Thursday, July 13, 2017


Donald H DeForge, VMD
Fellow of the Academy of Veterinary Dentistry
The New England and New York Animal Dental Health Services
Web Blog #23  13July2017

Comprehensive Oral Diagnostics and Treatment

The Teeth Cleaning
Periodontal Prophylaxis

The Components:

1] The Oral Structure Exam-
The teeth; ventral tongue; surrounding soft tissue structures; oral mucosa –gingiva; lips and cheeks; soft palate; tonsils; glossopalatine folds; frenula; incisive papilla and duct openings; lingual frenulum; commissures; and vestibules are examined by Dr. DeForge.

2] Crown Scaling-Supragingival-the visible crown is cleaned

3] Root Planing-Subgingival with curettes and/or Piezoelectric ultrasonic power instrumentation is completed.  Most periodontal pathology is subgingival and hidden from the eye on clinical exam.  Thorough subgingival root planing and oral radiology allows Dr. DeForge to see and treat areas which are not visible on clinical exam.

4] Cup Polishing and/or air polishing.  This removes micro-particulate  material that can accelerate plaque and calculus reformation.

5] Sulcar Lavage-flushing the gingival crevice and/or pathologic pockets with saline and/or Chlorhexidine 0.12% removes foreign material that can cause pathology to be readily introduced

6] Dr. DeForge records Periodontal Indices:
·        Plaque Index-0-3
·        Gingival Index-0-3
·        Furcation Index-0-3
·        Tooth Mobility Index-0-3
·        Calculus Index-0-3
·        Attachment Loss-0-3
·        Bleeding on probing-0-3
·        Oral Pain Index-0-3

The Oral Exam Continues
Comprehensive Oral Diagnostics and Treatment with Oral Radiology

The periodontium is composed of the gingiva, alveolar mucosa, cementum, periodontal ligament, and alveolar bone . These components serve to support the teeth in their alveolar bone [i.e. tooth socket] The tissues typically seen on clinical inspection are only those of the oral mucosa.  Radiology and probing allows the other areas of the periodontium to be evaluated.  Oral Radiology is essential in the treatment of all patients with advanced periodontal disease.

Examining and recording data on the state of the periodontium MUST is an intregral part of each teeth cleaning and periodontal exam by Dr. DeForge.

The following examination parameters have been completed:
Site Specific Periapical dental x-rays
A count of missing teeth
Occlusion problems noted
Tooth mobility has been recorded

Special Points of Care:
Please report any co-mobidities to Dr. DeForge-liver, kidney, heart, pancreas,
adrenal, Diabetes, thyroid, or other important health problems.
medicine, a comorbidity is the presence of one or more additional diseases or disorders co-occurring with (that is, concomitant or concurrent with) a primary disease or disorder.  Overweight patients suffer commonly from advanced periodontal disease.  Toy breeds and small breeds have a genetic linkage to periodontal disease.

Bleeding on probing is considered a sign of inflammation; Dr. DeForge’s goal with professional care and homecare is to reduce and/or eliminate bleeding on probing.

Dr. DeForge records pocket probing depths around specific teeth in advanced periodontitis.  Four readings are taken; mesial, distal, lingual/palatal, labial/buccal.  Pocket depths of 1-3mm are considered normal.

Clinical attachment level [CAL] is measured by adding pocket probing depth to the amount of gingival recession in each area of the tooth.

In Periodontitis: oral malodor; bleeding on probing; probing levels of 4mm or greater with pocket formation; indistinct periodontal ligaments; and interrupted lamina dura [seen on oral radiology exam] are classic signs of ADVANCED inflammatory gum disease and oral infection.

If deeper probing depths are noted periodontal surgery and/or extraction is always recommended by Dr. DeForge

The keep to all animal oral health is to stabilize periodontal end points of Peridontitis and return the patient to normal oral health. 

This is done with professional care under general inhalation anesthesia and different homecare programs.  Advanced forms of periodontal disease is only treated, by Dr. DeForge, with rechecks under anesthesia every 6-12 months.

Comprehensive Oral Diagnostics and Treatment must be coupled with Supportive Periodontal Therapy.  The more aggressive the pathology the more frequent the appointments for periodontal therapy.

Always consult with Dr. DeForge.  E-Reports are recommended daily for the first 14 days after any periodontal or oral surgery appointment.  Send E-Photos from your Smart Phone of the healing process to Dr. DeForge very 2 weeks for 4 times after the completion of any advanced periodontal care or oral surgery appointment.  The failure to communicate and to complete your re-check appointments will lead to a progression of pathology and the unnecessary need for further oral surgery.

Contact Dr. DeForge at:
or 1-800-838-3368


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