Dental Prophylaxis in Student Performing at VTI

1. Student performing a dental prophy at VTI*Note- all equipment in use, PPE, warming techniquesRemember to check ET tube cuff before beginning!

2. Routine Prevention or Necessary Treatment? • Dental prophylaxis OR periodontal therapy • Removal of deposits from supragingival and subgingivalsurfacesof the teeth • Uses nonsurgical OR surgical instrumentation • To prevent OR arrest infection • General anesthesia for both • What does that entail? • Risks? • Cost?

3. Start your cleaning- 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 (crowns) • Explore enamel defects and caries • Acid producing bacteria demineralization of enamel and dentin • What is the most common surface affected? • Look for pulp exposure • From wear or trauma

4. Check for Attachment Loss • Periodontal probe • Round, blunt instrument used subgingivally • Miniature intraoral ruler that measures: 1. Attachment levels (gingival recession and sulcus depths) 2. Loss of bone in furcation areas • Used to assess mobility of teeth and the presence of gingival bleeding What is normal sulcus depth for a canine? Feline?

5. Periodontal Probe • Williams’ markings have millimeter increments at 1,2,3,5,7,8,9 and 10mm.

6. Gingival Sulcus and Recession

7. Calculus Removers Removes gross calculus, supragingivally Which teeth do you think need this tool the most?

8. Scaling Above the Gingiva • Hand scaler – used to remove tartar / calculus supragingivally • Modified pen grasp technique • Gives precise control of the instrument; limits wrist motion • Where should all of your fingers be? Working end Shank Handle

9. Scaling Below the Gingiva Curette-used to remove tartar subgingivally Modified Pen Grasp *Tip is more round/dull than the hand scaler.

10. 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

11. Ultrasonic Scaler: Magnetostrictive Magnetic field in the hand piece is created by a zinc and nickel “stack”, sends vibrations to the tip in an elliptical pattern *Stack is delicate and should not be bent or twisted! • Attach an appropriate tip • All surfaces of the tip vibrate! • Most vibrations are on the toe • Use least amount of vibrations • Found on the lateral surfaces • The white nose cone should not be removed by students! • Modified Pen grasp

12. Set-up of Ultrasonic Scaler • Machine must be plugged in; turn on with rocker button • Must have a water source • Sink or distilled water tank- your preference • Ran via foot pedal • To scale, set to “scale” • Start power around 5, increase if needed • Strong mist should be seen, lateral surface of tip only • Must select tip of preference • Do NOT over tighten or use the key to secure • MUST USE KEY TO REMOVE TIP after use • Will be checked before your dental begins!

13. Using Ultrasonic Scaler Water through the tip also acts as a coolant; this machine can get very hot! Move tip from the sulcus, coronally, away from the gingiva. Time line/tooth- no more than 10 sec/tooth (sometimes less- Ex. Cat incisors) Go in order, as not to miss a tooth or surface Plaque/tartar must be removed from ALL surfaces

14. MagnetostrictiveScaler NOTE: Other than causing fractures from using at an incorrect angle, can also cause burns of the soft tissue- be aware!!! INCORRECT Distal third of tip should be held at 0-15° from long axis of the tooth.

15. Periodontal Debridement • Polishing – VERY IMPORTANT • The scaler microscopically scratches the tooth surface  creates more surface area  quicker bacterial build up • 1-3 seconds/tooth, touch all surfaces • To polish, you will switch to “forward” • Start power around 3, increase if needed • Prophy angle- attachment that is connected to the polishing hand piece • Can be reusable metal (need to buy prophy cups) • Can be disposable plastic, prophy cup is attached (we have both- your preference)

16. Polishing • Removable rubber cup holds polish, or prophypaste. • Modified pen grasp

17. Patient Position/Safety Comfortable for you and the patient • Set up a light source • Dorsal or lateral recumbency • Lateral takes longer bc we have to flip the patient twice • Elevate neck w/ towel; nose down so water can run out • Opening of mouth w/ oral speculum • Suction/gauze is not an option for us • Preemptive rinse-not done at VTI • PPE- required • Must provide warmth for your patient!

18. Feline Oral Speculums Cornell Feline Health Center study Maxillary artery blocked Blindness post anesthesia

19. Exodontics • Extraction of the tooth • Prognosis of tooth is grave, client prefers low cost method • Tooth will cause perio disease quicker, or tooth will cause malocclusion • Multiple anesthesias are contraindicated in patient • Complications: • Anesthetic factors • Hemorrhage after removal • Iatrogenic trauma from instruments • Closed extraction- single rooted teeth or teeth with severe periodontal disease (easily removed) • Surgical extraction- multi-rooted teeth with large surface area and strong attachment (not at VTI)

20. Instruments: Periosteal Elevators and Luxators • Goal is to weaken the PDL • Elevator 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 • Index finger is extended to working end • Minimizes iatrogenic soft tissue trauma

21. Winged Elevators

22. Extraction Prep • Pre and post radiographs may be required • Regional nerve block- calculated by you • Delivered to specific nerves to block an entire region of mouth • Bupivacaine 0.5% and lidocaine 2% • Delivered with a 27 gauge needle • Instruments needed: • Dental luxator/Periosteal elevators (ours are winged) • Extraction forceps • Small suture and needle drivers?

23. Tooth Resorption • Destruction of tooth structures • Lesions usually found clinically in the cervical region • Begin breakdown in the root, but easily hidden by gingiva • Which instruments help find these lesions? Periodontal probe/explorer; check all surfaces of each tooth • Idiopathic • Vitamin D levels? • Extraction required • Must check all cats for this! “Cervical neck lesions”

24. Client Education • Start young! • Inform client of periodontal disease during vaccination process • Explain home care oral hygiene techniques • Brushing with dentrifices, rinses/wipes, water additives • Mention acceptable bones and chews

25. Home Care BRUSH, BRUSH,BRUSH! Start with water, then dentrifice Begin caudal and buccal

26. Client Education Once routine dental cleanings begin: (1 -2 years of age) • Discuss the procedures actually performed and: • Possible complications • Medications • Diet changes (temp. or long term) • Prescription needed? • Discuss any follow up procedures needed • Prepare estimates • Helpful websites: https://www.aaha.org/ http://vohc.org/index.htm