Knowledge Base

Using Keystone Veterinary Products

The consequences of poor dental health go way beyond bad breath. Periodontal infection can lead to serious health concerns ranging from tooth loss to organ failure. It’s also no secret that dental problems are common in animals--dental problems are the most common problem in both dogs and cats, with periodontal disease at or near the top of the list. When our pets receive good dental care, they undoubtedly live longer and better lives.

The specific dental problem that we strive to prevent is periodontal disease, and the cause of periodontal disease is related to the presence of plaque bacteria on the tooth surface. Plaque bacteria can colonize a clean tooth in a period of 24-36 hours. This means that within just a few days following professional dental cleaning, the pet’s teeth are already starting to accumulate the bacte­ria that will again cause periodontal inflammation and disease. The good news is that home care can prevent this.

 

 

 

 

Getting Started

   Dental home care starts at the veterinary office. Patients must be evaluated for the presence of dental disease, and treated, if necessary, prior to beginning a home care program. The fact is that 80% of dogs over the age of three and at least 50% of cats have significant periodontal disease that requires immediate professional treatment. Professional dental treatment, performed when needed and under general (inhalant) anesthesia, is the cornerstone of preventative dental health for our patients. On average, dogs and cats benefit from an annual prophylaxis (cleaning) starting at the age of three, but each patient needs to have its dental program individualized.

   Many dental problems in dogs and cats are painful. For patients with painful dental problems, home care is contraindicated. In fact, the discomfort caused by trying to brush a painful tooth may adversely condition the pet to future attempts at home care. This is why home care should be instituted only after appropriate professional treatment has established a clean and healthy mouth (except in the youngest and healthiest of patients). Ideally, dental home care programs should be instituted with the puppy or kitten before any dental pathology has started.

   The use of systemic antibiotics (injections, pills) should be discouraged for routine dental procedures. The patient’s immune system is more than adequate to deal with the transient bacteremia that results from a dental scaling. A safe and effective alternative to reduce bacterial load in the patient’s mouth prior to dental prophylaxis or oral surgery is to administer a topical antiseptic. Veterinary professionals have always put 0.12% chlorhexadine on the top of the list as the first line oral antiseptic.

   Periodontal Prophylaxis

   Periodontal prophylaxis is the cornerstone of veterinary dentistry. The term “prophylaxis” implies prevention, and the goal of the periodontal prophylaxis procedure is to pre­vent (or at least halt) the progression of periodontal disease.

Step 1.

Disinfect the oral cavity with Petection 

   Petection is an oral gel that contains 0.12% chlorhexa­dine gluconate. As opposed to liquid flushes and rinses that were designed for human patients, Petection has been specially formulated for dogs and cats, is easy to work with, and “stays where you put it.” Additionally, Petection is packaged in easy to use single dose units for optimizing sterility for every patient.

 

Directions: Following anesthetic induction and endotracheal tube placement, apply 1 – 1 ½ cc of Petection to a gloved finger and rub the gel onto the tooth surfaces aiming for the gingival margin. This procedure can again be performed at the conclusion of the dental procedure prior to extubation (Figure 1).

An alternative method is to apply the Petection directly onto the buccal surfaces of the teeth, and then spread the gel around the tooth surface with a gloved finger.

 

In addition to the buccal surfaces, the gel can also be applied to the lingual surfaces. Most oral bacteria will be killed within the first 30 seconds, but some bacteria will require a longer time period.

This is why we recommend allowing the gel to remain in contact with the oral cavity for a full 3 minutes (Figure 2).

Petection can also be dispensed for owners to administer at home when an easy-to-use 0.12% chlorhexadine product is desired.

 

 

See this page for complete
product information.

 

 

 

 

Step 2.

Gross Tartar Removal

Use extraction forceps to pinch and chip at the larger tartar deposits on the teeth. The technique is to anchor one claw of the extraction forceps on the tip of the crown (cusp), and use the other to scrape and chip away. It is amazing how much of the “big stuff” you can very quickly remove with the extraction forceps.

Step 3.

Crown Scaling

Once the gross tartar has been removed from the crowns, the remainder of the crown scaling is accomplished with an ultrasonic scaler. Crown scaling by hand is also possible, but it is time-consuming.

The ultrasonic scaler should first be tuned. Tuning the scaler is accomplished by pressing the pedal and adjusting the water and power controls. Tuning is proper when the tip of the scaler is vibrating at its point of maximum inten­sity, and a fine mist of water is produced.

Ultrasonic scaling is performed by holding the scaler handpiece in a pen grasp. The side of the scaling tip is lightly applied to the tooth and immediately moved back and forth in a sweeping motion. No tooth should be scaled for more than 15 seconds at a time because excessive vibrations can result in a painful pulp inflammation. The ultrasonic scaler should be used very carefully. Excessive force or prolonged time spent on one spot can damage tooth structure. The water spray is also necessary to cool the tip of the ultrasonic scaler, which becomes very hot while in use.

All sides of every tooth need to be scaled. Learn to develop a pattern to make sure you don’t miss any teeth. My preferred method is to scale the buccal (outside or toward the gums) surface of the right side of the mouth, and then the lingual/palatal (inside or towards the tongue/palate) surface of the left side. Then, the patient is flipped over and the procedure is repeated.

Step 4.

Subgingival curettage

Once the crowns of the teeth have been scaled, it is time to clean below the gumline. Regardless of which power instrument is used to scale the crowns of the teeth, you will still need to use a hand instrument. This step, called subgingival curettage, is the most important part of the prophylaxis. The subgingival plaque and tartar are most responsible for causing periodontitis.

There is a variety of different curettes available. Differ­ent curettes cut at different angles and it is advantageous to have several on hand to perform subgingival curettage on all the teeth. A “Garcey 12/13” and a “Columbia 13/14” are good ones to always have in your collection.

The curette is held with a modified pen grasp. Grasp the curette like a pen, and then raise your second finger. This feels awkward at first, but it is the preferred method for using this instrument. Your fourth and fifth fingers should rest on the patient and act like a fulcrum. The cutting side of the curette is held toward the tooth, and the curette is inserted into the gingival sulcus. The curette is then held at the appropriate cutting angle to engage the blade, and the instrument is drawn out of the sulcus in a pulling motion. Most of the action should come from your elbow, keep­ing your wrist relatively straight. The operator will get the sensation of scraping bits of tartar and plaque until the subgingival tooth is clean. At that point, it will feel like you are curetting glass.

Step 5.

Polishing

At this point in the procedure, the teeth look clean. What we do not see, however, is the microscopic roughness on the tooth surface that has been caused by all this scaling and curetting. Polishing the teeth is very important to smooth out the roughness we have caused. Teeth that have not been polished rapidly accumulate plaque following the dental procedure.

 

Polishing is accomplished with a prophy angle operated on a low-speed handpiece, a polishing cup, and prophy paste. The prophy paste is loaded into the prophy cup, and is then applied to the tooth while the cup is spinning. Each tooth should be thoroughly polished on all sides. Follow your pattern. To polish the subgingival sulcus, place the polishing cup at the gingival margin and apply pressure. This pressure will cause the cup to flare out, and enter into the sulcus to polish it.

Never polish a tooth without prophypaste or polish for more than 15 seconds at one time. Both of these could lead to the development of painful pulpitis.

 

Keystone Vet Disposable Prophy Angles operate in a back and forth oscillation rather than simply spinning around in a circle. This is especially important for our furry faced-patients, since we want to avoid having the facial fur become entwined in the prophy angle.

Step 6.

Sulcus/Pocket Irrigation

Following the prophylaxis, the oral cavity should be thoroughly rinsed to remove debris, loose tartar, prophy paste, etc. This is especially true for the gingival sulcus area where trapped debris could have a very detrimental effect.

Especially in cats, make sure there is no saliva or bloody fluid in the oral pharynx area. Cats can have respiratory distress upon extubation if viscous saliva is caught in their throats.

Step 7.

Charting 

Dental charting is a means to record normal and abnormal findings in the mouth. Each patient should have a dental chart completely filled out every time dental procedures are performed. It is important to have a dental chart that you are familiar with, and a system of recording findings. A good dental chart will have a picture of all the teeth, as well as space to record patient information, anes­thetic protocol, and any advanced procedures performed. 

Start by recording any missing teeth. Circle any teeth on the chart that are not present. Next, take your periodontal probe and explore the periodontal pockets on all sides of every tooth. Record any pockets 3 mm or greater by writ­ing “P-” (for “pocket”) and the number corresponding to the depth of the pocket.

If there is gingival recession, write “GR-” and the number indicating the extent of gingival recession in millimeters. Loose teeth are indicated by an “L”, and so forth. You can certainly develop your own code; just be consistent and record your code on the dental chart so others can read it.

All dental treatments performed should be recorded on the dental chart as well. Extracted teeth are “X’ed” out. Amalgam fillings are indicated by an “AF”, and so on. Again, keep a list of your codes handy, and record every­thing.

Step 8.

Radiology, periodontal surgery, extractions, endodontics (etc.) as needed

After the dental prophylaxis has been completed and the dental chart has been filled out, all the abnormal findings should be addressed. In most cases, dental radiographs are beneficial to aid in our diagnosis and treatment planning.

 

Hemostasis during minor gingival surgery can be main­tained using the Keystone Vet Hemostatic Solution. Dip a sterile cotton tip applicator into the stock bottle of Hemo­static Solution to soak the cotton tip in the solution.

 

 

 

Gently press the soaked cotton tip onto the bleeding gingival and hold for 30 seconds. If reapplication is needed, use a new sterile applicator.

 

 

 

 

Step 9.

Fluoride Foam

The final step in the dental prophylaxis is the application of a fluoride foam. Fluoride can strengthen enamel, is anti bacterial, and can reduce dental hypersensitivity on exposed root surfaces. Fluoride can be toxic in large doses, so only professional application is advised.

Dry the tooth surfaces with an air syringe. One or two pumps of Keystone Fluoride Foam is applied to the dry tooth surfaces, and allowed to remain in contact for 60 seconds. Wipe off excess, but do not rinse off.

Post-operative oral care:

Following oral surgery, such as dental extractions, patients should be sent home on a soft diet, be given appropriate analgesia, and supplies to maintain good oral hygiene. PetORALeze is a 0.12% chlorhexidine gluconate solution that contains no alcohol and is supplied in a convenient spray bottle designed for ease of use.

Simply dispense one or two pumps of the spray bottle into each side of the oral cavity twice a day for the desired period of time (usually 5 – 7 days).

Brush those teeth every day

Daily tooth brushing is the best thing you can recom­mend for pet owners to do at home to promote good oral hygiene. Brushing the teeth once a week or every three days is not enough. A daily tooth brushing is necessary because plaque bacteria can re-colonize the tooth surface in a period of 24-36 hours.

The basic tools of tooth brushing include a toothbrush and toothpaste. The toothbrush should be soft bristled like a children’s toothbrush.

The toothpaste should be thought of as a flavoring to enhance acceptance of the toothbrush. Studies in humans show the use of dentifrice does not contribute to the instant mechanical plaque removal during manual tooth brushing. The mechanical action provided by the use of a toothbrush is the main factor in the plaque-removing process. There have been various claims of benefit from enzyme systems in some veterinary toothpaste, but no research has yet to validate these claims.

Keystone Vet Bright Bark & Meow is a pet toothpaste that is recommended for brushing your pets teeth. Bright Bark & Meow tooth paste combines an appropriately flavored gel formula with 0.12% chlorhexadine gluconate. Chlorhexadine gluconate is known to kill the oral bacteria that cause bad breath and periodontal disease.

How to Brush

To start, place a small amount of toothpaste on the finger and let the pet sniff and lick it. If there is positive inter­est in the flavor of the toothpaste, use it. If the pet is not interested in the toothpaste, brush the teeth without it. Do not use human toothpaste because it contains fluoride that should not be swallowed. Concentrate on the buccal (outside) surfaces of the teeth. Go slowly, and be patient. If things are not going well, wait a few hours before trying again. The toothbrush should be held at a 45º angle to the tooth surface, with the bristles pointing toward the gingi­val (gum) margin. This allows the cleaning of the gingival

sulcus (under the gums) during the tooth brushing process. Work the toothbrush in a circular motion concentrating around the canine tooth and upper fourth premolar tooth. Try for 30 seconds on each side of the mouth.

Prophy Angles.

Our Keystone Vet Prophy Angles provide a gear design which de­livers a continuous back and forth oscillation of the non-latex pro­phy cup. In a veterinary office the benefits obtained from oscillating motion over centrifugal motion, include no costly motor repairs arising from entrapped hair and no wasted time taking measures to prevent hair entanglement. Each disposable Keystone Vet Prophy Angle comes individually wrapped.

 

The combination of Keystone Vet Prophy Angles with our Keystone Vet Prophy Paste not only provides a cost effective alternative to centrifugal angles, but maximizes stain removal while minimizing enamel loss.

 

 

Prophy Paste.

What defines a good prophy paste? It is not the grit or the fancy additives, or the patented "integrated abrasion", but the ability of the paste not to splatter. It is important to have a material which will not break down from the heat or the centrifugal force being generated during the cleaning procedure.

Keystone Vet introduces Keystone Vet Prophy Paste. Our unique blend of materials provides both a splatter-free formula and a single, universal polishing and cleaning paste. For the same reasons we removed the fluoride from Bright Bark & Meow tooth gel, our prophy paste is fluoride free.

Keystone Vet Prophy Paste, for professional veterinary use only, is available in medium grit in four pleasant fragrances of bubble gum, cherry, mint or orange delight. While the pet obtains a clean and polished mouth, the technician enjoys the fragrance emitted during polishing.

 

Have you ever burned out a polishing motor due to entrapped animal hair? Try Keystone Vet Prophy Angles which oscillate in a back and forth motion to prevent catching the patient's hair. In addition to all the above benefits, the combination of Keystone Vet Prophy Paste and Prophy Angles maximizes tooth stain removal and minimizes enamel loss.

 

 

Fluoride Foam.

Keystone Vet Fluoride Foam combines the fluoride uptake of a 1.23% acidulated phosphate fluoride (APF) and the convenience of a foam delivery system. Keystone Vet Fluoride Foam is a light and airy, uniquely textured way to provide sodium fluoride to strengthen the tooth enamel of your patients. Just one minute delivers a non-acid form of sodium fluoride to your patient.

 

Keystone Vet Fluoride Foam, applied using a pumping mechanism, provides application control, less waste and excellent interproximal coverage. Available in cotton candy and grape flavors, each 7.4oz. bottle provides over 130 treatments. With use after each oral procedure, your patient will benefit from an effective and convenient fluoride treatment in addition to having fresher smelling breath.

 

PetORALeze.

PetORALeze combines an effective antiseptic with the convenience of a spray. Our alcohol-free blend of thickening agents combined with chlorhexidine gluconate provides maximum placement coverage to help reduce the redness and swelling of gums caused by gingivitis. The vanilla flavor is a very acceptable taste to the pet.

 

PetORALeze, when used in combination with Keystone Vet Bright Bark and Meow tooth gel and toothbrush helps prevent plaque build up in those hard to reach areas.

 

 

Bright Bark & Meow.

Our Keystone Vet Bight Bark and Meow toothbrush, included with our antiseptic tooth gel, has been chosen by us as the ideal toothbrush for brushing the animal’s teeth. Killing the bacteria which can cause plaque, with chlorhexidine gluconate is only part of the solution. The majority of the plaque removal results from the action of this unique toothbrush. The soft bristles, specially shaped head and ergonomic handle of the Keystone Vet Bright Bark and Meow toothbrush makes providing good oral care in our pets easier and less frustrating for the pet owner.

 

 

In an attempt to promote good and safe oral care in our pets, Keystone Vet introduces Bright Bark & Meow fluoride-free tooth gel and toothbrush combination pack. Formulated for easy use within the oral cavity, Bright Bark & Meow tooth gel combines a unique flavor blend of vanilla and mint with the antimicrobial agent chlorhexadine gluconate. Chlorhexadine gluconate has been proven to kill the oral bacteria that causes both periodontal disease and bad breath. The combination of vanilla and mint flavorings is agreeable to the pet while promoting a fresh smell pet owners prefer.

Bright Bark & Meow tooth gel, when used with our soft bristle brush, makes accomplishing daily tooth brushing of our pets easier than ever before.

Petection.

 

Petection is an oral antimicrobial gel, which contains 0.12% chlorhexadine gluconate. It is alcohol free and flavor formulated for all animals. Some of Petection's benefits include its antimicrobial activity against diverse bacteria and its' "stay where you place it" gel formulation which makes Petection easy to apply.

 

 

Hemostatic Solution.

Keystone Vet Hemostatic Solution is a topical astringent contain­ing aluminum chloride. Our Hemostatic Solution is free of such vasoconstrictors as epinephrine to help avoid dangerous cardiac reactions. Keystone Vet Hemostatic Solution can be used for either gingival retraction or control of minor gingival bleeding.

 

Gingival retraction can be achieved using a plain gingival retraction cord which has been moistened with Keystone Vet Hemostatic Solution. If you should inadvertently damage the gingival margin during tooth preparation or while placing either a strip, a band or a cervical matrix, simply soak sterile cotton tipped applicators with Keystone Vet Hemostatic Solution and apply with pressure to the area until bleeding stops.