Ah, yes, it’s dental month!! Yay! I love the smell of perio in the morning. When I know there is a Grade 4 dental coming in the next day, I am like a kid on Christmas Eve. I can’t sleep, thinking about how spectacular it is going to be. I have been known to call dibs on them, not that my co-workers would fight me for them, but I just want to make sure they are mine, all mine!
What is so great about a Grade 4? Well first of all, they’re becoming more rare due to Virbac’s Pet’s Have Teeth, Too campaign, National Dental Month, the Veterinary Oral Health Council (VOHC) seal of approval for dental products, promotion of preventive dental care by day practices and the American Veterinary Dental College (AVDC) and the American Veterinary Dental Society (AVDS). So Grade 4s should be savored and enjoyed much like a rainbow or a velvet Elvis painting.
Secondly, they’re so rewarding! I love pulling out clumps of hair and debris from around teeth and below the gum line. The best is when a dog has “hair braces” around the lower incisors. HAPPY BIRTHDAY to me!! Once, I removed a clump of hair from around some incisors and found a plastic bead and the back of an earring stuck below it. Sweet treasure trove, I almost passed out I was so excited!
I cannot imagine how good these pets feel after having rotten, abscessed teeth removed. They no longer have to smell that stench, or worse, taste it. No longer are they in pain and feeling miserable. Their kidneys, liver and heart do a little happy dance because there is no longer a barrage of bacteria coursing through them! Dogs can go back to playing with toys, eating normally and running around, no longer a lethargic, cranky lump. Cats can go back to, uh, napping and plotting world domination, I guess.
Although I do love a Grade 4, it’s important to get our patients in before their mouths are that bad. Assessing the mouth at every visit really is helpful to show owners that there is a progression. Maybe the owner does not want to perform a dental cleaning when it is a Grade 1, but when she comes in the next year and is told Sparky is now a Grade 2, she may okay a cleaning then. Preventive dental cleanings, at my hospital, are Grade 1 and 2’s. These are cleanings during which we’re able to prevent further build up of plaque and calculus, and save teeth. Grades 3 and 4 dental cleanings involve extractions and periodontal treatments.
Dental radiographs are required! So much of a dog and cat’s dental disease occurs below the gum line. Without radiographs you are flying blind. Believe it or not, taking dental rads will actually make extractions easier! In cats with resorbing teeth, you can frequently skip the extraction and just do a crown amputation, but ONLY if you take a radiograph. Amputating a crown with an intact periodontal ligament and full roots is a no-no. I learned that from the lovely Dr. Randi Brannan (board certified veterinary dentist extraordinaire). In dogs you will see any resorbtion that may be occurring, anatomy of the root and jaw, as well as any abscess that may be present. Any teeth that are “missing” should also be radiographed to make sure they are really missing and not sitting below the gum line, working on a dentigerous cyst. It only has to be done once!
I confess, I used to hate dental rads. The film is so tiny, you have to develop them, you need a magnifying glass to read them and if you have to retake it, forget it! I wanted to throw the stupid little film across the room. They mock me! And I will not be mocked! And then… we bought a digital dental sensor. Like the heavens parted! Holy cow! The image appears instantly and it is the size of the computer monitor. I love you Schick sensor and yes, I would marry you. My boss bought the digital dental before the big digital radiology (even though he wanted to get regular digital radiology first) and saved my sanity.
Charting is also required. Dr Brannan would ask me, “How do you know if the perio is worse if you don’t chart?” It’s tedious and annoying at first, but you will get faster! And it’s very helpful to the doctors to be able to assess teeth if they know the pocket depth and the gingival recession. We use a 2 number system that has the measured gingival recession on top and the pocket below. Our dental charts look like someone practicing writing fractions. I also used to chart every tooth and give every tooth a calculus score. But now, thanks to Dr Brannan, I chart what is abnormal (duh!) and give the mouth an overall calculus, gingival and plaque score. Such a timesaver!
So when you have a rush of dental cleanings this month, just think of how much you are helping your patients by cleaning their teeth! And, fingers crossed, that I get at least one Grade 4.