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Dental Procedures

The terms prophy, prophylaxis, and dental are often misused in veterinary medicine. A professional dental cleaning is performed on a patient with plaque and calculus adhered to some of the teeth, but otherwise has an essentially healthy mouth or mild gingivitis only. The intent of dental cleaning is to prevent periodontitis. Patients with existing disease undergo periodontal therapy in addition to professional dental cleaning. Dental procedures must be performed by a licensed veterinarian, a credentialed technician, or a trained veterinary assistant under the supervision of a veterinarian in accordance with state or provincial practice acts. Practice acts vary from jurisdiction to jurisdiction, and the veterinarian must be familiar with those laws. Surgical extractions are to be performed only by trained, licensed veterinarians. All extractions need to have postextraction, intraoral radiographs. All dental procedures need to be described properly (Table 1, Page 4), and a consistent method should be used to record findings in the medical record (Table 5, Page 10).

Positioning and safety of the patient is important. Manually stabilize the head and neck when forces are being applied in the mouth. Avoid using mouth gags because they can cause myalgia, neuralgia, and/or trauma to the temporomandibular joint. If a mouth gag is necessary, do not fully open the mouth or overextend the temporomandibular joint. Never use spring-loaded mouth gags. Do not overinflate the endotracheal tube. Always disconnect the endotracheal tube when repositioning the patient to prevent trauma to the trachea.

Essential Steps for Professional Dental Cleaning

The essential steps for a professional dental cleaning and periodontal therapy are described in the following list:

Additional Steps for Periodontal Therapy and Other Conditions

  1. Perform an oral evaluation, as described above, for the conscious patient.
  2. Radiograph the entire mouth, using either intraoral or digital radiographic systems. Radiographs are necessary for accurate evaluation and diagnosis. In one published report, intraoral radiographs revealed clinically important pathology in 27.8% of dogs and 41.7% of cats when no abnormal findings were noted on the initial examination.16 In patients with abnormal findings, radiography revealed additional pathology in 50% of dogs and 53.9% of cats.16 Standard views of the skull are inadequate when evaluating dental pathology. If full mouth films are not taken, the client must be informed that they were not done.
  3. Scale the teeth supra- and, most importantly, subgingivally using either a hand scaler or appropriate powered device followed by a hand instrument (i.e., scaler, curette). Do not use a rotary scaler, which excessively roughens the tooth enamel.36
  4. Polish the teeth using a low-speed hand piece running at no more than 300 revolutions/min with prophy paste that is measured and loaded on a disposable prophy cup for each patient (to avoid cross-contamination).
  5. Perform subgingival irrigation to remove debris and polishing paste and to inspect the crown and subgingival areas.
  6. Apply antiplaque substances, such as sealants.
  7. Provide instructions to the owner regarding home oral hygiene.
  8. Evaluate the patient for abnormal periodontal pocket depths using a periodontal probe. The depth that is considered abnormal varies depending on the tooth and size of the dog or cat.3,4,6,37 In medium-sized dogs, the probing depth should not be >2 mm, and in the mid-sized cats, the depth should not be >1 mm.
  9. Perform periodontal therapy (Table 1) based on radiographic findings and probing.38–40
  10. Administer perioperative antibiotics when indicated, either parenterally or locally.41,42
  11. Perform periodontal surgery to remove deep debris, eliminate pockets, and/or extract teeth. When either pockets or gingival recession is >50% of the root support, extraction or periodontal surgery is indicated and should be performed by trained veterinarians or referred to a specialist.
  12. Biopsy all abnormal masses that are visualized grossly or noted on radiographs. Submit all samples for histopathology to be analyzed by a pathologist qualified in oral tissues analysis.43
  13. Take postoperative radiographs to evaluate the treatment applied. This is especially important in extraction cases.
  14. Examine and rinse the oral cavity. Remove any packing or foreign debris.
  15. Recommend referral to a specialist when the primary veterinary practitioner does not have the skills, knowledge, equipment, or facilities to perform a specific procedure or treatment.
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