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