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Flashcards in Week 3 Notes Deck (49):
1

Provide Patient Care

Airway and anesthesia management

Circulatory and respiratory support

Monitoring Pain management

Temperature control

Appropriate dental care

2

MAP is important for?

Glomerular filtration

NEVER have a MAP of less than 60!!!

3

What is the maximum allowable dose for 2% lidocaine in a dog and a cat?

Dog 3-5 mg/kg

Cat 2 mg/kg

4

Normal looking patient

A image thumb
5

Name some aspiration hazards in dentistry

Tartar

Debris

Water

!!Aspiration is a major concern during dental procedures!!

6

Airway protection

Used cuffed ET tubes only

- check tubes before induction

- have 2-3 diff. size tubes available

- place largest comfortably fitting tube

- use laryngoscope, if possible

- secure tube

- connect PT to anesthetic machine

- inflate cuff

- pack oropharyngeal area to prevent aspiration

A image thumb
7

Patient monitoring

Begins at PA

DO NOT rely on machines, instead check:

- palpebral & oral reflexes

- jaw tone

- MMs

- chest

- pulses

Monitoring equipment should include:

- HR

- Pulse

- ECG

- Blood pressure

- Capnograph

8

What is the hypothalamus responsible for?

Breathing (primitive function)

9

Hypothermia can cause?

Hypoventilation, which could lead to death

10

Pain Management during dental procedures, why?

  Pain caused by:

- cleaning above and below the gumline

- manipulation of jaw

- Gingivitis

- Extractions

11

Duration of action of hydromorphone

60-120 minutes

12

When to administer pain meds?

Can be given in PA

Can be given during procedure (e.g. Rimadyl injectable)

Can be given as a local block

Post procedure home medication

13

Why should all patients have an IVC?

Access to circulatory system in case of emergencies

Used for anesthetic induction (supports major organ function)

Keeps PT hydrated

Monitor constantly (initiation, total dose of 10mL/kg/hr)

14

Internal body temperature control

Control metabolic processes (pre-, peri-, and post Sx)

Should only drop 1 degree

Beware of thermal burns

Supportive heat important:

- circulating water blankets

- warm blankets

- warm water bottles

- warm fluids

- feet warmers

- bair hugger

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15

What to do prior to scheduling the dental procedure?

Complete PT Hx and PE:

- Oral PE (heaviest calculus deposits are found on 108 and 208!)

- Blood work (CBC/Biochem)

- Note any abnormalities or condition (e.g. heart murmur, lymph node enlargement, asymmetry)

16

What to do at PT check-in?

Get consent forms signed

Get an updated Hx (changes since last PE, when did PT eat and drink last,...)

Explain process to client:

- exam

- doctor's exam

- define anesthetic plan

- pre-anesthetic

- place IV catheter (requires shaving)

- induction

- dental prophylactic procedure

- call to check in

- call as soon as PT is sitting up

- discharge instructions at dismissal

17

Initiate process

Check anesthetic machine

Pressure check:

- O2

- anesthetic agents

- soda lime

- cuff inflator

- scavange system

- tubing

Check monitoring equipment

Check fluid pump

Check your machines

- x-ray

- computers

- dentistry

18

Before you start (set up)

Set up your supplies and equipment:

- Self-protecting equipment (mask, gloves, goggles, lab coat, Sx cap)

- Instruments (hand, surgical instruments and suture)

- Others (gauze, cotton tip applicators, local blocks, needles, syringes, toothbrushes, prophy paste, dental floss, rinse, fluoride)

- PT supplies (towels for eye & fur protection; ET tubes; warming supplies such as blankets, fluid bags, water blanket, bair hugger; IVC; anesthetics)

19

Begin of procedure

Do your POE (pre-operative exam)

Assist DVM w/POE

Prepare anesthetics (PA, induction, emergency)

Give your PA

Place your IVC

Induce your PT:

- fluids

- ET tube (visualize tonsils)

- Monitor PT

- Lubricate eyes

- Monitoring equipment

- Heating supplies

- Nail trim

- Position PT comfortably

20

Initial oral Survey

Protect oropharynx w/oral gauze

Apply rinse (= chlorhex)

Note head type (meso, dolicho, brady)

Note any malocclusion

Look for abnormalities:

- lips

- gums

- palate

- tongue

- teeth

- TMJ (temporomandibular joint)

21

Oral exam

Take pics pre- and post-procedure

Remove supragingival calculus with:

- calculus removal forceps

- hand scaler

Start using the power scalers:

- scale for less than 15 secs per tooth

- be gentle, do not apply too much pressure

- clean above and below gum line

- clean buccal and lingual

- be sure to have constant irrigation

Curettage:

- use curette to clean under gums and in between teeth

Check yourself:

- air

- discoloring solution

- explorer

22

Difference between closed and open root planing

Closed root planing:

- cleans pockets that are 5-6 mm in depth w/o surgical flap

- aligns for reattachment

Open root planing:

- DVM creates surgical flap in order to clean pockets that are 5-6 mm in depth

- may include bone contouring

23

Polishing

Removes irregularities

Use w/a light circular motion

Do not polish a single tooth for more than 15 secs

Use at a speed of 1-3000RPM (should stall by pressing glove against a gloved fingernail)

Prophy should not spatter

24

Rinse

Remove all debris left by the scaling and polishing

- check under tongue

- check around cheeks

- check back of throat

25

Post Perio Evaluation

Perform your exam:

- re-check for abnormalities

- measure pockets

- chart

Ready for DVM exam:

- should confirm charting

- should make a plan (may take radiograph before or after)

26

Charting should include

Periodontal pockets

Tonsil description

Root and furcation exposures

Drain tracks

Masses

Ulcerations and lesions

Malocclusions

Gingivitis and calculus grade

Teeth:

- malaligned

- fractured

- missing

- loose

27

Once the plan is made

Always contact the client (make an updated estimate before you call - include all cost such as addtl. anesthetic, local blocks, addtl. radiographs)

Status of pet

How the procedure is progressing

Explain what you have found

Explain Tx and benefits

Get consent

!!!DOCUMENT CONVERSATION!!!

Proceed however agreed upon

28

Tx plan includes

Radiographs

Bonded sealants (acrylic polymer that seals tubules in dentin)

Open root planning

Doxirobe application (AB that slowly dissolves into tissues)

Extractions

Consil application (synthetic bone graft particulate is osteoconductive = attracts osteocytes)

Mass removals (always biopsy! high malignancy rate!)

29

Once all Tx are completed

Finish charting

Rinse mouth (remove blood clots, debris)

Apply fluoride (dry teeth first! Fluoride desensitizes tooth, provides antibacterial activity, and strengthens enamel):

- FluraFom (3-5 min, do not rinse! Blow dry or wipe off w/gauze)

Take post pictures

After Final Rinse:

REMOVE GAUZE!!!

30

Completion

Clean your PT's coat

Dry PT

Recover PT

Once PT is in sternal recumbency, call client

Discharge PT:

- review procedure w/owner

- show rads

- discuss at home oral care

- set next appt

- schedule call back time

31

PD0

Periodontal disease stage 0

Normal

Clincially normal

No gingival inflammation or periodontitis clinicially evident

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32

PD1

Periodontal disease stage 1

Gingivitis

Gingivitis only without attachment loss

Height and architecture of the alveolar margin are normal (no recession yet)

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33

PD2

Periodontal disease stage 2

Early Periodontitis

- less than 25% attachment loss or at most there is a stage 1 furcation involvement in multirooted teeth

- early radiologic signs of periodontitis

- attachment loss measured either by probing of the clinical attachment level or the radiographic distance of the alveolar margin from the cemento-enamel junction relative to the length of the root

- 3-4 mm probe depth (w/bony inflammation, possible bone loss)

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34

PD3

Periodontal disease stage 3

Moderate Periodontitis

- 25-50% of attachment loss measured either by periodontal probe or radiologic measurements

- stage 2 furcation involvement in multi-rooted teeth

- definite bone loss

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35

PD4

Periodontal disease stage 4

Advanced Periodontitis

- more than 50% attachment loss measured by periodontal probe or radiologic measurement

- stage 3 furcation involvement of multi-rooted teeth

- ~10mm of pocket depth

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36

What to do, if the radiographic image is foreshortened or elongated?

Adjust tube angle

To make roots longer, move tube head more laterally

37

What to do, if you cut the radiographic target off at the edge of the beam (cone cut)?

Simply move the beam over

toward the area of cone cut

38

What to do, if you cut the radiographic target off at the edge of the film?

Move the film over toward the area you cut off

39

Lower jaw shorter

Inferior brachygnathism

40

Upper jaw longer

Superior brachygnathism

41

Attachment of lips to tissue beneath lower canines

Frenulum

42

Beginning of larynx

Epiglottis

43

Q image thumb

Uvula

44

Bare area (no teeth) behind canines and in front of first premolars

Diastema

45

How can you check your work?

Air dry teeth (lefotover calculus and tartar will show up dull and chalky)

Use discoloring solution (be careful - stains very easily)

Use the dental explorer

46

What is polishing paste made of?

Pumice

47

What do you call the dried out, unsutured hole created after extraction?

Dry socket

Site for possible inflammation/infection, pain and sensitivity 

48

After discovering your PT is missing teeth, what should still be done?

Take radiographs of site anyway

Missing teeth may have root tips remaining that need to be removed

49

Is some mobility of teeth normal?

Mobility of about 1mm is completely normal