and calls out pathology to the assistant who records it on the chart. Using the modi ed triadan system will greatly increase ef ciency of this step. Dental charts must 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 8: Dental radiographs:
Dental radiographs should be performed of ANY pathology noted on dental exam. This includes any periodontal pocket which is larger than normal, fractured or chipped teeth, masses, swellings, or missing teeth. Dental radiographs are a critical aid in the evaluation of dental pathology. Help is available for any questionable cases at www.vetdentalrad.com.
Step 9: Treatment planning
The practitioner, utilizing all available information (visual, tactile, and radiographic) then decides on appropriate therapy. Additionally, the prudent veterinarian will keep
in mind the patient as a whole, the owner’s wishes and willingness to perform homecare, and necessary follow- up. Following the creation of a dental plan for the patient, an estimate is created and the client contacted for consent.
Home care:
This is a very important part of periodontal therapy. A recent study has shown that periodontal pockets are reinfected within 2 weeks of a prophylaxis if homecare is not performed. Therefore, homecare must be discussed with each client following a prophylaxis.
There are two divisions of homecare active and passive. They both can be effective if performed
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