INDICATIONS
- To remove deposits of plaque, calculus, and debris from teeth
- Another term, prophylaxis, is often used, but is less accurate, as it implies prevention, which is the case only in cleaning teeth in stage 1 periodontal disease.
EQUIPMENT
- Gloves, mask, eye protection
- Dilute chlorhexidine rinse (0.12%)
- Mouth wedge or gag
- Dental mirror
- Calculus forceps (Fig. 5-1)
- Scaler (ultrasonic, sonic) (Fig. 5-2)
- Hand scaler (Jacquette)
- Disclosing solution (optional)
- Slow-speed polisher, prophy angle, prophy cup
- Polishing paste
- Fluoride (optional)
PROCEDURE
- General anesthesia with cuffed endotracheal tube, monitoring, supportive care
- Gently flush oral cavity with dilute chlorhexidine (Fig. 5-3)
- Avoid getting solution on nasal mucosa, especially in cats
- Initial assessment to identify areas of significant disease that might require therapy; in particular, those areas that were not apparent on the alert examination
- Palatal aspect of maxillary canine—deep pockets
- Pockets at either aspect of mandibular first molar
- Any worn, chipped, fractured, or discolored teeth
- Palatal aspect of maxillary canine—deep pockets
- Gently dislodge larger sections of calculus with calculus forceps; take care not to damage teeth (Fig. 5-4)
- Use mechanized scaler (ultrasonic or sonic) to continue to remove gross deposits of calculus from crown surfaces
- Use side of scaler tip, not end (Fig. 5-5)
- Use sufficient water spray for coolant; replace scaler stack if tip overheats
- Apply side of scaler to individual tooth for no longer than 10–12 seconds at a time; return to the tooth later if additional scaling is necessary
- Use the sharp tip of a hand scaler (Jacquette) to remove remaining deposits of calculus in grooves (upper fourth premolar development groove); do not use tip of ultrasonic scaler there (Fig. 5-6)
- Use disclosing solution or air syringe to identify any remaining deposits of calculus
- Use sufficient water spray for coolant; replace scaler stack if tip overheats
- Complete examination, probing (Fig. 5-7), transillumination, and intraoral radiology (see Chapters 1–4)
- Additional therapy
- Periodontal pockets (see Chapter 6)
- Extractions as needed
- Periodontal pockets (see Chapter 6)
- Polishing (Fig. 5-8)
- Use proper speed (less than 3000 rpm), sufficient prophy paste, and moderate pressure to gently splay the foot of the prophy cup
- Note: try the prophy cup on your fingernail; if it generates heat, adjust the speed, amount of paste, or pressure to a safer level
- Polish each tooth surface—no more than 5–10 seconds per tooth; if further polishing is needed, continue to other teeth and return to this tooth for additional polishing later
- Use proper speed (less than 3000 rpm), sufficient prophy paste, and moderate pressure to gently splay the foot of the prophy cup
- Irrigation
- With an air-water syringe or blunt-tipped needle on syringe, rinse tooth surfaces and subgingival areas to remove any remnants of calculus or paste, which could cause a periodontal abscess if left (Fig. 5-9)
- The air syringe can be used to gently dry the tooth surface (or in the pocket) to identify any calculus remnants (discolored or chalky) (Fig. 5-10)
- With an air-water syringe or blunt-tipped needle on syringe, rinse tooth surfaces and subgingival areas to remove any remnants of calculus or paste, which could cause a periodontal abscess if left (Fig. 5-9)
- Fluoride
- For additional antibacterial activity; remineralization and desensitization.
- When indicated (avoid in renal patients), apply acidulated phosphate fluoride to dry tooth surfaces and leave on according to manufacturer’s recommendation
- Air blow or wipe off; rinsing deactivates most fluorides
- Avoid allowing ingestion
- For additional antibacterial activity; remineralization and desensitization.
Figure 5-3 Applying dilute chlorhexidine prior to starting the dental procedure.
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