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

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. Periodontal Disease = Septicemia
• Blood flow (gingivitis)
• Kidneys/Liver
• Heart (Coronary Vessels)

3. For the Veterinary
Technician

4. Cite:
http://AVDC.org

5. Cite:
http:www.aahanet.org

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. 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. Steps to a Dental Cleaning
Place pharyngeal pack

9. Steps to a Dental Cleaning
Pre-rinse

11. Steps to a Dental Cleaning
Remove bulky tartar
Extraction or Tartar
Removing Forceps

12. Steps to a Dental Cleaning
Power Scale

13. Power Scalers
MagnetostrictiveSonic/Ultrasonic
Peizoelectric

14. Steps to a Dental Cleaning
Hand Scale
Jacquet
(Sickle Scaler)

15. Hand Scalers

16. Steps to a Dental Cleaning
Root Plane

17. Modified Pen Grasp with fulcrum
Root Plane

18. Steps to a Dental Cleaning
Modified pen grasp

19. Curettes Universal vs Area Specific

20. Curettes

21. Steps to a Dental Cleaning
Rinse, polish, rinse

22. Steps to a Dental Cleaning
Look for
revealed
tartar
Rinse
pumice

23. Steps to a Dental Cleaning
Oral Exam/Radiograph Periodontal Probe
Explorer

24. Oral Exam/Radiographs
Probe and explore

25. Oral Exam/Radiographs
Probe and explore
Clinical Attachment

26. 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

27. Oral Exam/Radiograph
Radiograph

28. Indications

29. Steps to a
Dental Cleaning
Chart findings

30. Charting

31. 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

32. Furcation Exposure
FE1
FE2
FE3
FE3

33. 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

34. Grade vs Stage
Stage indicates a progressive condition
Grade may be either progressive or reversible
AVDC.org/nomenclature

35. 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

36. 4 Clinical Signs of Periodontal Disease
Horizontal bone loss

37. 4 Clinical Signs of Periodontal Disease
Vertical bone loss

38. 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

39. 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 ®

40. 12. Fluoride Treatment
•Desensitizes tooth
•Helps minimize plaque adherence
•Bacteriostatic
•Its application is controversial because
get fluoride from other sources

41. Questions?

43. Directional Terms

44. Periodontal and Endodontic Structures

45. CEJ

46. 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

47. Repairative Dentin

48. Maxilla

49. mandible

50. Regional Nerve Block
Bupivicaine
0.5%
Lidocaine
2%
Onset 10-20 min 1-2 min
Duration 4-8 hours ½ hour -1
hour

51. 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

52. Behavior response to pain
Modulation
Transduction
Perception
Transmission
Nociception
“The incision”

54. 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.

55. 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

56. 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 )

57. Mandibular Nerve Block
(Inferior Alveolar Nerve)
Intraoral Extraoral

58. 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

59. 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

60. Intraoral Radiography

61. Intraoral Radiography
3 Steps to remember
1. Patient positioning
2. Film placement within the patient’s mouth
3. Positioning the beam head

62. Patient positioning
Dorsal/Ventral/Lateral versus Lateral

63. Positioning the beam head
Parallel Technique Bisecting Angle
(Vertical Angle)

64. Positioning the beam head
Centering

65. Film or Sensor Placement

66. Bisecting Angle

67. 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

68. 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

69. 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

70. Improper Beam Angle
HORIZONTAL ANGLE

71. Maxillary Incisors

72. Maxillary Canines
Position as Max incisors with a 20°
lateral (Horizontal) tilt

73. Maxillary Premolars/Molars

74. Mandibular Premolars/Molars

75. Mandibular Incisors/Canines

76. Why we love cats

77. 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

78. Near Parallel
Special view to
Avoid the Zygomatic
Arch

79. 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

80. “Split the difference”

81. Tooth Resorption

82. High Vitamin D
Low Specific Gravity
Dogs

83. Present in 65% of all cats
TR1

84. Present in 65% of all cats

85. Present in 65% of all cats

86. TR4b
Root>crown

87. Type II

88. TR4b
Crown >root

89. TR5 aka “nubbin”

90. TR 5

97. TR4A- crown and root equally affected
Type II