DENTISTRY DENTISTRY
11 . Say no to spring-loaded mouth gags
You can insert a mouth prop or lap sponge between the maxillary and mandibular canines or between the cheek teeth to keep the mouth open during dental procedures . Placing spring-loaded gags between canines is not recommended because of potential iatrogenic damage to the teeth , temporomandibular articulation and decreased maxillary blood flow to the brain . In cats , this decreased cerebral blood flow may result in neurological impairment , including blindness . Alternatively , cut endotracheal tubes or syringes will prop the mouth open while allowing for flexibility ( Figure 5 ).
12 . Say no to systemic antibiotics — except in cases of advanced periodontal disease or in compromised patients
Forty years ago , the standard of care included giving a penicillin-streptomycin injection after every ovariohysterectomy . Once the science proved this wasn ’ t necessary , it stopped . Similarly , systemic antibiotics are not indicated before , during or after most dental procedures , other than cases of multiple extractions for advanced periodontal disease where we are removing the cause of the problem ( e . g . plaque , tartar and periodontally affected teeth ). There appears to be a place for local administration of antimicrobials , however , especially in cleaned periodontal pockets less than 5 mm ( Figure 6 ).
Figure 6 . Injection of local antibiotic into a cleaned stage 2 periodontal pocket .
13 . Say no to recommending tooth brushing
Figure 5A . Don ' t use spring-loaded mouth gags like this one . They can cause overextension of the temporomandibular joint .
Wait . Did you read that right ? No to the gold standard of tooth brushing ? What ’ s wrong with tooth brushing ? Simple : Virtually no one does it twice a day , or once a day , or even every other day , and anything less is worthless . So instead of continuing to push brushing , recommend twicedaily wipes , cotton-tipped applicators ( in cats ) rubbed along the gingival margin , and accepted Veterinary Oral Health Council products to help decrease the formation of plaque and tartar .
14 . Say no to forgetting to schedule follow-up dental examinations
Removing the plaque and tartar from crown and root surfaces and extracting teeth affected by advanced periodontal disease without periodic home care monitoring makes little sense . Plaque and tartar will soon return and inflame the gingiva . After the comprehensive oral prevention , assessment and treatment visit , schedule a follow-up appointment to discuss a tailored plaque control program , including monthly to quarterly rechecks , to monitor compliance and efficacy .
Figure 5B . Don ' t overextend the temporomandibular joint as in this image with a cut syringe .
Now that the negativity of saying no is out of the way , I look forward to getting to “ Y ” (“ Say yes to … ”) in a future piece .
Issue 04 | AUGUST 2017 | 27