descale or send home

RE: descale or send home

Linda Filshie — Sat, 12 Aug 2017 19:58:08 GMT

I had a greyhound patient with the most beautiful teeth - the owner used a cheap human electric toothbrush.

Now that I've written that I'm half tempted to try one with my own pooch, though we get on pretty well with a Sainsbury's kid's toothbrush with a cute penguin belly and a handy sucker to stick it next to the sink. Never got on too well with the "veterinary" toothbrushes...

RE: descale or send home

Rob Davis — Sat, 12 Aug 2017 17:01:16 GMT

[quote user="Anthony Todd"]Can you use an electric one on dogs??[/quote]

Yes, though sensible to train them with a normal one first. There are some electric ones designed for dogs:

RE: descale or send home

Anthony Todd — Sat, 12 Aug 2017 16:55:07 GMT

[quote user="Rob Davis"]Is this any better?[/quote]

Much,! never thought it through.... Can you use an electric one on dogs??

RE: descale or send home

Anthony Todd — Sat, 12 Aug 2017 16:52:52 GMT

[quote user="Rob Davis"]What do you use.... you do know that toothbrushes are the ones with long handles next to the toothpaste....?[/quote]

OH NO!

I've been using the long handled one just by the loo on the floor which is perhaps why the gingival sulky was inpenetrable, and I seemed to use a lot of paste.

So much to learn, so little time left.....

RE: descale or send home

Rob Davis — Sat, 12 Aug 2017 15:30:00 GMT

Is this any better?

RE: descale or send home

Rob Davis — Sat, 12 Aug 2017 15:25:36 GMT

[quote user="Anthony Todd"]

That's nothing like the toothbrushes I've ever seen......??

[/quote]

What do you use.... you do know that toothbrushes are the ones with long handles next to the toothpaste....?

RE: descale or send home

Anthony Todd — Sat, 12 Aug 2017 14:23:38 GMT

That's nothing like the toothbrushes I've ever seen......??

RE: descale or send home

Rob Davis — Sat, 12 Aug 2017 11:03:28 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]The gingival sulcus [/quote]

Just another question [personal as well as veterinary]

If plaque and calculus starts in the gingival sulcus I doubt if any brushing, unless with the bristles parallel to the tooth side are going to get into the GS.

Most electric toothbrushes for humans have bristles which hardly bend at all, so won't get near the GS either.

So one has to brush "vertically" not "horizontally"?

Sounds like there is scope for a new design if the GS is the vital area to brush?

[/quote]

45^o

RE: descale or send home

Anthony Todd — Sat, 12 Aug 2017 10:39:35 GMT

[quote user="Evelyn Barbour-Hill"]The gingival sulcus [/quote]

Just another question [personal as well as veterinary]

If plaque and calculus starts in the gingival sulcus I doubt if any brushing, unless with the bristles parallel to the tooth side are going to get into the GS.

Most electric toothbrushes for humans have bristles which hardly bend at all, so won't get near the GS either.

So one has to brush "vertically" not "horizontally"?

Sounds like there is scope for a new design if the GS is the vital area to brush?

RE: descale or send home

Rob Davis — Sat, 12 Aug 2017 09:18:51 GMT

[quote user="Evelyn Barbour-Hill"]Oh gawd I shouldn't do this, I really shouldn't, I'm just asking for trouble....[/quote]

Thank you, Evelyn. I didn't have the energy to compose a reply last night, and was intending to do so this morning, but you've already said it much more succinctly and eloquently than I could have managed.

[quote user="Anthony Todd"]

Thanks, I didn't realise that the subgingival plaque was the place it all starts

Succinct and clear, even to me, so probably bleedin' obvious to all other readers.

[/quote]

I'm not sure why this deserved one star, I've given you five to make up for it.

[quote user="Anthony Todd"]I must say I'd be really surprised if anyone cleaning their animal's teeth. and probably their own, would be able to prevent your scenario occurring, particularly in the early stages.[/quote]

The human dental profession has spent decades shifting it's focus to prevention. As Evelyn has said, disruption of the plaque is the key, and human dental health has improved massively as a result, which is in itself evidence that disruption of sub gingival plaque is achievable with brushing etc.

A large number of dog owners are perfectly capable of performing useful and effective homeware with the right instruction. Training is key. It will never be perfect (even people who brush diligently twice daily still often need to visit the hygienist periodically to clean up the areas they are missing) but it can make a significant difference to the progression of periodontal disease in our patients.

Not everybody will be prepared to make the effort, and not all dogs will accept it (though I believe most will especially if started at an early age), but that doesn't mean that we shouldn't try to teach owners to do it.

Cats, I will concede, are more difficult...

RE: descale or send home

Anthony Todd — Fri, 11 Aug 2017 20:06:55 GMT

[quote user="Evelyn Barbour-Hill"]Oh gawd I shouldn't do this, I really shouldn't, I'm just asking for trouble[/quote]

Thanks, I didn't realise that the subgingival plaque was the place it all starts and I must say I'd be really surprised if anyone cleaning their animal's teeth. and probably their own, would be able to prevent your scenario occurring, particularly in the early stages.

Succinct and clear, even to me, so probably bleedin' obvious to all other readers.

RE: descale or send home

Evelyn Barbour-Hill — Fri, 11 Aug 2017 17:58:09 GMT

[quote user="Anthony Todd"]

You think it's possible for an owner to brush below the gum margin???

Doubt if many humans can do that consistently?

[/quote]

Most do. Probably without realising it. Some don't. Then they get periodontal disease.Which is why dental hygienists sometimes have to teach people how to brush.

[quote user="Anthony Todd"]

[quote user="Rob Davis"]I'm afraid this can't be answered in a single sentence. Without wishing to sound patronising, a basic understanding of the aetiology of periodontal disease will answer these questions for you. [/quote]

Without wishing to sound patronising, it sounds to me as if you haven't got the answer since I assumed that you would have this basic understanding and could explain it to me, particularly the "crevasse between the gum and the tooth", the one that's probed and is forming plaque in 20 minutes.

[/quote]

The gingival sulcus is the phrase you're looking for, Mr. Todd.

Jeez, Anthony, it's not going to be a two-sentence answer when you are starting from a low level of knowledge. A one-day course or a couple of textbook chapters should tell you all you wish to know.

Oh gawd I shouldn't do this, I really shouldn't, I'm just asking for trouble.... but I'll try to give you a quick summary that's not too unscientific. Plaque constantly forms on the teeth. Plaque is a complex biofilm with its own private ecology. As plaque forms against the little subgingival strip of tooth, where it is protected a little from abrasion and saliva, it may and commonly will get thicker and thicker, unless it is disturbed. In the depths of this little world the proportions of the populations of different bacteria change, and anaerobes, aggressive and toxin-producing species become dominant. Inflammation begins. There's a complex interaction between the bacteria and the things that happen in the tissues. The gum attachment to tooth breaks down a little, which makes a deeper "crevasse" which is a nicer place for the plaque to get even thicker. And so it goes on. When inflammation gets within a certain distancve of the bone of the alveolar crest, the bone begins to resorb. Thus support is lost and the process goes on faster....

The object of what we do is not to prevent plaque forming, it's to keep disturbing, removing, stirring up and generally annoying the plaque so that it never gets a chance to get thick and mature.

RE: descale or send home

Anthony Todd — Fri, 11 Aug 2017 16:17:00 GMT

[quote user="Rob Davis"]What were you trying to treat? What "results" were you expecting? If all you're looking at is how grubby the crowns look, then scraping off the calculus will certainly improve the appearance. The point is that this is pretty irrelevant as far as oral health is concerned.[/quote]

We removed plaque [for 20 minutes?] and calculus which seemed to allow the ulcerated gum beneath to heal.

Er. so what is "relevant" to oral health if an ultrasound scrape and rotary brush polish isn't.

[quote user="Rob Davis"]By brushing correctly, same as with ourselves.[/quote]

You think it's possible for an owner to brush below the gum margin???

Doubt if many humans can do that consistently?

RE: descale or send home

David Mills — Fri, 11 Aug 2017 16:14:02 GMT

How many vets brush their own dogs' teeth?

RE: descale or send home

Evelyn Barbour-Hill — Fri, 11 Aug 2017 16:04:02 GMT

[quote user="Anthony Todd"]As an aside, do you think "dental" dried food has any merit?[/quote]

Not an awful lot. Depends on which one and what it actually does – they are not all the same. May be moderately useful as an addition to other oral hygiene measures.

[quote user="Anthony Dennison"]Almost 17 year old mini dachshund, doddery little guy with a lot of tartar, halitosis etc. Quite advanced periodontal disease. I scaled and polished his teeth 2 years ago along with multiple extractions. Would you put this dog through another GA to sort his mouth out considering the age?[/quote]

Yes, if no definite contra-indications.

RE: descale or send home

Anthony Dennison — Fri, 11 Aug 2017 15:59:46 GMT

As a slight tangent to this, a case I saw this afternoon:

Almost 17 year old mini dachshund, doddery little guy with a lot of tartar, halitosis etc. Quite advanced periodontal disease. I scaled and polished his teeth 2 years ago along with multiple extractions. Would you put this dog through another GA to sort his mouth out considering the age?

RE: descale or send home

Evelyn Barbour-Hill — Fri, 11 Aug 2017 15:59:43 GMT

[quote user="Dermod Malley"]

[quote user="Evelyn Barbour-Hill"]Take periodontal disease: how can you define when the condition "began"?[/quote]

In my time, only dental specialists could answer this. As you ask the question, Evelyn, I assume you specialists still can't. I gave metronidazole, "just in case".............

[/quote]

I meant for the rather simple-minded insurance company interpretation. If you've got a hefty periodontitis, the condition began years ago with the first plaque accumulation in gingival sulcus. Very probably before insurance was taken out and highly unlikely to have been declared, even if detected, when insurance was renewed.

Yeah, long long ago I used to "scale and polish" and I used to give Stomorgyl or clindamycin or other stuff. Makes me cringe now. Embarrassing, but we didn't know any better.

[quote user="Dermod Malley"]

[quote user="Evelyn Barbour-Hill"]And how do you separate the cost of the cosmetic stuff from that of the therapeutic stuff?[/quote]

From your previous posting, I assume the answer must be: cosmetic lies above the gum line; therapeutic, below??

[/quote]

Roughly speaking, yes, but how would an insurance company apportion your time, anaesthetic charges, and so on and so on? And then of the "therapeutic" what proportion is therapeutic and what proportion is preventative?

I don't want this tangent to go on and on, but I do think it is reasonable for insurance to exclude anything dental unless due to trauma – unless you want the premiums to be even higher.

[quote user="Dermod Malley"]

[quote user="Evelyn Barbour-Hill"]Does the veterinary surgeon of the "needs a scale and polish" brigade actually understand that what he was doing was largely cosmetic and of little benefit to the patient's health?[/quote]

If s/he attended CPD courses that emphasised attention to below the gum line, s/he learned how to do it therapeutically

[/quote]

Sure, and assuming he kept that learning and did not have it influenced out again by a senior partner, he would not be of the "needs a scale and polish" brigade.

RE: descale or send home

Rob Davis — Fri, 11 Aug 2017 15:39:22 GMT

Mark Rowland - is there any follow up to this, or is it just a tease to get debate going....?

RE: descale or send home

Rob Davis — Fri, 11 Aug 2017 14:38:18 GMT

[quote user="Anthony Todd"]

All the dinovets [except any enlightened ones?] "did a dental" as necessary, back in the day and, AFAIK, never probed or treated the gum/ tooth crevasse [can't remember the name].

The results always seemed satisfactory judging mainly by the owners' reports and subsequent inspections at boosters, but obviously we never "measured" the results at all, nor the intervals between these derided "dentals".

[/quote]

What were you trying to treat? What "results" were you expecting? If all you're looking at is how grubby the crowns look, then scraping off the calculus will certainly improve the appearance. The point is that this is pretty irrelevant as far as oral health is concerned.

[quote user="Anthony Todd"]Have you any evidence, that modern thorough probing etc. as you describe, prolongs the interval between procedures and actually improves oral health significantly if, as you say, plaque reforms within an hour?[/quote]

I'm afraid this can't be answered in a single sentence. Without wishing to sound patronising, a basic understanding of the aetiology of periodontal disease will answer these questions for you.

[quote user="Anthony Todd"]And how can an owner remove plaque which is below the gum margin?[/quote]

By brushing correctly, same as with ourselves.

[quote user="Anthony Todd"]As an aside, do you think "dental" dried food has any merit?[/quote]

Personally I think probably not much. Some with the VOHC seal of approval have evidence for the reduction of supra-gingival plaque and/or calculus, but, as previously pointed out, is of limited value. I'm not convinced they do very much for subgingival plaque and hence for oral health.

RE: descale or send home

Anthony Dennison — Fri, 11 Aug 2017 12:50:27 GMT

[quote user="Evelyn Barbour-Hill"]Most (all?) insurers exclude anything dental unless it's due to trauma. I'm no lover of insurance companies, but that particular one seems quite reasonable to me.[/quote]

I've had a client who successfully claimed for dentals on their two pugs. I even put 'periodontal disease' as the condition we were claiming for! I told them that it was highly unlikely they would pay out, but they still went for it and got it.

That was with More Than.

RE: descale or send home

Dermod Malley — Fri, 11 Aug 2017 08:36:01 GMT

[quote user="Evelyn Barbour-Hill"]Take periodontal disease: how can you define when the condition "began"?[/quote]

In my time, only dental specialists could answer this. As you ask the question, Evelyn, I assume you specialists still can't. I gave metronidazole, "just in case".............

[quote user="Evelyn Barbour-Hill"]And how do you separate the cost of the cosmetic stuff from that of the therapeutic stuff?[/quote]

From your previous posting, I assume the answer must be: cosmetic lies above the gum line; therapeutic, below??

If s/he attended CPD courses that emphasised attention to below the gum line, s/he learned how to do it therapeutically

RE: descale or send home

Anthony Todd — Fri, 11 Aug 2017 00:03:11 GMT

All the dinovets [except any enlightened ones?] "did a dental" as necessary, back in the day and, AFAIK, never probed or treated the gum/ tooth crevasse [can't remember the name].

Have you any evidence, that modern thorough probing etc. as you describe, prolongs the interval between procedures and actually improves oral health significantly if, as you say, plaque reforms within an hour?

And how can an owner remove plaque which is below the gum margin?

As an aside, do you think "dental" dried food has any merit?

RE: descale or send home

Evelyn Barbour-Hill — Thu, 10 Aug 2017 22:54:48 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Dermod Malley"]If you encourage owners to try brushing teeth with plaque on them, don't you risk them being too abrasive [/quote]

[/quote]

[quote user="Dermod Malley"]Sorry, slip of the finger - for "plaque" read "tartar".[/quote]

Ah. No, I don't think there's any risk of them being too abrasive, especially if you've demonstrated what to do and how to do it. (Which, of course, you have done, haven't you?)

[quote user="Dermod Malley"]Are insurers still "difficult" over claims for "dentals"?[/quote]

Most (all?) insurers exclude anything dental unless it's due to trauma. I'm no lover of insurance companies, but that particular one seems quite reasonable to me. Take periodontal disease: how can you define when the condition "began"? Did you declare when taking out the insurance that the mouth showed no gingivitis whatsoever? And how do you separate the cost of the cosmetic stuff from that of the therapeutic stuff? Does the veterinary surgeon of the "needs a scale and polish" brigade actually understand that what he was doing was largely cosmetic and of little benefit to the patient's health?

RE: descale or send home

Bob Russell — Thu, 10 Aug 2017 13:47:45 GMT

Not difficult. It is very easy for them to say No!

Traumatic damage tends to be an easy claim, no different to a fracture. Scale and polish is a non-starter for most policies.

RE: descale or send home

Dermod Malley — Thu, 10 Aug 2017 13:24:44 GMT

Re "Descaling above the gum line is not a therapeutic procedure. It is mostly cosmetic"

As I have said before, when I was practising, we had some difficulties convincing insurers that we were not performing cosmetic procedures when we put in claims for "dentals". This comment of Evelyn's seems provide the basis to define the difference between a cosmetic and a medical/surgical procedure. Are insurers still "difficult" over claims for "dentals"?