1. Stage III Periodontitis
The established stage; 25-50% attachment loss
Swelling, inflammation, and pocket formation (from attachment loss) are present.
Bone loss may be seen on dental x-rays.
*Note: this stage is the change from gingivitis, which is reversible with treatment, to true periodontitis, which is only controllable with therapy.
Animals that suffer from stage III disease usually have owners who are not educated on, cannot, or do not wish to perform home care.

2. Stage III Periodontitis
*Visualization of the cemento-enamel junction

3. Furcations
Furcations are areas between the roots of multi-rooted teeth and are indicative of stage 3 periodontal disease.
Gum tissue recedes with advanced periodontal disease and bone supporting the tooth is “eaten away”, exposing the area where the roots come together.
Exposed section appears as a hole at the gingival margin.

4. Stage IV Periodontitis
Advanced Periodontal Disease
May appear as any or all of the following forms of pathology: severe inflammation, attachment loss with deep pocket formation, gum recession, bone loss, pustular discharge, or tooth mobility.
Spontaneously bleeding gums.
Signs: animals will paw at their face, drop food while eating, and drool excessively.
Treatment consists of scaling, root planing, and surgical extraction of affected teeth.

5. Stage IV Periodontitis
Note- these teeth appear to have been cleaned already:

6. Stage IV Periodontal Disease
Periodontal disease has destroyed a significant portion of the alveolar bone and PDL of these incisor teeth.
The gingiva has receded from the crowns of these teeth, and the tooth roots are now exposed.
This is an irreversible stage of periodontal disease!

7. Routine Prevention or Necessary Treatment?
Dental prophylaxis OR periodontal therapy
Both = removal of deposits from supragingival and subgingival surfaces of the teeth
Prophylaxis uses non-surgical instrumentation to prevent infection
Periodontal therapy is provided when disease/infection already exists
This will be a longer procedure with
higher cost to the client
Usually due to no previous prevention

8. Explore the Teeth 1. Confirm dental caries (not common)
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
1. Confirm dental caries (not common)
Demineralization of enamel and dentin due to bacteria
Appears as a dark spot on the tooth
Most common found on the occlusal surface
Will feel “sticky”
2. Test for pulp exposure
Due to attrition or trauma
Appears as discoloration on the tooth

9. Check for Attachment Loss
Periodontal probe
Round, blunt working end
Intraoral ruler that measures attachment levels by measuring:
1. Gingival recession
2. Sulcus depth
3. Loss of bone in furcation areas

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

11. Calculus Removing Forceps
Removes gross calculus, supragingivally
Curved jaw is used on buccal aspect of tooth
Usually reserved for molars and premolars
This instrument has the potential to cause trauma
Use with caution!

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

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

14. 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

15. Ultrasonic Scaler
Water through the tip also acts as a coolant; this machine can get very hot w/o adequate water supply!
Move tip from the sulcus, coronally, away from the root’s apex.
Time line/tooth = < 10 seconds (use common sense)

16. Ultrasonic Scaler Two Parts: 1. Hand piece
Magnetostrictive- a magnetic field is created by a zinc and nickel stack in the hand piece, which sends vibrations to the tip in an elliptical pattern
Two Parts:
1. Hand piece
Contains the stack, which is replaceable
Stack is delicate and should not be bent or twisted!
Modified Pen grasp

17. Magnetostrictive Scaler Parts
2. Tip
Stainless steel instrument
Many sizes available, specific to each patient
All surfaces of the tip vibrate!
Most vibrations are on the toe
Use the least amount of vibrations!
Found on the lateral surfaces
Should be used subgingivally! (into sulcus)
Secured onto the hand piece via the
nose cone- no instrument is used to put
the tip on
Removed with the key
VERY IMPORTANT TO USE THE KEY

18. Using the Ultrasonic Scaler
Machine must be plugged in & then turned on
Must have a water source
1. Sink- machine attaches to the sink nozzle; use cold water
2. Distilled water tank- must be pressureized and locked into place
Amount of water used to scale is adjustable with a dial
Machine is operated via foot pedal
To scale, set dial to “scale”
Select desired tip- place on the hand piece until “hand tight”
Start power around 5, increase if needed

19. Using the Ultrasonic Scaler
If takes practice to become an efficient scaler
Goal is to remove all evidence of plaque and tartar
Use lateral surfaces of tip only
Distal aspects of teeth can be difficult to see
Use all instruments!
Work efficiently- animal is under anesthesia!
Be aware of tip placement at all times
Try not to touch cheeks or tongue
Check for over heating
Dental Mirror

20. Oral Speculum Instrument used to hold the patient’s mouth open
Placement:
Compress springs together
Place the black rubber cups on the patient’s canines
Let the mouth open into a natural position
Disadvantage:
Exerts pressure on the patient’s TMJ
Not used on cats
*Should be used at a minimum

21. Patient Position/Safety
Comfortable for you and the patient
Lateral or dorsal is most common
Elevate patient neck with towels
Point nose down
Water used will run into the sink
Prevents aspiration
Set up a light source
Head lamp or standing floor lamp
Provide warmth for the patient
PPE required- gloves, mask, eye protection

22. Ultrasonic Scaler Complications/Risks
Soft tissue burns
Trauma to the teeth
Aspiration

23. Polishing –IMPORTANT STEP
The scaler microscopically scratches the tooth surface and creates more surface area  quicker bacterial build up
Scratches must be smoothed, or polished
Use moderate pressure on every surface of tooth that was scaled
Much quicker than scaling!
Modified pen grasp

24. Parts of the Polisher
Prophy angle- attachment that is connected to the hand piece
Slides onto hand piece and then locked into place
Ensure hand piece is UNLOCKED before inserting prophy angle!
Prophy cup- disposable rubber piece; attaches to the prophy angle
This part actually touches the tooth
Holds the polish, or prophy paste

25. Exodontics Extraction of the tooth Indications:
Persistent deciduous teeth
Prognosis of a tooth is grave
Client prefers low cost method of treatment
Anesthesia is contraindicated in patient
Possible complications:
Anesthetic factors
Hemorrhage
Iatrogenic trauma

26. Instruments: Periosteal Elevators and Luxators
Goal is to weaken the PDL (done by a veterinarian)
Instrument 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 and is removed in one piece
Index finger is extended to working end
Minimizes iatrogenic soft tissue trauma

27. Winged Elevators

28. Extraction Prep Pre and post radiographs Regional nerve block
Delivered to specific nerves to block an entire region of mouth
Bupivacaine and/or lidocaine
Time of effect?
Instruments needed:
Dental luxator/elevators
Extraction forceps
Small suture and needle drivers

29. Tooth Resorption Idiopathic destruction of tooth structures
Break down begins in the root
Lesions usually found clinically in the cervical region
Easily hidden by gingiva
Periodontal probe and explorer will help find these lesions during a dental cleaning
Can be found earlier with radiographs
Extraction required
Cervical
“Cervical neck lesions”

30. Client Education Start young!
Inform client of periodontal disease during vaccination process
Distribute pamphlets or brochures
Explain home care oral hygiene techniques
Brushing
Rinses/wipes
Water additives
Dental treats
Mention acceptable bones and chews

31. Home Care Instructions
BRUSH, BRUSH,BRUSH!
Start with water, work towards dentrifice
Begin caudal and buccal, work towards incisors

32. Client Education
Once routine dental cleanings begin: (2-3 years of age)
Discuss the procedures actually performed and:
Any complications
Medications given or needed
Ex. Local anesthetics, antibiotic, etc
Diet changes (temp. or long term)
Prescription needed?
Any follow-up procedures needed
Prepare estimates
Give date of return
Helpful websites: