Lecture 11: home care Flashcards
Home care communication is importnat because
Client compliance is critical to success, and can only be achieved through client communication and education
Client education is an important way to evaluate the client’s willingness to perform homecare and the patient’s willingness to accept it
It should begin before the prophylaxis as client compliance regarding homecare affects the decision to save a tooth or extract it
Home Care Considerations at Discharge Post-Procedure
pain management
Antibiotics
Diet
Pain management before being sent home from a dental
Top up before discharge
Make sure to send appropriate pain control home
What to do for at home pain managment
Pills may be more difficult for clients due to sore mouth
Consider liquid analgesics
May require more than one kind of analgesic – owner to call if they feel their pet is painful on current protocol
Antibiotics for dental procedures
Not necessary for all dental procedures
Liquid medications may be easier for client to administer
Also dependent on veterinarian preference
What should the client watch for
Post-anesthesia – may be more sleepy than normal with reduced appetite for up to 24 hours
Bloody oral discharge – consider protecting rugs, furniture, etc.
Unusual behaviours
Pawing at mouth – may need e collar to allow gums to heal
Lip smacking
Head rubbing or shaking
Hiding (cats) or attention seeking (dogs)
Diet post op
Reduced appetite is common for the first 12-24 hours after anesthesia
If inappetence persists, need to re-evaluate the patient
If the pet has had extractions, soft food is usually recommended for 5-14 days depending on the procedure
Canned food
Soaked kibble
Why encourage homecare?
Maintain oral health
Improved mastication
Oral problems are detected (and treated) earlier
Decreased bacteremia
Oral hygiene procedures are easier
Increased life span
Increased bond between owner and pet
Increased quality of life
Time between oral hygiene procedures in increased
Decreased oral infections
Increased bond between client and staff
Relieves oral pain
When to follow up for a dental
Regular follow up and monitoring - differs by clinic:
1-2 days after prophy (phone call)
7-10 days after procedure (exam to assess healing, discuss homecare again)
Every 6-12 months (oral exam)
Factors for success of a dental post op
Adequate education in product use
Cooperative patient
Owner compliance
Reasonable goals for the owners
Home care products are acceptable to the owner and the pet
Regular follow up and monitoring
What type of home care products are there
Brushing with/without enzymatic toothpaste
Dental diets
Dental treats
Dental rinses, gels, and water additives
Chew toys
Mechanical mechanism of action is
most important!
Brushing – most effective method of plaque prevention!
Certain dental diets and treats
Chemical action of removing plaque is
Veterinary enzymatic toothpastes
Certain dental diets and treats
Dental rinses, gels, and water additives
How soon does plaque form on teeth and how to negate it
Plaque begins to build on the teeth within 6-8 hours after scaling so brushing teeth by owners is very important
Recommend daily brushing - gold standard
Replace the toothbrush regularly; one toothbrush per pet
What toothbrush would you use for different sizes
Adult toothbrush – large and medium dogs
Child toothbrush – small dogs
Proxabrush – cats and very small dogs
CET cat tooth brush – cats and very small dogs
Fingerbrush – pets that don’t tolerate a regular toothbrush, not as effective as toothbrushes but better than nothing
Electric toothbrush – may work in some patients
Waterpik or pipe cleaner – for full furcation exposure exposure
How to demonstrate brushing for owners
To demonstrate proper brushing techniques to owners it must be presented both verbally and visually
This can be accomplished first with the use of a model, then a demonstration animal can be used
Either the clinic cat, your own pet, or the client’s pet
You should demonstrate correct technique then have the owner attempt brushing in your presence so that you can assist them
If there have been extractions, this is best done at the 7-10 day post-dental visit
How to start introducing a brush to a dog
Start with simple touching of the lips and slowly advance to complete and correct brushing
Desensitize and counter-condition the pet to the procedure
Go slowly, and keep the pet below threshold
If they are pulling away or seem nervous (avoiding eye contact, lip licking, yawning, excessive blinking, or panting) – go back a step and go more slowly
Keep sessions short
Associate sessions with positive rewards (food, play, affection, verbal rewards)
Why is introduction to the toothbrush important
If you do it correctly, this should be fun, and the pet should look forward to it!
This will increase client compliance, because the pet enjoys it
Show the client how to hold their pet while brushing the teeth (generally seated and approaching from behind)
May be able to progress through several steps in one session
What steps do you use to introduce a toothbrush
Start with gentle touching of the face and lips
Then progress to lifting the lips
Keep the mouth closed (do not need to separate the upper and lower arcade)
Show the toothbrush to the pet
Let them sniff and lick it
May want to add flavour to the toothbrush via flavoured pet toothpastes or chicken/ beef broth or water from tuna/salmon can
Gently swipe the teeth with the toothbrush initially
Progress to correct brushing technique over time
Brushing technique
Brush at a 45 degree angle to the tooth
The toothbrush bristles should be placed at the gum margin where the teeth and gums meet
The movement should be in an oval pattern
Focus on pulling the plaque towards the crown and away from the gumline
Be sure to gently force the bristle ends into the area around the base of the tooth as well as into the space between the teeth
Ten short back-and-forth motions should be completed, then the brush should be moved to a new location
Cover three to four teeth at a time
Brush all surfaces if possible, but at least labial and buccal surfaces
What to use to brush a dogs teeth and what sides
Equipment = toothbrush + cooperative pet +/- enzymatic tooth paste
Usually just brush the buccal aspect of the teeth
In very patient pets, can open the mouth to brush the lingual and palatal surfaces of the teeth
Can use a toy or dental chew as a prop to hold open the mouth for brushing
Toothpaste is
Use of an enzymatic toothpaste in combination with brushing enables both mechanical and physical techniques of plaque prevention
The best pet toothpastes contain enzymes that help control plaque
The flavor of pet toothpastes will help make brushing fun for the pet
Avoid human toothpastes because pets cannot spit! They often contain compounds which should not be swallowed like baking soda, detergents, salt, or fluoride
Dental rinses are
Reduces bacterial load in the oral cavity reducing plaque accumulation
Binds to the salivary pelicle and is released over a prolonged period of time
Ingredients are antibacterial:
Chlorhexidine
Zinc
Drinking water additives are
Clinical studies show that adding dental water additives such as CET Aquadent® or BreathaLyser® in conjunction with regular hoe dental care significantly reduced plaque and tartar accumulation as well as halitosis
Chlorhexidine and Xylitol*
