Client Information

Home Care Some type of home care is a must in order to control periodontal disease and help prolong the intervals between professional teeth cleanings. If an owner cannot brush their pet’s teeth, they may be able to apply an antiplaque rinse. Feeding dry diets and treats designed to control plaque and calculus are helpful, but be careful when selecting chew toys because some objects that are too hard can cause broken teeth. If an object can be bent or dented, it is probably safe for a pet to chew.

 

Anesthesia

As with humans there is always a risk with any anesthesia.

Dr. Boyd sees many “high risk” patients: Pets with heart disease, liver disease, kidney disease, and diabetes, as well as pets that are pediatric, geriatric, tiny breeds and giant breeds.

To help prevent complications, every patient is required to have pre-anesthetic lab work. Dr. Boyd reviews the medical history of each patient, performs a physical examination, and then each patient receives an anesthetic protocol customized to fit their individual needs.
Pre-anesthetic medications are chosen including drugs for sedation and pain control. Giving pain medication before, during and after dental procedures has been shown to speed recovery and lessen the general anesthesia.

Each patient has an intravenous catheter placed and is maintained on Isoflurane gas anesthetic. Intravenous fluids are administered during anesthesia. Blood pressure, ECG, heart rate and blood oxygen saturation along with respiration and temperature are monitored throughout anesthesia. Core body temperature is maintained with heated tables, warm water blankets and fluids.

During recovery, all vital signs are monitored and pain medication is given to smooth the process. Recovery accommodations are heated and are located in the treatment area where the patient is in full view and is easily accessed by the staff.

Patients are discharged in the afternoon on the day of the procedure.

Importance of Dental Radiographs

Periodontal Disease

Periodontal disease is an infection of the tissues surrounding and supporting the teeth. The periodontal tissues are the gingiva, periodontal ligament, cementum, and alveolar bone. The primary etiologic agent for periodontal disease is plaque bacteria. Gram-positive aerobes are the first to adhere to the tooth and are found in healthy gingiva along with some facultative anaerobes. As periodontitis progresses the bacteria change to more gram negatives, anaerobes, rods, filamentous, and motile bacteria. Plaque may be seen on the teeth prior to the development of gingivitis, and appears as a white to gray soft material at the gingival margin. The first clinical sign of periodontal disease is gingivitis, which is caused by inflammation. If the defense system fails or is overcome by virulent strains of bacteria, inflammation will progress and cause a breakdown in the periodontal tissues resulting in a loss of attachment. Teeth will loosen and eventually be lost. It has long been suspected that a relationship exists between periodontal infection and disease of the heart, lungs, liver, kidneys, and brain.

Periodontal Treatment

One dental prophylaxis or cleaning is not enough! It is important to understand that periodontal disease is an infection that can be controlled but not cured. Ongoing treatment including professional cleanings and home care are needed to treat periodontal disease. The first noticeable sign that a pet needs periodontal treatment is halitosis.After anesthetizing the pet, complete oral and periodontal examinations can be performed, and the teeth can be charted. Some of the more obvious findings are dental calculus or tartar on the teeth, red or bleeding gums, oral ulcers, retained deciduous teeth, loose teeth, missing teeth or broken teeth. Dental radiographs are utilized for periodontal assessment, treatment planning and evaluation.Periodontal treatment includes scaling, curettage, root planing, polishing, sulcus irrigation, fluoride treatment, and may even involve some extractions. Calculated guesses can be made on the exam table, however, periodontal disease cannot be fully realized until the pet is evaluated under anesthesia.

Scaling or calculus removal is done with calculus removing forceps, sonic or ultrasonic scalers, and hand scalers. Ultrasonic scalers with periodontal inserts and curettes are the instruments used for subgingival cleaning and root planing. After calculus removal and sub-gingival cleaning are complete, the sulcus is irrigated with a chlorhexidine solution. Sulcus irrigation is performed to rinse any paste, calculus or other debris from the pocket or sulcus.Once the teeth are clean they can be evaluated with a periodontal probe. The probe is gently placed in the sulcus or pocket and gently walked around the tooth to measure periodontal pockets. These measurements are recorded on a dental treatment chart for current and future evaluations.Polishing is the final smoothing of the crown and any exposed root of the tooth. A slow speed hand piece with a prophy cup and a fine grit polishing paste or pumice is used to smooth the tooth surfaces. Fluoride is applied as a liquid, gel, varnish or pumice. Fluoride is effective as a bacteriostatic agent and is actually incorporated into the enamelPeriodontal Therapeutic (Perioceutic) is another method of treating the infection residing in the periodontal pocket. The antibiotic, doxycycline, is combined with a biodegradable vehicle so that it can be placed in the periodontal pocket where it will remain for several days.Extracting teeth may be a part of periodontal treatment if the teeth have lost most of their supporting tissues. Other reasons for extractions include retained deciduous (baby) teeth, crowding of the teeth, or too many teeth. Another consideration for extracting diseased teeth is whether an owner will be able to brush the teeth or administer periodontal care and home treatment to their pet. If an owner is able to maintain good oral hygiene for their pet and will bring their pet for frequent treatments, some of the questionable teeth can be saved. An important part of treatment planning is to find out what an owner is willing and able to do for their pet for home care.

Endodontic Disease

There are many causes of endodontic disease, however in pet animal patients traumatic tooth fracture is the most common. A recent study reported that 10% of dogs have teeth with pulp exposure.

A fractured tooth with pulp exposure is a painful experience for the animal; however, the pet will rarely exhibit oral pain. Since pain significantly increases when the pet chews they may stop playing with their toys, but pets most will not stop eating. Unfortunately, only very rarely will pets show discomfort. These pets are being affected locally as well as systemically, and ignoring the problem is not a viable option. Clients, who insist their pet is not bothered by a broken tooth, report the pet acts “years younger” in just a few weeks after the affected tooth is treated.

Bacteria in the mouth will contaminate the fractured tooth with pulp exposure and it will become infected. The bacteria will then use the root canal to gain entrance into the alveolar bone. The infection in the tooth will cause a tooth abscess which results in bone destruction and eventual tooth loss if untreated. Consequently, the nerve dies and much of the pain goes away. However it is replaced by infection, which affects the pet daily.

Another potentially serious sequel to infection is the potential for other serious systemic diseases. Dental infections have been linked to valvular endocarditis, chronic obstructive pulmonary disease (COPD), diabetes, strokes, liver and kidney disease.

Another sign of endodontic disease is discolored teeth. The tissue or pulp inside the tooth contains blood vessels, nerves and lymphatics which nourish and keep the tooth vital or “alive”. On occasion, a tooth will “die” and become discolored. This is most common in canine and incisor teeth. The cause of tooth death is usually unknown; however trauma is the most likely cause. The non-vital tooth may become infected from bacteria in the bloodstream and will act as a bacterial reservoir just like a broken tooth. A recent study reported that 93% of discolored teeth are non-vital and in need of therapy.

Endodontic disease is occasionally seen as an abscess at the root tips which flares up and causes facial swelling below the eye. The abscess may even drain through the skin or inside the mouth. This most commonly occurs with a fracture of the upper fourth premolar tooth in dogs (carnassial abscess). In cats, the abscess is usually due to a fractured canine tooth, but will occur below the eye as well.

Root canal therapy is necessary to resolve chronic infections. Antibiotics may control the acute abscess, but the infection will remain and invariably the abscess will reoccur or become chronic if the offending tooth is not treated. Resolution of the abscess can be achieved utilizing endodontic treatment or surgical extraction

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