Jan Bellows, DVM
Diplomate, American Veterinary Dental College
All Pets Dental Clinic
(954)432-1111
9111 Taft St,
Pembroke Pines, Fla. 33024
Pratical Veterinary dentistry - Really setting started !
Many veterinary practitioners have their priorities wrong. They spend so
much energy figuring out how to get more four legged creatures in the front
door and concentrate on the vaccine/spay/neuter side of the practices, rather
than in- depth examination and treatment recommendations
What does this have to do with dentistry? Everything-paying attention to
dental abnormalities can translate better patient care, and client
appreciation.
How do you become mentally ready to begin this overlooked area? Your practice
needs to move from point A (inertia-allowing a sometimes minimally trained
person clean the teeth with little or no exam or treatment suggestions) to
point B (the practitioner or trained assistant examines each tooth on its own
merit, notes and charts abnormalities, and proposes therapy to
the clients)
With the proper equipment and mind set, the veterinarian who is READY will be
SET to GO !. What is particularly nice about dental work is that you need so
little to do so much
BASIC EQUIPMENT FOR VETERINARY DENTAL CARE
PERIODONTAL PROBE ULTRASONIC SCALER
EXPLORER INTRAORAL RADIOGRAPHIC FILM
DENTAL MIRROR POLISHER
HAND SCALER INTENSE LIGHT SOURCE
CURETTE MAGNIFIER
ELEVATORS DENTAL CHARTS
Nearly all practitioners have an ultrasonic dental scaler. Unfortunately, few
have an adequate dental polisher. No matter which method is used to remove
supragingival calculus (ultrasonics, rotopro, hand scaling) grooves are left
in the enamel surface. Unless the enamel surface is polished smooth, it will
attract more plaque. There are many types of polishing units available. A
prophy polishing cup attaches to the low speed drill unit in most delivery
systems which is useful.
The periodontal probe is as important in a dental examination as a a
stethoscope is in a general physical exam. A perioprobe is marked off in
millimeters. As a general rule, gum pocket depths greater than three
millimeters in dogs and two millimeters in cates, need closer
attention-radiography, root planing, curettage, and/or periodontal
surgery.
Two other hand instruments, sickle scaler and a curette, can be used
effectively during dental prophylaxis. Sickle scalers are designed for
supragingival use (i~e~ above the gum line), where as curettes are used
subgingival (below the gum line). Sickle scalers that are double ended
(mirror-image ends) are ideal. The scaler is triangular in cross-section. The
most effective working angle is 45-90 degrees to the tooth surface. A pull
stroke is always used~
Proper use of a curette requires a gentle touch. When used properly, the
rounded toe and back cause little damage subgingivally. The curette is angled
acutely against the root surface to remove gingival calculus, which is dark
brown to black in color The strokes are over lapped 10 to 20 times to plane
the root surface until it feels glassy smooth when checked with the explorer
tip. For subgingival curettage, the opposite end of the curette is angled
against the lining of the gingival sulcus. While the operator presses on the
gingiva with the index finger of the opposite hand, the curette is used to
scrape the lining of the gingival sulcus.
Perhaps the most overlooked and important aspect of basic dentistry is
charting what is abnormal and proposed treatment plans. There is no better
way of learning than sitting down with a dental chart and a sedated patient,
evaluating each tooth's appearance, position in the arch, mobility and
periodontal pocket depth.
EQUIPMENT
Power equipment is necessary to enter the tooth's hard enamel surface without
damaging the internal or supporting structures. The primary procedures
performed with high speed drills are root canals, extractions, crown
preparations, and restorations. If high speeds (20,000-400,000 rpm) are not
used, the teeth could be injured through excessive heat and poor cutting
control.
Common ways of delivering dental power are electric and air .As with most
choices each has advantages and disadvantages~ Electric powered dental units
are referred to as micrometers, Dremel Tools, laboratory bench engines or
belt driven units. They are usually less expensive, smaller, deliver high
torque, and are portable, which are good features. The tradeoffs are they are
five to ten times slower than the air units causing the drill at times to
"walk off" the tooth while drilling rather than cutting into it; they vibrate
to some extent making highly accurate work more difficult: and electric
powered units may produce harmful heat within the tooth due to the lack of
water in the handpiece.
Air driven units are the most efficient and easiest to use with training. The
modest increased cost between the air and electric units make little long
term difference compared to faster speed of air and higher quality of
dentistry capable thanks to the increased speed making the drill easier to
control. In addition the stream of water that cools the high speed but
prevents thermal damage to the teeth. The decision to use an air driven
dental unit compared to the slower machines is like performing cell blood
counts with an automated cell counting machine compared to a hemocytometer.
Both will work but the automated machine will deliver the results easier,
faster and at times more accurately. If you are interested In performing the
best dentistry possible, air units are the way to go. The decision should not
be based on caseload-- enough cases are there, recognizing dental lesions
that would benefit from the high speed equipment can be gained from numerous
continuing education programs and fine veterinary dental texts.
Where does the air power come from? Either from compressors which take the
room air and deliver pressurized air to the handpieces, or from bottled
compressed air sources such as nitrous oxide, and carbon dioxide. The bottled
sources have the advantages or portability, and are generally less expensive
on the initial purchase. Long term, the units using gas cylinders may be
more expensive than the compressor driven air machines due to gas replacement
costs.
The location of the compressor is an important consideration in human dental
offices the air compressor is far away from the dental units which are
connected with air hoses. In most veterinary offices the compressors are at
the dental delivery table. Noise becomes an important concern. Some
compressors cycle every two or three minutes with disagreeable roaring
sounds. The "silent" compressors work best under the dental area because they
are never heard. When considering the compressor location make sure the area
is accessible for servicing and adding oil to cool the machine. The "oil
free" units may-be appealing in that they are maintenance free, but they are
usually nosier and more expensive than the silent compressors. Many
veterinary dental companies also converted half horse power refrigerator
compressors which are quiet, efficient but require periodic oil refit and
drainage of condensation from the tank.
Dental handpieces contain the mechanism to turn the bur at high speeds. The
high-speed handpieces rotate at 200,000-400,000 times per minute. They are
the "workhorse" of the dental unit. There are many systems used to attach the
bur onto the end of the handpiece. We use the wrenchless push button type
where thumb pressure is used to disengage the bur. Other systems require a
wrench or key to place and replace the bur. Fiberoptic lighting is another
helpful option on a high-speed drill. Illuminating the operating area is most
helpful.
Slow speed handpieces rotate the bur 5,000-20,000 times per minute in forward
or reverse directions, They are mainly used to polish teeth (with the
addition of a prophy angle). The contra-angle attachment redirects the
working tip of the slow speed handpiece to 65 degrees to the horizontal,
improving access to many awkward areas of the mouth. It is mainly used in
filling root canals with lentulo spiral fillers, polishing, and restoration
work.