1. Student performing a dental prophy at VTI
Student performing a dental prophy at VTI *Note- all equipment in use, PPE, warming techniques Remember to check ET tube cuff before beginning!

2. 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?

3. Start your cleaning- 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
From wear or trauma

4. 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?

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

6. Gingival Sulcus and Recession

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

8. 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

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

10. 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

11. 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

12. Set-up of Ultrasonic Scaler
Machine must be plugged in; turn on with rocker button
Must have a water source
Sink or distilled water tank- your preference
Ran via foot pedal
To scale, set to “scale”
Start power around 5, increase if needed
Strong mist should be seen, lateral surface of tip only
Must select tip of preference
Do NOT over tighten or use the key to secure
MUST USE KEY TO REMOVE TIP after use
Will be checked before your dental begins!

13. Using 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- no more than 10 sec/tooth (sometimes less- Ex. Cat incisors)
Go in order, as not to
miss a tooth or surface
Plaque/tartar must be
removed from ALL surfaces

14. Magnetostrictive Scaler
NOTE: Other than causing fractures from using at an incorrect angle, can also cause burns of the soft tissue- be aware!!!
INCORRECT
Distal third of tip should be held at 0-15° from long axis of the tooth.

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

16. Polishing Removable rubber cup holds polish, or prophy paste.
Modified pen grasp

17. Patient Position/Safety
Comfortable for you and the patient
Set up a light source
Dorsal or lateral recumbency
Lateral takes longer bc we have to flip the patient twice
Elevate neck w/ towel; nose down so water can run out
Opening of mouth w/ oral speculum
Suction/gauze is not an option for us
Preemptive rinse-not done at VTI
PPE- required
Must provide warmth for your patient!

18. Feline Oral Speculums Cornell Feline Health Center study
Maxillary artery blocked
Blindness post anesthesia

19. Exodontics Extraction of the tooth Complications:
Prognosis of tooth is grave, client prefers low cost method
Tooth will cause perio disease quicker, or tooth will cause malocclusion
Multiple anesthesias are contraindicated in patient
Complications:
Anesthetic factors
Hemorrhage after removal
Iatrogenic trauma from instruments
Closed extraction- single rooted teeth or teeth with severe periodontal disease (easily removed)
Surgical extraction- multi-rooted teeth with large surface area and strong attachment (not at VTI)

20. Instruments: Periosteal Elevators and Luxators
Goal is to weaken 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

21. Winged Elevators

22. Extraction Prep Pre and post radiographs may be required
Regional nerve block- calculated by you
Delivered to specific nerves to block an entire region of mouth
Bupivacaine 0.5% and lidocaine 2%
Delivered with a 27 gauge needle
Instruments needed:
Dental luxator/Periosteal elevators (ours are winged)
Extraction forceps
Small suture and needle drivers?

23. Tooth Resorption Destruction of tooth structures
Lesions usually found clinically in the cervical region
Begin breakdown in the root, but easily hidden by gingiva
Which instruments help find these lesions? Periodontal probe/explorer; check all surfaces of each tooth
Idiopathic
Vitamin D levels?
Extraction required
Must check all cats for this!
“Cervical neck lesions”

24. 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

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

26. 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: