Periodontal Debridement

Routine Prevention or Necessary Treatment? Dental prophylaxis OR periodontal therapy  Removal of deposits from supragingival and subgingival surfaces of the teeth Uses nonsurgical OR surgical instrumentation To prevent OR arrest infection General anesthesia for both  What does that entail?  Risks?  Cost?

Explore the Teeth Dental explorer – has a slender, wire-like working end that tapers to a sharp point and is used to explore the topography of the tooth surface (crowns) Explore enamel defects and caries  Acid producing bacteria  demineralization of enamel and dentin  What is the most common surface affected? Look for pulp exposure  How does this happen?

Check for Attachment Loss Periodontal probe  Round, blunt instrument used subgingivally  Miniature intraoral ruler that measures: 1. Attachment levels (gingival recession and sulcus depths) 2. Loss of bone in furcation areas  Used to assess mobility of teeth and the presence of gingival bleeding What is normal sulcus depth for a canine? Feline?

Periodontal Probe Williams’ markings have millimeter increments at 1,2,3,5,7,8,9 and 10mm.

Gingival Sulcus and Recession

Calculus Removers Removes gross calculus, supragingivally Which teeth do you think need this tool the most?

Scaling Above the Gingiva Hand scaler – used to remove tartar / calculus supragingivally Modified pen grasp technique  Gives precise control of the instrument; limits wrist motion  Where should all of your fingers be? Working end Shank Handle

Scaling Below the Gingiva Curette-used to remove tartar subgingivally Modified Pen Grasp *Tip is more round/dull than the hand scaler.

Periodontal Debridement Using Machines Ultrasonic scaler- uses vibrations and irrigation to remove tartar from surface of tooth.  Steady stream of water (strong mist) flushes out the sulcus AND can disrupt bacterial cell walls

Ultrasonic Scaler: Magnetostrictive Magnetic field in the hand piece is created by a zinc and nickel “stack”, sends vibrations to the tip in an elliptical pattern *Stack is delicate and should not be bent or twisted! Attach an appropriate tip  All surfaces of the tip vibrate!  Most vibrations are on the toe  Use least amount of vibrations  Found on the lateral surfaces  The white nose cone should not be removed by students! Modified Pen grasp

Using Ultrasonic Scaler Machine must be plugged in Must have a water source  Sink or distilled water tank Ran via foot pedal To scale, set to “scale”  Start around 5, increase if needed  Strong mist, lateral surface of tip only

Ultrasonic Scaler Water through the tip also acts as a coolant; this machine can get very hot! Move tip from the sulcus, coronally, away from the gingiva. Time line/tooth?

Magnetostrictive Scaler INCORRECT Distal third of tip should be held at 0-15° from long axis of the tooth.

Periodontal Debridement Polishing – VERY IMPORTANT  The scaler microscopically scratches the tooth surface  creates more surface area  quicker bacterial build up 1-3 seconds/tooth To polish, you will switch to “forward”  Start power around 3, increase if needed Prophy angle- attachment that is connected to the hand piece  Can be reusable (need to still buy prophy cups)  Can be disposable, prophy cup is attached (we have both)

Polishing Removable rubber cup holds polish, or prophy paste.

Patient Position/Safety Comfortable for you and the patient Plenty of light Elevate neck; nose down  Why? Opening of mouth  Oral speculum Suction/gauze Preemptive rinse? PPE

Feline Mouth Gags Cornell Feline Health Center study Maxillary artery blocked Blindness post anesthesia