Dental Advice Please

Re: Dental Advice Please

John Flynn — Sun, 27 Oct 2013 08:16:06 GMT

[quote user="Rob Davis"]If you mean the ones with the rubbery protrusions instead of bristles then I think they're fairly useless. The knobbly bits are too wide to fit into the sulcus, so will do nothing for subgingival plaque which is what you are aiming to remove.[/quote]

Duly noted!

Re: Dental Advice Please

John Flynn — Sun, 27 Oct 2013 08:14:36 GMT

[quote user="Evelyn Barbour-Hill"]Well, anything to chew has got to be good and I thought the waxy science stuff sounded a fair hypothesis. Jolly expensive though. Rawhide chews are the business.[/quote]

Thanks!

Re: Dental Advice Please

David Mills — Sat, 26 Oct 2013 23:25:10 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="David Mills"]

I'm looking to update some of our dental instrumentation, but having worked in mainly charity places, the instruments I've used are usually so well-used that there are few identifying labels or names on them.

What brand would people recommend for a basic dental kit? They all look shiny and new to me, but I'd like to know how people have found working with the various brands.

Basic as in extractions mainly.

Not too expensive.

[/quote]

If you only get one set, the new Kruuse short-handle luxator set, no question.

If money runs to it, a set of Vet Inst stubby elevators as well.

Most extraction forceps they try to sell you are far too big, and you don't need all the fancy shapes either. Get what the dealers insist on calling "small breed" forceps. Spring loaded.

[/quote]

Thank you. Ordered (Kruuse).

Re: Dental Advice Please

Evelyn Barbour-Hill — Sat, 26 Oct 2013 21:32:41 GMT

[quote user="John Flynn"]

For adult dogs that won't accept brushing, do you think that Dentagen chews (http://dechra.co.uk/files//dechra/Downloads/Pharma/Datasheets/Dentagen%20Chews.pdf) are or any value? I've been stocking them as they have less calories than Dentastix and I thought the "science" sounded sounder, but don't really know if they are of any true dental hygiene value or not? (The rep promised me 5 years ago that the only reason they didn't appear on the VOHC website was because their application was pending... and I believed him )

[/quote]

Well, anything to chew has got to be good and I thought the waxy science stuff sounded a fair hypothesis. Jolly expensive though. Rawhide chews are the business.

Re: Dental Advice Please

Rob Davis — Sat, 26 Oct 2013 21:28:53 GMT

[quote user="John Flynn"]I often recommend the finger brushes when starting with an adult dog not used to the procedure, what do others think of these?[/quote]

If you mean the ones with the rubbery protrusions instead of bristles then I think they're fairly useless. The knobbly bits are too wide to fit into the sulcus, so will do nothing for subgingival plaque which is what you are aiming to remove. If somebody knows of a finger brush with proper bristles that would be great, but is suspect they would be difficult to manufacture without making them impossibly bulky.

Re: Dental Advice Please

Evelyn Barbour-Hill — Sat, 26 Oct 2013 21:26:46 GMT

[quote user="David Mills"]

What brand would people recommend for a basic dental kit? They all look shiny and new to me, but I'd like to know how people have found working with the various brands.

Basic as in extractions mainly.

Not too expensive.

[/quote]

If you only get one set, the new Kruuse short-handle luxator set, no question.

If money runs to it, a set of Vet Inst stubby elevators as well.

Most extraction forceps they try to sell you are far too big, and you don't need all the fancy shapes either. Get what the dealers insist on calling "small breed" forceps. Spring loaded.

Re: Dental Advice Please

David Mills — Sat, 26 Oct 2013 18:40:22 GMT

What brand would people recommend for a basic dental kit? They all look shiny and new to me, but I'd like to know how people have found working with the various brands.

Basic as in extractions mainly.

Not too expensive.

Re: Dental Advice Please

John Flynn — Sat, 26 Oct 2013 18:27:43 GMT

Re: Dental Advice Please

John Flynn — Sat, 26 Oct 2013 17:29:17 GMT

Does anyone have a link to a good youtube tutorial or similar on cleaning a dog's teeth or similar? I've been linking to http://www.youtube.com/watch?v=xPvaXJ-Ki3M which is pretty good and succinct, but I wonder if something with a little more practical advice might get a better take-up (I would say less than 5% of dog owners do any brushing, and most of those are once or twice a week at best)?

I'm mainly talking about adult dogs that already have periodontal disease etc...

This seems to be a pretty different training exercise than if a puppy. Does everyone recommend brushing at first puppy vaccine and encourage owners to train dogs for this long before have full set of adult teeth (even if not much brushing actually needed or occurring)? I find it takes me longer than I'd like to go through this in any detail (and therefore in practice I simply don't always, though obviously I can see it may save time and bother and dental disease later in life), and the local puppy training classes don't cover the topic.

I often recommend the finger brushes when starting with an adult dog not used to the procedure, what do others think of these?

Re: Dental Advice Please

Evelyn Barbour-Hill — Sat, 26 Oct 2013 15:04:13 GMT

[quote user="Mark Holmes"][quote user="Michael Woodhouse"]

As time goes on I find myself taking more teeth out. Bought the basic machine from Roots and some decent instruments.

I was getting frustrated by owners getting bored with good oral hygiene and me delaying a tooth removal for a year, because they clearly couldn't be bothered to look after them properly.

Now I can get them out much easier I do tend to jump for that............

(a dog doesn't need teeth. If presented with stinking teeth and exposed root my experience is the owners not going to continue with regular oral hygiene).

Sorry to be cynical.

[/quote] My experience too. Even the most dedicated owner lets it slip. They often attend first 3m check and then you see them again at a booster with stinking teeth again. To be fair as I know of no Vet or Nurse who cleans their dog's teeth it doesn't surprise me.

[/quote]

No need to apologise, nobody ever got poor through an excess of cynicism about owners.

Anyway, here we go yet again. Your approach is all very well, but what do you do about the numerous teeth that are suffering a little periodontitis but are nowhere near severely enough affected to warrant extraction? Clean 'em up and leave it at that? Might as well do nothing at all.

[quote user="Mark Holmes"]They often attend first 3m check and then you see them again at a booster with stinking teeth again. To be fair as I know of no Vet or Nurse who cleans their dog's teeth it doesn't surprise me.[/quote]

Try a bit harder?

Three months seems an awfully long interval.

Re: Dental Advice Please

Rob Davis — Sat, 26 Oct 2013 14:45:50 GMT

[quote user="Evelyn Barbour-Hill"]And never ever let anyone else use your instruments.[/quote]

This is probably the best piece of advice in the whole thread!

[quote user="Evelyn Barbour-Hill"]And I think somebody, was it Rob?, researched this quite recently.[/quote]

Yes, it was me, and yes I did promise to write you something for the BVDA journal, but I've put this on the backburner for a bit and am continuing to use film (really not much bother with Kodac rapid chemicals). Everybody you speak to will tell you that theirs is the best digital set up, much better than X, Y or Z, so I think getting them on trial is the only real way to tell them apart. Going digital is a considerably larger investment, and if your boss is reluctant to splash out on a dental x-ray machine, then I would aim low to start with. Persuade him/her to buy the machine, demonstrate how much more revenue it generates by improving your dental diagnosis and treatment. Once you have done this, it may be easier to talk him/her into investing in digital kit.

I forgot to say in my first post, definitely don't feel ashamed of asking such questions, definitely no need for the anon posting. By asking the questions you are demonstrating a much greater understanding of dentistry than a large number of vets...

Re: Dental Advice Please

Mark Holmes — Sat, 26 Oct 2013 07:28:51 GMT

[quote user="Michael Woodhouse"]

As time goes on I find myself taking more teeth out. Bought the basic machine from Roots and some decent instruments.

I was getting frustrated by owners getting bored with good oral hygiene and me delaying a tooth removal for a year, because they clearly couldn't be bothered to look after them properly.

Now I can get them out much easier I do tend to jump for that............

(a dog doesn't need teeth. If presented with stinking teeth and exposed root my experience is the owners not going to continue with regular oral hygiene).

Sorry to be cynical.

Re: Dental Advice Please

Michael Woodhouse — Fri, 25 Oct 2013 23:53:23 GMT

As time goes on I find myself taking more teeth out. Bought the basic machine from Roots and some decent instruments.

I was getting frustrated by owners getting bored with good oral hygiene and me delaying a tooth removal for a year, because they clearly couldn't be bothered to look after them properly.

Now I can get them out much easier I do tend to jump for that............

(a dog doesn't need teeth. If presented with stinking teeth and exposed root my experience is the owners not going to continue with regular oral hygiene).

Sorry to be cynical.

Re: Dental Advice Please

Evelyn Barbour-Hill — Fri, 25 Oct 2013 23:46:27 GMT

[quote user="Rob Davis"]Evelyn, would you suggest coronal amputation without radiography?[/quote]

Humm, yes, good point, but: with no radiography available: better to do a neat coronal amputation (which as I say should be a bit more than strict crown), than hack and dig about hoping to entirely remove a root which is (unbeknownst to you since you have no radiograph) thoroughly ankylosed and half resorbed anyway.

[quote user="Rob Davis"] The extremes (grade three furcation or mobility) need extracting,[/quote]

Even a grade 4 furcation lesion does not absolutely dictate extraction (although, yes, I know, nearly always it will); especially in greyhounds and lurchers even these can some times be kept, with dedicated oral hygiene.

[quote user="GrooveJet"]I also realised that you just can't force these teeth, especially not the feline ones. You've got to know what you're doing, have sharp tools and a little patience.[/quote]

And never ever let anyone else use your instruments.

If you break a lot of teeth it may be because of your own lack of experience (extraction is a skill and it has to be learnt through doing), and it may be because you are trying to use the crappy orrible tools that the practice provides.

[quote user="An On MRCVS"] Can anyone recommend a machine/system that offers a balance of low cost and good quality, and/or recommend suppliers?[/quote]

Talk to Roots?

And I think somebody, was it Rob?, researched this quite recently.

Re: Dental Advice Please

An On MRCVS — Fri, 25 Oct 2013 23:02:41 GMT

Thank you all for your advice and support - it has made me feel better about my shortcomings!

I am really keen to try and get a dental x-ray in the practice - I have spent a little time volunteering at a charity and even they have one! From my (very limited!) experience of dental x-ray, I would be keen for a digital system. Can anyone recommend a machine/system that offers a balance of low cost and good quality, and/or recommend suppliers?

Many thanks again :-)

Re: Dental Advice Please

Miriam Lodewyks — Fri, 25 Oct 2013 21:46:44 GMT

Hey anon, really no need to be embarrassed. If anything I'm impressed that you have the intelligence to recognise your shortcomings and are asking for help. Your specific questions indicate that you understand the gravitas of the decisions you're making and not just "bungling through". Most of your questions are conundrums even for those of us with some experience. As Evelyn so eloquently put it: " it all depends..."

What I can tell you is that until fairly recently dentals were the bane of my life. But then I went to a couple of CPD courses with practical sessions included (one canine and one feline) and hey presto! Armed with actual specific knowledge on tooth structure, tool usage and how to raise a proper gum-flap, I now feel so much more confident in my decision-making capabilities, even without x-ray. I also realised that you just can't force these teeth, especially not the feline ones. You've got to know what you're doing, have sharp tools and a little patience. It's magic when you finally suss it out though!

Good luck, and enjoy!

Re: Dental Advice Please

Rob Davis — Fri, 25 Oct 2013 19:58:35 GMT

I think Evelyn has probably answered this as well as possible. The extremes (grade three furcation or mobility) need extracting, but all the other factors Evelyn mentioned need to be considered in lower grade periodontitis. If you can persuade your boss to by a dental x-ray machine (it is a relatively low cost which will pay for itself in no time) this gives you an awful lot more information on which to base your decision making.

[quote user="Evelyn Barbour-Hill"]

[quote user="An On MRCVS"]- should (cats) teeth with resorptive lesions be removed or have crownectomy only?[/quote]

Remove if you can, but carry out coronectomy and slightly deeper removal of tooth substance if not, according to circumstance. Never ever leave bits of tooth protruding above gum level, nor protruding high even if just below gum level.

[/quote]

Evelyn, would you suggest coronal amputation without radiography?

Re: Dental Advice Please

Wren — Fri, 25 Oct 2013 16:48:12 GMT

Don't be embarrassed. I did quite a few years SA work before I switched to things with hooves and I'd never even heard of a furcation grade until today!

Re: Dental Advice Please

Evelyn Barbour-Hill — Wed, 23 Oct 2013 22:40:27 GMT

Hallo, Anon. Why anon? Dental tuition at some veterinary schools is lousy, and anyway as Francisco suggested, many veterinary surgeons frighteningly expert in other matters haven't got a clue either. At least you are thinking about it instead of taking the standard approach of "If it looks bad yark it out, otherwise clean it a bit and hope for the best, good revenue stream this".

I can answer your last question easily: yes, use lidocaine by all means.

All the questions about extraction decisions, I'm afraid, have the answer "It depends.........".. What you are really asking for is a coursein basic dentistry, followed by practical tuition....... which I don't think I can provide in a forum context.

(Maybe tomorrow morning I shall think again)

Let me try. And please please bear in mind that the decision to extract a tooth should be made in consideration of a) the individual tooth; b) its neighbours and occlusal partners ; c) the dentition as a whole; d) the age and overall health of the patient; e) what you are actually trying to achieve; f) your own expertise and skill; and, g) very very important, the owner's attitude toward continuing oral hygiene.

[quote user="An On MRCVS"]- does a tooth with grade 1 or 2 furcation but no mobility warrant only periodontal treatment and no extraction, even if root is exposed?[/quote]

Not usually, assuming you are capable of applying treatment and the owner will do oral hygiene.

[quote user="An On MRCVS"]- does a tooth with mobility but no furcation exposure warrant extraction?[/quote]

Probably, yes; maybe not.

[quote user="An On MRCVS"]- does mobility = extraction?[/quote]

No. Little dogs can have astonishingly mobile incisors, with reduced gingival width but nonetheless healthy gingiva at that level.

[quote user="An On MRCVS"]- does a tooth with deep pockets on the buccal aspect but not on the lingual aspect of the tooth require extraction?[/quote]

The aspect on which the loss of gingival attachment is present is not too relevant........... except that obviously the buccal aspect is easier to maintain clean. Also, if you are deciding on gingival surgery, this may be more pracctical on the buccal aspect.

[quote user="An On MRCVS"]- does tooth root exposure always indicate a requirement for extraction?[/quote]

Not at all, assuming you are capable of doing something about it and the owner is going to do oral hygiene.

[quote user="An On MRCVS"]- if a tooth root has become one with the bone, does that indicate that extraction should not be attempted?[/quote]

Well, clearly "extraction" is a physical impossibility, but "removal" can be done. But in a cat where the ankylosis is the result of FORL, probably removal of the entire remaining tooth substance is neither necessary nor wise.

[quote user="An On MRCVS"]- should (cats) teeth with resorptive lesions be removed or have crownectomy only?[/quote]

Re: Dental Advice Please

Francisco Gomez — Wed, 23 Oct 2013 21:41:10 GMT

Don't feel embarrassed. Yes, these are basic questions but you'd be surprise how many 2+ experienced vets don't know the answer to them. I wouldn't even post as Anon, but that's your decision obviously. I won't give specific answers as there are ppl in the forum much better than me to give them... * edit* most new grads need help with the technique IMO rather than the decision coz they keep breaking them!