Monday, February 13, 2017

Blog 18 Periodontal Disease Part 2

Centers for Oral Care
New England & New York
Animal Dental Health Services
No. 18~13Feb2017
DH DeForge, VMD
Fellow of the Academy of Veterinary Dentistry

Periodontal Disease
Part Two
Professional Techniques in Removing Plaque- Biofilm

Abstract:  In Part Two of this Three Part series you will find a summary of Ultrasonic Debridement Techniques concerning plaque biofilm removal by the veterinary dentist; veterinarian trained in periodontal care; and the well educated veterinary dental hygienist.  There is a difference between the Periodontal Prophylaxis in the young dog or cat with gingivitis as compared to the older patient with periodontitis.  By four years of age, especially in small and toy breeds, periodontal diseases can be quite advanced.  In many instances, these and older patients may need referral to a veterinary dentist for Comprehensive Oral Health Assessment and Treatment.  Once diagnostics are completed and oral health is restored, the patient can be returned to the general practitioner for follow-up home care monitoring and continued supportive periodontal care under general inhalation anesthesia.

The  Beginning:
Once manual hand root planing is mastered, the veterinarian or veterinary dental technician should consider piezoelectric ultrasonic debridement.  Piezo- electric ultrasonic mechanics is activated by the expansion and contraction of quartz crystals to provide a frequency of 20-45 KHz.  Most authors feel that the piezoelectric units operate with a curved linear tip movement while others describe elliptical as well as linear movement based on power setting and water flow.

Water flow from the working tip’s insert cools the tooth surface.  Piezoelectric curettes affect excellent supragingival crown scaling- and subgingival root planing.

Piezoelectric Mechanisms of Action
Vibratory action of the oscillating metal tip against the deposit breaks the deposit from the tooth surface
Lavage action of water flowing over tip flushes biofilm-plaque from the tooth surface and debris from the treatment site
Removal/disruption of biofilm by shock waves resulting from the implosion of bubbles

Piezoelectric debridement is excellent in reducing pocket depth and gingival inflammation.  This debridement helps to eliminate bacteria pathogens by disrupting subgingival biofilm.  Mini-inserts allow access to deep narrow pockets with excellent debridement that is expedient and more efficient than manual root planing with curettes.  Some areas may need both manual and mechanical debridement.  Only with experience and multiple wet-labs will the veterinarian or animal dental hygienist be able to determine the most efficient combination of methods of root planing.  No effective periodontal care is possible without gas inhalation anesthesia. [See Periodontal Disease Professional Care and Home Care- Part One- No. 16- 20Jan2017

The end result is always the same: a debris free subgingival root surface.  With proper piezoelectric technique, there is less damage to healthy cementum, than with manual root planing when the unit is set at the manufacturer’s recommended power settings.
Abnormal pocket depth noted during debridement should be a red flag to initiate periapical oral x-rays.
Understanding the differences between reversible gingivitis and irreversible but controllable periodontitis should be a part of all veterinary oral care staff’s continuing education. 
Listed below is the Sequence Patterns of Advanced Periodontitis.  All of the below can be avoided with professional dental exams; site specific oral radiology; professional treatment based on oral x-ray findings; and an excellent homecare anti-plaque program.

Sequence Patterns of Advanced Periodontitis
Plaque-biofilm deposits
Calculus formation
Gingival 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
Tooth exfoliation
Sinus pathology
Fistulous tracts
Pathologic fractures

Very soon the Market Place section of our Website: will open.  This is a defining area of materials and equipment that will help the companion animal practitioner in their journey in animal dentistry.

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