7 - Complete Prophy

Question 1

What are the steps to complete prophy?

Answer 1

1. Preliminary examination/evaluation (initial oral exam)
2. Supragingival gross calculus removal
3. Dental radiographs
4. Periodontal probing and charting
5. Scaling and subgingival calculus removal
6. Detection of missed plaque and calculus
7. Polishing
8. Sulcus irrigation and fluoride treatment (sealant application – if
   applicable)
9. Periodontal diagnostics and extractions
10. Final charting
11. Client education/home care plan

Question 2

1. How does the preliminary exam/eval work?

Answer 2

a complete prelim exam will have already been preformed

WEAR GLOVES! Tartar/plaque is just literal bacteria shelves
remember occlusion is best evaluated in conscious patient
however, some patients won’t allow this at all
first step is a more complete eval to confirm or determine diagnostic and treatment measures

Question 3

1. What are things we are looking at during the prelim exam/eval?

Answer 3

color of gingiva, grade of gingivitis
grade of plaque and calculus
presence of gingival hyperplasia and oral masses
missing teeth and retrained deciduous teeth
malocclusions
fractures, exposed pulp, excess wear
mobile teeth not salvageable, should be extracted
abnormal tee

Question 4

2. What does supragingival gross calculus removal look like?

Answer 4

animal now under anesthetic
prior to removing any tartar, apply dilute chlorhex rinse to the teeth
usually use a string to apply the solution to all of the tooth surfaces (not from bottle)
reduce overall bact load in mouth
reduce back load = fewer bact will enter bloodstream during a routine prophylaxis

Question 5

2. What type of instruments will be used during supragingival gross calculus removal

Answer 5

hand scaler using a pull stroke is effecting in removing calculus
calculus removal foreceps cleave off calculus - caution req to prevent damage to gingiva or create iatrogenic slab fracture
ultrasonic or sonic scalers break up or pulverise calculus; caution req to prevent etching of tooth or thermal heating
minimize patient manipulation - ex if in L lat, remove calculus of buccal tooth and palatal/lingual of left before moving to right

Question 6

How do we use the supragingival scaling power instrument?

Answer 6

have a light hold and balanced int he hand
hand pieces does the work, not your hand - a modified pen grip is not as important as it is in the hand scaling
the hand piece is balanced on index or middle finger
to decrease stress on the hand, the cord may be looped over the little finger
a fulcrum is not required but good practice

Question 7

What is the technique used for ultrasonic cleaning?

Answer 7

Use side of instrument, not the tip
start with sweeping cross strokes, followed by various directions
keep instrument moving to prevent thermal damage -> no more than 10-12 s on a tooth at one time
to reach furcations, use tips designs for it or hand instruments
avoid pressing the scaler tip too hard on the tooth as it may cause thermal damage/etching

Question 8

For ultrasonic technique, which parts of the teeth should be used on low and high settings?
What happens if the power is not decreased?

Answer 8

high for broad tips
low for thin tips
failure to dec power may = instrument to not work at full potential/damage it

Question 9

3. What does the procedure of taking dental rads look like?

Answer 9

rads will evaluate the structures hidden below the gumline
dental xray will give better representation of teeth and supporting structures than regular x-ray
performing them early in the prophylaxis will save us time
- no point scaling/polishing teeth that will be removed
vets can eval rads while tech performs other parts of the procedure

Question 10

4. What does periodontal look like?

Answer 10

Determines depth of sulcus
probe the measurement markings usually calibrated in 1-2mm intervals and may be color-coded
probe is held parallel to long axis of the tooth for accurate readings
inserted to gingival crevice and gently walked around tooth or placed in at least 6 locs around tooth
- health gum will bleed if more than 20g of pressure is applied
- too much pressure can cause probe to puncture the junctional epithelium

Question 11

What are the normal sulcus depth for K9 and Fel

Answer 11

K9 2-3mm
Fel 0.5-1mm

Question 12

4. what are common locs for deep pockets when periodontal probing?

Answer 12

• crowded locs like btw 108/109 +208/209
  btw 309/310 + 409/410
  Buccal aspect of mandibular canines + palatal of max canines
  btw misaligned + crooked teeth
  pocket depth does not always = attachment loss
  gingival hyperplasia can give fall pocket depth scores

Question 13

4. In periodontal charting, what is assessed at this stage?

Answer 13

use consistent method
look for mobility, furcation exposure, probing depth, and attachment loss
may find teeth defects like tooth resorption, caries, fractures and wear) that may not have been noticed during prelim exam
good time to follow up abnormalities noted on rads
bc periodont dz is progressive, charting is important for follow up visits. accurate records = baseline
subsequent measurements of pockets, etc are compared to aid in progress of dz + tx plan

Question 14

5. what does subgingival culculus removal look like? What happens?

Answer 14

removal of subgingival plaque/calculus from root surface
if subgingival plaque and calculus remains, the patient will not receive long-term benefits from tx and bact plaque will continue to destroy the periodontium
leads to one deterioration and eval tooth loss
Also where the vet looks at xrays and stuff

Question 15

5. how do we us ea curette?

Answer 15

curette - cutting edge held at btw 45-90 degrees to tooth surface
a horizontal pulling or oblique stroke is used

can use an ultrasonic scaler if you are using a subgingival tip

Question 16

What is the modified pen grasp?

Answer 16

the thumb and forefinger are placed at the junction of the handle and the shank of the instrument. grasp is relaxed
pad of the middle finger is placed on the shank near the working end
the triangle is very stable
the ring finger is held straight and placed on the surface closest to the tooth being worked on (fulcrum)

Question 17

What is the modified pen grasp and wrist rock?

Answer 17

ring finger is placed on the quadrant you are working on
the ring finger serves as fulcrum
NO FULCRUM ON NOSE/EYE SOCKET
Hold pen and draw small circul by rotating ring finger (fulcrum). the fingers should not flex at all during this motion and the wrist should remain in alignment
scaling will be more effective with the fulcrum close to the tooth you are working on
rotation of the wrist inn a rocking motion is used to remove calculus (keep wrist straight)

Question 18

In terms of curettes, what does it means by adapting to the tooth?

Answer 18

if curette does not fit the curvature of the tooth, the opposite end of the instrument is used
as curette is inserted into pocket, the face of the instrument is facing the root surface (close position) this allows the smooth part of the instrument to roll into the sulcus and prevent gingival trauma
instrument is moved over calculus, repositioned so cutting surface under calculus ledge (open position) @ 45-90 to tooth surface
with rocking pull, calculus cleaved from oot surface

Question 19

What is root planing?

Answer 19

a periodontal therapy and is used to tx the root where there has been gingival attachment loss
in some practices, techs perform this, in other practices only the vet performs root planing
the objective is to remove calculus and cementum from the root surface to create a clean, smooth root surface to prevent bact growth and allow for reattachment of the ginginva
the technique uses a curette, a gracey is preferred
the blade of the curette is positioned against the root surface inside PD pocket (<5mm deep)
use 10-20 overlapping strokes in the horizontal, coronal, left oblique and r oblique angles to smooth the root surface

Question 20

What are gracey curette? How are they numbered and what are they used for?

Answer 20

gracey #’d 1-2, 3-4, 5-6,7-8, 9-10,11-12,13-14
7-8 + 13-14 most common in vet dentistry
1-2 + 3-4 used on incisors
5-6 for canines
7-8 + 9-10 used on premolars (not 108/208
11-12 + 13-14 used on upper 4th premolar andmolars

Question 21

6. what should we do when there is detection of missed plaque and calculus

Answer 21

an explorer is used to eval tooth surface - heightened tactile sense to feel smoothness of tooth surface
application of disclosing solution enables you to visualize missed plaque and calculus - can also be done via compressed air drying tooth (missed deposits become chalky) must be cautious of air embolus

Question 22

7. How might polishing look like? How is it done?

Answer 22

to maximize smoothness of enamel and remove micropitting of enamel (especially if ultrasonic scaler is used)
done with a slow speed prophylaxis cup and trophy paste
becease polishing generates heat, a liberal amount of trophy paste should be used
the trophy cut must be kept moving and should never linger over one area
the rim of the cup should be applied both supra and subgingibally (flare the cup)
rinse sulcus with water after as trophy paste can be irritating to surround gingiva

Question 23

7. what types of grits are available

Answer 23

Fine paste should be used in mos cases
coarse paste may remove enamel
if coarser pastes are used ( to remove stains) then finish with fine paste

Question 24

8. how do we use our sulcus irrigation and fluoride, what is it used for?

Answer 24

for the gentle flushing of the sulcus to remove any traces of dislodged debris
use a saline, sannous fluoride, fluoride foam or diluted chlorhex solution
use a blunted 23-guage needle
if you’re doing fluoride - it strengthen enamel + desensitize teeth, after irrigation teeth must be dried before application. Apply by manufacter’s labels
when removing, fluoride is wiped (not rinsed) off of the tooth surface

Question 25

How might the application of sealer work?

Answer 25

applied to the clean tooth surface with a sponge applicator or gloved finger
reduces plaque and tarter formation by repelling water and preventing bacteria from attaching to the teeth
req weekly application at home

Question 26

10. What is final charting?

Answer 26

involves reviewing of the previously performed diagnostic and periodontal charting
should include any additional tx performed