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An Urban Experience
correctly, however active homecare is still the gold standard in homecare.
Active homecare consists primarily of tooth brushing. There are various veterinary brushes; however a soft child’s toothbrush is also effective. There are numerous veterinary toothpastes available. These increase
the palatability of the toothbrush, and many add a cleaning aid. Human tooth pastes are generally not recommended. There are also antimicrobial preparations that can be used in certain cases. Technique: Use a circular motion with the brush at a 45-degree angle to the gingival margin.
Frequency: once a day would be ideal, as this is required to stay ahead of plaque formation, but for most owners this is unrealistic. Three days a week is considered the minimum frequency for patients in good oral health. If the patient has periodontal disease, daily brushing is necessary. One other option for active homecare is to rinse with a chlorhexadine solution. This has been shown to decrease gingivitis if done consistently over time. Even though brushing and rinsing greatly improves periodontal health, it does not completely eliminate the need for professional cleanings.
Passive homecare is the other option for minimizing periodontal disease. Since this requires no work by
the owner, compliance is more likely. This is especially important since long term consistency is the most important factor in the effectiveness of dental care. There are currently several diets that decrease tartar and plaque build-up. In addition, tartar control chews and treats have been developed.
All of these products have been shown to decrease plaque and calculus, however, they are most effective
on plaque and tartar on the cusp tips not at gingival margin. Supragingival plaque and calculus is in general non-pathogenic. Of the available products, only two have been clinically proven to decrease gingivitis.
The downfall of all passive homecare products is that
the patient is not likely to chew with the entire mouth; therefore areas will be missed. Passive homecare is most effective on the carnassial and surrounding teeth, where chewing is concentrated. Active homecare, in contrast, is most effective in controlling plaque and calculus on
the incisor and canine teeth, likely due to the ease in accessing these teeth. Therefore, a combination of active and passive homecare is likely ideal.
Periodontal Surgery
Any pockets greater than normal for the species are pathologic and in need of therapy. It is important
to note that this is a separate procedure from the prophylaxis and the practitioner should be charging for this. Periodontal therapy is aimed at removing the infection from the root surface (plaque, calculus, and
granulation tissue) as well as smoothing the diseased root surface. This will allow for reattachment and decrease in pocket depth.
In the canine patient, pockets between 3 and 5 mm which do not have mobility or other issues are best treated with closed root planing and subgingival curettage. This step is performed in a similar manner to subgingival scaling above, with a combination
of mechanical and hand scaling. This should be meticulously performed in order to achieve as clean a tooth as possible to promote healing.
Pockets greater than 5-mm require direct visualization of the root surface for effective cleaning. If the tooth is not effectively cleaned, the infectious agents remain along with the plaque and calculus. Visualization is best accomplished via periodontal  ap procedures. These procedures are very effective in animal patients. If
the clients are interested in salvaging the teeth, periodontal surgery can be performed. These are advanced procedure, but can be learned by general practitioners. However, the reader is encouraged to attend a hands on wet-lab prior to undertaking these surgeries.
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 likely not be attempted. Depending on the stage of periodontal disease, the involved teeth should be extracted.

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