Page 368 - WSAVA2018
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 25-28 September, 2018 | Singapore
A. Complete dental prophylaxis should include the following steps:
1. Pre-surgical exam
1. Decreases “surprises” under anesthesia
2. Proper and balanced anesthesia
3. Supragingival scaling
1. Mostly with a ultrasonic scaler
1. Hand scaling ideally follows the ultra- sonic step
1. SUBgingival scaling
1. Generally with a curette or SUBGINGI- VAL tip
2. Hand instruments MUST be sharp
2. Polishing
3. Sulcal lavage
4. Oral exam and charting
5. Dental radiology
B. Homecare
Homecare is an absolutely critical part of periodontal therapy. This is because plaque forms in 24 hours, tarter in 3 days and gingivitis in 2 weeks. This means that even with annual cleaning, patients are infected 50 weeks
a year. In fact, human studies show that professional cleanings without homecare are essentially worthless.
There are 2 major divisions of homecare, active and passive. Active homecare is defined that the client actually needs to perform work as opposed to feeding a diet or treat, the latter is considered passive.
Active Homecare
As far as homecare is concerned, tooth brushing is still the gold standard. Educate your clients early about the benefits and compliance will increase. Brushing is performed with a toothbrush and veterinary toothpaste. However, mechanical removal of plaque by the bris the most important part of periodontal care. The toothpastes typically only provide flavorings and anti-tartar agents, neither of which is actually helpful for control of periodontal disease.
Antiseptics such as chlorhexidine and zinc ascorbate can be good adjunct therapy for periodontal disease. However, as above, plaque bacteria are very resistant to antiseptics and therefore mechanical removal of plaque
is the most important part of periodontal care.
As great as effective toothbrushing is, this is rarely the case. Toothbrushing needs to be performed correctly on a very regular basis. If a client stops brushing even for a short time, gingivitis will return. Since it has been shown that less than 1% of clients brush their pets daily, this is rarely a great choice. Further, it is very difficult to access the distal teeth as well as the linguo-palatal surfaces.
It has been shown that brushing is effective on rostral teeth (canines and incisors) but less so on premolar and molar teeth. Chew based “passive” homecare is more effective on the chewing teeth. Therefore, a combination of the two is likely best.
Passive homecare
Passive homecare is mostly chew based removal of plaque. As far as “passive” methods of homecare are concerned, many available products have NO scientific evidence behind them. Essentially all pet store products have no studies.
Further, most studies just look at overall plaque and calculus reduction, not WHERE the reduction occurs.
This may or may not indicate true effectiveness against periodontal disease. This is because the decrease is generally at only the incisal edge to middle of the tooth and does not reach to the gingival margin where the disease actually occurs. This may or may not indicate true effectiveness against periodontal disease Therefore, when you are determining what products to recommend to your clients, ideally look beyond just plaque and calculus control and determine where that control occurs.
Softer and more pliable products are not only safer in general, they should clean all the way to the gumline.
C. Periodontal Surgery
The other “new” form of pathogen control should be periodontal surgery. As discussed in the last article, pockets greater than 3-mm are pathologic and in need of therapy. All pockets between 3 and 6-mm should
be treated with closed root planing and ideally the administration of a sustained release local antimicrobial. Pockets greater than 6-mm or furcation level II and III require periodontal flap surgery to effectively clean the root surface and allow for reattachment and infection control. These procedures can be learned by a
general practitioner and require minimal investment in equipment. If this is not an option, these teeth should be extracted.
D. Extraction
While extreme, the ultimate in plaque control is extraction. This will completely remove the plaque retentive surface of the tooth. It is the actual cure for gum disease. Dental radiographs will greatly facilitate the procedure.

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