At what point should we do a "dental"

RE: At what point should we do a "dental"

Rob Davis — Tue, 12 Apr 2016 12:23:23 GMT

Thank you

RE: At what point should we do a "dental"

Evelyn Barbour-Hill — Tue, 12 Apr 2016 11:56:54 GMT

[quote user="Rob Davis"]

[quote user="Evelyn Barbour-Hill"] (though the necessity for glassy smooothness now seems to be questionable)[/quote]

Can you elaborate on this bit?

[/quote]

Not really. I can't quote papers left right and centre but I understand that it's simply been shown to not be essential, as was once thought; so has the idea of opening the dentinal tubules, also once thought necessary to get re-attachment; the idea of "removing infected cementum" is now outdated, as the cementum is not actually infected. The emphasis now is all on eliminating the biofilm. One might well feel that all this makes very little difference to what one actually does in practical terms, of course!

RE: At what point should we do a "dental"

Rob Davis — Tue, 12 Apr 2016 10:19:11 GMT

[quote user="Evelyn Barbour-Hill"] (though the necessity for glassy smooothness now seems to be questionable)[/quote]

Can you elaborate on this bit?

RE: At what point should we do a "dental"

Kate Richardson — Mon, 11 Apr 2016 19:43:11 GMT

Thank you

RE: At what point should we do a "dental"

Evelyn Barbour-Hill — Mon, 11 Apr 2016 19:04:31 GMT

Well, techniques such as PBUD and rootplaning are designed to render the subgingival surface absolutely squeaky clean, and glassy smooth (though the necessity for glassy smooothness now seems to be questionable). Periodontal surgery techniques range from the relatively crude such as simply excising the pocket to 2mm deep, up to apically repositioned flaps with osteoplasty, all in various ways reducing or eliminating the pocket while, obviously, leaving the root more exposed. Then one might mention gingival grafting, on a pedicle or even free, with the aim of restoring some of the lost gingival depth...

RE: At what point should we do a "dental"

Kate Richardson — Mon, 11 Apr 2016 18:26:20 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Kate Richardson"] what exactly do these involve?[/quote]

A practical CPD course.....? Sorry, perhaps that was naughty, but I don't think Ican instruct you or anyone else in all the possible techniques within a forum post.

[/quote]

I shouldn't have used the word exactly! Just give me a hint!

Thank you

RE: At what point should we do a "dental"

Evelyn Barbour-Hill — Mon, 11 Apr 2016 18:09:30 GMT

[quote user="Kate Richardson"] what exactly do these involve?[/quote]

A practical CPD course.....? Sorry, perhaps that was naughty, but I don't think Ican instruct you or anyone else in all the possible techniques within a forum post.

An up to date textbook or two, purchase, read, mark, learn and inwardly digest, would be a good start.

[quote user="Kate Richardson"] so do local antibiotics/antiseptics eg chlorhexidine help with re-attachment?[/quote]

Chlorhexidine flushing both at the time of surgery and afterwards at home is all part of oral hygiene, and essential.

I don't think "local antibiotic" is applicable, especially now we can't get Doxirobe (which was rather over-rated anyway). There are one or two products for human dentistry that involve placing , for instance, threads impregnated with a tetracycline in the pocket, and removing a week later. I doubt if they have much applcation, if any, for veterinary use and they are horribly expensive.(And they still won't achieve anything without scrupulous oral hygiene).

RE: At what point should we do a "dental"

Kate Richardson — Mon, 11 Apr 2016 15:19:15 GMT

Thank you Evelyn Barbour-Hill

I used the term cleaning but to be honest, I meant scaling, can you give more detail or what else can be done- you mention [quote user="Evelyn Barbour-Hill"]periodontal bactericidal ultrasonic debridement (PBUD), there's root planing though that's pretty well obsolete now[/quote]

what exactly do these involve?

[quote user="Evelyn Barbour-Hill"]

[quote user="Kate Richardson"] do antibiotics help with any gingival reattachment in teeth where there is periodontal disease or is that a myth?[/quote]

Systemic antibiotic, you mean? Myth.

[/quote] so do local antibiotics/antiseptics eg chlorhexidine help with re-attachment?

Sorry for the questions, I am firmly in the no antibiotics camp, but I need to be able to back up my argument better!

RE: At what point should we do a "dental"

Evelyn Barbour-Hill — Mon, 11 Apr 2016 02:58:18 GMT

[quote user="Kate Richardson"]Can you site any papers to back up the not using antibiotics argument?[/quote]

Nope, sorry, I never have been one to remember references.

Mr. Southerden may be able to come along with some.

Can anybody cite a paper to back up the idea of loading up the antibiotics?

[quote user="Kate Richardson"] do they heal just as quick, even those horrible purulent mouths with loose teeth/advanced periodontal disease, simply by removing the tartar/plaque/rotten teeth including cleaning sub ginigivally-[/quote]

Yes, they do. And i'm glad you mentioned the subgingival work – which should really be a lot more than "cleaning", though "cleaning" is a good start – cos that's a really important bit.

[quote user="Kate Richardson"] do antibiotics help with any gingival reattachment in teeth where there is periodontal disease or is that a myth?[/quote]

Systemic antibiotic, you mean? Myth.

[quote user="Kate Richardson"]or should these teeth be extracted regardless if depth of pockets is greater than 2mm[/quote]

No of course not. 2, even 3mm, is quite normal in certain sites. And deeper pockets, no there's lots to be done other than extraction (fortunately, otherwise we'd all be extracting all day). There's periodontal bactericidal ultrasonic debridement (PBUD), there's root planing though that's pretty well obsolete now, there are various periodontal surgical procedures, and of course there's oral hygiene (which implies home care, obviously).

[quote user="Kate Richardson"]What situations should you use antibiotics?[/quote]

Not many! If you've made a pig's ear of an extraction, antibiotic might help save it from an alveolar osteitis ("dry socket"). If you have reason to suspect osteomyelitis, yes. If your patient is immunocompromised, or if it has recent orthopaedic implants, conventional opinion would advise an antibiotic.

[quote user="Kate Richardson"] Does gingival attachment ever occur[/quote]

Re-attachment? Yes.

[quote user="Kate Richardson"] We recently had a meeting to discuss antibiotic protocols/choices, and the consensus was to use antibiotics, starting preoperatively, in the really manky mouths.[/quote]

Sorry, the consensus was wrong.

This profession is still obsessed with the idea of "Bacteria present? It needs an antibiotic" (or indeed, "antibiotics" ).

RE: At what point should we do a "dental"

Kate Richardson — Sun, 10 Apr 2016 20:41:40 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Rob Davis"]Oral antibiotics will make no significant difference to periodontal disease, and are generally completely unnecessary. They will often temporarilly improved the halitosis, but do nothing for the underlying process.[/quote]

This cannot be repeated too often.

[/quote]

Can I just get some clarity on this. We recently had a meeting to discuss antibiotic protocols/choices, and the consensus was to use antibiotics, starting preoperatively, in the really manky mouths. Is there any evidence to show they heal quicker or it has any positive benefit at all, or do they heal just as quick, even those horrible purulent mouths with loose teeth/advanced periodontal disease, simply by removing the tartar/plaque/rotten teeth including cleaning sub ginigivally- do antibiotics help with any gingival reattachment in teeth where there is periodontal disease or is that a myth? Does gingival attachment ever occur or should these teeth be extracted regardless if depth of pockets is greater than 2mm or monitored plus home care (assuming ideal world situation of compliant animal/owner). To my mind, removing the focus of infection and allowing the animals own immune system to do the work seems the most logical. What situations should you use antibiotics?

Can you site any papers to back up the not using antibiotics argument?

Thanks in advance

RE: At what point should we do a "dental"

janine redman — Sun, 10 Apr 2016 10:02:31 GMT

I also find the over zealous use of the ultrasonic scaler can cause damage to the enamel and make further calculus more likely . My recommendations are also based on whether I think the owner is able to contnue with home dental care or some other dietary manipulation to maintain oral health

RE: At what point should we do a "dental"

Evelyn Barbour-Hill — Fri, 08 Apr 2016 16:59:22 GMT

This cannot be repeated too often.

[quote user="Mark Hedberg"]scale and polish is usually a shorter GA, isn't that good?[/quote]

Not if it's unnecessary........

(And, naughty I know, but I could not resist....[quote user="Mark Hedberg"]advanced decay is long, hard, nasty work to clean up,[/quote]

Tooth decay does not occur in the cat; it does occur regularly but not specially commonly, in certain teeth of the dog; and when it occurs it's not difficult to treat. )

RE: At what point should we do a "dental"

Rob Davis — Fri, 08 Apr 2016 16:02:41 GMT

[quote user="Anna Battek-Kosiorowska"] Plus with very bad periodontal disease I start antibiotics couple of days prior to the procedure so nurses question my sanity on the day. "It's not looking too bad"[/quote]

Oral antibiotics will make no significant difference to periodontal disease, and are generally completely unnecessary. They will often temporarilly improved the halitosis, but do nothing for the underlying process.

RE: At what point should we do a "dental"

Anna Battek-Kosiorowska — Fri, 08 Apr 2016 15:45:33 GMT

[quote user="Alet Engelbrecht"]

[quote user="Martin Atkinson"]PS why does gingivitis always look less severe than in the consult room when the patient is anaesthetised ?[/quote]

Peripheral vasoconstriction with GA? And hypostasis - Cedric Tutt showed us photos preGA and during GA - marked difference. So trust your gut when you booked it in!

[/quote]

It does make sense for sure. Plus with very bad periodontal disease I start antibiotics couple of days prior to the procedure so nurses question my sanity on the day. "It's not looking too bad"

RE: At what point should we do a "dental"

Alet Engelbrecht — Fri, 08 Apr 2016 15:36:49 GMT

[quote user="Martin Atkinson"]PS why does gingivitis always look less severe than in the consult room when the patient is anaesthetised ?[/quote]

Peripheral vasoconstriction with GA? And hypostasis - Cedric Tutt showed us photos preGA and during GA - marked difference. So trust your gut when you booked it in!

RE: At what point should we do a "dental"

Martin Atkinson — Fri, 08 Apr 2016 10:02:18 GMT

Back to the OP. We have a joke here when a cat dental procedure with just a bit of tartar and minimal gingivitis is started, 'must have been a quiet day when this was booked in'. I then carefully examine the mouth and find a FORL. This happens frequently with these 'quiet day dentals'. I can therefore happily justify performing a scale and polish on cats with minimal gingivitis.

PS why does gingivitis always look less severe than in the consult room when the patient is anaesthetised ?

RE: At what point should we do a "dental"

Gerry Henry — Fri, 08 Apr 2016 08:31:30 GMT

You've got qualifications - which means you're welcome. Admitting even 1 person without qualifications whilst there's even 1 benefit claimant less disabled than Stephen Hawkin in the entire country is sheer lunacy. This is definitely a tangent, so, if you want to reply, use the tangent icon.

Wynne

Wynne we are obviously identical twins separated at birth, 'less disabled than Stephen Hawkin' - brilliant

RE: At what point should we do a "dental"

Clare Tapsfield-Wright — Thu, 07 Apr 2016 18:40:02 GMT

[quote user="Rob Davis"]

[quote user="Clare Tapsfield-Wright"]Agreed , I think it's difficult to say a definite amount of tartar warrants a GA scale[/quote]

As Evelyn pointed out previously, calculus is largely irrelevent. It is not uncommon to get large amounts of calculus formation on teeth with relatively little periodontal disease and vice versa. I try to encourage people to look at the gingiva rather than the crowns to estimate periodontal health. Removing supragingival calculus is almost entirely cosmetic and unless you are addressing the subgingival areas then you are not likely to be benefitting the patient.

[quote user="Clare Tapsfield-Wright"]eg i wouldn't recommend a scale on a higher risk GA patient in an otherwise healthy mouth especially in breeds where you might end up doing it annually or even more frequently[/quote]

It could be argued that maintaining a high level of periodontal health in some "higher risk" patients is even more important. Bacteria from periodontal disease is probably more likely to colonise compromised heart valves, kidneys and liver than in totally healthy patients. Obviously all patients need to be assessed individually and benefits weighed up against risks, but I do get frustrated when many older patients with raging periodontitis are not treated because the anaesthetic is considered too risky. It is common when these patients come back for their post-dental check for their owners to comment on how they seem years younger since the procedure. Repeated bouts of bacteraemia and endotoxaemia every time these dogs chew anything can have a significant effect on their day to day wellbeing.

[/quote]

yes , agree entirely .

its tempting to take the original thread on a tangent since the thread has been hijacked

RE: At what point should we do a "dental"

Clive Ansell — Thu, 07 Apr 2016 18:28:25 GMT

[quote user="Anna Battek-Kosiorowska"]Oh poop, two kids here...No speed tickets and I'm defo NOT an NHS dentist. Which one is going to be cheaper for British taxpayers: death sentence or Rynair tickets for four? [/quote]

No you're not getting off that lightly. A fate worse, than a fate worse than death awaits you. You will be condemned to read the Daily Mail every day for the rest of your life!

RE: At what point should we do a "dental"

Rob Davis — Thu, 07 Apr 2016 18:02:09 GMT

[quote user="Clare Tapsfield-Wright"]Agreed , I think it's difficult to say a definite amount of tartar warrants a GA scale[/quote]

RE: At what point should we do a "dental"

Clare Tapsfield-Wright — Thu, 07 Apr 2016 17:16:39 GMT

[quote user="Mark Hedberg"]

The reason i recommend earlier rather than later is simply that advanced decay is long, hard, nasty work to clean up, and there's evidence that active dental disease causes reactive hepatitis - what else is it causing?

scale and polish is usually a shorter GA, isn't that good?

[/quote]

Agreed , I think it's difficult to say a definite amount of tartar warrants a GA scale as it depends on the circumstances eg i wouldn't recommend a scale on a higher risk GA patient in an otherwise healthy mouth especially in breeds where you might end up doing it annually or even more frequently. I would discuss the pros and cons with the owner as ultimately the decision and possible risks are theirs. I can understand the OP wanting to have all the vets singing from the same song sheet but think it's more complex than just the degree of tartar.

RE: At what point should we do a "dental"

Hannah Wynne Richards — Thu, 07 Apr 2016 17:02:59 GMT

Wynne

RE: At what point should we do a "dental"

Anna Battek-Kosiorowska — Thu, 07 Apr 2016 16:10:12 GMT

[quote user="Marie Kubiak"]

[quote user="Gillian Mostyn"]

[quote user="Marie Kubiak"]He came over from Poland[/quote]

So not only is he an evil thief, he's a bloody immigrant! Hope he didn't have more than 2 children or ever got a speeding ticker, or he could be facing the death sentence!

[/quote]

He had only two children (and we each only have one child so that's ok) but he has had not one but two speeding tickets. For shame.

[/quote]

Oh poop, two kids here...No speed tickets and I'm defo NOT an NHS dentist. Which one is going to be cheaper for British taxpayers: death sentence or Rynair tickets for four?

RE: At what point should we do a "dental"

Mark Hedberg — Wed, 06 Apr 2016 21:53:47 GMT

scale and polish is usually a shorter GA, isn't that good?

RE: At what point should we do a "dental"

Robin Grimmer — Wed, 06 Apr 2016 21:49:51 GMT

[quote user="Hannah Wynne Richards"]

Ditto Robin introduced the NHS when he compared our charges to those of NHS dentists.

Wynne

[/quote]

Don't blame it on me. I was just pointing out that low nhs dental charges mean clients don't realise the true cost of health care and think vets are too expensive. I didn't criticise the dentist. For the record my dentist is lovely!