Rarely in veterinary dentistry do we perform a “prophy” or prophylaxis treatment on clean teeth with healthy gingiva. Most patients seen in veterinary practice today actually need a thorough supragingival and subgingival cleaning, intraoral evaluation, polishing, and further periodontal therapy. This involves removal of plaque and calculus either with hand instruments, or sonic/ultrasonic instruments above and below the gingival margin, periodontal probing, intra-oral radiographs, charting, and more involved treatment such as deep periodontal therapy or extractions if indicated. Periodontal probe depth and extent of disease shown radiographically will dictate which treatment is appropriate.
Prior to periodontal evaluation, most veterinary patients must undergo a thorough cleaning of their teeth to allow accurate assessment. Once the patient has been examined, appropriate preanesthetic diagnostic tests performed and the patient is anaesthetized, an initial exam of the teeth and oral tissues should be done. Before placement of the cuffed endotracheal tube (read more regarding pet anesthesia), the occlusion or “bite” can be evaluated for orthodontic abnormalities and notations made on the dental record for future reference. Cuffed endotracheal tubes are vitally important due to the potential for bacterial aerosolization or aspiration during the procedure. After intubation, a quick exam of the oral cavity noting major problems such as calculus deposits, exposed roots, gingival recession, mobile teeth, oral masses, malpositioned teeth, missing teeth, discolored teeth, and worn or fractured teeth can be made and transferred to the dental record. An antiseptic rinse or gel (CHX gel) can be applied to the teeth surfaces to help decrease bacterial numbers and aerosolization of bacteria during the procedure. The “operator” (person cleaning the teeth) should take precautionary measures such as wearing gloves, mask, eye protection, and gown to prevent exposure to this aerosolized bacteria. Supragingival scaling is the removal of plaque and calculus above the gumline, or gingival margin. This can be accomplished in a variety of ways: calculus forceps for heavy deposits, hand instruments i.e. sickle scaler, hoe scaler and chisel scaler, or power instruments such as sonic and ultrasonic scalers. Each has its own advantages and disadvantages. The operator should be familiar with the proper use and potential for misuse of the mode chosen for this procedure. Once supragingival plaque and calculus is removed, the teeth should be polished with a medium to fine grit polishing paste to smooth surface irregularities which helps retard the biofilm of plaque and improve mechanical removal i.e. brushing and future scaling. Periodontal probing will reveal any “pockets” of periodontal disease and indicate the need for dental radiographs. In general, any abnormal probing depth should be radiographed to fully evaluate the alveolar bone and periodontal space around each of the roots of the teeth involved.
Once the teeth are evaluated, cleaned above the gumline, polished, probed, and radiographed, any areas deemed as having disease below the gumline can be addressed. This may mean cleaning the root surfaces via root planing with hand instruments, cleaning out any periodontal pockets, and further periodontal therapies. All points of disease and treatment should be noted on a dental chart to help show clients where the problem areas are and for monitoring of improvement at future visits.
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A summary of the steps to a complete cleaning is below:
Steps to Cleaning Teeth
- Rinse oral cavity with antiseptic solution
- Supra-gingival calculus removal: ultrasonic scaler
- Periodontal probing and charting pathology
- Dental x-rays
- Sub-gingival cleaning: root planing and sub-gingival curettage (hand curette or ultrasonic tip)
- DVM exam and further treatments if necessary
- Polish the teeth
- Irrigation: flush away debris
- Fluoride treatment if indicated
- Chart treatment
After the teeth have been cleaned, fully evaluated, and any disease treated, the patient is recovered from anesthesia and allowed to go home. Now that the teeth are clean, this is an excellent time to start home prophylaxis or prevention of the return of plaque. There are several modalities to help reduce plaque accumulation, but brushing is still the gold standard. Some recommendations for the initiation of a brushing program are given below:
Pet Dental Home Care Recommendations
It is very important to your pet’s health to receive regular dental home care just as you take care of your own teeth. Animals have no special ability to resist dental disease. Please read the following guidelines to help assist you in achieving a successful dental home care program for you and your pet.
Step 1: Examine and Touch the Mouth, Teeth, and Gums
The first step is to make it fun and relaxing for your pet. Use lots of praise and start slowly. Begin by offering a small amount of flavored pet toothpaste on your index finger as “a treat” daily for 5-7 days. This conditions your pet to expect a treat when they see the tube of toothpaste.
Step 2: Brushing or wiping the Teeth with Pet Toothpaste
After this initial introductory period, as you give the paste, use your index finger to rub the teeth and gums in small circles, the same motion as a toothbrush. Continue this for 5-7 days. Once your pet becomes comfortable with this, then progress to a soft bristle brush and continue the same routine. You may want to offer a small amount of the paste before and after brushing as a reward. Some pets will require daily brushing, while others can be maintained by brushing a few times a week.
*** Human toothpaste is not meant to be swallowed and should NOT be used on your pet.
Step 3: Mouth Rinses
Pets with advanced periodontal disease or pets that will not allow brushing may also benefit from an antiseptic oral rinse. These rinses are not as well liked as the flavored toothpastes and will not remove plaque as well as brushing, but they will help reduce plaque bacteria.
Step 4: Treats
There are products that have been proven in clinical trails to reduce plaque and tartar accumulation. Look for the Veterinary Oral Health Council (V.O.H.C.) Seal of Approval on products to ensure that are beneficial for your pet’s dental health.
*** Avoid hard treats such as real bones, hard plastic bones, and cow hooves as they can lead to broken teeth.
Step 5: Diets
Specially formulated diets are available that help reduce plaque and tartar build-up. Iams and Eukanuba diets have added chemicals that retard the mineralization of plaque to tartar, thus making the teeth easier to keep clean. Other diets such as Hill’s Prescription t/d diet works mechanically to “brush” the teeth when chewing. The t/d diet can be fed as the sole diet, or as treats.
If you find you cannot perform dental home care on your pet, and you want to keep your pet healthy and avoid bad breath and dental disease, you MUST seek professional treatment more frequently! For most pets a professional cleaning once a year is adequate. Pets with pre-existing dental disease and those lacking dental home care will need professional care more often.