Periodontal Debridement

Routine Prevention or Necessary Treatment? Dental prophylaxis OR periodontal therapy Both involve 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 Explore for _________ 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 Explore for _________ Acid producing bacteria demineralization of enamel and dentin Most common surface affected? Test for attrition vs. pulp exposure

Check for Attachment Loss Periodontal probe Round, blunt working end Intraoral ruler that measures ____________ levels: 1. Gingival recession 2. Sulcus depth 3. Loss of bone in furcation areas Used to assess mobility of teeth and the presence of gingival bleeding

Periodontal Probe ________________have millimeter increments at 1,2,3,5,7,8,9 and 10mm.

Gingival Sulcus and Recession

Calculus Removing Forceps 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?

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

Ultrasonic Scalers: Two Options Magnetostrictive- magnetic field in the hand piece is created by a zinc and nickel __________, sends vibrations to the tip in an elliptical pattern All surfaces of the tip vibrate! Most vibrations are on the ____ Use least amount of vibrations Found on the lateral surfaces Modified Pen grasp

Magnetostrictive Scaler Hand piece Contains the stack, which is replaceable Stack is delicate and should not be bent or twisted! Tip Stainless steel instrument Attaches to hand piece and secured in place with the _____ _____. Many sizes available, specific to each patient Removed with the ______ (VERY IMPORTANT)

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

Ultrasonic Scalers: Two Options 2. Piezoelectric- ceramic discs or crystal that produces liner movements Only lateral surfaces vibrate More fragile, more skill required More expensive, growing in popularity

Polishing –IMPORTANT The scaler microscopically scratches the tooth surface and creates more surface area  quicker bacterial build up Scratches must be smoothed Polish- use moderate pressure on every surface of tooth that was scaled Much quicker than scaling Modified pen grasp

Parts of the Polisher Prophy angle- attachment that is connected to the hand piece Prophy cup- disposable rubber piece attached to the prophy angle This part actually touches the tooth Cup holds the polish, or prophy ___________ Reusable or disposable plastic

Polishing

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

Oral Speculum Use Cornell Feline Health Center study Maxillary artery blocked Blindness post anesthesia

Exodontics Extraction of the tooth Complications: Malocclusion Prognosis of tooth is grave Client prefers low cost method Multiple anesthesias are contraindicated in patient Complications: Anesthetic factors Hemorrhage Iatrogenic trauma

Instruments: Periosteal Elevators and Luxators Goal is to ________ the PDL Elevator is placed in between tooth and bone Tool is rotated slightly, held, and then rotated in the opposite direction and held Tooth is separated from its gingival attachments Index finger is extended to working end Minimizes iatrogenic soft tissue trauma

Winged Elevators

Extraction Prep Pre and post _____________ Regional nerve block Delivered to specific nerves to block an entire region of mouth Bupivacaine 0.5% and lidocaine 2% Instruments: Dental luxator/Periosteal elevators Scalpels  gingival flap Extraction forceps Small suture Sx: High speed hand piece/burs, scissors, curettes, dilute chlorhexidine, and root tip elevators if fx Client instruction: no hard food or toys for 14 days Bupivicaine used in mandibular block?

Endodontics Disease of the pulp Commonly indication is fx Pulp is the vital part of the tooth, should not be exposed to bacteria of the mouth Can lead to infection and abscesses Commonly indication is fx More invasive and expensive than extraction Which teeth are commonly fractured? Why is this painful? What instrument can determine exposure vs. attrition? As dentin is produced, the pulp chamber and root canal become smaller  stronger tooth Should be completed by 1 to 1.5 years of age

Endodontics Endodontic disease requires treatment 1. Root canal therapy Removal of pulp with a dental bur, shape with H-files or K-files, disinfect with sodium hypochlorite or bleach, dry with paper points, fill canal with Gutta Percha, and place protective seal. Require pre and post radiographs 2. Vital pulp therapy When tooth is alive and can be saved Immature teeth

Oronasal Fistulas (ONF) Holes formed between mouth and nasal cavity, usually secondary to PDL destruction. Tooth becomes mobile and eventually falls out, leaving a communication between oral and nasal cavities. Which teeth commonly affected? CS: sneezing, and persistent, usually single sided, nasal discharge (with or without bleeding). Treatment includes surgery to close fistula.

Oronasal Fistula

Tooth Resorption Destruction of tooth structures Lesions usually found clinically in the cervical region Easily hidden by gingiva Which instruments help find these lesions? Actually begin break down in the root structures… How can we find this earlier? Idiopathic Vitamin D levels? Extraction required “Cervical neck lesions”

Gingival Hyperplasia Thickening or over growth of gingival tissue. Not a malignant condition. How do we confirm this? May be caused by periodontal disease. Overgrowth of gingiva can increase sulcus depths, forming pseudopockets. Treatment: Remove tissue if needed More prophylactic cleanings

Trauma Jaw Fractures Most common type is symphyseal separation Left and right mandibles separate from each other at the symphysis Require rigid fixation for ~3-4 weeks Ex. Cerclage wire, tape (puppies) Tape muzzles- stabilize fracture until Sx Adhesive side up! Loose enough to allow tongue to move between incisors  allows eating of slurry

Client Education Start young! Inform client of periodontal disease during vaccination process Explain home care oral hygiene techniques Brushing with dentrifices, rinses/wipes, water additives Mention acceptable bones and chews

Home Care BRUSH, BRUSH,BRUSH! Start with water, then dentrifice Begin caudal and buccal

Brushing Techniques Stillman Technique: Bass Technique: Sweep in a coronal direction *When is this used? Bass Technique: Bristles go into the sulcus

Client Education Once routine dental cleanings begin: (1 -2 years of age) Discuss the procedures actually performed and: Possible complications Medications Diet changes (temp. or long term) Prescription needed? Discuss any follow up procedures needed Prepare estimates Helpful websites: https://www.aaha.org/ http://vohc.org/index.htm