26 VETERINARY PRACTICE GUIDELINES
considered abnormal varies depending on the tooth and size of the dog or cat.3,4,6,37
In medium-sized dogs, the
probing depth should not be >2 mm, and in the mid- sized cats, the depth should not be >1 mm.
9. Perform periodontal therapy (Table 1) based on radiographic findings and probing.38–40
10. Administer perioperative antibiotics when indicated, either parenterally or locally.41,42
11. Perform periodontal surgery to remove deep debris, eliminate pockets, and/or extract teeth. When either pockets or gingival recession is >50% of the root support, extraction or periodontal surgery is indicated and should be performed by trained veterinarians or referred to a specialist.
Essential Steps for Professional Dental Cleaning The essential steps for a professional dental cleaning and periodontal therapy are described in the following list: 1. Perform an oral evaluation, as described above, for the conscious patient.
2. Radiograph the entire mouth, using either intraoral or digital radiographic systems. Radiographs are necessary for accurate evaluation and diagnosis. In one published report, intraoral radiographs revealed clinically important pathology in 27.8% of dogs and 41.7% of cats when no abnormal findings were noted on the initial examination.16
radiography revealed additional pathology in 50% of dogs and 53.9% of cats.16
Standard views of the skull
are inadequate when evaluating dental pathology. If full mouth films are not taken, the client must be informed that they were not done.
3. Scale the teeth supra- and, most importantly, subgingivally using either a hand scaler or appropriate powered device followed by a hand instrument (i.e., scaler, curette). Do not use a rotary scaler, which excessively roughens the tooth enamel.36
4. Polish the teeth using a low-speed hand piece running at no more than 300 revolutions/min with prophy paste that is measured and loaded on a disposable prophy cup for each patient (to avoid cross-contamination).
5. Perform subgingival irrigation to remove debris and polishing paste and to inspect the crown and subgingival areas.
6. Apply antiplaque substances, such as sealants. 7. Provide instructions to the owner regarding home oral hygiene.
Additional Steps for Periodontal Therapy and Other Conditions 8. Evaluate the patient for abnormal periodontal pocket depths using a periodontal probe. The depth that is
Trends magazine, April 2013
12. Biopsy all abnormal masses that are visualized grossly or noted on radiographs. Submit all samples for histopathology to be analyzed by a pathologist qualified in oral tissues analysis.43
13. Take postoperative radiographs to evaluate the treatment applied. This is especially important in extraction cases.
14. Examine and rinse the oral cavity. Remove any packing or foreign debris.
15. Recommend referral to a specialist when the primary veterinary practitioner does not have the skills, knowledge, equipment, or facilities to perform a specific procedure or treatment.
In patients with abnormal findings,
Postoperative Management Maintain an open airway via intubation until the animal
is either swallowing or in sternal recumbency. Maintain body temperature and continue IV fluid support as needed. Continu- ously monitor and record vital signs until the patient is awake. Assess and record pain scores throughout the recovery period, continuing pain management while the pet is in the hospital and upon discharge.34,44
Client Education and Follow-up Postoperative Communication Client communication is fundamental to the maintenance
of oral health. At the time of discharge, discuss all operative procedures and existing/potential complications (e.g., seda- tion, vocalization, bleeding, coughing, dehiscence, infection, neurologic signs, halitosis, vomiting, diarrhea, anorexia, signs of pain). Discuss immediate postoperative home oral hygiene, including medications and their side effects. Provide antibiot- ics and medication for inflammation and pain as indicated.41,42 Discuss any change in diet that might be necessary, such as a change to either soft or premoistened food or to a prescription dental diet. Also indicate the duration of those changes. Pro- vide individualized oral and written instructions at the time of discharge. Establish an appointment for a follow-up examina- tion and further discussion.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68