A plethora of articles about feline dentistry have been written in the last 15 years. Unfortunately, the data have not been disseminated well to those in general, ER and strictly feline specialty practices throughout the United States. So this month's column will concentrate on basic products and equipment to perform excellent feline oral care. There is a major overlap, obviously, between feline and canine dentistry equipment. Equipment knowledge has been the No. 1 request from practitioners across the United States who write to me at DonDeForge@aol.com. The discussion initiated here will be continued on my website, www.TheVetDent.com, in the education center. There is no fee to become registered within this CE online, which is linked to the VPN columns. For the record, I am an independent clinical investigator and am not employed or contracted to any companies mentioned in this column. No practice can complete a detailed feline diagnostic exam without oral radiology. The general practice should put away the idea of using its whole body general X-ray unit for oral X-rays. Dental X-ray units are reasonably priced and should be in every veterinary hospital. Because two-thirds of the dental structure lies hidden beneath soft tissue, veterinarians must accept the fact that they are doing an incomplete oral diagnostic workup without dental X-ray technology. The unit should be wall-mounted in the area where oral care is performed. It does not belong in the radiology room or in your general surgery rooms. A dental suite is the ideal location for your X-ray unit. If a dental suite is not possible, the unit can be placed in a treatment area as long as radiation safety is practiced according to specific state guidelines. Check with your state about what is required to use your unit in a free treatment space. This is done commonly in human dentistry, quite effectively, with dividing walls and free-standing cubicles. It can be set up similarly in a veterinary hospital. Digital Radiography If feasible, digital oral X-ray diagnostic processing is recommended. It eliminates dental X-ray film, chemical processing, darkrooms and automatic processors. Digital sensors use 75 percent to 80 percent less radiation than standard X-ray film. Phosphor plate technology, wire-sensors and wireless sensors are all available. Digital systems provide excellent resolution, contrast, color and instant retake features. They are an important telemedicine feature for communication with specialists and for client education. A future column will deal solely with digital radiology in oral care. Continuing Education There must be a commitment by both professional veterinary staff and technical staff in feline oral care continuing education. This education must include basic periodontology and oral radiology. If there is not a conceptual understanding and working knowledge of normalcy and common pathology, the oral radiology technology in your hospital will be wasted. I strongly recommend two books, "Veterinary Dentistry Principles and Practice," Eds. R.B. Wiggs and H.B. Lobprise, Lippincott Raven, 1997; and "An Atlas of Veterinary Dental Radiology," Eds. D.H. DeForge and B.H. Colmery III, Blackwell Publishing, 2000. Adding these books to your library and scheduling procedure wet labs at a facility such as the Animal Dental Training Center (www.AnimalDentalCenter.com) will allow the general practitioner to become quite advanced in feline oral care. Other Equipment Quality piezo-electric ultrasonic equipment is needed to perform state-of-the-art periodontal care. All doctors and technicians should first become familiar with manual oral diagnostic treatment techniques and instrumentation (i.e., Modified Pen Grasp, scalers, curettes, probes, explorers) before taking the next step into piezo-electric ultrasonic debridement (PUD). Every operatory should have hand instruments available for diagnostics and adjunct periodontal treatment. Drs. Wiggs and Lobprise in "Veterinary Dentistry Principles and Practice" describe these instruments and how they are utilized. A wet lab should be scheduled after reviewing this material. An alternative is to meet with a human hygienist who can explain the instruments of periodontal care and effective root planing techniques. A few reflections on piezo-electric debridement must be reviewed. Without this understanding, it is difficult to speak to manufacturers with a working knowledge of available equipment. Always seek a demonstration of the equipment you are about to purchase or consult with a veterinary oral specialist. Ask what piezo-electric ultrasonic equipment they use. Piezo-electric ultrasonic mechanisms are activated by the expansion and contraction of quartz crystals in the handpiece to provide a frequency or energy level of 30 to 40 KHz. They operate with a water-cooled curved linear tip movement. There are both scaling inserts for supragingival usage and curette inserts for subgingival root planing. These are excellent in reducing pocket depth and gingival inflammation. They eliminate bacteria by disrupting or disturbing a pathologic subgingival bacterial substructure. Many investigators have acknowledged that they produce less damage to cementum than with manual root planing when used at the correct power setting. They are excellent for debriding periodontal abscesses. Some manufacturers have diamond-coated mini-inserts to treat difficult-to-reach subgingival pathology sites. Work Station The compressed air or nitrogen driven dental work station is the most complex instrument to consider. When purchasing such a piece of equipment, veterinarians must evaluate their commitment to continuing education. If the primary purpose for your dental unit is exodontics, you need a far different unit than if you plan to perform specialty dentistry. Mobile carts, built-in units, specialized work stations, and combination work-station digital X-ray and digital camera systems are all available. Contact a veterinary dentist in your area. The Dental Chair In my November column, I briefly touched on the importance of ergonomics in my discussion of the new AAHA Oral Care Guidelines. That led to a barrage of e-mails asking for more details. Ergonomics plays a very large part in feline dentistry because of the micro-oral areas that the operator must investigate and treat. Illumination and magnification are essential. More ergonomic dental chairs and dental assistant chairs are being manufactured for the human oral care industry. A search on the Internet on posture ergonomics for dental professionals is recommended. Radiosurgery With the microsurgery areas faced in feline dentistry it is essential to have a surgical field of vision that is as blood-free as possible. With cold steel, the field is impossible to visualize. Even with surgical suction, the areas cut with cold steel are blanketed with blood. Radiosurgery produces an essentially blood-free field of vision with decreased operatory time. I use the Ellman Surgitron Dual Frequency radiosurgery system, which utilizes a 4.0 MHz output, minimizing lateral heat with little or no tissue damage. There is not a surgical procedure in veterinary dentistry that I would attempt without this technology. In the feline oral inflammatory disease patient (i.e. feline stomatitis), surgery time is decreased by greater than 30 percent when utilizing it. In future columns I will address radiosurgery as an independent feature. --- Dr. DeForge is a Fellow of the Academy of Veterinary Dentistry and adjunct instructor at Northwestern Connecticut Community College in oral radiology and periodontology. He is co-editor of "An Atlas of Veterinary Dental Radiology" and has authored more than 200 articles on veterinary oral medicine, oral surgery and advanced dentistry. He may be reached at DonDeForge@aol.com.
