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.
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.
1. A technician performs a dental prophylaxis. Note that the operator has protective clothing to protect from her from aerosolized bacteria.
2. An extraction forcep is used to carefully remove gross calculus from the crown.
3. The ergonomic modified pen grasp on this piezoelectric hand piece allows optimal control, feel and patient comfort, minimizing fatigue.
4. A periodontal scaling tip is a special tip that directs water flow under the gumline for cooling and
lavage. Only special tips of this sort may be used for this portion of the procedure.
5. A polishing tip with abundant polishing paste is used on the crown and below the gumline following scaling.
6. A disclosing solution can be used to detect plaque missed following polishing.
7. Periodontal probing allows detection of unwanted pockets. These pockets are then treated based upon depth and radiographic changes.