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PERIODONTICS

DENTAL PROPHYLAXIS (CLEANING)

A dental prophylaxis is performed not only to clean the teeth, but also to evaluate the oral cavity for any other problems that might be present. The cleaning not only includes what you can see, but also the area under the gumline, which is the most important part.

For this reason, “Non-anesthetic” cleaning is not a viable option. The area under the gumline, as well as the inside of the mouth is not cleaned effectively. In addition, the teeth are not polished, which as we know will leave the cleaned surface rough and increase the adherence of plaque bacteria and hasten dental disease. We have devised a seven-step prophylaxis to give our patients the maximum benefit available.


Before the prophaxis can begin, the patient must be placed under general anesthetic. This will greatly increase patient comfort and effectiveness of cleaning. In addition, it allows us to place an endotracheal tube in the patient's trachea. This will protect the lungs from the bacteria that are being removed from the teeth.

PROPHYLAXIS:

Step 1. Supragingival cleaning: This is cleaning the area above the gumline. It is usually accomplished by mechanical scalers in our animal patients. This increases the speed that the cleaning can be performed, which decreases anesthetic time.

Step 2. Subgingival cleaning: This is cleaning the area under the gumline. In our animal patients, this is one of the most important steps. The subgingival plaque and calculus is what causes periodontal disease. This is the most common ailment diagnosed in ALL animal patients. Cleaning the tooth surface will make the teeth look nice, but in reality has done little medically for the patient.

Step 3. Polishing: The mechanical removal of the plaque and calculus causes microscopic roughening of the tooth surface. This roughening increases the retentive ability of the tooth for plaque and calculus, which will buildup faster and increase the rapidity of periodontal disease progression. Polishing will smooth the surface and decrease the adhesive ability of plaque.

Step 4. (Subgingival/Sulcal) Lavage: The scaling and polishing of the teeth will cause a lot of debris to become trapped under the gums. This will cause local inflammation, as well as increase the chance of future periodontal disease. For this reason we gently flush the gingiva with an antibacterial solution, or if periodontal disease is present, we will use saline solution.

Step 5. Fluoride treatment: This is the use of fluoride foam to impregnate the teeth with fluoride, since animals don’t usually get their teeth brushed. The benefits of fluoride are that it hardens the dentin, decreases tooth sensitivity, and is reported to retard the formation of Feline Oral Resorptive Lesions, and be anti-plaque.

Step 6. Treatment planning: This step is where the teeth and entire oral cavity are evaluated, using not only our eyes, but a periodontal probe to determine if there is a periodontal pocket. Finally, dental radiographs are taken to determine the extent of the disease process present. Using all of these modalities, a plan is developed (with the owners input) to reestablish the patient’s oral health.

Step 7. Dental Charting: All of the pertinent oral findings and treatment rendered and planned in the future is placed on a dental chart in the patients permanent medical record. This will allow the veterinarian to follow the patients progress (or regression) through the years.

These are the steps that we follow to ensure that the patient leaves with a clean mouth. However, dental care does not end there. Within 24 hours, plaque has already started to form on the teeth, and the periodontal disease process starts over. This is where Home Care comes in. Imagine what would happen in you mouth if you never brushed your teeth, all the cleanings in the world won’t keep your mouth healthy.


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SCALING

Without proper cleaning and dental visits, plaque and tartar build up in the mouth and collect at an area just below the gum line called the sulcus. Eventually, this buildup will cause the gums to move away from the teeth, forming pockets in the mouth. These pockets fill with even more plaque. This buildup can lead to periodontal, or gum, disease.

In severe cases, a dentist may have to perform gum surgery, such as a gingivectomy (removal of gum tissue) or periodontal flap surgery (removal of gum tissue and underlying bone). More routine cases can be treated through scaling, the removal of tartar and plaque from the tooth, especially below the gum line along the root surface.

Before he or she begins the scaling process, your dentist might first remove larger chunks of tartar with a device called a cavitron, an ultrasonic scaler that uses high frequency sound vibration to blast away tartar. This method can remove up to fifty percent of existing tartar. (Note, though, that this step must be skipped if the patient has a pacemaker, as the vibrations caused by the cavitron can interfere with the pacemaker.)

In scaling, our dentist deep-cleans your tooth, using hand-held instruments called scalers and curettes, above and below the gum line to remove plaque and calculus. He or she then planes the root until it is smooth. The purpose of root planing is threefold: first, it removes rough calculus deposits on the root that can attract and collect bacteria; second, it buffs out any scratches the scaling process may have caused; and third, a smooth surface is much better for the gum ligaments to reattach. When the ligaments reattach, the pocket of space between the tooth and gums is much smaller than before. The breeding ground for bacteria has been destroyed.

The amount of times you will need to return to your dentist depends on how widespread your case of periodontis, or gum disease, is. Localized cases can be treated in a single scaling and root planing session. Cases spread throughout the mouth, however, are often treated one quarter of the mouth at a time. Such cases, then, require four visits to your dentist.

Your dentist will likely send you home with prescriptions for antibiotics to combat any leftover bacteria and for chlorexidine, an antibacterial mouth rinse. Expect a follow-up appointment with your dentist in four to six weeks. Often, scaling and root planing will eliminate the need for surgical treatment.

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Root planing:

This is the cleaning of pockets to stop further gum problems.

Root planing is used to treat perio conditions, which are moderate to advanced gum diseases. When the gum is inflamed, gum pockets become deeper and they lose bone connections inside. The deeper these pockets are the easier it is for them to trap plaque deposits and make the gum worse.

Root planing is essentially inserting the pointy front of handle scalers into below the gum pockets to clean plaque buildup. Sometimes local anesthesia is needed to prevent any feeling of pain and depending on the degree of difficulties, root planning can take several dental visits.

 

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