DOCSLIB.ORG

2019 AAHA Dental Care Guidelines for Dogs and Cats*

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
2019 AAHA Dental Care Guidelines for Dogs and Cats* VETERINARY PRACTICE GUIDELINES 2019 AAHA Dental Care Guidelines for Dogs and Cats* Jan Bellows, DVM, DAVDC, DABVP (Canine/Feline), Mary L. Berg, BS, LATG, RVT, VTS (Dentistry), Sonnya Dennis, DVM, DABVP (Canine/Feline), Ralph Harvey, DVM, MS, DACVAA, Heidi B. Lobprise, DVM, DAVDC, Christopher J. Snyder, DVM, DAVDCy, Amy E.S. Stone, DVM, PhD, Andrea G. Van de Wetering, DVM, FAVD ABSTRACT The 2019 AAHA Dental Care Guidelines for Dogs and Cats outline a comprehensive approach to support companion animal practices in improving the oral health and often, the quality of life of their canine and feline patients. The guidelines are an update of the 2013 AAHA Dental Care Guidelines for Dogs and Cats. A photographically illustrated, 12-step protocol describes the essential steps in an oral health assessment, dental cleaning, and periodontal therapy. Recommendations are given for general anesthesia, pain management, facilities, and equipment necessary for safe and effective delivery of care. To promote the wellbeing of dogs and cats through decreasing the adverse effects and pain of periodontal disease, these guidelines emphasize the critical role of client education and effective, preventive oral healthcare. (JAmAnimHospAssoc2019; 55:---–---. DOI 10.5326/JAAHA-MS-6933) AFFILIATIONS * These guidelines were supported by a generous educational grant from Boehringer Ingelheim Animal Health USA Inc., Hill’s® Pet Nutrition, Inc., From All Pets Dental, Weston, Florida (J.B.); Beyond the Crown Veterinary and Midmark. They were subjected to a formal peer-review process. Education, Lawrence, Kansas (M.L.B.); Stratham-Newfields Veterinary Hos- These guidelines were prepared by a Task Force of experts convened by the pital, Newfields, New Hampshire (S.D.); Department of Small Animal Clin- American Animal Hospital Association. This document is intended as a ical Sciences, College of Veterinary Medicine, University of Tennessee, guideline only, not an AAHA standard of care. These guidelines and recom- Knoxville, Tennessee (R.H.); Main Street Veterinary Dental Hospital, Flower mendations should not be construed as dictating an exclusive protocol, Mount, Texas (H.B.L.); Department of Surgical Sciences, School of Vet- course of treatment, or procedure. Variations in practice may be warranted erinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin based on the needs of the individual patient, resources, and limitations (C.J.S.); Department of Small Animal Clinical Sciences, College of Veter- unique to each individual practice setting. Evidence-based support for spe- inary Medicine, University of Florida, Gainesville, Florida (A.E.S.S.); and cific recommendations has been cited whenever possible and appropriate. Advanced Pet Dentistry, LLC, Corvallis, Oregon (A.G.VdW.). Other recommendations are based on practical clinical experience and a CONTRIBUTING REVIEWERS consensus of expert opinion. Further research is needed to document some R. Michael Peak, DVM, DAVDC (The Pet Dentist, Tampa, Florida); Jeanne R. of these recommendations. Because each case is different, veterinarians must Perrone, CVT, VTS (Dentistry) (VT Dental Training, Plant City, Florida); base their decisions on the best available scientific evidence in conjunction Kevin S. Stepaniuk, DVM, FAVD, DAVDC (Veterinary Dentistry Education with their own knowledge and experience. and Consulting Services, LLC, Ridgefield, Washington). Note: When selecting products, veterinarians have a choice among those formulated for humans and those developed and approved by veterinary Correspondence: [email protected] (C.J.S.) use. Manufacturers of veterinary-specific products spend resources to have their products reviewed and approved by the FDA for canine or feline use. These products are specifically designed and formulated for dogs and cats and have benefits for their use; they are not human generic products. AAHA suggests that veterinary professionals make every effort to use veterinary FDA-approved products and base their inventory-purchasing decisions on what product is most beneficial to the patient. y C. Snyder was the chair of the Dental Care Guidelines Task Force. NAD (nonanesthetic dentistry); PD (periodontal disease staging); VOHC (Veterinary Oral Health Council); VTS (Dentistry) (Veterinary Technician Specialist[s] in Dentistry) ª 2019 by American Animal Hospital Association JAAHA.ORG 1 Introduction excellent, basic resource for clinicians, the 2019 guidelines published here provide important new information. This includes (1) an ex- The concept that a pet is suffering from oral pain, infection, and panded and updated discussion of commonly performed veterinary inflammation that may not be apparent but is affecting their quality dental procedures, supported by photos that illustrate oral pathol- of life is a reality that may not always be fully appreciated by ogy and therapeutic techniques; (2) criteria for periodontal disease the veterinary profession and often not understood by the pet- staging; (3) the importance for addressing pain and stress in dental owning public. Compromised dental health can affect a pet’sover- patients; and (4) client communication tips for explaining the im- all health, longevity, quality of life, and interaction with its owner portance and rationale behind specific dental and oral procedures. without exhibiting obvious clinical signs of disease. The purpose of Client education is a particularly important and often underap- this document is to provide guidance to veterinary professionals that preciated aspect of veterinary dentistry. Without the pet owner’s will enable them to recognize dental pathology and deliver appropriate understanding and acceptance of the veterinarian’s oral health rec- preventive and therapeutic care to their patients, as well as to provide ommendations, the decision to pursue dental cleaning, oral evalu- essential dental education to their clients. ation, and treatment will seem optional. Applying the AAHA Dental In consideration of our patients’ welfare, veterinary profes- Care Guidelines with an emphasis on client communication will sionals must understand that dental patients often experience con- enhance your practice by providing your clients with services that siderable fear, anxiety, stress, pain, and suffering. In order to achieve address a critical component of canine and feline healthcare. optimal clinical success and client satisfaction, it is essential that the veterinary team address these concerns with every client, beginning Dental Terminology with the first interaction when scheduling an appointment. Although dental terminology is constantly being defined, current The guidelines are based on evidence-based information definitions applicable to veterinary dentistry are shown in Table 1. whenever possible, although we recognize that relevant data and well- Readers will find it helpful to review these definitions before reading designed veterinary dental studies have not always been conducted the remainder of the guidelines. for all the topics covered in these guidelines. As a result, expert Veterinary dentistry is a discipline within the scope of veterinary opinion and the extensive clinical experience of the Task Force practice that involves the professional consultation, evaluation, di- members have been used in writing the guidelines. The collective goal agnosis, prevention, and treatment (nonsurgical, surgical, or related of the Task Force was to apply the highest level of evidence-based procedures) of conditions, diseases, and disorders of the oral cavity information available when preparing the guidelines. and maxillofacial area and their adjacent and associated structures. The guidelines are intended primarily for general practitioners Veterinary dental diagnoses are made and treatments performed by a and veterinary team members without advanced dental training. The licensed veterinarian, within the scope of his or her education, Task Force encourages all veterinary professionals to continuously training, and experience, in accordance with the ethics of the pro- improve their veterinary dentistry knowledge, skills, and treatment fession and applicable law. capabilities and to recognize cases needing referral. It is well known The term “dental” has lost favor as an all-purpose descriptive that many pet owners use the internet as a default resource for pet term because it does not adequately define a particular procedure to 1 healthcare information and home treatment. However, because of be performed. For example, specific diagnostic and treatment ter- the specialized nature of dental procedures, including diagnosis and minology should be used to describe procedures such as a complete treatment, professional veterinary care is necessary for maintaining oral health assessment, orthodontics, periodontal surgery, and ad- pet oral health. Therefore, veterinary dentistry represents an op- vanced oral surgery. Using specific diagnostic and treatment ter- portunity for a primary care practice to demonstrate a high level of minology will help staff and clientele understand the importance service and professional expertise to its clients and to positively and specifics of a scheduled procedure. impact patient comfort and wellbeing. Additional information on veterinary dental nomenclature can The guidelines are intended to be a first-line resource in helping be found on the American Veterinary Dental College (AVDC) website practitioners achieve that essential goal. Readers should consider the (avdc.org/Nomenclature/Nomen-Intro.html).
Load more

Recommended publications
  • 120260 Vdent Spring
    ISSUES IN DENTISTRY AND HEAD & NECK SURGERY SMALL MOUTHS, BIG HOLES: aney are partnersaney are What To Do When There Is Still Tumor Present? A T It is not unusual to remove a relatively small tumor only to find that the pathology report indicates that the tumor was not completely excised. As a general practitioner, how do you advise your client? Well, the tumor will continue to grow and at this time it is as small as it is ever going B to be. Although no owner is happy to hear that a second dstrom is a 2010 graduate of the Colorado State State of the Colorado dstrom is a 2010 graduate E surgery is recommended, watching and waiting only makes in entering practice before private 16-years ech for ditor of the Journal of Veterinary Dentistry and co- Veterinary of ditor of the Journal T E mily mily future surgery more extensive and difficult….especially E Dr. Mark M. Smith and Dr. Kendall Smith and Dr. M. Mark Dr. Surgery Dentistry and Oral Veterinary in the Center for of the Smith is a Diplomate Dr. in 2006. established American and the Surgeons Veterinary American of College of Surgery Professor He was Dental College. Veterinary Veterinary of Regional College VA-MD the and Dentistry at in the mouth where “extra” tissue for wound closure is at Dr. a completed She Medicine. Veterinary of School University at internshiprotating in small animal medicine and surgery She MD. in Gaithersburg, Associates Referral Veterinary VCA Dental Society. Veterinary American is a member of the a premium.
    [Show full text]
  • Growing Your Practice with Pathology Recognition, Preventive Dental Care, and Value Marketing©
    1 Veterinary Dentistry: Growing your Practice with Pathology Recognition, Preventive Dental Care, and Value Marketing© Kevin S. Stepaniuk, DVM, Fellow AVD, Diplomate AVDC Columbia River Veterinary Specialists, Vancouver WA Adjunct Assistant Professor University of Minnesota College of Veterinary Medicine CVMA - Society of BC Veterinarians Chapter Fall Conference and Trade Show – November 9, 2014 INTRODUCTION Developing and growing a successful veterinary dentistry service in a general practice relies on several key factors. But what do I know? My background has allowed me the opportunity to build a general practice, a private referral dentistry practice, develop programs in academia, and develop a specialty practice within a multiple discipline specialty hospital. I do not have a business degree or a corporate leadership position or an entrenched academic ivory tower position. I have, and continue to, work on the front line in the trenches. However, my collective experiences, clinical training, leadership and business training, board positions, and opportunity to see success and failure from both sides of the referral fence, provide me with a unique perspective on veterinary dentistry and oral surgery in veterinary practice; where it has come from, where it is at, where it is going, and where can we direct it to go. I believe there are many missed opportunities in veterinary dentistry, patient avocation, and patient care due to seven (7) common short comings in practical veterinary dentistry©: 1) Lack of collective veterinary dental education
    [Show full text]
  • Veterinary Dentistry Extraction
    Veterinary Dentistry Extraction Introduction The extraction of teeth in the dog and cat require specific skills. In this chapter the basic removal technique for a single rooted incisor tooth is developed for multi-rooted and canine teeth. Deciduous teeth a nd feline teeth, particularly those affected by odontoclastic resorptive lesions, also require special attention. Good technique requires careful planning. Consider if extraction is necessary, and if so, how is it best accomplished. Review the root morphology and surrounding structures using pre-operative radiographs. Make sure you have all the equipment you need, and plan pre and post-operative management. By the end of this chapter you should be able to: ü Know the indications for extracting a tooth ü Unders tand the differing root morphology of dog and cat teeth ü Be able to select an extraction technique and equipment for any individual tooth ü Know of potential complications and how to deal with them ü Be able to apply appropriate analgesic and other treatment. Indications for Extraction Mobile Teeth Mobile teeth are caused by advanced periodontal disease and bone loss. Crowding of Teeth Retained deciduous canine. Teeth should be considered for extraction when they are interfering with occlusion or crowding others (e.g. supernumerary teeth). Retained Deciduous Teeth Never have two teeth of the same type in the same place at the same time. This is the rule of dental succession. Teeth in the Line of a Fracture Consider extracting any teeth in the line of a fracture of the mandible or maxilla. Teeth Destroyed by Disease Teeth ruined by advanced caries, feline neck lesions etc.
    [Show full text]
  • Dentish Recommending Scaling and Root Planing
    Dentish Recommending Scaling And Root Planing Giorgi cracks abundantly while Israeli Ulick disentitles fluidly or hemorrhage taxonomically. Mason comes her rounds piecemeal, she nuggets it educationally. Maniac Virgil assimilates furthest. The root scaling and the gum pocket and dental schools are missing the expert dentist may also make Of patients with chronic periodontitis by arrest of scaling and root planing SRP. Corona Dentist James Lai Dentistry Family & Cosmetic. Of previous dental practitioners' preventive recommendations in western. The Dentist's Quick mind to Medical Conditions. San Antonio TX Scaling Root Planing Deep Dental Cleanings. Removing all plaque from a touchy tooth and placing a dab of fluoride toothpaste on his will greatly reduce cold to touch sensitivity within this few days APPEARANCE Your gums will tighten up redness will round to pink bleeding will put almost entirely if not completely. Treatments called periodontal cleaning or scaling and root planing. Treating periodontal diseases American Dental Association. Is root planing and scaling necessary? I could been practicing dental hygiene for seven years and snag work get another. And wave a diagnosis before recommending or shape these procedures. And rally a diagnosis before recommending or handbook these procedures. Periodontal Scaling & Root Planing Brown Family Dentistry. Typically they are recommended as a preventative measure but those day are. Doctor disagrees with hygienists Conservative approach. What real Deep Cleaning in Encinitas Deep Scaling Root Planing. They relay a common treatment procedure called scaling and root planing. Scaling and root planing effectiveness dental char and tools. Periodontal Scaling & Root Planing Torrance CA Matthew. Dental hygienists have a tangible and ethical obligation to have either solid.
    [Show full text]
  • Brochure We Would Like to Address the Most Common of These
    Scan me! Patient information Q&A on dental implants Scan me! "Naturally white implants" Dear Patients, There are many reasons for tooth loss, but whatever the cause, your quality of life is impaired. Impaired chewing and speech frequently occurs, especially when more than one tooth is lost. Constant bone degeneration of the jaw can also cause lasting problems.1 Implants as tooth root replacements can be the ideal solu- tion in this case. They can replace individual teeth, restore a set of teeth and bridges and serve as a basis for fixed dentition or a removable denture. For many years the use of dental implants has been a re- liable treatment method and is scientifically recognised.2 As every person, every patient is unique, there are a whole host of questions that arise. In this brochure we would like to address the most common of these. The brochure has been developed in collaboration with dentists with many years of experience in dental implantology. 3 Preface 4 Tooth loss – now what? 5 What are dental implants? "In a survey, Zeramex asked 1000 6 When are dental implants used? participants about their opinion on the 9 Implant treatment, step by step colour of dental implants. The result was 16 Dental implantation – a routine procedure? 19 Dental implants – the best alternative? clear – 87% of those surveyed would opt 21 Is a dental implant worth it? for a white dental implant." 22 Why Zeramex ceramic implants? 24 Zeramex – dental implants Made in Switzerland 2 3 "Tooth loss – now what?" "What are dental implants?" A sports accident, decay, periodontitis what we have until it is gone.
    [Show full text]
  • 001-017-Anesthesia.Pdf
    Current Fluid Therapy Topics and Recommendations During Anesthetic Procedures Andrew Claude, DVM, DACVAA Mississippi State University Mississippi State, MS • Intravenous fluid administration is recommended during general anesthesia, even during short procedures. • The traditional IV fluid rate of 10 mls/kg/hr during general anesthesia is under review. • Knowledge of a variety of IV fluids, and their applications, is essential when choosing anesthetic protocols for different medical procedures. Anesthetic drug effects on the cardiovascular system • Almost all anesthetic drugs have the potential to adversely affect the cardiovascular system. • General anesthetic vapors (isoflurane, sevoflurane) cause a dose-dependent, peripheral vasodilation. • Alpha-2 agonists initially cause peripheral hypertension with reflex bradycardia leading to a dose-dependent decreased patient cardiac index. As the drug effects wane, centrally mediated bradycardia and hypotension are common side effects. • Phenothiazine (acepromazine) tranquilizers are central dopamine and peripheral alpha receptor antagonists. This family of drugs produces dose-dependent sedation and peripheral vasodilation (hypotension). • Dissociative NMDA antagonists (ketamine, tiletamine) increase sympathetic tone soon after administration. When dissociative NMDA antagonists are used as induction agents in patients with sympathetic exhaustion or decreased cardiac reserve (morbidly ill patients), these drugs could further depress myocardial contractility. • Propofol can depress both myocardial contractility and vascular tone resulting in marked hypotension. Propofol’s negative effects on the cardiovascular system can be especially problematic in ill patients. • Potent mu agonist opioids can enhance vagally induced bradycardia. Why is IV fluid therapy important during general anesthesia? • Cardiac output (CO) equals heart rate (HR) X stroke volume (SV); IV fluids help maintain adequate fluid volume, preload, and sufficient cardiac output.
    [Show full text]
  • Pharmacology – Inhalant Anesthetics
    Pharmacology- Inhalant Anesthetics Lyon Lee DVM PhD DACVA Introduction • Maintenance of general anesthesia is primarily carried out using inhalation anesthetics, although intravenous anesthetics may be used for short procedures. • Inhalation anesthetics provide quicker changes of anesthetic depth than injectable anesthetics, and reversal of central nervous depression is more readily achieved, explaining for its popularity in prolonged anesthesia (less risk of overdosing, less accumulation and quicker recovery) (see table 1) Table 1. Comparison of inhalant and injectable anesthetics Inhalant Technique Injectable Technique Expensive Equipment Cheap (needles, syringes) Patent Airway and high O2 Not necessarily Better control of anesthetic depth Once given, suffer the consequences Ease of elimination (ventilation) Only through metabolism & Excretion Pollution No • Commonly administered inhalant anesthetics include volatile liquids such as isoflurane, halothane, sevoflurane and desflurane, and inorganic gas, nitrous oxide (N2O). Except N2O, these volatile anesthetics are chemically ‘halogenated hydrocarbons’ and all are closely related. • Physical characteristics of volatile anesthetics govern their clinical effects and practicality associated with their use. Table 2. Physical characteristics of some volatile anesthetic agents. (MAC is for man) Name partition coefficient. boiling point MAC % blood /gas oil/gas (deg=C) Nitrous oxide 0.47 1.4 -89 105 Cyclopropane 0.55 11.5 -34 9.2 Halothane 2.4 220 50.2 0.75 Methoxyflurane 11.0 950 104.7 0.2 Enflurane 1.9 98 56.5 1.68 Isoflurane 1.4 97 48.5 1.15 Sevoflurane 0.6 53 58.5 2.5 Desflurane 0.42 18.7 25 5.72 Diethyl ether 12 65 34.6 1.92 Chloroform 8 400 61.2 0.77 Trichloroethylene 9 714 86.7 0.23 • The volatile anesthetics are administered as vapors after their evaporization in devices known as vaporizers.
    [Show full text]
  • Six Great Reasons to Have Your Teeth Cleaned
    Six great reasons to have your teeth cleaned We’ll do whatever it takes and then some. 1. To prevent gum disease 3. To have a brighter smile Preventive care is the key to good Gum (periodontal) disease is a Personal habits — such as tobacco oral health bacterial infection caused by plaque use or drinking coffee, tea and — the sticky, colorless, bacteria-filled other beverages — can cause tooth Regular dental care can film that adheres to your teeth. As staining. Certain medications also can help you and your family plaque builds up on teeth, it hardens discolor teeth. Teeth cleaning by your stay healthy and pain-free. and becomes tartar, which can be dentist or hygienist, however, can difficult to remove. The bacteria in often remove these external stains • You can get treatment plaque produce toxins that irritate the — and it promotes good oral health. before a problem gums and cause inflammation and In addition to removing plaque and becomes more serious. gingivitis. If bacteria are not removed tartar during your cleaning, your • The state of your dental and the inflammation continues, hygienist will also polish your teeth to health can affect other the gum tissues can be destroyed a beautiful shine. The result? A whiter health conditions. and more advanced stages of gum and brighter smile! disease may follow. • Many undetected health conditions have 4. To prevent bad breath oral symptoms. 2. To keep your teeth Persistent bad breath (halitosis) As gum disease advances, the pockets has many possible oral causes such There are many reasons to have regular dental grow deeper, and plaque moves as poor oral hygiene, periodontal examinations and further down the tooth root, destroying disease, a coating on the surface of cleanings, so make an supporting bone.
    [Show full text]
  • Air Polishing: a Review of Current Literature
    Literature Review Air Polishing: A Review of Current Literature Sarah J. Graumann, RDH, BS, MDH; Michelle L. Sensat, RDH, MS; Jill L. Stoltenberg, BSDH, MA, RF Introduction Abstract An air polisher provides an alter- Purpose: Routine tooth polishing continues to be an integral part of native method of removing suprag- clinical practice even though the concept of selective polishing was ingival extrinsic stain and deposits introduced in the 1980s. This procedure assists in the removal of from the teeth. Unlike conventional stains and plaque biofilm and provides a method for applying vari- mechanical polishing (handpiece ous medicaments to the teeth, such as desensitizing agents. Use with rubber–cup and prophylaxis of traditional polishing methods, i.e. a rubber–cup with prophylaxis paste) used to polish teeth, the air paste, has been shown to remove the fluoride–rich outer layer of polisher uses a light handpiece simi- the enamel and cause significant loss of cementum and dentin over lar to an ultrasonic scaler to gener- time. With the growing body of evidence to support alternative tooth ate a slurry of pressurized air, abra- polishing methods, dental hygiene practitioners should familiarize sive powder and water to remove themselves with contemporary methods including air polishing. plaque biofilm and stains (Figures 1, The purpose of this review is to provide a comprehensive overview 2). Air polishing was first introduced of recent advancements in air polishing. The effect of air–powder to the dental profession in the late polishing on hard and soft tissues, restorative materials, sealants, 1970s. The first air polishing device orthodontic appliances and implants, as well as health risks and (APD), the Prophy Jet Marck IV™, contraindications to air polishing are discussed.
    [Show full text]
  • Abrasiveness of an Air-Powder Polishing System on Root Surfaces in Vitro
    Abrasiveness of an air-powder polishing system on root surfaces in vitro Mette S. Agger, DDSVPreben Hörsted-Bindslev, DDSTOle Hovgaard, Objective: The purpose oí Ihis study was tc evaluate the abrasiveness of a new air polisher on roof surfaces. Method and materials: Fifty extracted human teeth were air polished for 5 seconds. Results: Ali root surfaces showed a circular defect visible wifh fhe naked eye. Scanning elecfron microscope examination showed smooth crater wails and a few open denfin fubules, but most seemed fc be obliterated. Laser profilomefry of the exposed areas revealed defecfs wifh an average depth of 484 ym, whereas fhe unexposed root surfaces showed irreguiarifies wifh an average depth of 323 gm. The depths of fhe abraded areas were evaluafed in relafion fo the values for the unexposed surfaces, and an average depth of 161 |jm was found.The difference befween the exposed and unexposed surfaces was statisticaliy significanf. Conclusion: The presenf sfudy indicates that the air polisher has a strong abrading effect on exposed roof surfaces and should therefore be used with caution on patients with gingival retractions. (Quintessence Int 2001:32:407-411 ) Key words: abrasiveness, air polishing, exposed roof surfaces Sound, mature enamel has been shown to be resis- CLINICAL RELEVANCE: Air polishing should be per- tant to air polishing and polishing with pumice with- formed wifh caufion on exposed root surfaces. out significant signs of abrasion lesions,^^ whereas air polishing on white spot lesions and enamel (where the prisms have been cut or ground) left an eroded he most common method used for tooth polishing surface.* Tis a rotating rubber cup and pumice.
    [Show full text]
  • Dental Cleanings
    DENTAL CLEANINGS Frequently Asked Questions Dental cleanings are important for maintaining healthy teeth and gums. But there are different types of cleanings and their corresponding billing code, which may require a different patient payment.* The information below will help you understand the differences between types of cleanings and the role each can play in the prevention and/or treatment of dental disease. Your dentist will recommend the right cleaning for you. Q. What is a prophylaxis – billing code D1110? A. A prophylaxis, sometimes called a “regular cleaning,” is considered a preventive procedure where the dentist or dental hygienist removes plaque, calculus (tartar) and stains from the teeth. The dentist may recommend this procedure at regular intervals, typically twice per year, for patients whose gum health is generally good (healthy gum color and texture, minimal plaque and calculus, and shallow gum pockets around the teeth). A regular cleaning may also be appropriate for a patient with a gum condition limited to mild gingivitis (gum inflammation). Q. What is scaling in the presence of inflammation – billing code D4346? A. Scaling in the presence of inflammation is considered to be a therapeutic procedure where the dentist or dental hygienist removes plaque, calculus, and stains from the teeth. Unlike a prophylaxis (D1110) that may be recommended when there is mild gingivitis (gum inflammation), scaling in the presence of inflammation may be recommended when there is moderate to severe gum inflammation. This procedure is intended for patients who exhibit swollen, inflamed gums and moderate to severe bleeding when the dentist or hygienist probes the gum pockets.
    [Show full text]
  • Manual of Applied Infection Prevention and Control
    MANUAL OF APPLIED INFECTION PREVENTION AND CONTROL 2021-2022 1 Table of Contents OVERVIEW: APPLIED INFECTION PREVENTION AND CONTROL .............................. 5 Introduction ......................................................................................................................................... 5 Rationale ................................................................................................................................................ 5 How does infection occur ................................................................................................................. 5 Contact transmission .................................................................................................................................... 5 i. Direct ..................................................................................................................................................................... 5 ii. Indirect ................................................................................................................................................................. 5 Droplets .............................................................................................................................................................. 5 Aerosols .............................................................................................................................................................. 5 Infection Control Protocol: Standard Precautions ................................................................
    [Show full text]