Thursday, August 31, 2017

Oral Pain in Our Pets-Idenitfy and Treat! Donald H. DeForge, VMD Fellow of the Academy of Veterinary Dentistry-Centers for Oral Care



Donald H. DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
www.SilverSandsVeterinary.com
1-800-838-3368
The New England and New York Animal Dental Helath Services
31August2017
No. 26


Oral Pain in Our Pets......
Idenitfy and Treat!
The Key is Comprehensive Oral Diagnostics and Treatment [CODAT]



Image result for Picture of a dog with advanced oral disease


It is 2017 and we are well into the New Millennium and there is still a reluctance on the part of many pet advocates to believe that oral pain is real and........... that it must be identified and treated!

In the photo above a small breed patient has lived with the pain of advancing end stage Periodontal Diseases for months.  There is little hope for this patient without referral to an animal dentist for Comprehensive Oral Diagnostics and Treatment [CODAT]!

CODAT allows identification of pathology and a proper treatment course to be employed.  The key to all oral diagnostics is a complete oral exam and digital oral radiology under general inhalation anesthesia.

No teeth should be removed from any companion-i.e. dog or cat-without complete oral radiology of all affected quadrants.

The signs of ORAL PAIN in the dog and cat before referral to an animal dentist can include any of the following:

Changed patterns of contact with the pet owner-i.e. not wanting to play; not wanting to go for walks; sleeping excessively

Hypersalivation

Aggression

Withdrawal

Disturbances in sleep patterns

Reduced grooming in cats

Changes in eating patterns

Preferrng soft food to hard foods

Swallowing food whole

Tossing food into back of mouth and not chewing the food

Chewing on one side of the mouth only

Reluctance to eat favorite hard treats

Smacking of lips

Mouth chattering

Teeth grinding

Intermittent sneezing

Blood tinged or pustular discharge from nostrils

Swelling anywhere in proximity to the upper and lower jaws

Frequent nose bleeds

If you observe any of the above, please call your local doctor of veterinary medicine immediately for an examination. If your local doctor does not have dental x-ray availability......please ask your doctor for a referral to an animal dentist.  Do not put off this exam.  

Bad Pain

Dogs and cats can live in "bad pain"!  "Bad pain" is constant low level pain with periods of significant pain excitement--i.e. severe oral pain!  The pet lives with "bad pain" until they can take no more of it; at that point they just give up and stop eating.  If this point is missed, the patient can develop a cascade of medical problems.

What can be causing your pet's oral pain?

Advanced Periodontal Disease

Endodontic Disease-opened pulp canals with tooth root abscesses

Oral Abscesses

Oral Masses and Cysts

Impacted and Luxated Teeth

Cavities in dogs

Crown/Root resporption in cats

Pulpitis-i.e. the tooth with the abnromal colored crown-gray, red, maroon, brown, yellow, or blue.  These colors are a sign of hemorrhage from trauma inside the tooth and must be addressed.  Never ignore a discolored tooth.

In complete extractions with retained abscessed reactive roots

Cat Stomatitis

Dog Stomatitis

TMJ Pathology

Fracture teeth

Oral Ulcers

Jaw fractures-jaws can fracture spontaneously from advanced periodontal disease affecting the bone--- in the mandible-lower jaw--- especially.  Trauma to the jaws from impacts of many types can lead to acute fractures.

Pain Control is Essential:

It is important to treat pain before dianostics are performed; and after treatment has been completed.  Pre-emptive pain control programs should follow detailed pre-anesthesia assessments.  This is especially important in the geriatric patients that could be already affected with aging heart and lung disease. 

Pre-Anesthesia Testing:

See your doctor about detailed pre-anesthesia testing prior to any general inhalation gas anesthesia.  The type of pre-anesthesia testing is based on the life stage of the patient and any pre-existing medical problems.
Do not proceed with any general inhalation anesthesia without in-depth pre-anesthesia discernment to allow a safe journey.  

Image result for Picture of a dog under general gas anesthesia


Modern Gas Inhalation Anesthesia:

Modern animal general gas inhalation anesthesia is very safe as long as pre-anesthesia testing has been performed; and the patient is monitored by a veterinary nurse technologist with a doctor present at all times.  

Discuss this with your veterinarian before proceeding. Some patients need pre-treatment with specific medicines, after the pre-anesthesia testing has been completed, before undergoing anesthesia. 

Never worry...... but be concerned and follow the simple steps outlined in this report before beginning your journey in Comprehensive Oral Diagnostics and Treatment. [CODAT]

Questions about this web log:
Contact Dr. DeForge at:
DoctorDeForge@yahoo.com



Saturday, August 5, 2017

Guided Bone Regeneration in Animal Dentistry- Donald H. DeForge, VMD-Fellow of the Academy of Veterinary Dentistry-The New England and NY Animal Dental Health Services-Centers for Oral Care


Donald H. DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
Silver Sands Veterinary-Milford Veterinary Hospital
The New England and New York Animal Dental Health Services
Centers for Oral Care
05August2017
DoctorDeForge@yahoo.com
www.AnimalDentistrySolutions.com
1-800-838-3368
No. 25


Guided Bone Regeneration in Animal Dentistry
Celebrating Twenty Years of Removing Oral Pain and Restoring Quality of Life with Bone Alloplast- ConsilⓇ
Donald H. DeForge, VMD
Fellow of the Academy of Veterinary Dentistry



In The Journal of Veterinary Dentistry-[JVD, Vol. 14, No.4, Dec 1997], I evaluated Bioglass/PerioGlas now under the veterinary label of ConsilⓇ/Nutramax Labs.  That clinical journey has led to hundreds of animals being helped throughout the United States and in countries around the world.  A bone alloplast fills voids in extraction cases; oral mass removal sites; and in periodontal surgery.  New bone occurs as osteoblasts infiltrate and proliferate on the surface of the material.  Bone growth occurs uniformly throughout the defect.

My mentor and friend, Dr. Robert Wiggs who was lost at too young and age, wrote the following in 1997: "As advances in veterinary dentistry occur, new techniques and materials are being utilized to offer treatment for teeth with advancing periodontal lesions that previously would have been extracted."  If he were alive today, he would be delighted to know that general practitioners, veterinary dentists, and veterinary orthopedic surgeons have incorporated bone alloplast into their treatment programs contributing to patient well being; re-establishment of a quality of life; and accelerated healing.

With the use of any Guided Tissue Regeneration and Bone Grafting material, comes a responsibility to take pre- and post oral x-rays of the site.  Patients must be followed with regular rechecks with oral x-ray appointments under general inhalation anesthesia.

The veterinarian must realize that the primary therapy of all periodontal disease management is the control of the periodontal pathogens that cause the patient to suffer.
Technicians must be trained in all aspects of root planing and periodontal piezoelectric mechanical equipment for perfect removement of plaque.  These technicians must be given the foundation of digital oral radiology diagnostic training to allow the doctor visualization of pathology.

In many instances, the veterinarian can with Informed Consent perform basic periodontal surgery and or exodontia with usage of synthetic bone graft particulate. [i.e. ConsilⓇ]

In other cases, the small animal practitioner may want to make use of the expertise of an animal dentist.  

The important fact is to believe what Dr. Wiggs taught me a quarter of a century ago. He stated, "one of the biggest challenges in animal dentistry is incorporating technology with insight into education!"  He wanted individuals to move forward and to improve the oral care of companion animals but only with a complete understanding of each and every technique they introduce into their general practice...... oral care programs.

I encourage all veterinarians to study and utilize Guided Tissue/Bone Regeneration in their practices. ConsilⓇ has been tested and proven to be an exceptional bone alloplast.  I never remove any tooth without restoring alveolar ridge height with ConsilⓇ.  I have been the advocate of the general practitioner for more than two decades.  With national, regional, and local lectures and wet labs, I have brought the techniques and the educational tools that Dr. Bob Wiggs taught me in my early years of training.

I continue to write, lecture, and be active in oral clinical practice through The New England and New York Animal Dental Health Services.  Take the information supplied in this brief web log and consider re-educating yourself in the techniques utilized in periodontal and oral surgery.

In the second edition of An Atlas of Veterinary Dental Radiology......in a tribute and dedication to Robert B. Wiggs, DVM-and Diplomate of the AVDC I write:

"Success is to be measured not so much by the position one has reached in life but by the obstacles one has overcome while trying to succeed."
Booker T. Washington



Please find below important information about ConsilⓇ from Nutramax Labs. Questions can be addressed directly to Nutramax Labs.

What is Consil®?
Consil synthetic bone graft material is a bioactive ceramic containing salts of calcium, sodium, silica, and phosphorus. It undergoes a time dependent surface reaction when implanted at the dental or orthopedic repair site. The surface reaction results in the formation of a calcium phosphate layer that is substantially equivalent to the hydroxyapatite layer found in bone material. Osteoblasts infiltrate and proliferate on the surface of the material, and bone growth occurs uniformly throughout the defect.
Consil material accelerates the healing process and research has shown that Consil’s mechanisms of action include enhancing cell signaling and cell division necessary for facilitating bone regeneration and repair of bony defects. 1,2



ADVANTAGES OF CONSIL DENTAL, ORTHOPEDIC AND PUTTY PRODUCTS
  • Restore bone, contributing to patient comfort and well being
  • Conform readily to the defect site
  • Composed of materials naturally present in the body
  • Begin to repair bony defects through new bone production within 4 weeks3
  • Develop a bending strength and stiffness very similar to normal bone in 3 months
  • Can be used in contaminated sites because of the physiological pH maintained which inhibits bacterial growth,4,5 though site should be flushed well to remove debris
  • Minimize bleeding at the site and will not migrate due to hemostatic properties3,6
  • Multiple year shelf life

 ConsilⓇ FOR USE IN DENTAL AND ORTHOPEDIC PROCEDURES
Dental Applications:
  • Infrabony pockets caused by periodontal disease
  • Tooth extraction sites
  • Endodontic-periodontic lesions
  • Traumatic defects or intraosseous flaws related to pulpal floor or lateral root perforations


Orthopedic Applications:
  • Long bone multiple or comminuted fracture repair
  • Osteotomy sites
  • Delayed unions/nonunions
  • Arthrodesis


  • \om cysts, tumors or screw removal
  • Or anywhere a bone graft material is needed

CONSIL PUTTY SYNTHETIC BONE GRAFT
  • The same bone graft particulate as Consil Dental and Orthopedic pre-mixed with a synthetic, absorbable binder for improved handling and adaptability
  • Ready to use (no mixing or other prep needed) – just apply to surgical site
  • Non-hardening putty consistency makes graft material very easy to handle and mold to surgical site
  • Available in two sizes: 2.5 cc and 10 cc tray packaged with a dual sterile barrier
References:
  1. Au AY, Au RY, Al-Talib TK, et al. Consil bioactive glass particles enhance osteoblast proliferation and maintain extracellular matrix production in vitroJ Biomed Mater Res Part A 2008; 86(3):678-684.
  2. Au AY, Au RY, Demko JL, et al. Consil® bioactive glass particles enhance osteoblast proliferation and selectively modulate cell signaling pathways in vitro. J Biomed Mater Res Part A 2010;94(2):380-388.
  3. Oonishi H, Kushitani S, Yasukawa E, et al. Particulate bioglass compared with hydroxyapatite as a bone graft substitute. ClinOrthop 1997: (334)16-325.
  4. Allan I, Newman H, Wilson M. Antibacterial activity of particulate bioglass against supra- and subgingival bacteria. Biomaterials 2001;22:1683-1687.
  5. Stoor P, Soderling E, Salonen JI. Antibacterial effects of a bioactive glass paste on oral microorganisms. Acta Odontol Scand 1998;56:161-165.
  6. DeForge DH. Evaluation of Bioglass/PerioGlas (Consil) synthetic bone graft particulate in the dog and cat. J Vet Dent 1997;14:141-145.