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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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