veterinary dentistry for technicians
DESCRIPTION
Veterinary Dentistry for Technicians -Dental cleaning and Oral Exam -Intraoral Radiogprahic Positioning -Oral Regional Nerve BlocksTRANSCRIPT
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Dentistry for the Veterinary Technician The way it begins:• Plaque begins as a biofilm (pellicle). *In 20 minutes a
tooth is covered in a pellicle (a sticky coating of saliva and glycoproteins). The pellicle is viscous and increases the chance of bacteria adherence.
• In 6-8 hours bacteria begin to colonize. This is what is known as plaque.
• The first bacteria to adhere to the pellicle are gram-positive aerobic organisms
• As the plaque thickens, it extends to the sulcus and subgingivally. The bacteria convert to gram negative anaerobes.
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Periodontal Disease = Septicemia• Blood flow (gingivitis)• Kidneys/Liver• Heart (Coronary Vessels)
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For the Veterinary Technician
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Cite:http://AVDC.org
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Cite:http:www.aahanet.org
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Steps to a Dental CleaningPPE**Protect yourself-----Protect your patient
Exam Gloves
Or face-shields instead of goggles
Surgical Mask
+/- Waterproof aprons?
Safety goggles
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Steps to a Dental Cleaning
1. Prolonged recovery2. Bradycardia3. Respiratory depression4. Apnea5. Ileus6. Hypotension7. Impaired clot function8. Impaired immune function
PPE Prevent Hypothermia
War
m
dry
blan
kets
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Steps to a Dental Cleaning
Place pharyngeal pack1.
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Steps to a Dental Cleaning
Pre-rinse 2..
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Steps to a Dental CleaningRemove bulky tartar3
. .
Extraction or Tartar Removing Forceps
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Steps to a Dental Cleaning Power Scale 4.
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Power Scalers
Magnetostrictive
Sonic/Ultrasonic
Peizoelectric
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Steps to a Dental Cleaning Hand Scale 5.
Jacquet(Sickle Scaler)
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Hand Scalers
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Steps to a Dental Cleaning Root Plane 6.
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Modified Pen Grasp with fulcrum Root Plane
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Steps to a Dental Cleaning Modified pen grasp
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Curettes Universal vs Area Specific
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Curettes
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Steps to a Dental Cleaning Rinse, polish, rinse 7.
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Steps to a Dental Cleaning 7.
Look for revealed tartar
Rinse pumice
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Steps to a Dental Cleaning Oral Exam/Radiograph 8. Periodontal
ProbeExplorer
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Oral Exam/Radiographs Probe and explore 8.
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Oral Exam/Radiographs Probe and explore Clinical
Attachment
8.
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Some anatomy review Gingival Structures
409 (lower right first molar)
Attached gingiva(Base of sulcus)
Mucogingival junction (line)
Gingival margin(Free Gingiva) Sulcus inside!
Oral mucosa
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Oral Exam/Radiograph Radiograph
8.
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Radiographs• Fractures
• Unerupted/missing tooth• Retained tooth
• Periodontal pocket• Facial swelling• Malocclusion
• Resorptive lesions• Pulp exposure• Post-extraction
• Root canal therapy• Pulpotomy
8. Indications
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Steps to a Dental Cleaning Chart findings 9.
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Charting 9.
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5 Criteria for staging periodontal disease
1. Gingivitis and gingival index (GI) (grade 1-3)2. Periodontal Probing Depth (P) in mm3. Gingival recession (GR) in mm 4. Furcation exposure (FE) (Grade 1-3)5. Tooth Mobility (M) (Grade 1-3)* Chart the stage of periodontal disease using the “worst tooth”.
*Abnormal probing depth (pocket) + Gingival recession (from CEJ to gingival margin) = Total Attachment Loss
9. Charting
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Furcation ExposureFE1FE2FE3
FE3
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Normal (PD 0): Clinically normal - no gingival inflammation or periodontitis clinically evident.
Stage 1 (PD 1): Gingivitis only without attachment loss. The height and architecture of the alveolar margin are normal.
Stage 2 (PD 2): Early periodontitis - less than 25% of attachment loss measured via probing or radiographs from CEJ to alveolar margin.Or stage 1 Furcation Exposure
Stage 3 (PD 3): Moderate periodontitis - 25-50% of attachment loss measured via probing or radiographs from CEJ to alveolar margin or stage 2 Furcation Exposure.
Stage 4 (PD 4): Advanced periodontitis - more than 50% of attachment loss measured via probing or radiographs from the CEJ to alveolar marginOr Stage 3 Furcation Exposure
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Grade vs StageStage indicates a progressive conditionGrade may be either progressive or reversible
AVDC.org/nomenclature
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4 Clinical Signs of Periodontal DiseaseDepends on hosts’ response to the bacteria1. Gingivitis2. Calculus3. Horizontal bone loss4. Vertical bone loss
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4 Clinical Signs of Periodontal Disease
Horizontal bone loss
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4 Clinical Signs of Periodontal Disease
Vertical bone loss
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Step 10. DVM Assessment/ Treatment PlanCalculate/Administer Nerve block(s)•Radiographs/Treatment plan•DVM views•Talk to client (via phone)?•Verbal estimate?•Plan/draw up Nerve block
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11. Periodontal TreatmentINCLUDE:
• Closed-Currettage
-(debride pocket)
• Open –surgical (flap)
-root planing and currettage
• Perioceutic
- (Antibiotic pocket treatment)
• Systemic antibiotics
(BEFORE) cleaning
- Clindamycin
- “Pulse Therapy”
• Extraction • Crown Reduction
• Guided Tissue Regeneration
-(Bone stimulant/Bone substitute)
- Osteoallograft, Consil ®
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12. Fluoride Treatment•Desensitizes tooth
•Helps minimize plaque adherence
•Bacteriostatic
•Its application is controversial becauseget fluoride from other sources
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Questions?
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Directional Terms
DistalMesial
CoronalApical
Rostral
Caudal
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Periodontal and Endodontic Structures
Crown- enamelRoot- cementum
Periodontal Ligamen
t(space)
Apex
Pulpal Horns
Pulp Chamber
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CEJ
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Types Of Dentin:
Primary Dentin
Forms before tooth eruption
Secondary Dentin
The natural process of mastication
stimulates production of more
layers of dentin
Tertiarty (Reparitive) Dentin
Stimulates rapid formation as a
result of pathology or injury
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Repairative Dentin
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Maxilla
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mandible
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Regional Nerve Block
Bupivicaine 0.5%
Lidocaine 2%
Onset 10-20 min 1-2 min
Duration 4-8 hours ½ hour -1 hour
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Regional Nerve BlockCalculation for Nerve Block
1 mg/kg each drugMix together
0.1mL/site –cats/sm dogs0.3-0.5mL /site- med/large dogs÷ how many nerve blocks (ie 4)
•Don’t go over toxic dose of 1mg/kg each•ASPIRATE!•Monitor rhythm and blood pressure
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Behavior response to pain
Modulation
Transduction
Perception
Transmission
Nociception
“The incision”
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Regional Anesthesia
Materials-1mL or 3mL Syringe25 x 5/8” needle unless large skeletal structure
Warning-A less invasive approach= right outside the foramen vs insideAspiration-3x (1/3 rotation and repeat) to check for blood
Inject slowly. Apply digital pressure for 60 sec. Monitor patient.
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Rostral Mandibular Nerve Block
Middle Mental Foramen
•Bone, teeth and soft tissue rostralto the mandibular pm/canine incats•Dogs: Palpate foramenLandmark- labial frenulum &ventral to the mesial root of pm2•Cats: Small foramen- palpateLandmark-Caudal to apex of canine
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Mandibular Nerve Block(Inferior Alveolar Nerve)
Mandibular Foramen•Bone, teeth and soft tissue of the ENTIRE mandible•Extraoral or Intraoral•Landmarks- ventral notch of mandible, lateral canthus of eye•Palpation of mandibular foramen-intraorally(Lingual surface 2/3 way from molar to angular process )
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Mandibular Nerve Block(Inferior Alveolar Nerve)
Intraoral Extraoral
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Rostral Maxillary Nerve Block
Infraorbital Foramen•Bone, teeth and soft tissue of the maxilla rostral to PM3
•Landmarks- Palpate juga of pm4- opening just rostral
•Needle parallel to palate
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Caudal Maxillary Nerve Block
Infraorbital Nerve•Affects bone, teeth and soft tissue of the ENTIRE maxilla •Landmarks- Dogs: Max 2nd molarCats: Divot caudal to max molar
•Needle parallel to m root
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Intraoral Radiography
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Intraoral Radiography3 Steps to remember
1. Patient positioning2. Film placement within the patient’s mouth3. Positioning the beam head
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Patient positioningDorsal/Ventral/Lateral versus Lateral
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Positioning the beam head
Parallel Technique Bisecting Angle
(Vertical Angle)
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Positioning the beam head
Centering
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Film or Sensor Placement
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Bisecting Angle
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Positioning5 areas of the mouth
1- Mandibular PM and M2- Mandibular incisors/ canines3- Maxillary incisors4- Maxillary canines5- Maxillary PM and M
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Improper Beam Angle
Beam
Tooth
FORSHORTENING•If the beam is pointing too close to the film or sensor •We have a short shadow when the sun is at noon
fILm
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Improper Beam Angle
Beam
Tooth
ELONGATION•If the beam is pointing too close to the tooth root •We have a long shadow when the sun is going down
fILm
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Improper Beam AngleHORIZONTAL ANGLE
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Maxillary Incisors
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Maxillary CaninesPosition as Max incisors with a 20° lateral (Horizontal) tilt
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Maxillary Premolars/Molars
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Mandibular Premolars/Molars
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Mandibular Incisors/Canines
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Why we love cats
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Decreased Angle
•Instead of Beam head perpendicular to BA•Angle is decreased by 20 °•This purposefully elongates roots past Zygomatic Arch
Special view to Avoid the Zygomatic Arch
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Near Parallel
Special view to Avoid the Zygomatic Arch
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Simplified MethodRelies on approximation instead of measurements
Based on three basic angles:
45° Caudal maxillary teeth60 ° Rostral teeth (incisors)20 ° Horizontal tilt for Maxillary canines
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“Split the difference”
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Tooth Resorption
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High Vitamin DLow Specific GravityDogs
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Present in 65% of all catsTR1
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Present in 65% of all cats
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Present in 65% of all cats
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TR4b Root>crown
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Type II
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TR4bCrown >root
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TR5 aka “nubbin”
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TR 5
![Page 91: Veterinary Dentistry for Technicians](https://reader038.vdocuments.us/reader038/viewer/2022102805/555dbbb4d8b42a63328b55af/html5/thumbnails/91.jpg)
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![Page 93: Veterinary Dentistry for Technicians](https://reader038.vdocuments.us/reader038/viewer/2022102805/555dbbb4d8b42a63328b55af/html5/thumbnails/93.jpg)
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TR4A- crown and root equally affectedType II
![Page 98: Veterinary Dentistry for Technicians](https://reader038.vdocuments.us/reader038/viewer/2022102805/555dbbb4d8b42a63328b55af/html5/thumbnails/98.jpg)