Jennifer Hertzoff, CVT
VETERINARY DENTISTRY TRAINING
www.vetdentistrytraining.com
602-499-0870
Proper dental care is an essential part of a pet’s overall health. The American Veterinary Dental College has reported that the majority of cats and dogs have periodontal disease by the age of 2 or 3 years of age. Knowing how to correctly perform a thorough Periodontal Therapy is critical in identifying pathology and treating dental disease. I was a veterinary technician in general practice for over 20 years and my initial dentistry training consisted of being handed an ultrasonic scaler and told to clean the teeth. Not until I started working at Arizona Veterinary Dental Specialists in 2004, did I really learn proper dentistry protocols and techniques. I wish I knew then what I know now! I will walk you through the right way to perform a quality and complete Periodontal Therapy.... Start to finish.
What equipment do you need? Hand Scaler (Rec: Towner/Jacquette) Hand Curette (Rec: Gracie 13/14 deep pocket)
Probe/Explorer (Rec: Williams Probe/Explorer) Ultrasonic Scaler (Rec: Piezo or Ferrite rod) Polisher (Rec: Fine paste) Antimicrobial Rinse (Rec: CLS) Dental x-ray unit (Sensor or Phosphorous Plates)
Dental Delivery Unit (High Speed Hand piece, Polisher, Air/Water) *Hand instruments should be stored in a tray where they can’t touch each other to prevent damaging the tips.
General anesthesia is required to perform these steps
Supra-gingival scaling
Sub-gingival scaling
Polishing
Irrigation
Exam with x-ray
Here are detailed steps on how to perform the complete Periodontal Therapy:
Check occlusion: Before they are intubated, check the pet’s occlusion. This is the best time to get an accurate assessment. Occlusion classes: How the teeth of the mandible and maxilla come together when closed. Class 0 - Normal occlusion Class 1 - One or a few teeth are out of position. Jaw lengths are correct.
Class 2 - Lower jaw is abnormally shorter than the upper jaw. Class 3 - Upper jaw is a shorter than the lower jaw.
Full mouth dental x-rays:
It is helpful to take these before the cleaning if possible. This gives the veterinarian time to examine the radiographs and make an initial treatment plan while the cleaning is being done. Not all pathology is visible without x-rays.
Antimicrobial rinse: Rinse the mouth with dilute chlorhexidine or CLS. This decreases the amount of airborn bacteria. It's recommended
to do this step before and after the cleaning.
Hand scaling:
A hand scaler has a sharp tip and is designed to remove the “chunks” of tartar above the gum line. Place the curved edge of the scaler below the edge of tartar and pull up towards the crown. It is very important to keep all hand instruments sharpened on a regular basis.
Ultrasonic scaling:
Remove the remainder of tartar above the gum line. Remember, if it’s sharp, it doesn’t belong below the gum line. Use a very light touch. The vibration of the water is what is removing the plaque and calculus, not the mechanical touching of the instrument. The harder you push, the less it’s going to work and can damage the enamel as well as the scaler. Best technique is a “cross hatch” approach. This covers more surface area compared to circles. This instrument is not designed to clean periodontal pockets, a hand curette is used for that purpose. It is impossible to get a tactile feel of what is below the gum line with an ultrasonic scaler. The ultrasonic scaler should be adjusted so there is a fine mist in the shape of a V at the tip. Changing the tips on a regular basis is crucial for best efficiency. Tips come with guides to measure wear. Many ultrasonic tips are safe to go slightly below the gum line but, not with pressure.
Hand curetting:
Most important step! A hand curette is sharp on the side and has a blunt, rounded tip and is designed to remove tartar below the gum line. The curette has two purposes. One is to “peruse” slightly below the gingiva for any missed tartar, pockets, recession or lesions. Just using the rounded tip, slide the curette around the gingival margins with the lightest pressure. The second purpose is to root plane. If there is pocketing or tartar found, place the head portion of the curette at the bottom of the pocket and with firm pressure on the cementum, pull straight up towards the crown. Repeat until cementum is smooth, usually about 5-10 strokes.
Polishing:
The polishing smooths out the microscopic grooves that are made with scaling the teeth. Always use a fine grit paste. Flare below the gum line with the rubber prophy cup and prophy paste. Do not stay more than 4-6 seconds on each tooth at a time.
Irrigation:
This step is indicated for removing residual polish or debris from the teeth, below the gum line and the entire oral cavity. Use the water nozzle on your dental machine. Use high pressure to ensure all debris is gone. Irrigate or final rinse with CLS or dilute chlorhexidine solution.
Antimicrobial Gel:
Coats the teeth and gives some plaque protection.
Charting and complete examination:
This is performed with a dental probe and explorer.
Both of these tools are usually found on the same instrument. The probe will have markings on it, indicating measurements. Know what these measurements are on your probe for accurate charting. The probe is either bounced or slid below the gingiva, around each tooth. This is checking for periodontal pocket depths. It can also be used for measuring furcation exposure and gingival enlargement. The explorer is used to check for defects on the crown of the tooth. Have a full-page dental chart to easily note any pathology and treatments. A printable list of charting abbreviations can be found on www.avdc.org
Additional treatments:
After the full cleaning, x-rays and examination, the veterinarian will develop a plan for any further therapy needed.
The teeth cleaning is just a portion of the Periodontal Therapy. The Professional Teeth Cleaning not only removes tartar but, it allows us to also evaluate the teeth and oral cavity and perform any further treatments. My goal is to help you perform the best dental procedures possible. Offering quality Professional Teeth Cleanings will improve the overall health and happiness of your patients.
