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**The following has been borrowed from a handout written by Dr. Brook Niemiec, Southern California Veterinary Dental Specialties

Dental Prophylaxis

Dental "cleanings" are performed almost every day in every veterinary practice in America.  Most people understand the need for proper dental care and take care of their own teeth (after every meal).  Additionally, we visit our dental hygienist every six months for dental care.  But what actually goes on when our beloved pet has its teeth cleaned?  I think many of you will be quiet surprised by everything that happens during a dental prophylaxis.  Before we start, think back to the last time you had your teeth cleaned, how long it took, and everything that happened.

First, the proper name is prophylaxis, not cleaning.  Cleaning the teeth is only a small part of the process.  The word prophylaxis means prevention, in this case the prevention of dental disease.  There are numerous steps that are included in a thorough dental prophylaxis.

Before the prophylaxis can begin, the veterinary patient must be placed under general anesthetic.  This will greatly increase patient comfort and effectiveness of cleaning.  Every pet owner is concerned about the risk of anesthesia.  The combination of new and improved anesthetic medication, the proliferation of quality of monitoring equipment, increase in the availability of continuing education training among veterinarians and support staff, and availability of pre-operative blood testing and other database information to evaluate for pre-existing conditions has markedly decreased that risk. 

Placing the patient under anesthesia not only increases the comfort and quality of cleaning, it also allows us to place an endotracheal tube to protect the patients' airways and lungs under anesthesia.  Dental calculus (tarter) has over 300 million bacteria per gram, and if any gets into the lungs it could result in pneumonia.

THE THOROUGH DENTAL PROPHYLAXIS

Step 1.  Supragingival scaling:  This is cleaning the area of the tooth above the gumline.  It is the removal of mineral deposits on the crowns of the teeth.  In our pets, it is usually accomplished by mechanical scalers.  This increases the speed that the cleaning can be performed, which decreases anesthetic time.  This step cleans the surface of the teeth and affords a nice, cosmetic look, but is of little to no true medicinal value.

Step 2. Subgingival scaling and curettage:  This is the removal of bacterial plaque and mineral deposits beneath the gumline.  In our animal patients, this is the most important step.  The subgingival plaque will initiate inflammation, which is the cause of periodontal disease.  This is the most common ailment diagnosed in ALL animal patients examined by veterinarians.  The infection is also the cause of oral malodor (bad breath) associated with the disease process.  This step is usually accomplished by gentle hand scaling with a sharp and delicate curette.

Step 3.  Polishing:  The mechanical removal of the bacteria-laden plaque (soft deposits) and calculus (hard deposits) causes microscopic roughening of the tooth surface.  This roughening increases the retentive ability of the tooth for plaque and calculus, which will further the progression of the periodontal disease and loss of tooth supporting bone.  Polishing will smooth the surface and decrease the adhesive ability of plaque, which increases the interval between prophylaxis appointments.

Step 4:  Sulcal Lavage:  the scaling, curettage and polishing will cause a lot of debris (calculus, loosened fibrotic tissue and polishing paste) to become trapped beneath the gums.  This trapped debris will cause local inflammation, and hasten the onset, or recurrence of, periodontal disease.  For this reason we gently flush the crevice between the gums and the teeth. 

Step 5:  Fluoride treatment:  The benefits of fluoride are that it is reported to harden the enamel, decreases tooth sensitivity, and is antibacterial.  This step is most critical in young dogs and cats as well as those patients with exposed root surfaces.

Step 6:  Treatment planning:  This step is where the teeth and entire oral cavity are evaluated.  This step is accomplished using a periodontal probe as well as possibly dental radiographs to determine if there is periodontal attachment loss (a pocket) or tooth defects.  There are quite commonly significant problems that cannot be visualized or otherwise detected without the use of general anesthesia.  The periodontal probe can ferret out these "camouflaged" danger areas.  The most common place for these pockets is on the inside of the upper canine and around the back of the mouth.  These are areas that cannot be evaluated effectively with an awake patient.

Step 7:  Dental Charting:  The pertinent oral findings and treatment rendered is placed on the dental chart in the patient's permanent medical record.  This will allow the health care professional to follow the patient's progress (or regression) through the years.

Finally, dental radiographs may be taken to determine the extent of the disease process present.  Using all of the modalities, a plan is developed (with the owner's input and approval) to reestablish the patient's oral health.

These are the steps that veterinarians follow to ensure that the patient leaves with a totally clean mouth.

Recently, anesthetic free cleanings in grooming salons and at home have become very popular.  The reasons for this popularity are obvious:  it is apparently cheaper, faster and safer.  However, is it effective?  We will let you decide.  Again, think to your last dental cleaning.  When the dentist of hygienist was cleaning your teeth, was it completely comfortable?  Of course not, why are many of us afraid of the dentist?  We have to sit there for a long time with our mouth open while someone scrapes our teeth and curettes below our gums.  Remember also, dogs have 42 teeth, we only have 28.  In addition, many dogs' teeth are much larger than ours.

You should know also, that these anesthesia free cleaning procedures are not completely safe.  There are confirmed cases of fatalities as well as broken necks during anesthesia free cleanings.  In the state of California these cleanings are ILLEGAL if done outside a veterinary office.  And, remember, just because teeth look clean, it does not mean that there is no disease present.  "Anesthesia free" cleanings are NOT a substitute for a thorough dental prophylaxis.

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