Veterinary Dentistry for Technicians


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Veterinary Dentistry for Technicians
-Dental cleaning and Oral Exam
-Intraoral Radiogprahic Positioning
-Oral Regional Nerve Blocks

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Veterinary Dentistry for Technicians

  1. 1. Dentistry for the Veterinary Technician The way it begins: • Plaque begins as a biofilm (pellicle). *In 20 minutes a tooth is covered in a pellicle (a sticky coating of saliva and glycoproteins). The pellicle is viscous and increases the chance of bacteria adherence. • In 6-8 hours bacteria begin to colonize. This is what is known as plaque. • The first bacteria to adhere to the pellicle are gram- positive aerobic organisms • As the plaque thickens, it extends to the sulcus and subgingivally. The bacteria convert to gram negative anaerobes.
  2. 2. Periodontal Disease = Septicemia • Blood flow (gingivitis) • Kidneys/Liver • Heart (Coronary Vessels)
  3. 3. For the Veterinary Technician
  4. 4. Cite:
  5. 5. Cite:
  6. 6. Steps to a Dental Cleaning PPE **Protect yourself-----Protect your patient Exam Gloves Or face-shields instead of goggles Surgical Mask +/- Waterproof aprons? Safety goggles
  7. 7. Steps to a Dental Cleaning 1. Prolonged recovery 2. Bradycardia 3. Respiratory depression 4. Apnea 5. Ileus 6. Hypotension 7. Impaired clot function 8. Impaired immune function PPE Prevent Hypothermia
  8. 8. Steps to a Dental Cleaning Place pharyngeal pack
  9. 9. Steps to a Dental Cleaning Pre-rinse
  10. 10. Steps to a Dental Cleaning Remove bulky tartar Extraction or Tartar Removing Forceps
  11. 11. Steps to a Dental Cleaning Power Scale
  12. 12. Power Scalers MagnetostrictiveSonic/Ultrasonic Peizoelectric
  13. 13. Steps to a Dental Cleaning Hand Scale Jacquet (Sickle Scaler)
  14. 14. Hand Scalers
  15. 15. Steps to a Dental Cleaning Root Plane
  16. 16. Modified Pen Grasp with fulcrum Root Plane
  17. 17. Steps to a Dental Cleaning Modified pen grasp
  18. 18. Curettes Universal vs Area Specific
  19. 19. Curettes
  20. 20. Steps to a Dental Cleaning Rinse, polish, rinse
  21. 21. Steps to a Dental Cleaning Look for revealed tartar Rinse pumice
  22. 22. Steps to a Dental Cleaning Oral Exam/Radiograph Periodontal Probe Explorer
  23. 23. Oral Exam/Radiographs Probe and explore
  24. 24. Oral Exam/Radiographs Probe and explore Clinical Attachment
  25. 25. Some anatomy review  Gingival Structures 409 (lower right first molar) Attached gingiva (Base of sulcus) Mucogingival junction (line) Gingival margin (Free Gingiva) Sulcus inside! Oral mucosa
  26. 26. Oral Exam/Radiograph Radiograph
  27. 27. Indications
  28. 28. Steps to a Dental Cleaning Chart findings
  29. 29. Charting
  30. 30. 5 Criteria for staging periodontal disease 1. Gingivitis and gingival index (GI) (grade 1-3) 2. Periodontal Probing Depth (P) in mm 3. Gingival recession (GR) in mm 4. Furcation exposure (FE) (Grade 1-3) 5. Tooth Mobility (M) (Grade 1-3) * Chart the stage of periodontal disease using the “worst tooth”. *Abnormal probing depth (pocket) + Gingival recession (from CEJ to gingival margin) = Total Attachment Loss Charting
  31. 31. Furcation Exposure FE1 FE2 FE3 FE3
  32. 32. Normal (PD 0): Clinically normal - no gingival inflammation or periodontitis clinically evident. Stage 1 (PD 1): Gingivitis only without attachment loss. The height and architecture of the alveolar margin are normal. Stage 2 (PD 2): Early periodontitis - less than 25% of attachment loss measured via probing or radiographs from CEJ to alveolar margin. Or stage 1 Furcation Exposure Stage 3 (PD 3): Moderate periodontitis - 25-50% of attachment loss measured via probing or radiographs from CEJ to alveolar margin or stage 2 Furcation Exposure. Stage 4 (PD 4): Advanced periodontitis - more than 50% of attachment loss measured via probing or radiographs from the CEJ to alveolar margin Or Stage 3 Furcation Exposure
  33. 33. Grade vs Stage Stage indicates a progressive condition Grade may be either progressive or reversible
  34. 34. 4 Clinical Signs of Periodontal Disease Depends on hosts’ response to the bacteria 1. Gingivitis 2. Calculus 3. Horizontal bone loss 4. Vertical bone loss
  35. 35. 4 Clinical Signs of Periodontal Disease Horizontal bone loss
  36. 36. 4 Clinical Signs of Periodontal Disease Vertical bone loss
  37. 37. Step 10. DVM Assessment/ Treatment Plan Calculate/Administer Nerve block(s) •Radiographs/Treatment plan •DVM views •Talk to client (via phone)? •Verbal estimate? •Plan/draw up Nerve block
  38. 38. 11. Periodontal Treatment INCLUDE: • Closed-Currettage -(debride pocket) • Open –surgical (flap) -root planing and currettage • Perioceutic - (Antibiotic pocket treatment) • Systemic antibiotics (BEFORE) cleaning - Clindamycin - “Pulse Therapy” • Extraction • Crown Reduction • Guided Tissue Regeneration -(Bone stimulant/Bone substitute) - Osteoallograft, Consil ®
  39. 39. 12. Fluoride Treatment •Desensitizes tooth •Helps minimize plaque adherence •Bacteriostatic •Its application is controversial because get fluoride from other sources
  40. 40. Questions?
  41. 41. Directional Terms
  42. 42. Periodontal and Endodontic Structures
  43. 43. CEJ
  44. 44. Types Of Dentin: Primary Dentin Forms before tooth eruption Secondary Dentin The natural process of mastication stimulates production of more layers of dentin Tertiarty (Reparitive) Dentin Stimulates rapid formation as a result of pathology or injury
  45. 45. Repairative Dentin
  46. 46. Maxilla
  47. 47. mandible
  48. 48. Regional Nerve Block Bupivicaine 0.5% Lidocaine 2% Onset 10-20 min 1-2 min Duration 4-8 hours ½ hour -1 hour
  49. 49. Regional Nerve Block Calculation for Nerve Block 1 mg/kg each drug Mix together 0.1mL/site –cats/sm dogs 0.3-0.5mL /site- med/large dogs ÷ how many nerve blocks (ie 4) •Don’t go over toxic dose of 1mg/kg each •ASPIRATE! •Monitor rhythm and blood pressure
  50. 50. Behavior response to pain Modulation Transduction Perception Transmission Nociception “The incision”
  51. 51. Regional Anesthesia Materials- 1mL or 3mL Syringe 25 x 5/8” needle unless large skeletal structure Warning- A less invasive approach= right outside the foramen vs inside Aspiration-3x (1/3 rotation and repeat) to check for blood Inject slowly. Apply digital pressure for 60 sec. Monitor patient.
  52. 52. Rostral Mandibular Nerve Block Middle Mental Foramen •Bone, teeth and soft tissue rostral to the mandibular pm/canine in cats •Dogs: Palpate foramen Landmark- labial frenulum & ventral to the mesial root of pm2 •Cats: Small foramen- palpate Landmark-Caudal to apex of canine
  53. 53. Mandibular Nerve Block (Inferior Alveolar Nerve) Mandibular Foramen •Bone, teeth and soft tissue of the ENTIRE mandible •Extraoral or Intraoral •Landmarks- ventral notch of mandible, lateral canthus of eye •Palpation of mandibular foramen- intraorally (Lingual surface 2/3 way from molar to angular process )
  54. 54. Mandibular Nerve Block (Inferior Alveolar Nerve) Intraoral Extraoral
  55. 55. Rostral Maxillary Nerve Block Infraorbital Foramen •Bone, teeth and soft tissue of the maxilla rostral to PM3 •Landmarks- Palpate juga of pm4- opening just rostral •Needle parallel to palate
  56. 56. Caudal Maxillary Nerve Block Infraorbital Nerve •Affects bone, teeth and soft tissue of the ENTIRE maxilla •Landmarks- Dogs: Max 2nd molar Cats: Divot caudal to max molar •Needle parallel to m root
  57. 57. Intraoral Radiography
  58. 58. Intraoral Radiography 3 Steps to remember 1. Patient positioning 2. Film placement within the patient’s mouth 3. Positioning the beam head
  59. 59. Patient positioning Dorsal/Ventral/Lateral versus Lateral
  60. 60. Positioning the beam head Parallel Technique Bisecting Angle (Vertical Angle)
  61. 61. Positioning the beam head Centering
  62. 62. Film or Sensor Placement
  63. 63. Bisecting Angle
  64. 64. Positioning5 areas of the mouth 1- Mandibular PM and M 2- Mandibular incisors/ canines 3- Maxillary incisors 4- Maxillary canines 5- Maxillary PM and M
  65. 65. Improper Beam Angle Beam Tooth FORSHORTENING •If the beam is pointing too close to the film or sensor •We have a short shadow when the sun is at noon fILm
  66. 66. Improper Beam Angle BeamTooth ELONGATION •If the beam is pointing too close to the tooth root •We have a long shadow when the sun is going down fILm
  67. 67. Improper Beam Angle HORIZONTAL ANGLE
  68. 68. Maxillary Incisors
  69. 69. Maxillary Canines Position as Max incisors with a 20° lateral (Horizontal) tilt
  70. 70. Maxillary Premolars/Molars
  71. 71. Mandibular Premolars/Molars
  72. 72. Mandibular Incisors/Canines
  73. 73. Why we love cats
  74. 74. Decreased Angle •Instead of Beam head perpendicular to BA •Angle is decreased by 20 ° •This purposefully elongates roots past Zygomatic Arch Special view to Avoid the Zygomatic Arch
  75. 75. Near Parallel Special view to Avoid the Zygomatic Arch
  76. 76. Simplified Method Relies on approximation instead of measurements Based on three basic angles: 45° Caudal maxillary teeth 60 ° Rostral teeth (incisors) 20 ° Horizontal tilt for Maxillary canines
  77. 77. “Split the difference”
  78. 78. Tooth Resorption
  79. 79. High Vitamin D Low Specific Gravity Dogs
  80. 80. Present in 65% of all cats TR1
  81. 81. Present in 65% of all cats
  82. 82. Present in 65% of all cats
  83. 83. TR4b Root>crown
  84. 84. Type II
  85. 85. TR4b Crown >root
  86. 86. TR5 aka “nubbin”
  87. 87. TR 5
  88. 88. TR4A- crown and root equally affected Type II