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VETERINARY PRACTICE GUIDELINES


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some dental texts and through the manufacturer. Instruments must be sharp and properly stored, and instruments in poor condition need to be replaced. A written protocol needs to be established and followed for equipment and instrument care. As with human dentistry, instruments that enter the oral cav- ity should be sterilized. Packets organized by dental procedure (e.g., examination, extraction, periodontal surgery) should be prepared and sterilized before use. Recommended materials, instruments, and equipment for performing dental procedures are listed in Tables 2 and 3 (Page 24). Consult the reference list associated with these guidelines for recommendations and information on ordering equipment.3–7


Operator Protection Pathogens and debris such as calculus, tooth fragments, and


prophy paste are aerosolized during dental procedures. Irrigat- ing the oral cavity with a 0.12% chlorhexidine solution before dental scaling decreases bacterial aerosolization.8 The safety of the operator must be ensured during dental pro-


cedures by using radiographic, oral, respiratory, skin, eye, and ear protective devices (Table 4, Page 27). Ergonomic consid- erations include proper seating, fatigue mats for standing, and proper positioning of both the patient and materials to minimize immediate and chronic operator injuries. Provide the operator with instruction on proper instrument handling techniques.


Patient Assessment History and Physical Examination The history must include prior home dental hygiene deliv-


ered by the client; diet; access to treats and chews; chewing habits; current and previous dental care and procedures; prior and current diseases, including any behavioral issues and aller- gies; and medications or supplements currently administered. Perform a physical examination of all body systems based on the species, age, health status, and temperament of the animal. If the patient is presented for a complaint not related to den- tistry, give due consideration to the primary complaint, per- forming the diagnostic tests and treatments indicated. Establish priorities if multiple procedures are indicated.


Assessment by Life Stage Focus on age-related dental conditions and common abnor-


malities in the dog and cat. From birth to 9 mo of age, evaluate the patient for problems related to the deciduous teeth, miss- ing or extra teeth, swellings, juvenile diseases (such as feline juvenile onset periodontitis), occlusion, and oral development. From 5 mo to 2 yr of age, evaluate the patient for problems related to developmental anomalies, permanent dentition, and the accumulation of plaque and calculus. Periodontal diseases may begin during that time period, especially in cats and small- breed dogs. The onset andseverity of periodontal diseases var- ies widely depending on breed, diet, and home dental care. In


a small-breed dog without home dental care, periodontal dis- eases can start as early as 9 mo of age. In a large-breed dog, periodontal diseases may not start until later. Many small-breed dogs have periodontal diseases by 3 yr of age.9–12


Beyond 2 yr


of age, evaluate the progression of periodontal diseases, dam- age to tooth structures, occurrence of oral masses, and the existence and adequacy of preventive home dental care. As the animal ages, continue to evaluate the patient for progressive periodontal diseases, oral tumors, and other aspects of dental pathology.13


Oral/Dental Examination in the Conscious Patient Record all findings in the medical record (Table 5, Page 27).


Evaluate the head and oral cavity both visually and by palpa- tion. Changes in body weight, eating habits, or other behaviors can indicate dental disease. Specific abnormal signs to look for may include pain; halitosis; drooling; dysphagia; asymmetry; tooth resorption; discolored, fractured, mobile, missing, or extra teeth; inflammation and bleeding; loss of gingiva and bone; and changes in the range of motion or pain in the temporomandibu- lar joint. In addition, the practitioner should assess the patient’s occlusion to ensure it is normal, or at least atraumatic. Evalu- ate the patient’s eyes, lymph nodes, nose, lips, teeth, mucous membranes, gingiva, vestibule (i.e., the area between the gum tissue and cheeks), palatal and lingual surfaces of the mouth, dorsal and ventral aspects of the tongue, tonsils, and salivary glands and ducts. Note all abnormalities such as oral tumors, ulcers, or wounds. A diagnostic test strip for the measurement of dissolved thiol levels can be used as an exam room indicator of gingival health and periodontal status.14 The oral examination performed on a conscious patient


allows the practitioner to design a preliminary diagnostic plan. Take into consideration potential patient pain. Do not offend the patient by probing unnecessarily when such manipulations can be better achieved under anesthesia. Also, realize in many instances that the examiner will underestimate the conditions present because it is impossible to visualize all oral structures when the patient is awake. It is only when the patient has been anesthetized that a complete and thorough oral evalua- tion can be accomplished successfully. The complete examina- tion includes a tooth-by-tooth visual examination, probing, and radiographic examination. Only then can a precise treatment plan and fees for proposed services be tabulated and discussed with the pet owner(s).


Making Recommendations and Client Education Discuss the findings of the initial examination and addi-


tional diagnostic and/or therapeutic plans with the client. Those plans will vary depending on the patient; the initial findings; the client’s ability to proceed with the recommenda- tions; as well as the client’s ability to provide necessary, life- long plaque prevention.


Trends magazine, April 2013


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