The oral cavity has an abundant blood supply and an epithelial surface constantly bathed by saliva, a fluid rich in antimicrobial properties, resulting in oral tissue healing more rapid than skin. Sterile surgical preparation of the oral cavity for extractions is not necessary, however, using clean instruments and adequate preparation of the surgical working area is recommended. Good accessibility and exposure to the surgical site is important while creating gingival flaps to expose the tooth and alveolar bone adequately. Gentle tissue handling is used to minimize tissue trauma and promote faster healing. Appropriate instruments that are clean, sharp, well taken care of and stored properly will maintain the effectiveness and longevity of the instruments.
Preference for suture material will vary, however, absorbable sutures are recommended such as chromic gut, Vicryl or Monocryl. Suturing techniques may vary according to procedure, but generally a simple interrupted pattern is used. Gingival flaps are created to adequately expose the alveolar bone over the roots. One problem many veterinarians have is that they do not make a large enough flap and when they go to suture closed, the gingival flap may not be large enough to lay over the extraction site and as a result creates too much tension resulting in dehiscence of the flap. When closing gingival flaps there should be absolutely no tension, avoid unnecessary gaps and the sharp edges of alveolar bony crests with spicules should be smoothed with a diamond bur, all will promote optimal healing.
Potential causes include previous blunt trauma, e.g., being hit by a car, running into a wall or excessive chewing on hard objects such as rocks, hard Nylabones®, cow hooves, antlers and other objects that do not soften when chewed.
Dogs and cats with fractured teeth typically have pain while chewing and may selectively eliminate hard food from their diet in the acute phase or when the tooth is abscessed. In between the initial insult of injury and when the tooth becomes abscessed there may be no pain present. The dog or cat may pick up food, attempt to eat it, and drop it out of the mouth (indicating oral pain). Reluctance to play with toys or failure to retrieve or engage in bite work (in working dogs) also signals oral pain. These patients may also resist oral examination or possibly “snap” at you when examining the mouth. Clinical overt signs include pawing at the mouth, rubbing the head or chin along the ground, reluctance to be patted on the head, obvious tooth fractures, ulcers on the tongue or lips from rough sharp enamel edges, excessive salivation and discoloration of the tooth itself.
Discolored teeth indicate the tooth or teeth are non-vital or dead. When a tooth is discolored red or pink, the blood supply to the tooth has leaked into the dentin. The blood supply coming into the tooth at the apex will be compromised causing complete separation of the blood supply. If left untreated, vascular necrosis develops over time and the tooth dies. The crown will initially will be red or pink, then will change to purple, light gray and eventually dark gray. Damage to the pulp can also result from thermal injury caused by incorrect use of ultrasonic scaling or polishing when the scaler or polishing cup is placed on the tooth surface for an extended time. The treatment of choice for fractured teeth where pulp is exposed or when discolored teeth are present is either root canal therapy or surgical extraction.
Ignoring fractured or discolored tooth or teeth will prolong the pain and discomfort and allow the infection to propagate, which will eventually cause major problems.
Professional periodontal treatment is important to the health and well-being of dogs and cats. Poor oral health may directly affect an animal’s overall health. Recent studies have shown there is an association with advanced periodontal disease and heart disease further validating the importance of periodontal health. Other studies have shown similar implications for the relationship of periodontal disease to heart, liver and kidney disease in the dog.
The goal of periodontal treatment is not only eliminating the causes of periodontal disease but to stop the progression of disease. Recognition of dental and oral disease, careful treatment planning, appropriate treatment modalities, and a quality dental hygiene program to prevent or at the very least, decrease the progression of periodontal disease are all important in the overall health of dogs and cats.
Professional Periodontal Cleaning is not an elective procedure!! It is the responsibility of the veterinarian and the entire hospital team to recognize the importance of dental and oral disease, to educate the client appropriately, to develop a treatment plan for each patient, and to offer all available dental services available to treat the pet and promote a complete oral health care plan. Professional Periodontal Cleaning must be done under general anesthesia with preoperative blood work, an intravenous catheter, fluid therapy and sound anesthetic monitoring. Due to the aresoloation of bacteria during the periodontal cleaning, each team member performing the periodontal cleaning should wear protective eye wear, surgical masks and gloves. With the dog or cat under general anesthesia it will be easier to identify dental disease and abnormalities that otherwise would not be found while the patient is awake or only sedated. Dental radiographs need to be taken (only under general anesthesia) to identify disease such as bone loss that would not be discovered clinically. With those hospitals that have dental radiology capability, full mouth dental radiographs should be taken for all first time dental cleaning patients not only as a base line, but to identify any disease under the gum line that would otherwise go undetected.