1. Periodontal Debridement

2. 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?

3. 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

4. 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

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

6. Gingival Sulcus and Recession

7. Calculus Removing Forceps
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?

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
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?

12. 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

13. 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)

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

15. 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

16. 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

17. 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

18. Polishing

19. 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

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

23. 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

24. 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

25. Winged Elevators

26. 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?

27. 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

28. 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

29. 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.

30. Oronasal Fistula

31. 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”

32. 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

33. 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

34. 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

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

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

37. 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
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