DENTISTRY
Article reprinted with permission of DVM360 – October 09,
2017 DVM360 MAGAZINE is a copyrighted publication of
Advanstar Communications inc. All rights reserved
The ABCs of Veterinary Dentistry
"L" is for
"Looks Like we're too Late"
Dr. Bellows asks whether we're emphasising
prevention enough in the dental care of our patients.
By Jan Bellows, DVM, DAVDC, DABVP, FAVD
DVM360 MAGAZINE
Recently I was asked to give a talk titled, “How can a
Chihuahua have full dentition into old age?” I stressed
starting plaque control early once the permanent
teeth erupt and performing periodic professional oral
assessment, treatment and prevention (oral ATP) visits when
gingival inflammation and halitosis were present, including
extracting teeth affected by advanced periodontal disease. proactive and very active plaque control, significant
moderate to advanced periodontal disease arises in
those dogs and cats that are prone. (Note: Not all
dogs and cats automatically get periodontal disease
because they have plaque and tartar. Periodontal
disease is mostly an individual immune response
resulting in inflammation and infection.)
On the way home from the talk it dawned on me that this
approach to dentistry is in the wrong order. Our office
sends yearly oral ATP reminders, but our clients are usually
motivated to make an appointment to have their pet’s
teeth cleaned in response to oral malodour and not a card
that arrives in the mail. Following our approach, we get
into the mouth too late, practicing fire engine dentistry
necessitating multiple extractions (Figure 1). Human dental patients are sent notices at least every
six months for a prophylaxis, which is a procedure
that involves cleaning the teeth ultrasonically and
using hand instruments on a patient who does not
have significant subgingival deposits or periodontal
pocketing thanks to lifelong plaque prevention. The
typical human prophylaxis patient has healthy gingival
tissues, which do not bleed on gentle probing, and
have no periodontal pockets over 4 mm in depth.
Oral malodour originates from putrefying materia alba
lying in periodontal pockets. This is the problem: Without
Figure 1. Advanced periodontal disease affecting the maxillary
fourth premolar and first molar in a dog. (Photos courtesy of Dr.
Jan Bellows)
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Issue 04
Human dentistry embraces prevention first. In our
model of oral ATP, prevention is offered last. In the
acronym that many veterinarians use—COHAT, or
comprehensive oral assessment and treatment—
prevention is not even mentioned. A small percentage
of human patients need to have teeth extracted due
to periodontal disease compared with the patients we
work on, which generally have not benefited from
dogged plaque control efforts.
Once you have embraced the concept of prevention
first, share it with your clients. Consider replacing the
terminology used in your practice from oral ATP or
COHAT to COPAT—comprehensive oral prophylaxis,
assessment and treatment—thus placing prevention