Contributors: Mark Thompson, Matthew Oxford
Species: Canine | Classification: Techniques
- Active plaque is the cause of periodontal disease Periodontal disease.
- Plaque is a biofilm of salivary proteins and oral bacteria which adheres to the exposed tooth surface. Plaque is a very stable environment, which can be affected only very minimally by chemicals such as disinfectants and antibiotics. Plaque elimination requires mechanical removal.
- If plaque persists for a prolonged period it can become calcified to form calculus. Calculus is a largely inert material, however it has two factors that promote the progression of periodontal disease. It increases surface area, which is rough and aids plaque deposition. It accumulates around the gingival margin, reducing oxygen tension here and promotes the proliferation of anaerobic bacteria. It is these that are presumed to be responsible for the progression from gingivitis Gingival enlargement to periodontitis.
- Dental scaling, carried out under anesthetic, is used to remove calculus from the tooth surface.
- Daily tooth brushing is required to prevent further plaque deposition.
- To remove calculus from the teeth and provide a smooth tooth surface that discourages further plaque and calculus decomposition.
- Conservative management of periodontal disease Periodontal disease.
- Required to treat early periodontal disease Periodontal disease, which in combination with daily tooth brushing, can result in the resolution of clinical signs. Required to treat periodontitis Periodontitis, which in combination with daily tooth brushing, can result in the prevention of progression of clinical signs.
- Requires general anesthesia General anesthesia: overview. Conscious dental scaling must never be carried out.
- Proper home dental care, consisting of daily tooth brushing, may increase the interval between prophylactics, but periodic dental sealing will still be necessary.
- 15-45 min depending on the severity of calculus and other oral lesions.
- Varies depending on extent of disease and associated dental work required.
Criteria for choosing test
- Teeth not suitable for preservation will require dental extraction Dental extraction.
- Piezo-scaler or other ultrasonic dental scaling machine .
- Periodontal pockets measuring depth with a graduated periodontal probe .
- Periodontal probe is used to assess gingivitis, periodontal probing depths, gingival recession, tooth mobility and furcation exposure.
- Soft rubber prophy cups.
- Fine grade prophy paste.
- Fast patient for 12 hours prior to general anesthesia to prevent reflux esophagitis.
- General anesthesia Anesthesia: for dental procedures.
Step 1 - Ultrasonic scaling
- Remove gross calculus from the exposed tooth surfaces.
- Must use plenty of water to cool scaler tip which will prevent thermal damage to tooth pulp and will also help flush away debris.
- Keep tip moving over surface of teeth.
- Periodontal therapy scaling.
- Move to next tooth after 10 seconds .
Stroke teeth with scaler - applying pressure may damage enamel and cause thermal damage. Ultrasonic vibrations will break up and loosen calculus.
Either Use scaler with hollow tip to ensure that cooling water flows through and reaches tip.
Or Very carefully hold gingivae away from tooth surface.
Or Make repeated 0.5 second excursions subgingivally.
Do not use rotosonic scalers. These can rapidly remove enamel (only 0.5 mm thick in dog) from tooth surface. This will result in damaged enamel and exposed dentine and will cause pain (rotosonic scaler is six-sided, non-cutting dental roto-pro burr which fits high speed handpiece of dental drill; rotates at 300,000 rpm → when held against tooth shatters surface, dislodging calculus but also damaging enamel, dentine and pulp).
Step 2 - Hand-scale
- Remove remaining calculus from teeth, above and below gingiva.
- Use sickle shaped supragingival hand scaler for supragingival debris.
- Use subgingival curette for subgingival debris.
- Always pull debris away from gingival margin.
Step 3 - Subgingival curettage
- Most important step in whole scaling and polishing procedure - searching for remaining debris or tooth surface defects.
- Search subgingivally, using periodontal probe.
- Measure gingival pocket to pocket depth by inserting graduated probe at between 4-6 locations around the tooth . Insert probe tip until soft resistance felt at bottom of pocket.
Ensure tip is not caught on cemento-enamel junction.
- Very carefully and thoroughly remove all debris and excessive inflammatory epithelium from pockets and gingival crevices.
- Withdraw curette from pocket → sharp edge of curette against tooth surface removes plaque, calculus and necrotic cementum, and sharp edge of curette against crevicular epithelium removes excessive inflammatory tissue. If the epithelium can be gently removed then some re-attachment to the tooth may be possible.
- Pockets >4 mm with inflamed gingiva may need surgical intervention.
Step 4 - Periodontal surgery
- Where pocket depth >4 mm, the exposed root surface will need to be opened to allow curettage, as otherwise it is impossible to removal all calculus.
- This can be done either by creation of a surgical mucoperiosteal flap to expose the root surface. The flap is sutured back in place following calculus removal. Alternatively, a gingivectomy Gingivectomy and gingivoplasty can be carried out to eliminate the periodontal pocket and allow complete calculus removal.
- Where the pocket depth is greater than 7 mm, or where the pocket extends to within 1 mm of the mucogingival junction, extraction of the tooth should be considered.
Step 5 - Polish
Polishing remains a controversial subject. It is unlikely that polishing will have any effect on the damage caused to the enamel surface during scaling. However, it may be useful to eliminate residual small fragments of calculus and plaque. When carrying out polishing, care must be taken not to have the polisher head rotating too fast, with too much pressure or for too long a period of time. If this happens, the tooth may be heated causing pulpitis which may lead to pulp necrosis.
- Use soft rubber prophy cups with a slurry of fine grade prophy paste .
To avoid overheating tooth and consequent iatrogenic damage: add water to paste if it is not runny; refill prophy cup with runny paste to maintain a constant slurry.
- Maximum speed = 1000 rpm.
- Keep moving over tooth surfaces - 15 seconds maximum for each tooth.
- Apply just enough pressure to flare soft prophy cup out under gingival margin .
- Antibiotic treatment is not required following dental scaling.
- Instigate effective homecare regimen to prevent recurrence. This will consist of daily tooth brushing.
- Potential for anesthetic complications.
- Dental scaling can lead to bacteremia but this is largely resolved by the patient's immune system.
- Good for life.
- Prognosis for oral health depends on degree of periodontal disease and the willingness of the owner to follow up with good home care.
Reasons for Treatment Failure
- Animals with severe periodontal disease are more likely to require tooth extraction.
- Periodontal therapy under anesthetic is only the start point for treatment. Good home care consisting of daily brushing is essential for long term periodontal health maintenance. Without this, plaque and calculus will reform quickly, and periodontal disease will again progress.