Welcome to the Vet Dental Show. I'm Brett Beckman, board certified veterinary dentist, and we bring this podcast to you every Wednesday as a veterinarian, as a technician, as a dentistry team to help you be even better if veterinary dentistry in your practice. We're sponsored and partnered today with the Veterinary Dental Practitioner Program. If you're interested. In being among the best anywhere in general practice as a team in veterinary dentistry, I invite you to request an invitation.
It's go to i d.org/i nv. Like invitation first three letters, INV, so IVDI, international Veterinary Dentistry Institute, i vdi.org/i nv and we'll get you the information that you need. Let's let's start off with the first question. Carol Kka ask if and this is a fairly common question. If you fractured a conal root of three 10 or four 10, so think about that. So first, more 10 or four 10 in a very small dog, how can you get the best access to remove Bcal bone?
And I think what we need to do is we need to go back and answer this question by laying out how we would approach that initially from the standpoint of extraction. So there are a couple of different scenarios there. The the three 10 and four 10, the two rooted tooth in the caral mandible are a difficult extraction to begin with. Certainly difficult if it's not approached correctly.
Let's say that this that 11 is gone, which is generally an easy extraction unless that's ankylos, but let's say 11 is gone and we need to extract this with, and there's not a lot of disease, but maybe there's periodontal disease associated with the. Mesial root and it's affecting the carnal or the distal aspect of 3 0 9 or 4 0 9. So the mandibular first molar there, which is a strategic tooth.
So rather than try to do any type of salvage procedure on three 10 and four 10, we commonly find that we need to extract it. So in so doing. I personally prefer, and this has been through adjustments and changes that I've made in my approach over the years, I have always hated to extract this tooth with a flap. So I've migrated toward not doing a flap and all other than exposing the furation with a. Small end of a feline periosteal elevator on both the vestibular side and the lingual side.
So just not a true flap, but just exposing that furation so that when I section it's not going to impinge on the gingival margin there because we're gonna wanna close that. And that said, we may, if there's not. A lot of periodontal disease. We may need to get a little bit more than just that minor manipulation, especially on the lingual side to close, but we'll talk about that in a second. So using a number 1.2 to 1.5 luxate elevator or a two luxate elevator.
Placing that between those two routes and using very slow and patient pressure for maybe even a couple minutes. And this is where you can throw that, that 15 second rule that I've always talked about out the window. If you're trying to extract this with a simple extraction technique without having to do. A big flap and remove a lot of bone. This is the way to go, and this proves very successful in most cases, as long as you are patient with it.
So placing that luxate elevator between those two routes and moving them in different directions based on where the concave portion of that elevator is. Initially you can use, let's say we're pointing that concave portion toward the distal root. We're between those two and we're putting pressure from going toward the vestibular side. We're pushing that way that we can certainly do the o opposite, turn that around and push it toward the lingual way with that.
Convex or cut portion still at the distal root and pushing it lingual. Now, that is much easier to show on a video, but for the most part, you're using that to leverage that tooth root in both cases to different orientations as you're manipulating those with that luxate elevator. And using the edge of that cup on that con pave portion of that luxate elevator to push very gently and very patiently toward the direction that you want to go, that you want to loosen.
And you just, you want to just change that up as you move to the other route as well. So just that I know that. It sounds like it might be com complicated. It isn't. But essentially just use that elevator to put slow, continuous pressure against those routes, using them against each other until you get reasonable mobility and going for a couple minutes at a time.
And if you've got your loops on, you can watch that move and you can watch that distance between the two Roofs get bigger gradually if you do it too quick. You're gonna fracture the root and you're gonna end up doing a flap anyway. So the best way to approach that is to be very patient and use that technique. And then once you get significant mobility, put your extraction forceps on there and extract each one of those roots individually, and that is successful maybe 80% of the time or better.
If you have a patient let's look at another scenario. Excuse me. If you have a patient where you're doing a flap to remove that first molar anyway, you can easily extend it back and you can use your vestibular bone removal with a 7 0 1 L elbow to remove that bone parallels to the root until that root comes into view. Then use that same technique. You don't wanna take it to the apex. In that case, you could, because the mandibular canal is apal to that.
But you don't want to use that where it's all the way the apex because it takes a long time. That bone gets really thick as you approach the apex. So you wanna make sure that you try to. Only go maybe about a half to two thirds of the way down if you're gonna remove vestibular bone, if you're doing a flap in a quadrant type approach to, to remove it anyway.
So then once once you fracture that, so back to the question that Carol asked, once you fracture that, if you do, and you have to get that distal root out, you really need a technician to. Retract that tissue to retract that lip commissure back and down so that you can access that.
You want the, a mouth gag on the other side in the front, so it's not your way, the tongue definitely on the side of the mouth, gag the, and on the other side of the mouth gag away from the arcade and the endotracheal tube there as well. And that way you've got enough room to get back there.
You'll have to use a periosteal elevator or some other retracting device that's small to pull that gingival tissue down, remove a little bit more vestibular bone, hopefully to the point where you can see it start to reach or to get to the apex. But again, you're gonna have to remove quite a thick area of bone to do that. And then same technique very carefully. Ator elevator. You create your mesial and distal grooves, obviously on that root tip.
And then use your, probably your number 1.2 to 1.5, whatever you have to very gently elevate that out and try to elevate it up and sideways toward the vestibular side. I hope that answers your question. I know a lot of these questions get to the point where they're not just very easy answers. We have to set the stage for what we're trying to get at eventually, and I hope that didn't get in too much detail, but that's how you would do that. So Carol, I hope that answered your question.
Let's go to Glen Hughes. And back to one of the, one of the common problems we have, fracturing teeth and incisors in this case, in cats is something that might be pretty difficult unless you are extracting them and you are initiating the extraction. What I mean by that is there's a little trick that we teach in the wet labs that allows you to very easily extract those incisors without getting damage to adjacent incisors. So let's say you only have to extract one that is partially fractured.
It may be at the gum line. You can use a an 18 gauge needle. As your ator elevator, put that on a handle. And your handle is a three cc syringe with a lu lock tip. So you've got your mini homemade luxate elevator, and all you do is place that mesial and vestibular, or mesial and lingual. Initially or distal in the same respect, and just with a digging manner with some force. Take that down to where you think the apex is and where you feel that is.
You can take and you can move that in a manner where it is. Very slightly torqued and leveraged a little bit toward the other tooth and not damage the other tooth In that regard, you do the same thing going back on the other side, whether it's mesial or distal, and eventually with actually not eventually, pretty quickly you'll be able to get mobility with that. You'll want to use your loops. Your good light in order to see what you're doing.
I would never recommend not using loops in a specifically 3.5 loops that are perfect for veterinary dentistry and canine extractions, or, I'm sorry, feline extractions, especially where you really need great magnification, great lighting, and you need it for canine as well, but you need it specifically for. For feline extractions and gum manipulation, flap neco, periosteal flap creation, all that helps considerably if you've got loops.
I would not even think about doing a case unless I had loops and good lighting on. One place that you can get the best loops of three grand Dr. Brett's pets our website, that we have everything on there, equipment wise and instrument wise for the most part.
For the veterinarian in dentistry service you don't have to go looking around trying to find what the best is, the best not necessarily the most expensive, but the best that is out there that we use in our practice, that we use in our wet labs. For anything that you need, burrs, hand pieces the cocoon, x-ray. Generator, all those things including that, that small luxate elevator, which is included in a set.
So get off on a tangent there, but don't waste your time looking other places when you can go to one spot and get almost everything that you need for your dentistry service at great prices. And the loops are really a novel. Product on there, because I look for six or seven years trying to find loops I could recommend to our students. And about five years ago, I found these, there's nothing that compares to them.
And I have dis discarded, if you will, my $3,000 loops that I've had forever in a place of a thousand dollars pair. Custom loops that are 3.5, or actually minor 4.5 magnification that are lighter and just as good as those expensive loops. So if you're in practice and you are doing dentistry and surgical extractions, you need something like that. I would strongly suggest you go to dr bretts pets.com. Get those there. And sorry for the plug guys, but this is.
This is critical to your dentistry service. And the reason I created that was because my students had a list three pages long with all of the recommendations that we had of what we were using that they could go to. And I just decided to create a website and get all that stuff on there to make it a heck of a lot easier than going to 20 different sites to get 20 different products. We just put 'em all on one site, back to those incisors and the root tips.
It's a, that's a really good way to do that. That is the way to extract incisors in cats. If you are having to do it without root tips, you probably you don't probably, you do need a 1.2 to 1.5 luxating elevator to get those lateral incisors. You can certainly start them.
By using that 18 gauge needle on that three cc syringe, but to complete the straps, because those are bigger teeth, they're curved, there's a lot more girth to them, and they're generally separate and away from the other adjacent incisors. You can use it, bigger s say elevator to get a little bit more torque, and you'll need that for that lateral maxillary incisor. So glenys again, long answer. Hopefully that helped. And we'll go to one more question here from Carol.
How do you differentiate bone versus root when there's ankylos? Even if you have a high powered loop you still have di Carol still has difficulty. Everybody has difficulty with that. The question that you have to ask is if you are. Extracting a tooth that is ankylos, is it resorbing as well or is it have, does, is it being replaced? And we're talking specifically about dogs here. Is it replacing or is it, has it been replaced radiographically with bone?
If not, then we're talking about the same thing. True Ankylos, there's no tooth resorption within the root. Then very difficult to do that. You literally have to outline the tooth root where you think the tooth root is, and follow that contour of that tooth bone interface in order to be able to see that because you've got the same tissue bone mixed with another tissue dentin, and so it's very difficult to make that differentiation.
I will say that and we have not had a chance to try this, and I thought I would do it last week and I totally forgot about it, but I got a a tip from one of our mastermind members who had some really a sad compromise and visual problems as a young person, and she's just now getting through some of that. And she has been struggling to see the differentiation between two through and bone, and she came across a blue light, an ultraviolet light, that's a portable blue light.
She can get them on Amazon. That will if a technician or otherwise shines that light on the tissue that you're working on. It is. They use that in forensics to differentiate tissue and you can see with much greater acuity the differentiation between the tooth root and the bone. So again, I have not tried that in a live patient. I don't she had not tried that in a live patient. She was doing it on her. Working on her specimens for surgical extractions, and she found it very helpful there.
So less than $20 for a UV penlight on Amazon. And you could certainly give that a try to help with differentiation. I don't know how good it would be for Frank Osis, but I would imagine it would be pretty effective. That being said, there are only a few times where you're gonna find where you have ankylos and you just cannot tell where the tooth root is and where the bone is.
But at that interface you will get some mixing, as I said, of dentin and bone where there is a little bit of initial fusion of those tissues. As long as it's not tooth resorption as well. And we've got a 30 minute presentation in the Veterinary dentistry workshop, just about that topic, showing different things. And I would imagine if you go into your Facebook group, search and put a search in there for canine tooth resorption. Dog or dog tooth resorption.
You're gonna find some posts and you're gonna find some examples of what I'm talking about. So hope that answers your question. That is the best thing that I can give as far as a hint to that, because you already have a good loop and light. So that would be 80% of my answer if you had not had already mentioned that. Great questions guys. Thank you very much for those. I did want to touch on a topic here.
We've got we, we plan to do these based on q and As, but I've got a couple of things I'd like to cover as well, and this is. Something that Christina Gilbert had posted December 2nd, and I'll read what she said after I described this. This system, so this is a, an ultrasonic battery powered tooth cleaning device, and it's a complete oral hygiene kit that has a dental mirror. It's got a toothbrush, it's got a. Period.
Curette, it has some forceps that have no idea why they would need forceps to facilitate that. They've got some other kind of instrument there that I can't make out. But anyway the main thing is the handheld ultrasonic, which has what would look like an ultrasonic tip on a. High speed or a low speed system for your scalor tip period. Periodontal scalor tip. It looks like it's sharp tipped which would be a periodontal tip. And Christina comments that I'm horrified.
Someone posted a video of them cleaning their dog's teeth in a group I'm in using a tool like this. As I described, battery powered ultra side staler, no water, no reasonable instructions that I could find, no polisher included. And there were a lot of people that asked for the link. What is my, my, the best approach to this? What is my best way to approach this in your situation, Christina? Certainly. Depending on your group, you, whatever you post in there.
If you've got people that are wanting something like this, they're probably of the mindset that you're not going to convince them otherwise. And it's just, that's just human nature. So you can attempt to walk around the problem and not directly fault. These people verbally do it in a very nice way and start a discussion. I'm sure you'll have people in that group will support the fact that this really doesn't do anything other than harm.
The talking points here are, number one, it does no good at all to clean teeth. It probably does harm to clean teeth without polishing. Secondly, we are putting the dog at risk. We're putting the person at risk that's performing this because dogs do not tolerate hand scaling very well. Hence the uprising in non anesthesia dentistry and all of the situations where pets were harmed.
And all the situations where pets were harmed and nobody knew about it and probably still don't know about it, where they didn't, you know how our pets are, they don't show, they're painful. And if something happened where a periodontal puree punctured through something or rip gingiva, it's gonna be painful. But are they gonna show that pain when they go home? So a lot pets probably.
I would say the majority of them probably are painful and experience pain during those procedures, let alone a vibrating tip that will get hot. I guarantee you that gets hot because it vibrates, it creates heat and could certainly burn gingiva and could, if it's used on the tooth long enough. Certainly the potential to start the process of. Polk necrosis from heat. So we, we definitely don't want to be using something like this. We wanna do what we can obviously to steer people away from this.
But people are going to do what they're going to do. You can't get you can't cure all the ills, and this is a huge ill in our world, but you can do what you can to. Gently try to walk around the problem, get support verbally from your comments from other people in the group. And you're certainly welcome to, to post part of this video.
If you'd like to do that, if there's a way that you could do that covers this, if you wanna do a screen capture of the video when we're done you're certainly welcome to do that as well. I have no problem with that. But that, that being said, that the problem with cleaning in general doesn't need to be without anesthesia. The problem with cleaning in general is that many situations where we get in specialty practice are where pets have been cleaned and they've been cleaned predictably.
With a reasonable frequency over their young lives, and we get them in, especially again, and you've heard me talk about this probably before, in patients that are 20 pounds or less that are five, six years of age, they've maybe got, have the owner brushing at home. They go yearly for cleaning. They've never had RA radiographs, they've never had subgingival cur for bleeding pockets that are picked up before the radiographic. Port portion comes into play. So we do our probing.
We have bleeding pockets that can be treated, and then we have our radiographs that we take, and we have significant pockets that usually can't be treated. It's usually already to the point where we need to extract a lot of those and in that 18 month to five, six year period of time, and those patients are getting cleaned and are getting polished correctly. But are not doing sub digital cure and root planning.
Starting at that eight month phase of not getting radio radiographs to pick up those two phases of periodontal disease, which are under the gum they're allowing those that, that granulation tissue and the pockets in the gum to expand to the bone and eventually cause the bone destruction. Cleaning with this instrument. Cleaning in practice with a proper scalor with water and polishing properly still does not do anything for the disease process.
It cleans the normal tissue in order to alter the progression of periodontal disease and prevent it those pockets. That are bleeding on probing, have to be treated with a hand curette, with subgingival, cartage and root plate. It's the only way to arrest that problem and properly clean to prevent periodontal disease. So these patients that we're seeing, I mentioned just a second ago in, in our practice, our specialty practice, these patients are coming in and they look fantastic.
They have attached gingiva. The gingival margin looks really nice and they've got clean teeth. Sometimes they've been cleaned in a two, three months ago. Sometimes they've been cleaned a couple weeks prior, and we take x-rays and we've got 10 or 15 extractions in these patients. And the owners obviously are really taken aback and very upset. That, that, that's occurred. And this is not something that happens every now and then. This is something that happens all the time in our practice.
And if you're not taking that approach in, in your practice, this is a, an action step to get the proper training, to be able to progress to the point where you act, where you know how to do those procedures correctly in order to prevent from. The sub genital cureology and root planning aspect, and then also how to treat early to extract teeth that need to be extracted before they progress to severe periodontal disease.
So not only is this a problem with people at attempting to do this on their own with devices like this is, in my opinion, I think it's a bigger problem in general practice. Due to the lack of training of veterinarians starting with veterinary schools. And I know I harped on this for years, it's still pervasive. It's, it hasn't changed much. There are some excellent programs at universities, but they're a big minority.
They, most of the universities, most of the veterinary schools do not have a program where students learn practical dentistry and are able to come out of there knowing that they have capable skills and knowledge to, to perform these procedures. That's why our wet labs that we do in Atlanta and a couple places around the country sell out way ahead of time.
Because there's so much need in the profession, not just people who have just graduated, but people who have been in the profession for a long period of time that maybe are changing practices, and these practices know that it's a problem. They know that's a big deficit in the marketplace for people who have the training. That allows 'em to walk into the practice and be able to take that dentistry service and provide that type of care. For their patients.
So if you're interested in that veterinary dentistry.net, all of our courses on there. If you're really interested, if you love dentistry, the International Veterinary Dentistry Institute Veterinary Dental Practitioner program is a eight month training and it's the top end of our training offerings. I would suggest that if you're really involved, you really want to get really good that would be your option.
But any of the live trainings that we do will get you on a kickstart to getting to the point where you know how to do these things correctly. So let's let's transition Now. We've come to the end of our session and I. Strongly encourage all of you to do what Christina is likely going to take from this and try to do what they can for this problem. But again in my opinion the people that have that opinion formed already, no matter what it is, no matter whether it's this or something else.
They base those opinion on experience and their subconscious expressions that they've taken in over months to years. So those things are super difficult to pry loose and if not impossible. So don't get discouraged when you get people rub up against you because they will I've had people rub up against me. For a long period of time. And I know it's gonna happen, it may happen for some of the things I'm saying here today, but you just have to realize that's gonna happen.
There are people out there that are trying to do good for their pets and trying to do it where they feel that they're not doing harm. But unfortunately they are. We really appreciate everyone coming today. This is a good opportunity for us to do this and we'll do these more. One thing that I do wanna mention we are going to be doing a live course creation on this topic, feline, chronic gvo, stomatitis, and we're going to do updates on everything up to the current, including stem cells.
The research that's going on uc, Davis, or the vet school. So what we would like to do is we would like to come back and we'd like to get some of you to be with us when we are recording a live course. That's going to be a online course, and we will do 30, 40, 45 minutes of my presentation. Then we will stop and we'll ask questions. This will be in a Zoom meeting. You'll register, this will be for race credit and it will be to help essentially create the course.
There will be a fee for that to be in that group. It will be nominal, but you'll get the race credits and we'll be doing this very soon. So we'll let you know. We'll come back and give you the information for that. But essentially we'd like to invite those who are really into dentistry to join that group and to help in that course creation. And we're going to be creating a lot of courses going forward as well in that same modality if this is successful.
So guys, until next time, enjoy the rest of the weekend. Thanks for coming this morning, and we'll see you soon. Take care. I hope you enjoyed that episode. If you'd like more information about the Veterinary Dental Practitioners Program, please submit to request an invitation@ivdi.org slash INV.