Veterinary Dental Prophylaxis
Dental cleaning and dental prophylaxis (prophy) mean the same thing.
Both terms describe the process of preventive care for the mouth, teeth and gums that includes detailed examination, scaling (removal of plaque and calculus) and polishing.
In veterinary practice, the first step is preanesthesia laboratory testing. Pets must be anesthetized to have their teeth cleaned properly. Sharp instruments will be introduced under the gumline, just as in people, to remove the most important calculus. People are taught at an early age to be very still so that their gums are not inadvertently damaged. In pets, anesthesia must be used to invoke stillness.
Some veterinary hospitals perform the lab tests in-house, even on the same day as the procedure. Others may send the blood and urine samples to an outside “reference laboratory” for processing, which usually takes one or two days.
If test results are satisfactory then we may proceed to anesthesia. Veterinarians use many different protocols for induction and maintenance of anesthesia, too many to cover in this post. However, most pets will be kept in Stage 2, Plane 1 or 2. The lighter level would be used if no invasive procedures are planned, such as painful extractions. The deeper level is suitable for surgical incisions and most patients will feel no sensation at this level, even with difficult extractions.
Most veterinarians, veterinary dental technicians and certified veterinary technicians who clean teeth have a pattern and start on the same tooth each time, rotating around until all teeth have been properly treated. Personally, I like to begin with the tiny incisors at the very front of the mouth. Cleaning those teeth is very tedious and many older small breed dogs will require extractions there if proper daily home care is not practiced. Each tooth is evaluated for firmness of its fit in the bone of the jaw, for the amount of calculus present and sulcus depth. The pocket of space between the tooth and gum, called the sulcus, should be no deeper than three millimeters (mm). Each tooth is evaluated individually and notes are made on the medical record for abnormalities. Every tooth is scaled with hand instruments and/or ultrasonic scaler, removing plaque and calculus. I find that the ultrasonic scaler removes material faster and with less effort, which helps to shorten anesthesia time. Still, I go back over each tooth with a hand instrument because I can feel tiny bits of calculus the ultrasonic machine might leave behind.
It is difficult to determine which teeth might need removal or other additional treatment prior to scaling. Often pets’ teeth are covered with calculus, and problems are hidden from view.
The next step is polishing the teeth. While some recent research has questioned the value of the polishing process, we traditionalists still perform it, as does my own hygienist. Electron micrographs of teeth before and after polishing show a dramatic reduction in striations when the teeth have been polished. The smoother the tooth surface, the harder it is for new calculus to gain a foothold. Much more research needs to be performed before tooth polishing can be eliminated.
Prophy paste, the gritty material used to polish teeth, can include fluoride, which is a good preventive step for teeth.
Some dental problems require treatment beyond the equipment and capabilities of the general practitioner. We are fortunate that veterinary dentistry has become a boarded specialty and that advanced treatment is available to most parts of the country. Not far from us is Dr. Andy Duke of Mobile, AL, who handles all of the dental problems we cannot. We are extra-fortunate that he sees patients in his brother’s Ocean Springs office twice monthly, so most clients don’t have to drive far.
These are the basics of the dental prophy. Some veterinarians offer additional services aimed at preventive care, and these will be covered in future posts.
See you tomorrow, Dr. Randolph.