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Veterinary Dentistry for Technicians -Dental cleaning and Oral Exam -Intraoral Radiogprahic Positioning -Oral Regional Nerve Blocks
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Dentistry for the Veterinary Technician The way it begins:• Plaque begins as a biofilm (pellicle). *In 20 minutes a
tooth is covered in a pellicle (a sticky coating of saliva and glycoproteins). The pellicle is viscous and increases the chance of bacteria adherence.
• In 6-8 hours bacteria begin to colonize. This is what is known as plaque.
• The first bacteria to adhere to the pellicle are gram-positive aerobic organisms
• As the plaque thickens, it extends to the sulcus and subgingivally. The bacteria convert to gram negative anaerobes.
Periodontal Disease = Septicemia• Blood flow (gingivitis)• Kidneys/Liver• Heart (Coronary Vessels)
For the Veterinary Technician
Cite:http://AVDC.org
Cite:http:www.aahanet.org
Steps to a Dental CleaningPPE**Protect yourself-----Protect your patient
Exam Gloves
Or face-shields instead of goggles
Surgical Mask
+/- Waterproof aprons?
Safety goggles
Steps to a Dental Cleaning
1. Prolonged recovery2. Bradycardia3. Respiratory depression4. Apnea5. Ileus6. Hypotension7. Impaired clot function8. Impaired immune function
PPE Prevent Hypothermia
War
m
dry
blan
kets
Steps to a Dental Cleaning
Place pharyngeal pack1.
Steps to a Dental Cleaning
Pre-rinse 2..
Steps to a Dental CleaningRemove bulky tartar3
. .
Extraction or Tartar Removing Forceps
Steps to a Dental Cleaning Power Scale 4.
Power Scalers
Magnetostrictive
Sonic/Ultrasonic
Peizoelectric
Steps to a Dental Cleaning Hand Scale 5.
Jacquet(Sickle Scaler)
Hand Scalers
Steps to a Dental Cleaning Root Plane 6.
Modified Pen Grasp with fulcrum Root Plane
Steps to a Dental Cleaning Modified pen grasp
Curettes Universal vs Area Specific
Curettes
Steps to a Dental Cleaning Rinse, polish, rinse 7.
Steps to a Dental Cleaning 7.
Look for revealed tartar
Rinse pumice
Steps to a Dental Cleaning Oral Exam/Radiograph 8. Periodontal
ProbeExplorer
Oral Exam/Radiographs Probe and explore 8.
Oral Exam/Radiographs Probe and explore Clinical
Attachment
8.
Some anatomy review Gingival Structures
409 (lower right first molar)
Attached gingiva(Base of sulcus)
Mucogingival junction (line)
Gingival margin(Free Gingiva) Sulcus inside!
Oral mucosa
Oral Exam/Radiograph Radiograph
8.
Radiographs• Fractures
• Unerupted/missing tooth• Retained tooth
• Periodontal pocket• Facial swelling• Malocclusion
• Resorptive lesions• Pulp exposure• Post-extraction
• Root canal therapy• Pulpotomy
8. Indications
Steps to a Dental Cleaning Chart findings 9.
Charting 9.
5 Criteria for staging periodontal disease
1. Gingivitis and gingival index (GI) (grade 1-3)2. Periodontal Probing Depth (P) in mm3. Gingival recession (GR) in mm 4. Furcation exposure (FE) (Grade 1-3)5. Tooth Mobility (M) (Grade 1-3)* Chart the stage of periodontal disease using the “worst tooth”.
*Abnormal probing depth (pocket) + Gingival recession (from CEJ to gingival margin) = Total Attachment Loss
9. Charting
Furcation ExposureFE1FE2FE3
FE3
Normal (PD 0): Clinically normal - no gingival inflammation or periodontitis clinically evident.
Stage 1 (PD 1): Gingivitis only without attachment loss. The height and architecture of the alveolar margin are normal.
Stage 2 (PD 2): Early periodontitis - less than 25% of attachment loss measured via probing or radiographs from CEJ to alveolar margin.Or stage 1 Furcation Exposure
Stage 3 (PD 3): Moderate periodontitis - 25-50% of attachment loss measured via probing or radiographs from CEJ to alveolar margin or stage 2 Furcation Exposure.
Stage 4 (PD 4): Advanced periodontitis - more than 50% of attachment loss measured via probing or radiographs from the CEJ to alveolar marginOr Stage 3 Furcation Exposure
Grade vs StageStage indicates a progressive conditionGrade may be either progressive or reversible
AVDC.org/nomenclature
4 Clinical Signs of Periodontal DiseaseDepends on hosts’ response to the bacteria1. Gingivitis2. Calculus3. Horizontal bone loss4. Vertical bone loss
4 Clinical Signs of Periodontal Disease
Horizontal bone loss
4 Clinical Signs of Periodontal Disease
Vertical bone loss
Step 10. DVM Assessment/ Treatment PlanCalculate/Administer Nerve block(s)•Radiographs/Treatment plan•DVM views•Talk to client (via phone)?•Verbal estimate?•Plan/draw up Nerve block
11. Periodontal TreatmentINCLUDE:
• Closed-Currettage
-(debride pocket)
• Open –surgical (flap)
-root planing and currettage
• Perioceutic
- (Antibiotic pocket treatment)
• Systemic antibiotics
(BEFORE) cleaning
- Clindamycin
- “Pulse Therapy”
• Extraction • Crown Reduction
• Guided Tissue Regeneration
-(Bone stimulant/Bone substitute)
- Osteoallograft, Consil ®
12. Fluoride Treatment•Desensitizes tooth
•Helps minimize plaque adherence
•Bacteriostatic
•Its application is controversial becauseget fluoride from other sources
Questions?
Directional Terms
DistalMesial
CoronalApical
Rostral
Caudal
Periodontal and Endodontic Structures
Crown- enamelRoot- cementum
Periodontal Ligamen
t(space)
Apex
Pulpal Horns
Pulp Chamber
CEJ
Types Of Dentin:
Primary Dentin
Forms before tooth eruption
Secondary Dentin
The natural process of mastication
stimulates production of more
layers of dentin
Tertiarty (Reparitive) Dentin
Stimulates rapid formation as a
result of pathology or injury
Repairative Dentin
Maxilla
mandible
Regional Nerve Block
Bupivicaine 0.5%
Lidocaine 2%
Onset 10-20 min 1-2 min
Duration 4-8 hours ½ hour -1 hour
Regional Nerve BlockCalculation for Nerve Block
1 mg/kg each drugMix together
0.1mL/site –cats/sm dogs0.3-0.5mL /site- med/large dogs÷ how many nerve blocks (ie 4)
•Don’t go over toxic dose of 1mg/kg each•ASPIRATE!•Monitor rhythm and blood pressure
Behavior response to pain
Modulation
Transduction
Perception
Transmission
Nociception
“The incision”
Regional Anesthesia
Materials-1mL or 3mL Syringe25 x 5/8” needle unless large skeletal structure
Warning-A less invasive approach= right outside the foramen vs insideAspiration-3x (1/3 rotation and repeat) to check for blood
Inject slowly. Apply digital pressure for 60 sec. Monitor patient.
Rostral Mandibular Nerve Block
Middle Mental Foramen
•Bone, teeth and soft tissue rostralto the mandibular pm/canine incats•Dogs: Palpate foramenLandmark- labial frenulum &ventral to the mesial root of pm2•Cats: Small foramen- palpateLandmark-Caudal to apex of canine
Mandibular Nerve Block(Inferior Alveolar Nerve)
Mandibular Foramen•Bone, teeth and soft tissue of the ENTIRE mandible•Extraoral or Intraoral•Landmarks- ventral notch of mandible, lateral canthus of eye•Palpation of mandibular foramen-intraorally(Lingual surface 2/3 way from molar to angular process )
Mandibular Nerve Block(Inferior Alveolar Nerve)
Intraoral Extraoral
Rostral Maxillary Nerve Block
Infraorbital Foramen•Bone, teeth and soft tissue of the maxilla rostral to PM3
•Landmarks- Palpate juga of pm4- opening just rostral
•Needle parallel to palate
Caudal Maxillary Nerve Block
Infraorbital Nerve•Affects bone, teeth and soft tissue of the ENTIRE maxilla •Landmarks- Dogs: Max 2nd molarCats: Divot caudal to max molar
•Needle parallel to m root
Intraoral Radiography
Intraoral Radiography3 Steps to remember
1. Patient positioning2. Film placement within the patient’s mouth3. Positioning the beam head
Patient positioningDorsal/Ventral/Lateral versus Lateral
Positioning the beam head
Parallel Technique Bisecting Angle
(Vertical Angle)
Positioning the beam head
Centering
Film or Sensor Placement
Bisecting Angle
Positioning5 areas of the mouth
1- Mandibular PM and M2- Mandibular incisors/ canines3- Maxillary incisors4- Maxillary canines5- Maxillary PM and M
Improper Beam Angle
Beam
Tooth
FORSHORTENING•If the beam is pointing too close to the film or sensor •We have a short shadow when the sun is at noon
fILm
Improper Beam Angle
Beam
Tooth
ELONGATION•If the beam is pointing too close to the tooth root •We have a long shadow when the sun is going down
fILm
Improper Beam AngleHORIZONTAL ANGLE
Maxillary Incisors
Maxillary CaninesPosition as Max incisors with a 20° lateral (Horizontal) tilt
Maxillary Premolars/Molars
Mandibular Premolars/Molars
Mandibular Incisors/Canines
Why we love cats
Decreased Angle
•Instead of Beam head perpendicular to BA•Angle is decreased by 20 °•This purposefully elongates roots past Zygomatic Arch
Special view to Avoid the Zygomatic Arch
Near Parallel
Special view to Avoid the Zygomatic Arch
Simplified MethodRelies on approximation instead of measurements
Based on three basic angles:
45° Caudal maxillary teeth60 ° Rostral teeth (incisors)20 ° Horizontal tilt for Maxillary canines
“Split the difference”
Tooth Resorption
High Vitamin DLow Specific GravityDogs
Present in 65% of all catsTR1
Present in 65% of all cats
Present in 65% of all cats
TR4b Root>crown
Type II
TR4bCrown >root
TR5 aka “nubbin”
TR 5
TR4A- crown and root equally affectedType II