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Three Elements Of Expert Dental Care

Important functions of Expert Dental Care

Tooth #409 has been removed from this patient with advanced periodontitis Stage II; note the lytic zone in the mandible caused by osteolysis in the distal root from this advanced septic process. This could have easily led to a pathologic fracture. A full thickness mucoperiosteal flap was created with radiowave radiosurgery the area was debrided and the site was bone augmented with Consil bone alloplast. The surgical flap was sutured with an absorbable synthetic suture. The patient was placed on antibiotics and recovered

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The most common question I receive via e-mail centers on dental operatory design in the companion-animal practice.

Space, equipment and technology advancements always lead the list of practitioner points of interest. My answer is always the same: The veterinarian’s commitment to continuing education, the technical staff’s skill levels and the veterinarian’s willingness to dedicate proper time to oral diagnostics, consultation and the explanation of treatment algorithms all influence operatory design parameters.

Once this is indexed on an oral technology spread sheet, the rest is quite simple.

General practitioners must have proper knowledge of oral pathology. 
For example, knowing the differences between reversible gingivitis, stages I and II, and irreversible periodontitis, stages I and II, should be part of a staff’s continuing education.

Gram-positive bacteria become re-established within 24 hours of routine periodontal prophylaxis. In the following weeks, plaque increases with the introduction of Gram-negative rods, cocci and filamentous forms. This causes acute inflammation with a strong immune response. In the months ahead, gingivitis is well established without proper care. Supragingival inflammation becomes subgingival as inflammatory cells migrate below the free gingival margins.

If untreated, the bacteria continue to migrate deep into the pocket epithelium. These cascading negative changes are affected by the direct effect of the bacteria, bacterial by-products and the inability of a patient’s immune system to fight infections.

Once periodontal pathology is understood the periodontal prophylaxis must be mastered. Without oral radiology, much pathology goes unnoted, treatment is incomplete and patients suffer needlessly.
   
 

Step One: Oral Radiology

Dental radiology is the key diagnostic tool in oral care—all oral diagnostics begin with a dental X-ray. Because the tooth root and subgingival structures lie hidden, it’s the only way to visualize them. Standard whole body X-ray units can be utilized for oral X-ray exams, but they are not optimal. No tooth should be extracted without pre- and post-radiology with informed client consent. Feline oral pathology is often missed because of lacking X-rays in these patients. I have told many practitioners that if you gave me a dental X-ray unit at a feline-only practice I would stay busy for 12 hours each day in diagnostics and oral treatment. 

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Oral trauma, advanced periodontitis, the common slab fracture of the upper fourth premolar and oral masses should be radiographed before treatment or referral.

In 2008, making no attempt to address these common problems in general oral conditions, through treatment without dental X-ray diagnostics, could be labeled negligence in care. It comes down to either the introduction of dental X-ray into the companion animal practice or referral to a specialist. 

Commit yourself to quality dental X-rays, consult clients and have a radiologist or specialist in oral care interpret the films. The time and effort with be rewarded with a pain-free patient and a satisfied, well-informed client.

Step Two: Dental Operatory-Piezoelectric Ultrasonic Debridement

Once manual-hand root planing is mastered, the veterinarian or veterinary dental technician should use piezoelectric ultrasonic debridement.

Piezoelectric ultrasonic mechanics is activated by the expansion and contraction of quartz crystals to provide a frequency of 20 to 45 KHz. These units operate with a curved linear tip movement.

Water flow from the working tip’s insert cools the tooth surface.

Piezoelectric curettes effect excellent subgingival root planing. They are excellent in reducing pocket depth and gingival inflammation. They eliminate bacterial pathogens by disrupting the subgingival biofilm. New mini-tips allow access to deep narrow pockets with excellent debridement that is faster and more efficient that manual root planing with curettes.

The result is a calculus and debris-free sub-gingival root surface that is essentially bacteria free. There is less damage to healthy cementum than with manual root planing when these units are set at the manufacturer’s correct power settings.

Piezoelectric ultrasonic debridement can serve as a diagnostic tool to trigger the measurement of an abnormal probing depth or as a “red flag” indicator for oral radiology.

Step Three: Radiowave Radiosurgery

If performing oral surgery on a routine basis (extractions, biopsy, periodontal surgery, oral mass resection) radiowave radiosurgery—with the Surgitron Dual RF- Bipolar and Monopolar- 4.0MHz high-frequency low-temperature technology is essential.

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Minimal lateral heat without bleeding into the surgical site results in excellent healing with this unit. For general practice, this technology is multi-functional in the ER room, dermatology, general surgery and exotics. The technology is superior to all cutting modalities I have used. It is safe, effective and decreases patient anesthesia time. 

Clarence Rawlings, DVM, Ph.D., Dipl. ACVS, and Derrell Elkins, DVM, Dipl. ACVS, are advocates of this technology in companion –animal practice and specialty practice.

The radiowave radiosurgery technology removes the expense, photonic hazard potential and char of the laser in veterinary surgery. Jeffrey A. Sherman, DDS, FACD, FICD, Dipl. American Board or Oral Electrosurgery, said, “The waveform of the radiosignal is variable. A fully rectified waveform will create an incision producing an adequate amount of hemostasis, although it can be filtered to produce a very fine, delicate incision with a minimal amount of hemostasis. It can also be varied further to create a partially rectified waveform, which will produce excellent coagulation of the soft tissue.” <HOME>

Dr. DeForge is an adjunct professor at Northwestern Connecticut College nad Mercy College. He has a telemedicine oral radiograph reading service for analog and digital X-rays, VetDent Oral Imaging Services. He may be reached at dondeforge@aol.com.

Sequence and Findings in Attachment Loss-Periodontitis

  • Inflammation
  • Pathologic pocket formation
  • Bone resorption
  • Hyperplastic gingiva
  • Gingival bleeding
  • Gingival recession
  • Furcation exposure between roots
  • Tooth mobility
  • Root exposure and cementum loss
  • Apical periodontitis
  • Osseous destruction and infrabony pockets
  • Pain
  • Tooth exfoliation
  • Sinus pathology
  • Fistulous tracts, oronasal, oroantral, mandibular
  • Osteomyelitis
  • Pathologic fractures

Disclaimer: Dr. DeForge is an independent clinical researcher and has no contractual ties or arrangements with any of the corporations mentioned.

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