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VETERINARY MEDICAL CENTER OF TURLOCK
TEETH CLEANING IS NOT ENOUGH!
Simply "cleaning the teeth" is not enough to prevent and control infection in the gums (gingivitis) and bones of the upper and lower jaw surrounding the tooth socket (periodontal disease). This infection is initiated by the formation of plaque. Plaque is a "biofilm" composed of bacteria, saliva and food particles that stick to the surface of the teeth. This process of plaque formation begins within hours, hence the reason for advocating brushing pets' teeth (and ours!) every day. In time, the plaque calcifies and hardens on the tooth surface to become tartar or calculus. In contrast to plaque, once tartar/calculus forms, it is virtually impossible to eliminate it by simply brushing the teeth.
The most important point to understand is that the gingivitis and periodontal disease is caused by the bacteria when it invades the gum tissues, and not directly by the tartar. The bacteria on the tooth crown (within the calculus) is much less important than plaque bacteria within the gum tissues and on the tooth roots. Suffice it to say that simply "cleaning the teeth" to remove calculus or tartar is largely cosmetic and does NOTHING for the overall oral health of your pet. It is also quite important to note that infection within the gum tissues (gingivitis) is REVERSIBLE, while infection that has spread from the gums into the surrounding bone and tooth socket is NOT REVERSIBLE. It is a huge understatement to say: Prevention is the key!!! Therefore, if we catch dental disease before the gingivitis spreads to true periodontal disease, we can save your pet a lot of oral pain and discomfort as well as many systemic problems that are associated with dental infections (e.g. kidney, liver, heart problems). Needless to say, your pocketbook will be spared as well!
At Veterinary Medical Center we do much more than clean teeth during a "dentistry." We perform a complete oral health assessment and treatment. This approach to dentistry is what sets us apart.
THE COMPLETE ORAL HEALTH ASSESSMENT AND TREATMENT: What is this and what does this mean?
NON-ANESTHETIC DENTAL PROCEDURES
Lastly, lets discuss DENTAL PROCEDURES WITHOUT ANESTHESIA: While no one wants anesthesia on themselves, nor their pets, dental procedures without anesthesia are impossible and considered malpractice. Why?
The most important parts of dental evaluation and treatment cannot be performed without anesthesia. This includes: close visual inspection of the teeth and mouth, periodontal probing, subgingival scaling (the most important part of the dental "cleaning"), xrays (the most important diagnostic step) and polishing to smooth the tooth surface. None of these parameters can be performed or evaluated without anesthesia in veterinary patients!!!!! Without periodontal probing and xrays, we're going to miss tooth problems 75% of the time. Without subgingival scaling, we're missing where ALL the gingivitis and periodontal disease begins. Without polishing, the plaque and tartar builds up faster and accelerates dental disease. Simply removing the calculus is purely cosmetic and not only does it do nothing for the oral health of your pet, but it makes any gingivitis or periodontal disease that is most likely present worse. If these vital portions of the complete oral health assessment are left out, then we are simply not treating dental problems properly. That's why these non-anesthetic procedures are not only malpractice, but simply an injustice to our patients who deserve proper dental care.
Now you can see why Veterinary Medical Center is vehemently opposed to non-anesthesia dentals. We are advocates for your pet and we only promote proper dental diagnostics, treatment and care so that your pet will not have to suffer in silence with dental disease and pain.
VISUAL TOUR OF A DENTAL
If a dental procedure is deemed necessary after initial physical exam and oral assessment, the following will, hopefully, give you a better understanding of the thorough and rigorous comprehensive dental health evaluation and treatment at Veterinary Medical Center.
During the anesthesia we take every precaution and monitor the patient closely. We place every patient on intravenous fluids and monitor the blood pressure, breathing, temperature, oxygen levels and depth of anesthesia. Critical to proper anesthesia is to ensure that proper blood pressure is maintained. These parameters are measured a minimum of every 10 minutes.
You can see this patient is being kept warm with a warm air "blanket", maintained on intravenous fluids (for blood pressure support) and the technician is monitoring the blood pressure (pictured) as well as temperature, anesthetic depth, respiration and blood oxygen levels.
Posted below are before and after pictures of dental scaling. It shows how nice and clean the teeth look. BUT this is only the tip of the iceberg. Since about two-thirds of the tooth is invisible under the gum and within the jaw, the next steps of periodontal probing and most especially dental xrays complete the vitally important diagnostic portion of the comprehensive dental health assessment.
Before Dental Scaling After Dental Scaling
Periodontal probing Taking Dental X-rays
Example of Dental X-ray
The last part of the teeth "cleaning" process is polishing the tooth surface to smooth out the rough "etches" left after ultrasonic and hand scaling. Polishing does not mean making the teeth shiny and pearly-white, but serves to decrease plaque adhesion to the tooth surface and retard subsequent dental disease.
Polishing the Teeth
The final evaluation, performed by the veterinarian, is where all the pieces of the oral exam and evaluation come together (visual exam, periodontal probe assessment, xrays) so a treatment plan and consultation is constructed. I consider this the evaluation of information from the visible and invisible portions of the teeth. In other words, the visible information is that which we can see: are there any fractured or chipped teeth, red gums, swelling, exposed roots (indicating severe tooth bone loss) or loose teeth, to name just a few examples. The invisible evaluation examines the 67% of the tooth that is below the gum line and in the tooth socket. This is where periodontal probing and x-ray evaluation is imperative. Without ALL these pieces of knowledge, a proper dental assessment cannot be achieved.
The following is an example where, without periodontal probing and dental xrays, a severely infected, and undoubtedly painful tooth, would have been missed. This illustrates the necessity for a complete and comprehensive oral health assessment ………………….. so much more than merely a "dental cleaning."
The picture below shows a totally normal looking tooth with equally normal gum tissue overlying it. There were absolutely no visible signs of pathology (disease) in this tooth (second one to the right of the large "canine" (fang) tooth).
Visually Normal Teeth X-ray showing marked bone loss
However, we could see on the x-ray that, due to infection, there was so much bone loss that the bone around the tooth socket had receded more than half way down the length of the root. This is indication of severe periodontal infection at this tooth. Remember, infection that is limited to the gums (gingivitis) is reversible, but infection in the tooth socket and bone (periodontal infection) is NOT reversible. Therefore, the only treatment option for this severely infected, but visibly normal, tooth was extraction.
Again, the tooth looked totally normal on visual exam, didn't it? It was only after examining the x-ray that the bone loss (infection) was seen. After periodontal probing, the bone loss was found to be so severe that the probe advanced down into the tooth socket so far that it passed between the two roots!
Periodontal probe passing between where the roots split (furcation)
The only option in this advanced case was extraction of the infected tooth. We perform surgical extractions and these are only done by the veterinarian.
The first step is to use a novocaine-like local anesthetic, similar to what your dentist will use on you! If the pet is already anesthetized, why do we numb the area with novocaine? Dental procedures can be painful and blocking the dental pain during and after the procedure greatly minimizes the amount of anesthetic needed for the patient. This not only minimizes post-operative pain, but the lower anesthesia minimizes anesthetic related problems such as lowered blood pressure and makes the recovery from anesthesia much faster and safer! I am a huge advocate of the use of these local anesthetics.
Injecting a novocaine-like nerve block
Teeth with more than one root are surgically transected (cut) with a drill so the roots can be taken out seperately as if they were individual teeth. This greatly speeds up the surgery and minimizes complications such as fractured tooth roots left behind.
"Splitting" the tooth with a dental drill
Using dental elevators to extract the individual tooth sections
After the tooth is removed, the gum tissue is surgically closed. Using sterile surgical techniques and performed ONLY by the veterinarian, virtually all our extractions are closed.
The results is a nice, neat closed tooth socket that heals quickly with very few complications.
We recheck the surgical procedures two weeks later to not only evaluate healing, but to also consult the owners regarding future dental care. Although brushing your pet's teeth is the absolute best dental care, other options exist and we will teach you all that you want to know about dental care for your pet. We want to minimize the amount of veterinary dental care your pet will need in the future. Your pet will thank us and your wallet will thank us.