Veterinary dental nursing procedures

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Veterinary dental nursing procedures

• DENTISTRY SUMMARY

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Owner contact details reqd

• In case unexpected procedures
• Radiographs
• Gingival surgery
• Extractions
• Specialised dentistry
• Additional risks and costs
• Owner needs to give consent.

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Toothpaste

• If swallow toothpaste
• stomach upset (gastritis)

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Possible Risks of raw meaty bones

• Traumatic
• Stuck in mouth
• Tooth breakage
• Stuck in oesophagus
• Gastritis
• Perforation/peritonitis
• Constipation
• Dietary
• Pancreatitis (some bones high in fat)
• Dietary imbalance (if sole food)
• Behavioural
• Competitive fighting

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Possible Benefits of raw meaty bones

• Less periodontitis etc
• Also less associated systemic health problems
• Enjoyment for animal
• Chewing exercise
• Variety
• Overcome boredom

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Minimising bone risks

• Raw
• Soft (veal or lamb)
• Remove after 10 mins (?)
• Appropriate size
• Appropriate shape
• Avoid (vertebral) chop bones

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Raw Meaty Bone Alternatives

• If bones cause problems and want to reduce
  periodontitis
• Chews
• Toys
• Brushing
• Gels
• Washes
• Special diets (e.g. Hills t/d)

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Terms

• Gingiva Gums
• Pulp Blood vessels, nerves, connective tissue,
  odontoblasts.

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Tooth structures
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Tooth structures detail
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Gingival sulcus/pocket
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Gingival pocket

• Gingival sulcus
• Subgingival space

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Tooth structures

• Apex
• Apical End

the tip of the root
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Crown

• Crown (coronal surface) covered by enamel.

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Dentin

• Dentin layer can sense pain has sensitive
  tissues in dentinal tubules.
• These tubules within the dentin layer are formed
  by tubular extensions of the odontoblasts
  (dentinal tubules)

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Carnassial tooth

• Largest tooth
• Most prominent
• 3 roots
• Most likely to have slab fracture
• Most likely to have root canal infection
• Carnassial root abscess seen below the eye

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Periodontal ligament

• Holds the tooth firmly within the socket.
• Needs to be slowly stretched before a tooth can
  be removed

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Alveolus

• The bony socket holding the tooth.

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The Cuspid (Canine) tooth

• Normally permanent canine erupted by 5-6 months
  of age in dogs (check your spays!)
• If permanent canine doesnt erupt directly under
  temporary canine ? retained temporary canine is
  likely
• May distort growth of permanent canine
• May predispose to plaque

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Deciduous Temporary

• Deciduous means shedding
• Just as deciduous trees shed leaves

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Dental surgery

• Is contaminated (i.e. dirty)
• Therefore scheduled after sterile surgery

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Plaque (Furry Film)

• Can form in 6 hours
• The most damaging plaque is that found under the
  gums (i.e. in the gingival pocket)
• Owner may not immediately appreciate the benefit
  of removing subgingival plaque, but animal will!

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Plaque components

• Bacteria (mainly)
• Salivary proteins
• Food debris
• Oral cellular debris

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Plaque Calculus

• The vicious cycle

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Periodontal disease
plaque
Inflamed Gums (gingivitis)
Inflamed Socket (periodontitis)
Inflamed Mouth (stomatitis)
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Periodontal disease

• Gingivitis
• Inflammation of gums
• Gingival hyperplasia
• Periodontitis
• Inflammation of tissues around tooth
• Ligament loss
• Bone loss
• Tooth loosening and loss

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Gingivitis systemic effects

• Absorption of bacteria or bacterial complexes.
• Organs affected
• Heart valves (endocarditis) gt heart murmurs
  congestive heart failure
• Kidneys
• Lungs
• Meninges/brain.

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Calculus ( Tartar)

• Is mineralised plaque
• Can start to form in 1-2 days
• Provides a rough base for more plaque
• In itself is not as damaging as the plaque it
  supports
• Except occasional lip lesions

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Whats going on here?
Dog
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Retained deciduous canines

• Trap food
• Promote plaque
• Can distort growth of following permanent canines

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Coronal v Apical
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Dental arcade
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Medial
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Lateral
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Mesial
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Mesial

• Refers to the surface between teeth
• Towards midline

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Distal
midline
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Distal

• Refers to the surface between teeth
• Away from midline

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Buccal / Labial
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Buccal / Labial

• Buccal
• On the cheek side
• Labial
• On the lip side

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Palatal / Lingual
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Palatal / Lingual

• Palatal
• On the palate side (upper jaw)
• Lingual
• On the tongue side (lower jaw)

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Ankylosis

• Fusion of tooth root with alveolar bone

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Hand instruments

• Many types
• Know functions (more impt than names)
• Probing depths
• Exploring surfaces by touch
• Scaling above gingival pocket only
• Scaling above below gingival pocket
• Extraction

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Dental prophylaxis

• Most important area is the gingival pocket
• Check depth with gingival probe
• Check smoothness with dental explorer
• Finish scaling with curette
• Polish into gingival pocket
• Rinse
• Fluoride (/-)

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Hand instruments

• Supra- or Sub-gingival or Both?
• Supra

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Hand instruments

• What is the general name?
• Scaler

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Hand instruments

• Where particularly useful?
• Between teeth

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Hand instruments

• Supra- or Sub-gingival or Both?
• Both

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Hand instruments

• What is the general name?
• Curettes

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Hand instruments

• What are these called?
• Root tip picks

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Hand instruments

• When are they used?
• Removing retained roots

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Hand instruments

• What are these called?
• Dental explorers

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Hand instruments

• How are they used?
• Tactile audible visual feedback from tooth
  surface

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Hand instruments

• What are these called?
• Gingival or periodontal probes

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Hand instruments

• What are these used for?
• Measuring gingival pocket depths

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Hand instruments

• What are these called?
• Dental extraction forceps

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Hand instruments

• What uses?
• Loosen by pushing twisting teeth
• Tartar breaking
• Once loose gt pulling teeth

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Hand instruments

• What name?
• Root / Dental Elevator

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Hand instruments

• What is this called?
• Lip or cheek retractor

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Machine instruments

• What is this?
• Fissure bur (straight)

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Machine instruments

• What is this?
• Crosscut Fissure bur (straight)

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Hand instruments

• What kind of instrument?
• Periosteal elevator

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Hand instruments

• What use?
• Elevating oral and gingival mucosa

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Thus two kinds of elevator

1. Root elevator
2. Periosteal elevator

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Hand instruments

• What kind of instrument?
• Bone curette (compare descaling curette)

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Hand instruments

• What use?
• Debriding bone e.g. infected sockets

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2 kinds of curette

• Descaling curette
• Bone curette

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Sharpening hand instruments

• Ideally after each dental
• Even during a dental

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Estimating Sharpness

• Magnifying glass
• Plastic stick test
• Scrape edge to see if catches
• Glare test
• Should not see light line on edge

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Machine scalers

• 3 Main types
• Learn about particular machine you use
• Whether safe in gingival pocket
• How damaging to teeth
• Maximum time on a tooth
• Qty of Water cooling required

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Machine scaling

• Keep tip moving
• No more than 10 secs per tooth
• To avoid overheating
• Water cooling
• No digging point into crevices or surfaces
• Check that your machine / tip is ok to use in
  gingival pocket

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After machine scaling

• Hand scalers are often used to remove any
  remaining plaque and calculus, especially in the
  gingival pocket (i.e. subgingivally).

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Machine polishing

• Keep moving
• 5 seconds per tooth
• less time than scaling because no water cooling
• To avoid overheating
• Allow polishing cup to flare under the gums a
  little (i.e. into gingival pocket)
• Light pressure only

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Vet Base Machines
High Speed Port
Low Speed Port
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Vet Base Machines
Water Air Port
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Vet Base Machines
Water On/Off
Water Flow Rate
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Oral and subgingival rinsing

• Chlorhexidine 0.1-0.2
• Usually added to water spray bottle
• Water
• Saline (isotonic)
• Saline and Peroxide (H2O2)

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Fluoride after polishing

• Strengthens enamel
• Helps desensitize teeth
• Helps kill bacteria in plaque

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Call vet if

• Pocket depth
• dog 3-4 mm (normally lt 2-3 mm)
• cat 2 mm (normally lt 2 mm)
• Loose or fractured teeth
• Periodontal disease
• Neck Lesions in cats, or Caries
• Retained or extra teeth
• Tumours

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Need for dental radiography

• Suspected tooth root infections
• Gauging extent of periodontal disease
• Neck lesions
• Suspected Neoplasia
• Fractures
• Miscellaneous dental anomalies

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Dental film

• Small
• Can be placed inside mouth to provide more useful
  radiographs.
• Flexible.

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Using bisecting angle

• To overcome lengthening or shortening distortion
  (shadow) effect when film cannot be positioned
  parallel to tooth
• Required in root canal treatment
• where it is important to accurately measure
  length of teeth when using burs of correct length
  to remove pulp.

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Reasons to extract

• Fractured tooth
• Pulp exposed
• Severe periodontitis
• Deep neck lesions
• Tooth within a jaw fracture
• Retained temporary (deciduous)
• Supernumerary
• Malocclusions

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Extraction complications

• Leaving broken root tips possible later bone
  infection
• Pushing broken root tips into nasal cavity or
  into mandibular marrow cavity
• Persistent haemorrhage can indicate a bleeding
  disorder
• Fracture of maxilla or mandible
• Creation of oronasal fistula (especially when
  extracting canines in breeds with narrow snouts
  Toy Poodles)
• Retrobulbar haemorrhage

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Patient safety problems

• Care of tracheal and ET tube
• Head movement
• Tube injury to trachea
• Tube pushed too deep gt into bronchus
• Tube pulled out
• Tube kinking gt obstruction
• Aspiration
• Care of eyes
• Body temperature
• Wet face

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Patient safety measures

• Tilted table- chest high point.
• Cuffed ET tube
• Swab in pharynx, not squeezed.
• Heating mat, temp monitoring, bubble wrap
• Turn under ventrum
• Disconnect ET tube when turning
• Rubber band or sticky ET tube tie in

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Operator risks

• Lungs Aerosol inhalation
• Eyes injury and aerosol
• Gross contamination with bacteria hands and
  clothes
• Posture
• Anaesthetic gases
• Disconnected tubing

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Operator safety

• Face mask
• Eye protection
• Gloves
• Gown
• Adjustable stool
• Anaesthetic scavenging

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Practical exam

• Practice modified pen grip
• Place middle finger close to working end as a
  rest
• Recognise basic instrument types/functions

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Common sense

• Cant beat it
• More important than the details presented,
  especially
• Patient operator safety
• Unforseen or unusual situations

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Common test mistakes

• Methods of cutting teeth
• Chisel mallet
• Cutting wire (Gigli wire)
• Cutting bur
• Use root elevator before extraction forceps
• Protect delicate points of instruments
• Ideally sharpened frequently

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• THANKS

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Most Important Points

• Operator safety
• Mask, goggles, posture, lighting, gown, gloves,
  instrument holding
• Patient safety
• Anaesthesia for dentals
• Scaling polishing technique (time, angle,
  pressure)
• Instrument holding to prevent slippage
• Efficacy
• Scaling polishing technique (subgingival)
• Prophylaxis
• Appropriate advice for owners situation

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Owner Advice Scaling/Polishing Anaesthesia
Bones common sense Post-op diet Post-op signs to watch for (c) Post-op recheck Polish time on tooth Oral injuries fractures, haemorrhage Call vet pocket depths U/S subgingival scaler use U/S scaler tip use care ET tube cuff inflation Body tilt ET tube kink ET tube secure in-out movement Throat pack of absorbent material Remove throat pack Body temp
Operator
Operator mask Operator eye protection Operator posture
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The End