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Dental
Homecare and Oral Hygiene
Bacterial
plaque is the center-point in the development of periodontitis.
Daily oral hygiene with the removal of plaque from all supragingival
sites as well as the gingival crevice is essential to attain
positive periodontal health.
The
ultimate control of periodontal disease does not lie in the
hands of the veterinary dentist, hygienist, veterinarian,
or technician but in the responsiveness of the client-pet
owner to excellent homecare. After the completion of a thorough
periodontal prophylaxis by the above named professional operators,
it is then the sole responsibility of these individuals to
educate and train the public in the core fundamentals of oral
hygiene.
The
triad of diagnosis, treatment, and prevention cannot be broken.
Any veterinary facility treating periodontal disease without
dental x-ray is missing greater than fifty percent of the
pathology that needs to be treated. Oral hygiene will not
be successful if the diagnosis is incomplete. Without dental
x-ray in the advanced periodontitis patient, homecare will
fall incomplete because essential operative treatments go
unacknowledged and become non-resolved pathology. (Reference:
An
Atlas of Veterinary Dental Radiology, DeForge
and Colmery Editors, Iowa State University Press-January 2000)
The
veterinarian cannot instruct the client about homecare if
their staff is not educated about its importance. That includes
professional, technical, para-technical, and ancillary support
staff. Continuing education for these individuals is paramount
if oral hygiene is to be understood and transmitted to the
pet-owning public seeking post-oral care consultation. No
patient should be discharged after any dental prophylaxis
without a dental report, a consultation with a doctor or trained
dental technician, and a full explanation of the importance
of the implementation of a specifically designed oral hygiene,
DAILY, homecare program. It is up to the veterinarian to choose
the correct product for the condition being treated. It is
the responsibility of the client to complete the treatment
once it is outlined by the doctor. It must be emphasized that
none of the below treatments will be successful without a
prior professional dental cleaning, probing, and site-specific
dental x-rays where indicated. To begin an oral hygiene program
without a completion of the diagnostic and treatment corners
of the dental triad will be meaningless.
Tools
of Oral Hygiene
1] Human
tooth brushes-Pediatric Soft
2[ Veterinary
Brushes
3] Finger
Gauze or Nylon Wraps
4] Finger
Cover Brushes
5] Periodontal
Microbrushes
6] Powerbrushes
It is
my opinion that unless the client has multiple moments of
free time to dedicate to oral hygiene that the implements
of brushing listed #1-5 above are completely useless. The
Ct. Dental Referral Service over a ten year period has completed
tracking of #1-5- traditional brushing methods and has found,
with compliance, only about 25% efficacy in plaque control.
That does not mean the system of hand brushing does not work.
It means that without time, dedication, and persistence it
fails or is incomplete. Handbrushing if overzealous can also
lead to gingival recession (i.e. receding gum-line). The most
common result is underbrushing with the accumulation of plaque
subgingivally and the acceleration of the cyclic periodontal
pathology.
The
Ct. Dental Referral Service has independently tested two powerbrush
systems in the treatment of periodontal disease and in the
maintenance of periodontal health post-crown placement. Optiva
Sonicare/TM and Oral B-3D Excel/TM. With these brushes, two
different technologies appear to accomplish the same result.
In the
first (Optiva Sonicare/TM),
the concept of rapid brush movement which produces low frequency
acoustic energy (LFAE) and streaming actually lifts and disperses
plaque from teeth. The fluid dynamic action created by the
brush leads to the removal of viable bacterial flora.
The
3D Excel/TM by Oral
B Braun uses an oscillation and pulsation system in their
electronic head to produce a similar purgation of offending
plaque bacteria.
Both
systems must be used daily to be effective and must be combined
with a professional periodic (i.e. 12-24 months apart) professional
"cleaning" of the teeth. This frequency assumes daily powerbrushing
of the patient for two minutes. In the advanced periodontitis
patient, it is very important to schedule supportive periodontal
care appointments and to never initiate powerbrushing without
the advice of your oral health care professional. Many oral
conditions in their acute phases can be exacerbated by any
brushing system until brought under control.
The
reason powerbrushing is ideal for veterinary patients is that
it is quick, efficient, and will not damage the oral tissues
if all of the manufacturer's guidelines are followed. Even
the toy breeds and the feline can be conditioned to accept
the powerbrush. The brush should never be activated until
seated in the mouth under the lip to eliminate fear of the
low pitch sound created by the system. The patient must then
be conditioned to the brush by using it without power for
two weeks and then for only a few seconds at a time. In many
reward is important after brushing. The full potential of
power brushing will not be reached until a time period of
two minutes for brushing all arcades can be reached. Try to
work on the outside of the teeth where the gums meet the tooth.
Do not put pressure on the brush and do not push or thrust
the brush in any motion (i.e. circular or diagonal) as done
with a manual brush. Gently holding the brush at the gum tooth
margin will accomplish the desired effect and control plaque
accumulation supragingivally and subgingivally until your
next professional appointment. Do not get fooled by "copy-cat"
systems or inexpensive electric tooth brushes. The technology
with powerbrushes is superior and saving cost will only lead
to failure in the control of periodontal pathogens. Consult
with your veterinarian or your veterinary dentist if you are
going to purchase a substitute unit. Remember this is reasonable
new technology and your veterinarian may not be comfortable
in advising on such a purchase. Have them visit this website
and review the information herein.
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