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ASC183 Surgical Nursing > T11: Veterinary Dental Nursing > Flashcards

T11: Veterinary Dental Nursing Flashcards

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1
Q

What does dental prophylaxis involve?

A

oral examination in the conscious and anaesthetised patient, sub- and supra-gingival tooth scaling and polishing and the subsequent development of a homecare plan

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2
Q

Oral or peridontal disease is defined by:

A

progressive process of inflammation causing changes to the tooth and surrounding structures.

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3
Q

What is plaque, what does it do and how does it form?

What other diseases does it cause?

A
  • Plaque is comprised of bacteria, food particles, saliva, white blood cells and epithelial cells that have sloughed off
  • begins to release bacterial endotoxins and disrupt the tooth structure. Plaque then calcifies with minerals in the saliva to form a hard thick substance which is tartar or calculus
  • ongoing formation of calculus can harbour bacteria which then are enabled to get under the gum line, causing gingivitis
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4
Q

Examination of the awake dental patient involves?

A

looking at the shape of the skull, the symmetry of the head and face, the absence or presence of any lumps, any ocular or nasal discharge or swelling, any abnormalities of the lips, tongue, mouth, tissue etc.

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5
Q

What is the cephalic index?

A

charting of or classification of the Cephalic ratio; the cranial width as compared to cranial length. The cephalic index refers to the cranium and its relative size, comparing cranial length to cranial width.

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6
Q

Describe the 3 cephalic indexes

A
  1. Brachycephalic (short-headed)
    - length of cranium is shorter than width
    - eg pug or persian
  2. Mesaticephalic (medium)
    - medium length and width
    - most domestic cats, labradors, cattle dogs
  3. Dolichocephalic (long)
    - breadth less than 80% of total length
    - eg greyhounds, saluki’s, oriental cats
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7
Q

What does apical mean?

A

towards the root

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8
Q

What does lingual mean?

A

surface of tooth towards tongue

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9
Q

What does mesial mean?

A

surface towards front midline

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10
Q

What does occlusal mean?

A

surface facing tooth in opposite jaw

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11
Q

What does palatal mean?

A

surface of tooth towards palate

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12
Q

What does buccal mean?

A

surface of tooth towards cheeks

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13
Q

What does coronal mean?

A

towards the crown

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14
Q

What does distal mean?

A

surface away from midline

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15
Q

What does interproximal mean?

A

surface between two teeth

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16
Q

What does labial mean?

A

surface of tooth towards lips

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17
Q

A dental patient pre-questionaire is a good way of gathering info.
What questions might you include in this questionnaire?

A
  • When was the last time your pet had any food?
  • Has your pet been unwell recently?
  • Does your pet have any diagnosed illnesses?
  • Is your pet currently taking any medications or supplements?
  • Has your pet received any medications or supplements before being dropped off today?
  • What was the name and dose?
  • When was your pets last dental cleaning and have they had any previous extraction’s or oral surgery?
  • What food does your pet normally eat?
  • Some others could be things like:
  • Does your pet have bad breath?
  • Discoloured teeth?
  • Does your pet drool or salivate excessively?
  • Does your pet have trouble or seem reluctant to eat?
  • Do you find it easy to medicate your pet with tablets? Liquid? Paste? Other?__________________
  • Does your pet paw at its mouth?
  • Do you think your pet is painful?
  • Have you noticed any inflamed or red gums?
  • Have you noticed any facial swelling?
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18
Q

How can you assist with drainage during a dental procedure?

A
  • have table slightly tilted
  • lateral recumbency= towel or sandbag under head
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19
Q

What information should be recorded on a dental chart

A
  • intra and extra oral examination findings
  • changes to gums or teeth
  • missing ot broken teeth
  • extra teeth
  • plaque
  • gingivitis
20
Q

Describe the modified triadan system for dental charting

A
  • system is based on the permanent dentition of the pig, which has 11 teeth in each quadrant - three incisors, one canine, four premolars and three molars. The grand total is 44 teeth. The same framework exists for all species
  • first digit of the modified Triadan system denotes the quadrant:

Right upper permanent = 1
Right upper deciduous = 5
Left upper permanent = 2
Left upper deciduous = 6
Left lower permanent = 3
Left lower deciduous = 7
Right lower permanent = 4
Right lower deciduous = 811

  • second and third digits denote the tooth position within the quadrant, with the sequence always starting at the midline.
  • rule of fours and nines”. The canine teeth are always Number 4 when present. The first molars are always number 9 when present. In addition, the carnassials are always the upper fourth premolars and lower first molars.
21
Q

What is rule of fours and nines?

A

The canine teeth are always Number 4 when present. The first molars are always number 9 when present. In addition, the carnassials are always the upper fourth premolars and lower first molars.

22
Q

What are ultrasonic scalers used for?
how does it work?

What types are available?

A
  • to remove calculus rapidly from the tooth surface.
  • scaling tip vibrates in the ultrasonic range of 20-45 kHz (i.e. 20,000 to 45,000 times per second), with an optimum frequency between 18 kHz and 32kHz.
  • Most of the scaling power is available at the tip, which is cooled with a jet of water.
  • There are three basic types – magnetostrictive, piezo-electric and Odontoson™.
23
Q

What is the maximum time able to spend scaling each tooth and why?

A
  • 10 seconds
  • can kill tooth by ultrasonic trauma (over heating)
24
Q

How should you hold an ultrasonic scaler?

A

Use a modified pen grip - use only the side of the tip. This is the most effective and least damaging area of the instrument to place on the teeth.

25
Q

What instrument is this?

A

Peridontal probe- this looks like a shepherds hook on end and a graduated blunt end at the other with the latter used for examining the sulcus, while the shepherds hook end is used on the crowns to check for lesions, check pulp exposure and look for caries.

26
Q

What instrument is this?

A

Extraction Forceps- These instruments are used to remove the root once it has been luxated loose.

27
Q

What instrument is this?

A

Periosteal Elevators - these come in a variety of sizes and styles and are used to lift full thickness soft tissue flaps. These need to be kept very sharp in order to do the job they are intended.

28
Q

What instrument is this?

A

Supragingival scaler is used for removing and lifting supragingival calculus. They must be used with a modified pen grip.

29
Q

What instrument is this?

A

Subgingival curettes are used to clean off debris subgingivally.

30
Q

What instrument is this?

A

Tooth Luxators & Elevators

Elevators come in a wide range, each with its own purpose.

31
Q

When should dentals be placed in the days schedule?

A
  • last, after sterile procedures
  • bacterial laden aerosol will be present for several hours after
32
Q

What features should a dental treatment table (and area) have?

A
  • adjustable height
  • angled for drainage
  • good ventilation and lighting
33
Q

What PPE should dental nurses wear?

A

As a minimum:

  • surgical mask
  • gloves
  • scrub top
  • goggles
34
Q

Safety considerations for humans working with dental patients?

A
  • Calculus flicked into eyes and aerosol in eyes
  • Large number of bacteria in aerosolised droplets
  • Moisture contaminating clothing
  • Posture- dentals take a long time so fatigue and back strain are common.
  • Sharps can cause injuries if not effectively used.
  • Bites and scratches from patients when restraining or if in a lighter plane of anaesthesia.
  • Water and electricity don’t mix well, ensure you have a safety cut out switch on your electrical board.
  • Anaesthetic gases are a risk and a scavenge system should be used.
35
Q

Safety considerations for dental patients?

A
  • Movement of ET tube or changing sides without disconnecting patient can cause strictures or subcutaneous emphysema.
  • Hypothermia
  • Aspiration- patient can easily aspirate fluids into trachea. Use pharyngeal packing.
  • Place patient on a tilt so it drains towards head, not away
  • Liquid tears in eyes to help reduce absorption of aerosol
  • Keep in laternal or sternal recumbency with head and neck extended, at front of cage.
36
Q

Describe how you would perform dental prophylaxis

A
  • 1st physical exam and history of the patient then the exam of both extraoral and oral cavities of the patient +/- Anaesthesia and radiographs.
  • 2nd supragingival cleaning (removal of calculus)
  • 3rd subgingival cleaning (area under gumline)
  • 4th extractions
  • 5th polishing
  • 6th lavage
37
Q

Why do we polish teeth?

A
  • scaling causes microscopic roughening which increases ability of plaque to adhere
  • polishing smoothens and makes this more difficult
38
Q

What do you do to close down the dental machines and tools?

A
  • empty ultrasonic water reservoir, rinse and allow to dry
  • remove scaler and clean
  • drain all water from scaler lines
  • clean unit, cords, hoses, polishing angle and handpiece with alcohol wipes’
  • lubricate and sterilise hand pieces
  • once per week check compressor tank for condensation and drain water if necessary
39
Q

Cleaning considerations for dental treatment area?

A
  • aerosol can spread 1.5m
  • clean entire area at least weekly by scrubbing with detergent and water
  • Tx area cleaned after every use by wiping with neutral detergent
  • PPE must be worn when cleaning
40
Q

Describe how dental instruments should be cleaned?

A
  • wash immediately after surgery in cold or lukewarm water with a detergent
  • CHLORHEX NOT SUITABLE (use enzymatic cleaner)
  • use soft brush or tooth brush
  • rinse in hot water, dry on towel
  • ultrasonic cleaner may be used with metals of same kind
41
Q

How should you prepare dental instruments for autoclaving?

A
  • Secure the groups of instruments using an instrument pin through one side of the handle of each instrument
  • Ensure instruments are not locked (if instruments are locked not all surfaces are sterilised)
  • Pack the instruments together neatly in the centre of the wrapping material
  • Add swabs and suture needles
  • Add autoclave indicator if internal indicators used
  • Set the steriliser (heat, pressure, timers as required)
  • Wrap the drape around the instruments in a concertina pattern
  • Place package in an autoclave bag, or wrap with autoclave paper or second drape. Label, date and initial the pack. Attach autoclave indicator
  • Loading items into an autoclave.
42
Q

Main considerations post-op dental?

A
  • protect the blood clot
  • reduce infection
  • prevent stimulation of secondary haemorrhage
43
Q

Name some common antibiotics used for dental procedures

A
  • clindamycin
  • metrondiazole
  • clavulanate/amoxycillin
44
Q

Problems that can occur with a tooth extraction include:

A
  • Fractured lower jaw
  • Haemorrhage
  • Roots left in causing infection and pain.
  • Oronasal fistulas caused by too deep probing
  • Punctured eye from misplaced elevator!
45
Q

What is the adult dog dental formula?

A

3 1 4 2

3 1 4 3

=21

46
Q

What is the adult cat dental formula?

A

3 1 3 1

3 1 2 1

= 15

ASC183 Surgical Nursing (15 decks)

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