THERAPEUTIC PLANS

THERAPEUTIC PLANS FOR PATIENTS WITH DENTAL DISEASE:

STAGES OF DENTAL DISEASE

0 Healthy teeth and gums Prevention Brushing EOD
I Gingivitis Prevention Brushing EOD
II Mild periodontal disease Treatment Scale + polish then Brushing SID
III Moderate periodontal disease Treatment Curette, scale, polish then Brushing BID
IV Severe periodontal disease Treatment Curette, scale, polish then Brushing BID

HEALTHY TEETH AND GUMS

Recommendations
No evidence of disease. Gums are coral pink or shrimp color.

  • Home care using Hill’s Prescription Diet® Canine t/d® or Feline t/d® as the regular diet and other home care products listed below every 7 days.

STAGE I GINGIVITIS

The gum margins – gingiva – are inflamed and swollen, plaque covers the teeth. This stage is reversible with home care.
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Recommendations

  • Tartar Control Diet-Hill’s Prescription Diet® Canine t/d®
  • Home Care every other day
  • C.E.T.® Toothpaste/Brush – toothpaste that is specific for dogs and cats, or, C.E.T.® Pads. C.E.T.® Pads can be placed over your finger and inserted between the cheek and gum to rub and rinse away particles of food adhering to the teeth.
  • C.E.T.® Chews l C.E.T.® Oral Spray l C.E.T.® Mouthrinse or C.E.T.® Aquadent water additive

STAGE II EARLY PERIODONTITIS

The whole of the attached gum is now inflamed and swollen. Tartar is present on the crown of the tooth and plaque is present below the gum margin as pocket formation begins. The mouth is painful and an odor is present. A combination of professional prophylaxis and home care can prevent periodontal disease from becoming permanent.
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Recommendations

  • Annual Professional Dental Prophylaxis Begins – Includes removal of tartar from the teeth above and below the gum line. Flushing the gingival crevice and polishing above and below the gum line. Applying chlorhexadine oral rinse for the use in prevention of plaque, calculus and gum disease. Fluoride treatment recommended.
  • Tartar Control Diet-Hill’s Prescription Diet® Canine t/d®
  • Home Care every day
  • C.E.T.® Toothpaste/Brush – toothpaste that is specific for dogs and cats, or, C.E.T.® Pads. C.E.T.® Pads can be placed over your finger and inserted between the cheek and gum to rub and rinse away particles of food adhering to the teeth.
  • C.E.T.® Chews l C.E.T.® Oral Spray l C.E.T.® Mouthrinse or C.E.T.® Aquadent water additive

STAGE III MODERATE PERIODONTITIS

Swelling of the gums and chronic inflammation evidences infection, there may be bleeding from the gums. The gums are starting to recede. Tartar is present above and below the gum line. Bad odor is present and pain from the mouth affects eating and behavior. This is the first stage of permanent loss of the support of the tooth. Radiographs are recommended to help determine the amount of bone loss. Antibiotic therapy recommended for at least three days prior to the dental procedure to reduce the amount of bacteria in the mouth.
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Recommendations

  • Dental prophylaxis – Includes removal of tartar from the teeth above and below the gum line. Flushing the gingival crevice and polishing above and below the gum line. Applying chlorhexidine oral rinse for the use in prevention of plaque, calculus and gum disease. Fluoride treatment recommended.
  • Curettage – Removal of diseased gum tissue and debris above and below the gum line to promote healthy gums and retard tartar formation.
  • Gum Surgery to allow complete cleaning of teeth
  • Professional Dental Prophylaxis every 12 months
  • Tartar Control Diet-Hill’s Prescription Diet® Canine t/d®
  • Home Care TWICE A DAY – Mouth flush also recommended
  • C.E.T.® Toothpaste/Brush – toothpaste that is specific for dogs and cats, or, C.E.T.® Pads. C.E.T.® Pads can be placed over your finger and inserted between the cheek and gum to rub and rinse away particles of food adhering to the teeth.
  • C.E.T.® Chews l C.E.T.® Oral Spray l C.E.T.® Mouthrinse or C.E.T.® Aquadent water additive

STAGE IV SEVERE PERIODONTITIS

Chronic severe infection of periodontal structures causes loss of normal bone surrounding the tooth root and the teeth are starting to loosen. There can be severe infection of the underlying bones with probable abscess formation. A foul odor is present. Hair and pus may be visible around tooth roots. Radiographs are necessary to determine the severity of bone loss and avoid fracture of the jaw during the dental procedures. Infection of the gum tissues is a severe health threat to the entire body and should be treated as soon as possible. Antibiotic therapy recommended for at least three days prior to the dental procedure to reduce the amount of bacteria in the mouth.
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Recommendations

  • Professional Dental Prophylaxis every six months – Includes removal of tartar from the teeth above and below the gum line. Flushing the gingival crevice and polishing above and below the gum line. Applying chlorhaxadine oral rinse for the use in prevention of plaque, calculus and gum disease. Fluoride treatment recommended.
  • Curettage– Removal of diseased gum tissue and debris above and below the gum line to promote healthy gums and retard tartar formation.
  • Gum Surgery to try to save teeth
  • Tartar Control Diet – Hill’s Prescription Diet® Canine t/d®
  • Home Care After Every Meal Mouth Flush also Recommended
  • C.E.T.® Toothpaste/Brush – toothpaste that is specific for dogs and cats, or, C.E.T.® Pads. C.E.T.® Pads can be placed over your finger and inserted between the cheek and gum to rub and rinse away particles of food adhering to the teeth.
  • C.E.T.® Chews l C.E.T.® Oral Spray l C.E.T.® Mouthrinse or C.E.T.® Aquadent water additive.

Dietary Recommendations:

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Hills Prescription Diet® Canine t/d® or Feline t/d®
We recommend feeding your pet soft food for the next two weeks to help reduce pain when chewing. We recommend feeding Hills Prescription Diet® Canine t/d®. It helps reduce plaque, stain, and tartar to support oral health. Canine t/d® also aids in the prevention of gingivitis and aids in the control of bad breath in dogs.

Medications commonly used for dental infections

Antirobe® – Dogs 11mg/kg PO q12h or 22 mg/kg q24h, Cats 5.5 mg/kg PO q12h or 11 mg/kg q24h. Antirobe® antibiotic has unique activity against bacteria that live in a reduced oxygen environment. This environment is typical around the gum tissues or in bone. This antibiotic is effective against the bacteria that cause gum disease and bone disease.
CET Aquadent® Add 1 teaspoon per pint of water and use as sole water source. This is a natural oxidizing, antibacterial mouth rinse used for bacterial complications in periodontal or other dental disease.

Diagnostic Plan – “We always diagnose before we treat”

Pre-Anesthesia/Dental Radiographs

Radiographs of the mouth and teeth are done in pets much the same that your dentist does. These radiographs will help us determine if any tooth root has an abscess and/or bone loss.

Blood Screen Pre-Anesthetic:

We recommend a blood test to determine the internal function of the organs prior to the anesthetic period. This test will help us to identify risk factors for disease processes and to make adjustments in the anesthetic protocol accordingly.

ECG

We recommend ECG screening to determine if the electrical activity of the heart is normal. Anesthetics may accentuate existing arrhythmia. Prior detection will help reduce the incidence of anesthetic complications.

Isoflurane

Isoflurane gas anesthesia is used for general anesthesia to allow us to do the procedure and not discomfort the pet. Isoflurane gas is a safe inhalant type of anesthesia that is administered directly into the lungs by an endotracheal tube. This anesthesia does not have to be metabolized by the internal organs in order for it to exit the body, it is breathed in and breathed off. This allows for rapid recovery from anesthesia with little “hangover” effect. During the anesthetic procedure there is someone with your pet at all times until it is fully recovered and able to walk around.

IV Fluid Therapy

IV catheterization and fluid therapy aid in maintaining blood pressure during anesthesia. Having direct vascular access also allows prompt response should complications occur.

Pain Management

Pain medication is recommended for surgical procedures that are considered to be painful upon awakening from surgery. An injection is given prior to the surgery and is followed up as needed with additional injections or oral medication.
Rimadyl®: 1mg per pound twice daily. This medication is a great pain reliever for dogs and can be given for one week for this type of pain.

Suture Removal

Sutures were placed in the mouth. These sutures are absorbable but may be persistent for some time. We need to check the healing process in 10-14 days. Please notify us if your pet chews or pulls the sutures or re-opens the incision. Also, contact us if swelling occurs, there is excessive bleeding or discharge, or if the pet seems uncomfortable.
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