Tools of the Trade: 6 Essential Tools for a Modern Veterinary Dentistry Practice

Jan Bellows, DVM, DAVDC, DABVP, details six tools that help to make veterinary dentistry diagnostics and treatment a joy.

by Jan Bellows, DVM, DAVDC, DABVP

ONE OF THE GREATEST JOYS of being a veterinarian is sharing and learning from each other what works and what doesn’t. I have found the instruments and equipment discussed here help to make veterinary dentistry diagnostics and treatment a joy.

Periodontal Probe

Periodontal probes are used to indirectly determine the position of the tooth’s epithelial attachment by measuring the depth of the gingival sulcus or periodontal pocket. The graduated periodontal probe is placed along the root surface, under the gingival margin, until it reaches the resistance from the epithelial attachment. Gentle force should be used, as it is easy to penetrate through inflamed tissues.

The depth of the sulcus or pocket is measured in millimeters from the gingival margin to the epithelial attachment. I used to have the dental assistant do the probing, but now I prefer to do it myself. It gives me a feel for the case. Measurements are made in two to three places on the buccal surface and two to three places on the lingual/palatal surface of each tooth. Healthy periodontal tissues exhibit pocket measurements of 0–0.5 mm in the cat and 2–3 mm in the beagle-size dog. Abnormal probing depths are called out to the dental assistant and noted in the dental chart.

If the gingiva has receded, then the measurement from the epithelial attachment to the cementoenamel junction in millimeters is the attachment loss. The depth of the pocket and gingival recession, if present, should be added together and recorded on the dental chart.

Intraoral Radiography

With approximately 60% of the tooth below the gingiva, intraoral radiography is needed to properly evaluate our dental cases. Human dental patients help their doctors diagnose lesions based on expressed feelings of pain, temperature, and pressure. Even with this assistance, radiographs help to fully evaluate the presence and extent of dental lesions.

Figure 1a. Periodontal probe with 15-mm markings

Figure 1b. 10-mm probing depth around a partially erupted left mandibular canine tooth

Figure 2. 10-mm attachment loss affecting a right maxillary canine tooth

Skull and dental radiographs may be obtained with the standard veterinary radiography X-ray generator and cassettes, but the results are far from optimal. The location and fixed nature of whole-body veterinary units require animal patients to be moved from the dental table to the radiograph area. With most oral surgical procedures, patient relocation has to be performed multiple times, which adds time and multiplies inconvenience. Additionally, skull films used to evaluate dental disease are not recommended because of poor periodontal detail and superimposition. The radiographic quality obtained from a veterinary film or cassette does not usually allow adequate evaluation of the periodontal and endodontic structures to the level required for treatment decisions. At this time, at least one state practice act (Nevada’s) mandates that dental radiographs are examined when extractions are being performed.

Intraoral images can be obtained by three methods:

  • Captured on film and processed using developer and fixer chemicals (analog)
  • Captured using a phosphor plate system coupled with a computer and monitor (computed radiography)
  • Captured using digital sensor and computer (digital radiography)

All methods produce a high-quality, readable image suitable for dental needs. However, the latter two methods are preferred because they save significant anesthesia time and chemical, environmental, and labor expense. When they are not available, because of practice size or availability in a country, intraoral film analog is acceptable.

Figure 3a. Clinically normal appearing left maxillary fourth premolar and first molar in a dog

Figure 3b. Marked tooth resorption of the fourth premolar at the furcation, necessitating extraction

Dental X-ray generators can be mounted on the wall, the ceiling, cabinetry, or rolling floor stands or be handheld. Floor stand units, because of their inherent size and bulk, create additional floor clutter. However, they do provide mobility, which may be an advantage when the generator is required in multiple locations. Handheld units or wall-, cabinet-, treatment table–, or ceiling-mounted units alleviate this problem.

Photosensitive phosphor technology (CR) utilizes an X-ray–sensitive plate that replaces film. The exposed plate is placed in a scanning device, which records the latent image and converts it to a digital file in a computer. Phosphor plates are available in sizes 0, 1, 2, 4, 5, and 6. While the plate is relatively rugged and flexible, with fewer size restrictions, the processing equipment can be bulky. The plates have a finite life span and will eventually need replacing, which, depending on the manufacturer, can cost about $60 each.

Direct imaging sensors (DR) connect directly via a USB port or employ wireless technology to communicate with the computer. The digital sensor replaces film in the patient’s mouth. Sensors are available in three sizes similar to analog film numbers 0, 1, and 2. The image can be viewed onscreen within seconds without additional handling or processing. A typical sensor requires replacement after approximately five years of use or 20,000 exposures. They cost between $5,000 and $12,000. Patient bites can fracture the sensor and render it useless.

A computer and separate monitor, tablet, or laptop computer in the treatment area can be used to capture and display the images. Most commercially available monitors have resolutions of 1024 × 768 (pixel matrix size). High-performance monitors have pixel matrices as high as 2048 × 2048.

Figure 4. Periosteal elevator being sharpened on an oiled Arkansas stone

Sharpening Stone and Oil

Sharpening wing-tipped elevators and curettes before every use is essential to quality dental therapy. This not only prolongs the instrument’s useful life but is essential to maintain proper function. Immediately after each use, all dental instruments must be thoroughly cleaned with disinfectant, dried, and sterilized. Before sterilization, hand instruments that contain cutting surfaces (e.g., scalers, wing-tipped elevators, and curettes) should also be lightly sharpened to maintain the cutting edges. A dull instrument will push calculus into the dental surface.

How can you determine whether your instrument is sharp? Look at the area where the face of the blade and its side come together. Very dull cutting edges become rounded, causing them to reflect light. If no light is reflected, the cutting edge is still sharp. You can also check for a “bite” on your test stick or your thumbnail—if it doesn’t “bite,” it’s dull.

The stationary stone method is used by most dental assistants. The sharpening stone is kept stationary on the tabletop, and the instrument is moved along the stone. Correct angulation to the sharpening stone is approximately 70 degrees. It’s important to maintain this angle consistently during the sharpening process. Insufficient angulation can make the cutting edge difficult to adapt to the tooth, while overangulation will cause the blade to weaken and dull quickly.

Types of sharpening stones include the following:

  • The natural fine-grit Arkansas stone, lubricated with oil before use
  • The synthetic fine- or medium-grit India stone, lubricated with oil before use
  • The synthetic fine- or medium-grit ceramic stone, lubricated with water before use

Stone shapes and uses include the following:

  • The conical Arkansas or ceramic stone can be used to remove fine wire edges from the instrument. Conical stones can also be used for lightly sharpening scalers and rounding the toe of curettes after each use.
  • The Arkansas or ceramic cylindrical stone is similar in function to the conical stone.
  • The Arkansas, India, or ceramic flat stone is used for most instrument sharpening and recontouring.

Sharpening stones should be scrubbed to remove metal particles after each use, and then rinsed and autoclaved. Alternate the areas of the stone used for sharpening to prevent grooves from forming on the stone surface.

Sharpening Techniques

The work area for sharpening should be well lit. A sturdy table that is high enough to support the operator’s elbows and allow the operator to handle the instrument at eye level will facilitate the process. Regardless of the method used, care must be taken to avoid removing too much metal, which can damage the structural integrity of the instrument while altering its shape.

Follow these steps for the moving stone curette sharpening method:

  1. Place a drop of oil on the flat stone and distribute over the face.
  2. Hold the instrument’s terminal shank with the point perpendicular toward the floor. The face will automatically be parallel to the floor.
  3. To determine the correct edge (lower) to sharpen in an area-specific curette, hold the curette with the toe pointed toward yourself and the terminal shank perpendicular to the floor.
  4. Place the stone against the instrument so that the angle between the face of the instrument and the stone is approximately 110 degrees.
  5. Move the stone up and down while maintaining the 110-degree angle.
  6. End sharpening on a downward stroke.
  7. Sharpen the opposite blade side (if it is a universal curette).
  8. Wipe the tip with alcohol-soaked gauze.
  9. Test the instrument with a plastic stick or by visual examination.

Follow these steps for the stationary stone curette sharpening method:

  1. Place a drop of oil on the stone and distribute over the face of the stone.
  2. Place the stone flat on the table.
  3. Position the instrument at a 110-degree angle to the stone.
  4. Move the instrument back and forth across the stone.
  5. Sharpen the other side of the blade (if universal).
  6. Wipe the tip with alcohol-soaked gauze.
  7. Test the instrument with a plastic test stick or by visual examination.

Figure 5a. #2 Molt elevator placed subgingivally to help expose the buccal alveolus of the left maxillary canine

Figure 5b. Apical advancement of exposure

Follow these steps for the conical stone use:

  1. Place a drop of oil on the conical stone.
  2. Hold the instrument with the tip pointing toward the ceiling.
  3. Hold the conical stone with the face of the instrument toward the stone.
  4. Roll the stone between the thumb and fingers so that it comes into contact with the face of the instrument.
  5. Repeat the process for 10–15 strokes against the instrument.
  6. Wipe the tip with alcohol-soaked gauze.
  7. Test the instrument with a plastic stick or by visual examination.

#2/4 Flat Molt Surgical Curette

The #2/4 flat Molt surgical curette is used to detach and lift gingival tissue that is adhered to bone from both the vestibular and palatal surfaces. Pressure on the shank of the instrument is directed apically, allowing the blade to progress toward the root apex and sever the periodontal ligament. With apical pressure being applied, the instrument is rocked slightly along its long axis to maximize the apical progress of each insertion. The blade is systematically reinserted several times to free up and eliminate the fibrous attachment. The instrument should be sharpened before each use.

Figure 6a. Various sizes of wing-tipped elevators in a cassette

Figure 6b. Wing-tipped elevator wrapped around the mesial root of the left mandibular second premolar to aid extraction

Wing-Tipped Elevator

Dental elevators are instruments that look like small screwdrivers designed to be wedged into the periodontal ligament space between the tooth and its surrounding bone to loosen the tooth from the alveolar socket, separate the periodontal ligament from the tooth, and help expand the socket for extraction.

Elevators have thicker working ends compared with luxators and are not as sharp. Elevators fatigue and tear the periodontal ligament rather than incising as the sharp luxator does. Modified winged ends have extended sides to enfold around the tooth root.

Even though the edges of luxators are thinner compared with elevators, it is wise to choose an elevator tip that is thin enough to enter into the periodontal ligament space. When a winged elevator that is too large or wide is used to extract a tooth, the wings have a tendency to enter the surrounding alveolar bone rather than the periodontal ligament space, which causes local trauma and possible root fracture.

Figure 7a. Various lengths of burs used in veterinary dentistry

Figure 7b. 701S bur used to gain additional working length, facilitating extraction of a cat’s left mandibular canine tooth

Number 701S Surgical-Length Burs

Most large-breed dog and cat teeth have longer roots compared with those of humans. The increased length anchors the teeth into the jaws to prevent luxation when catching and consuming prey. The most commonly used human dental high-speed water-cooled friction grip burs are 19 mm long. Long (L) burs are 21 mm long, while surgical-length burs (S) greatly improve access to the root apices facilitating extractions.

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Get to Know Your Dental Tools

For detailed and invaluable information on even more dental tools, check out Companion-Animal Dental and Surgical Instruments: A Reference for Veterinary Technicians and Assistants, available from AAHA Press.

Jan Bellows
Jan Bellows, DVM, DAVDC, DABVP (Canine and Feline), is in private practice in Weston, Florida. He is a frequent national and international lecturer on topics related to companion-animal dentistry. He is a past president of the American Veterinary Dental College and is currently the president of the Foundation for Veterinary Dentistry. He is a coauthor of the 2010, 2013, and 2019 AAHA Dental Guidelines for Dogs and Cats and the author of the books Feline Dentistry (2010) and Small Animal Dental Equipment, Materials and Techniques, Second Edition (2019).

 

Photo credits: Photos courtesy of Jan Bellows

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