
Dental Prophy

Dental Prophy - showing the steps involved in a complete dental prophy

An in depth knowledge of dentistry, medicine and surgery is needed to do a competent job of dentistry. The necessary equipment is also needed. At Little Mountain Veterinary Clinic Ltd the veterinarian does all work below the gum line. The veterinary technician is trained to scale and polish the teeth. The patient has a veterinary assistant or technician monitoring the anesthetic throughout the procedure. This affects the outcome of the anesthetic significantly. The term 'dental prophy' is a very confusing. When people think of the 'prophy' they think of the teeth clean people have when they go to see their dentist. This is far from reality in the veterinary world. In veterinary medicine the majority of patients have varying degrees of advanced dental disease. The most common type of dental disease is periodontal disease. This is a slow progressive disease that leads to chronic infection within the mouth, around the teeth and causes halitosis (bad breathe). When people think of 'doggie breathe' this is actually decaying teeth. The patient becomes used to the discomfort and continues to eat because if he or she stops eating, well then he or she would not have one problem but two problems...pain AND hunger. It is only when the pain is excruciating and the pet can no longer hide the pain that the owner will realize something is amiss and will seek help from the veterinarian. Putting these patients on antibiotics is not the answer - this is like putting your finger in a dyke - once the antibiotics removed the problem recurs. It also contributes to the development of antibiotic resistant which is a health concern.
	The first important step to a comprehensive oral health assessment and treatment (COHAT) is a complete physical exam. The veterinarian needs to know the physical health of the pet. If there are health concerns such as heart or kidney disease these need to be known before anesthesia.
All patients undergoing anesthesia should have blood and urine testing. If a pet has evidence of heart disease during the exam a heart work up needs to be done. What is found on physical exam will vary from patient to patient. Once the physical exam and tests have been done and have been found to be acceptable for safe anesthesia, we make an appointment to admit the pet. The COHAT is a day procedure. The pet can go home at night. It is the FIRST step to treating the teeth and improving the oral health of the pet.
	Based on the exam and test results the anesthetic protocol is determined. On the day of the COHAT, the pet is rechecked to make sure there are no changes since the last exam and if all is well, the pet is sedated.
	When the pet is drowsy an intravenous catheter and intravenous line is put in place and the injectable anesthetic is given.
	All patients undergoing a COHAT must have an endotracheal tube placed in the trachea - this protects the lungs during anesthesia. If the pet vomits while asleep this tube stops any material getting into the lungs. If this happens a serious pneumonia will develop. The technician is on the alert for this possibility and is trained to take the necessary step to clear the air passages if this rare event occurs. Steps are taken to prevent this occurance during the anesthetic episode. Please do not feed your pet before an anesthetic procedure.
	The anesthetic is monitored by a veterinary assistant throughout the procedure. Monitors are also used. Throughout the procedure the vital signs of the patient are recorded in the patient's anesthetic chart. This vigilance is necessary for the early detection of anesthetic problems. No monitor can replace a good anesthetic assistant. This is an essential of our anesthetic protocol and increases the cost of anesthesia to the client. This is a protocol that we cannot remove without great risk to the patient. Therefore it is not an option but, as with the blood tests and intravenous fluids, it is a mandatory part of the procedure.
	Before any cleaning takes place the status of the oral health is charted.
	The teeth are scaled by the assistant.
	The veterinarian curettes (scrapes away) plaque and tartar from under the gumline. She will record any pathology encountered during this step.
	Dental radiographs are taken of all teeth. For full mouth x-rays 6 to 20 views are taken. The number of intraoral radiographs needed is determined by the size the patient.
	The radiographs are evaluated by the veterinarian and a treatment plan is decided on based on the oral exam and the radiographic findings. If time allows some treatments may be performed. In some cases a second procedure is required.
	Post op x-rays are needed if any extractions or treatments are performed.
	After the dental cleaning and any dental treatments, the dental chart is updated.
	The teeth are polished with pumice and a low speed hand piece.
	The pockets are flushed to remove all debris.
	Fluoride is applied to the teeth.
	The patient is woken up in the presence of the anesthetic assistant. The patient records are also updated.

This procedure will usually take three quarters to one and a half hours and requires a minimum of 2 trained personnel at all times. This is the reason COHAT's are costly. If any corners are cut this will compromise patient care. For ways to keep the costs down by reducing the need for long procedures such as extractions which are the result of long standing periodontitis, please see Maintaining Good Oral Health. Avoiding regular COHAT is not an option. This is a mistake many people make and results in the loss of teeth in the long run. It is a mistake to think that by saving money in the short term the teeth will be unharmed. Periodontitis is a slow PROGRESSIVE disease.

46793 Yale Road East

Chilliwack, BC Canada V2P 2S5
Phone: 604-792-2844

Last updated 4/1/2007