10 steps to scale like a pro
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.
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.
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.