Proper periodontal therapy -Technicians are the key (Proceedings)
Proper professional dental prophylaxis and detailed periodontal therapy is a must for every small animal practice. Prevention and treatment of periodontal disease can only be accomplished though regular professional care under general anesthesia. Multiple steps are involved in this process and the technician provides a vital role in ensuring quality control, efficiency and completeness. The following discussion details the essential steps that technicians can ensure in providing proper periodontal therapy for their patients.
Client Communication Before and During the Prophylaxis
A complete physical and oral examination of all cooperative patients should be performed prior to anesthesia. Assuming no physical abnormalities exist that would preclude anesthesia any oral findings that should be resolved or investigated during the anesthetic episode should be discussed with the pet owner and estimates for possible diagnostics and treatments given. Complete oral evaluations under anesthesia many times reveal additional pathology requiring dental radiography and/or further treatment. Therefore it is imperative that owners are available by phone during the procedure so that any abnormalities can be relayed to the owner and permission granted to approach these problems during the same anesthetic episode. It is common to find periodontal pockets that require treatment surround what appears to be a normal tooth.
Minimize Patient and Operator Exposure
Aerosolization is unavoidable with the use of mechanical scalers during dental prophylaxis exposing both the staff and the patient to oral bacteria. Chlorhexidine solution may be used as a rinse prior to cleaning to decrease this factor and possibly diminish the degree of bacteremia. Protective glasses, gowns and face masks reduce exposure as well and should be worn by the operator. Finally proper insuflation of the endotracheal tube prevents aspiration of microbes by the patient.
Gross Calculus Removal
Calculus removal forceps are used in cases with gross calculus accumulation. Small breed extraction forceps may also be used for this purpose. One tip of the forcep is placed at the ridge of tartar that approximates the gingiva. The other tip is placed on the crown. Careful, controlled force is applied by leveraging the upper portion of the forcep toward the crown tip to fracture off the calculus mass. Care must be taken not to damage the tooth or the gingiva. The mouth may again be rinsed with chlorhexidine at this point.
Supragingival (Above the Gum) Calculus Removal
Hand scaling is a viable technique for removal of supragingival calculus but has largely been replace by the use of mechanical scalers.
A light feather touch is used with mechanical scalers. This avoids damage to the enamel. Although some micropitting occurs even with a light touch the polishing step will help eliminate this. Make sure that water is constantly bathing the tip to avoid potential thermal damage to the pulp. All tooth surfaces should be thoroughly cleaned with a sweeping or painting motion using the most active portions of the instrument.
With both mechanical and hand scaling a modified pen grasp should be used to reduce operator fatigue and maximize operator control of the instrument.
Subgingival (Below the Gum) Calculus Removal
Special tips are available for mechanical units that are designed to be used subgingivally. Supragingival scaling tips will damage the gum tissue and should only be used as designed. Currettes may also be used to clean subgingivally.
Polishing and Lavage
Polishing should include the entire tooth including the subgingival surface. Commercial polishing paste is placed on the tooth and in the prophy cup that is mounted on a prophy angle attached to a slow-speed handpiece. Disposable prophy angles with the cup already attached are also available.
All prophylaxis paste should be removed from the tooth. Gentle saline lavage can be performed subgingivally using a blunt ended canula and a 12 cc syringe or gentle spray from the air/water syringe to remove residual prophy paste and debris. Irrigates including chlorhexidine can be used for this purpose however no studies exist at this time to show any medical benefits over saline.