10 steps to scale like a pro

10 steps to scale like a pro

Polish your technique, client communication, record keeping to improve compliance

Proper professional dental prophylaxis is a must for every small animal practice. Prevention of periodontal disease can be accomplished only through regular professional care under general anesthesia. The following discussion details the essential steps in providing a thorough dental prophylaxis for our patients.

Step 1: client communication A complete physical and oral examination of all cooperative patients should be performed prior to anesthesia. Assuming no physical abnormalities exist that would preclude anesthesia, any oral findings that should be resolved or investigated during the anesthetic episode should be discussed with the pet owner, and estimates for possible diagnostics and treatments should be given. Complete oral evaluations under anesthesia many times reveal additional pathology requiring dental radiography and/or further treatment. Therefore, it is imperative that owners are available by phone during the procedure so that any abnormalities can be relayed to the owner and permission granted to approach these problems during the same anesthetic episode. Some of the more common examples include periodontal pockets 4 mm or deeper, feline odontoclastic resorptive lesions, caries, mobile teeth, masses, missing teeth and fractured teeth.

Step 2: Minimize patient and operator exposure Aerosolization is unavoidable with the use of mechanical scalers during dental prophylaxis, exposing both the staff and the patient to oral bacteria. Chlorhexidine solution may be used as a rinse prior to cleaning to decrease this factor and possibly diminish the degree of bacteremia. Protective glasses, gowns and face-masks reduce exposure as well and should be worn by the operator. Finally, proper insuflation of the endotracheal tube prevents aspiration of microbes by the patient.

Photo 1: The proper orientation of extraction forceps used to remove gross calculus.
Step 3: gross calculus removal Calculus removal forceps are used in cases with gross calculus accumulation. Small-breed extraction forceps also may be used for this purpose. One tip of the forcep is placed at the ridge of tartar that approximates the gingiva. The other tip is placed on the crown. Careful, controlled force is applied by leveraging the upper portion of the forcep toward the crown tip to fracture off the calculus mass (Photo 1). Care must be taken not to damage the tooth or the gingiva. The mouth may again be rinsed with chlorhexidine at this point.

Step 4: Supragingival (above the gum) calculus removal Hand scaling is a viable technique for removal of supragingival calculus. Scalers have two cutting edges and a pointed tip and are intended only for supragingival use. Curettes also may be used.

Photo 2: Improper orientation of a mechanical scaler tip.
Mechanical scalers are used more commonly now because they are quicker than hand scaling and produce similar results. Sonic, ultrasonic and piezoelectric mechanical units are widely accepted for supragingival and subgingival scaling and have many similarities. One important difference is the active portion of the working end of the instrument. Ultrasonic instruments are active throughout the entire working portion of the instrument with slightly more power toward the tip of the instrument. With piezoelectric units, most the active portion of the instrument is on the sides (at the 3 o'clock and 9 o'clock positions). These differences determine the most efficient contact point of the instrument and the tooth. Keep in mind that the tip should never be directed at the tooth surface (Photo 2).

A feather touch is used with sonic and mechanical scalers. This avoids damage to the enamel. Although some micropitting occurs even with a light touch, the polishing step will help eliminate this. The tip should not be left in contact with the tooth for more than 15 seconds. Make sure that water is constantly bathing the tip to avoid potential thermal damage to the pulp. All tooth surfaces should be cleaned thoroughly with a sweeping or painting motion using the most active portions of the instrument.

It should be noted that studies have shown that rotopro burs used on high-speed handpieces can cause considerable damage to the tooth and should not be used for dental prophylaxis.