October 13, 2025 • 14 mins
A comprehensive overview of feline dentistry, ranging from the anatomy of the oral cavity and dental operatory setup to advanced diagnostic and treatment protocols. The text highlights the importance of general anesthesia for thorough dental care and details numerous anesthetic agents and monitoring techniques. Specialized topics covered include the diagnosis and management of periodontal disease, tooth resorption, trauma, malocclusion, and feline chronic gingivostomatitis (FCGS), with emphasis on surgical extractions and other therapeutic interventions. A significant portion of the text is dedicated to Dr. Paul D. Pion, recognizing his foundational contributions to veterinary medicine, particularly his discovery linking taurine deficiency to feline cardiomyopathy and his role as co-founder of the Veterinary Information Network (VIN).
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the deep dive. We're skipping the noise today, yeah,
and going straight into the core material on feline dentistry.
Speaker 2 (00:06):
That's right. We're drawing heavily on doctor Jan Bellow's work,
which is incredibly comprehensive.
Speaker 1 (00:11):
Yeah, it really is. So if you're a dental pro,
a VET student, maybe just someone trying to get a
handle on this, our goal today is pretty straightforward.
Speaker 2 (00:20):
We want to take this dense scientific stuff and distill
it and get practical, actionable clinical insights you.
Speaker 1 (00:26):
Can use without losing the critical.
Speaker 2 (00:28):
Details, of course, exactly, and a big part of that
is understanding the shift in thinking. It's not just do
no harm anymore. That's too passive for feline dentistry, right.
Speaker 1 (00:37):
The sources really hammer this home. Doing nothing just waiting
that is harm in many cases.
Speaker 2 (00:43):
Precisely, we need to be actively doing good for these patients,
which leads us straight into the framework.
Speaker 1 (00:50):
Yeah, the foundational structure we need. Let's get into it.
Speaker 2 (00:53):
Okay, First things first, we got to ditch the vague
language things like doing a dentistry. The one that Source
Material insists on is the professional oral prevention assessment and
treatment visit.
Speaker 1 (01:05):
Or COPAT for sure, much more accurate.
Speaker 2 (01:08):
Right, it standardizes everything, make sure nothing gets missed.
Speaker 1 (01:11):
Okay, so let's unpack copat three pillars Assessment, treatment prevention,
starting with assessment A. What's key before anesthesia?
Speaker 2 (01:22):
It really starts with the history. You know, what's the diet,
what's the home care situation? Compliance?
Speaker 1 (01:27):
And pain? Cats hide pain so well exactly.
Speaker 2 (01:30):
That's where the Feeline Groom scale comes in. It's validated.
You look at ear position, whisker tension, head position, subtle
signs in the conscious cat.
Speaker 1 (01:39):
To quantify that discomfort before you even.
Speaker 2 (01:42):
Induce now national data absolutely okay, So.
Speaker 1 (01:44):
That's the awake assessment. But then under anesthesia the picture changes. Right,
This gets us into treatment t What dictates the approach.
Speaker 2 (01:52):
It's all based on what you find once they're under
visual exam, probing and crucially full mouth radiographs non negotiable and.
Speaker 1 (01:59):
The period donald Z stage, the PD stage that drives
the decision completely.
Speaker 2 (02:03):
So PD two, maybe early PD three, that's less than
say fifty percent support loss, you're thinking root planning, trying
to save the tooth.
Speaker 1 (02:11):
But when you hit PD four more than fifty percent
loss or maybe an F three furcation probe goes right through.
Speaker 2 (02:19):
Then extraction is the standard of care. The tooth isn't
salvagable at that point.
Speaker 1 (02:24):
Makes sense, and all this work, the assessment, the treatment,
it hinges on the last pillar, prevention P which puts
the owner front and center.
Speaker 2 (02:32):
Oh, absolutely, the owner is critical. Gold standard for prevention.
Daily plack removal.
Speaker 1 (02:38):
Brushing daily, that's the key.
Speaker 2 (02:39):
It dramatically slows down disease progression. The source is really
clear on that. Now, if brushing isn't feasible.
Speaker 1 (02:45):
Which let's be honest, can be tough with some.
Speaker 2 (02:47):
Cats, right, then you look at VOAPC accepted products, things
like orevit sealent, specific diets, certain treats. They help control
plaque and tartar.
Speaker 1 (02:56):
But the reality is without that owner commitment to prevention,
even good treatment for PD two or PD three might
just fail long term.
Speaker 2 (03:03):
It can yeah, yeah, which might make extraction a better
option from the start in some cases. It's a tough
conversation sometimes.
Speaker 1 (03:10):
Okay, good foundation. Now to treat effectively, we need the anatomy.
Let's touch on Denton. We know it's hard, but what's
the clinical worry?
Speaker 2 (03:19):
The tubules thousands and thousands of them per square millimeter,
like over forty thousand, and they communicate directly with the pulp.
So any breach, even a minor fracture without obvious.
Speaker 1 (03:31):
Pulp exposure, it's an open door for bacteria for pain stimulus.
Speaker 2 (03:35):
It's instantly exactly, super sensitive, high contamination risk.
Speaker 1 (03:39):
And the support system the periodontium. That's dementum PDL, alveolar bone.
Speaker 2 (03:44):
Right cementum is interesting produced continuously. The periodontal ligament or
PDL has the blood supply, the nerves carrying pain and
pressure signals.
Speaker 1 (03:53):
And the alveolar bone. On the X ray, that's the
laminadura right, That white line.
Speaker 2 (03:56):
A thin white line around the root. Yes, that's the
cribberform plate the bone. Proper and quickly on naming, use
the modified triad.
Speaker 1 (04:03):
End system important for charting. And remember the missing teeth
and cats.
Speaker 2 (04:07):
Yeah, so that first premolar you see in the upper
left jaw, that's two of six. There's no two of five.
Just got to remember those gaps, all.
Speaker 1 (04:14):
Right, Philosophy and framework down copat. Now let's get practical.
The actual setup the operatory. It's not just any room.
Speaker 2 (04:21):
Is it. Absolutely not. It has to be a dedicated space,
ideally multiple tables if you can manage it and critically
separate from general surgery.
Speaker 1 (04:29):
Why that's separation aerosols.
Speaker 2 (04:31):
When you use an ultrasonic scaler, it aerosolizes, saliva, bacteria, everything,
massive contamination risk for a sterile surgical field.
Speaker 1 (04:39):
Makes total sense. And what about the practitioner? This work
can be tough physically, ergonomics are key.
Speaker 2 (04:45):
Hugely important. The source details avoiding those bad repetitive motions
Class four, Class five, lots of twisting or reaching that
leads to muscular skeletal damage over time.
Speaker 1 (04:55):
So things like the right stool.
Speaker 2 (04:57):
Yeah, one designed to keep your hips open wider than
one hundred degrees, protects the lower back, and keeping your
head tilt minimal less than twenty degrees, which is where
magnification comes in handy too. Right loops essential usually two
point five x of maybe four point zero x. Helps
you see and helps your posture. Plus good lighting obviously
about twenty five thirty inches from the mouth.
Speaker 1 (05:15):
Okay, power systems air delivery runs at pretty high pressure yeah.
Speaker 2 (05:18):
Eighty to one hundred and twenty psi. Typically the tank
cycle on and off, and noise and heat are issues,
so ideally put the compressors and suction units somewhere remote.
Speaker 1 (05:28):
Good tip. Now, scaling powered scalers are efficient, but there's
a big warning in.
Speaker 2 (05:33):
The text a huge one. Rotary scaling is not recommended.
Don't do it.
Speaker 1 (05:38):
Okay, So we're talking sonic or ultrasonic. What's the difference.
Speaker 2 (05:41):
Sonic scalers are lower frequency, wider movement, better for like
fresh soft calculus. Not great on the really hard chronic stuff.
Speaker 1 (05:52):
So for that tougher calculus. Ultrasonic is the way to go.
Magnet restrictive or.
Speaker 2 (05:56):
Piazo exactly, higher frequency, very effective. You have to be careful,
how so, use only the sight of the tip, never
the point directly on the tooth that causes thermal damage, cancussive.
Speaker 1 (06:06):
Damage, and especially when you go subgingible below the gum line.
Speaker 2 (06:09):
Right, Decrease the power setting, increase the water flow, keep
it cool, keep it safe.
Speaker 1 (06:13):
Got it now? For extractions. Luxitters versus elevators, big difference,
critical difference.
Speaker 2 (06:19):
Luxitters are thin, sharp, They're designed to incise the PDL
expand the socket slightly. They are not for prying or leverage.
Speaker 1 (06:26):
So if you need leverage, especially if you're less experienced, then.
Speaker 2 (06:29):
You reach for a wing tipped elevator. They're designed for
that elevation force. But whichever you use sharpening, got to
keep them sharp constantly. The source says a one hundred
and ten degree angle between the instrument face and the
stone maintains that cutting edge geometry dull instruments cause more trauma.
Speaker 1 (06:45):
Makes sense. Okay, last piece of equipment, but maybe the
most important.
Speaker 2 (06:50):
Radiography, Absolutely mandatory FMX full mouth radiographs. You can't see
what's happening below the gum line without them.
Speaker 1 (06:58):
Period technology choices DR sensors versus CR plates.
Speaker 2 (07:03):
DR gives you instant images, which is great, but they're
expensive and usually only come in the smaller sized two
sensor CR phosphor plates need processing, but they're often more
durable and you can get larger sizes.
Speaker 1 (07:13):
And for tricky interpretations like overlapping roots on that upper
fourth pre.
Speaker 2 (07:18):
Moler, remember the slob rule, same lingual opposite bickle. It's
a tube shift technique helps you figure out which root
is which when they're superimposed.
Speaker 1 (07:27):
Okay, let's talk anesthesia.
Speaker 2 (07:28):
This is critical, it really is, and we have to
start with a strong statement from the AVDC, the American
Veterinary Dental College, which is anesthesia free dentistry AfD, sometimes
called non professional dental scaling or NPDS is inappropriate. It's
below the standard of care and risks serious injury.
Speaker 1 (07:47):
So proper general and athesia is the only way to
do copat safely and effectively, absolutely.
Speaker 2 (07:52):
And that starts with airway protection. A properly fitted cuffed
endotracheal tube is mandatory protects against all that water.
Speaker 1 (07:59):
And we also need to flag high risk patients. The
source mentions small cats.
Speaker 2 (08:04):
Yeah, cats under two kilograms, they have something like a
fifteen times higher mortality risk under anesthesia. Hypothermia, drug metabolism
big concerns.
Speaker 1 (08:13):
Okay, induction drugs. Let's compare propofol needs a.
Speaker 2 (08:16):
Bit higher dose in cats than dogs. Main issue is hypotension.
It depresses the myocardium and watch out for Heinz's body
anemia risk with repeated use.
Speaker 1 (08:26):
So if hypotension is a big worry, maybe a heart patient.
Speaker 2 (08:29):
Atominate is often the choice. Then it maintains cardiac output better,
but there's a potential downside reports of hemolysis red cell
breakdown in cats.
Speaker 1 (08:39):
Any other alternatives.
Speaker 2 (08:40):
Elfacts alone is a good one. Maintains laryngeal function well,
which is nice. Recovery can sometimes involve a bit of
paddling or trembling, though.
Speaker 1 (08:47):
Right now during the procedure monitoring, what's the absolute must have.
Speaker 2 (08:53):
Beyond just watching the patient, you need the electronic monitors
and the author calls one the anesthesia disaster early warning system.
Speaker 1 (09:00):
That would be etc. Two cabnography.
Speaker 2 (09:03):
Yes, it's the only thing that truly tells you about
their ventilation. Normal is thirty five to forty five millimealis g.
What if it goes up sharply could be hypoventilation. Maybe
the CO two absorbent is exhausted, faulty valves, something's wrong
with gas exchange.
Speaker 1 (09:17):
And if it suddenly drops, say way down to fifteen mili.
Speaker 2 (09:21):
Miliu stree, that's an emergency. Investigate immediately. It could be
the circuit is disconnected or worst case, cardiopulmonary rest. You
have to react fast.
Speaker 1 (09:28):
And pulse oxymmetries PO two. Keep it above ninety five percent.
Speaker 2 (09:31):
Ninety five to one hundred percent is the goal. Blow
ninety percent you need to intervene find out why.
Speaker 1 (09:35):
Anesthesia also means analggia. Pain control is key. Regional blocks crucial.
Speaker 2 (09:41):
Using local anesthetics like light a cane for fast onset
boopyvicane for longer duration, makes a huge difference in recovery.
Speaker 1 (09:49):
Okay, where are the main block locations for the upper.
Speaker 2 (09:52):
Jaw, the maxillary nerve block you target, the terygopalatine fossa
roshprevenral to the orbit, and the lower jaw. The mandibular
nerve block gets all the lower teeth, the jawbone, even
the front part of the tongue.
Speaker 1 (10:03):
What about the middle mental block.
Speaker 2 (10:05):
It's tricky In cats the foramen is tiny, angled, weirdly,
often difficult to hit, reliably good.
Speaker 1 (10:11):
To know and postop pain relief.
Speaker 2 (10:13):
The AUSO prefers bupernorphine good duration eight to ten hours.
Also be aware of feline or of facial pain syndrome FOPS.
It's a neuropathic pain thing often doesn't respond well to
standard painkillers. All right, Let's say some key pathologies periodonal
disease staging again PD one, just gingivitis up to.
Speaker 1 (10:30):
PT four and PD four especially with that F three
through and through furcation.
Speaker 2 (10:34):
That means extraction, no question, Okay.
Speaker 1 (10:36):
A uniquely feline issue tooth resorption. Tr How common.
Speaker 2 (10:40):
Is this extremely? The source says maybe fifty percent of
caps over three years old habit it's staged TR one
to TR five and.
Speaker 1 (10:48):
The tricky part is diagnosis right. They often don't show
obvious signs exactly.
Speaker 2 (10:51):
Hypersalivation, dropping, food, headshaking often absent, especially if the lesion
is purely subgingible, you won't see it without X rays
FMX again essential.
Speaker 1 (11:01):
What about trauma fractured teeth.
Speaker 2 (11:04):
Two main types. Uncomplicated just enamel or dentin loss and
complicated where the pulp is exposed.
Speaker 1 (11:11):
If it's complicated, pulp exposed, but it's recent, like less
than forty eight hours old and the cats young under
nine months, maybe with open root tips.
Speaker 2 (11:20):
Then you might attempt vital pulp therapy VPT that involves
placing an MTA plug mineral trioxide aggregate. Success means a pexogenesis,
the root keeps developing and the apex closes.
Speaker 1 (11:30):
And if VPT isn't an option older cat older.
Speaker 2 (11:33):
Fracture, then it's standard Root canal therapy RCT clean out
the puls shape the canal fill it opteruration, usually with
good of PERCHA, but RCT doesn't work well if there's
already advanced ped adonyal disease GOTCHA.
Speaker 1 (11:44):
Another big one feline chronic gingeovitis comatitis FCGS. That really painful,
widespread inflammation.
Speaker 2 (11:52):
Yeah, the exact cause is still a bit murky. Seems
like an over the top immune response to something antigens plaque,
maybe viruses type two FCGS involves inflammation way in the back,
the caudal mucositis, and.
Speaker 1 (12:07):
There's a link to multicat household.
Speaker 2 (12:09):
Seems to be Yeah, shared environment factor treatment standard.
Speaker 1 (12:12):
Now extractions full mouth or at least the caudal teeth first.
Speaker 2 (12:16):
Right, That helps or resolves it in maybe seventy eighty
percent of cases. For the ones that don't respond, the
refractory cases.
Speaker 1 (12:23):
Adjunctive therapies like cyclass.
Speaker 2 (12:25):
Brain, yes, but you need to monitor for toxicplasma with that.
CO two laser ablation is another option, or low level
laser therapy LLT Okay.
Speaker 1 (12:34):
Nearly there. Oral masses how common?
Speaker 2 (12:36):
About ten percent of feline tumors are oral. The big
bad one is squamous cell carcinoma.
Speaker 1 (12:41):
SEC malignant, poor prognosis, very poor.
Speaker 2 (12:43):
Medium survival is often just a couple of months. There
are links to environmental stuff, secondhand smoke, maybe canned tune
of fish consumption. Treatment is aggressive surgery if possible, Yes,
partial man to be electimir max eelectomy offers the best
though still guarded outcome.
Speaker 1 (12:56):
Also need to mention alveolar bone expansion that idiopath swelling
often around the canines.
Speaker 2 (13:01):
Yep, looks like bone swelling. Treatment is extraction and smoothing
the bone, alveoloplasty.
Speaker 1 (13:07):
And finally occlusal issues. What if a cat presents with
its jaw locked.
Speaker 2 (13:12):
Open that's open mouthed jaw locking usually due to TMG dysplasia.
The coronoid process gets stuck on the zygomatic arch. Treatment
often involves removing the coronoid process or part of the
arch and.
Speaker 1 (13:24):
Mal oclusion mal bad bites.
Speaker 2 (13:27):
Yeah, depends on the breed standard. Sometimes brackisphalics often have
a normal underbite mL three, but severe malclusion like lower
canines hitting.
Speaker 1 (13:35):
The palette that needs fixing. Extraction, maybe crown reduction with
VPT if appropriate, or even orthodonics with buttons and elastics.
Speaker 2 (13:43):
Phew.
Speaker 1 (13:43):
Okay.
Speaker 2 (13:44):
That covers a lot of ground from basic anatomy to advanced.
Speaker 1 (13:46):
Surgery, and the unifying theme really comes back to copat doesn't.
Speaker 2 (13:50):
It It does? It's complex knees anesthesia needs a deep
understanding of anatomy pathology. It's way beyond just scraping teeth.
Speaker 1 (13:57):
Absolutely, it's true medical and surgical management.
Speaker 2 (14:00):
So to kind of cement some of that critical safety
information we covered, let's.
Speaker 1 (14:04):
Give you the listener a quick exercise based directly on
the source material.
Speaker 2 (14:07):
Okay, imagine this. You're monitoring a cat under anesthesia for
a copad visit. Suddenly the kapnograph reading plummets. It goes
from a steady forty millimli at hg right down to
fifteen milli MILIHG.
Speaker 1 (14:22):
What do you check? Immediately, think fast, list two possible
causes that are not related to the patient, dying thing, equipment,
or circuit issues, and.
Speaker 2 (14:30):
Then list two potential patient related causes that would trigger
such a drastic drop and require urgent life saving intervention.
Speaker 1 (14:37):
All that over, think about airway circuit patient status. It
really brings home the importance of that EtCO two monitor.
Speaker 2 (14:43):
Definitely, keep diving into those resources until next time.
Welcome to the deep dive. We're skipping the noise today, yeah,
and going straight into the core material on feline dentistry.
Speaker 2 (00:06):
That's right. We're drawing heavily on doctor Jan Bellow's work,
which is incredibly comprehensive.
Speaker 1 (00:11):
Yeah, it really is. So if you're a dental pro,
a VET student, maybe just someone trying to get a
handle on this, our goal today is pretty straightforward.
Speaker 2 (00:20):
We want to take this dense scientific stuff and distill
it and get practical, actionable clinical insights you.
Speaker 1 (00:26):
Can use without losing the critical.
Speaker 2 (00:28):
Details, of course, exactly, and a big part of that
is understanding the shift in thinking. It's not just do
no harm anymore. That's too passive for feline dentistry, right.
Speaker 1 (00:37):
The sources really hammer this home. Doing nothing just waiting
that is harm in many cases.
Speaker 2 (00:43):
Precisely, we need to be actively doing good for these patients,
which leads us straight into the framework.
Speaker 1 (00:50):
Yeah, the foundational structure we need. Let's get into it.
Speaker 2 (00:53):
Okay, First things first, we got to ditch the vague
language things like doing a dentistry. The one that Source
Material insists on is the professional oral prevention assessment and
treatment visit.
Speaker 1 (01:05):
Or COPAT for sure, much more accurate.
Speaker 2 (01:08):
Right, it standardizes everything, make sure nothing gets missed.
Speaker 1 (01:11):
Okay, so let's unpack copat three pillars Assessment, treatment prevention,
starting with assessment A. What's key before anesthesia?
Speaker 2 (01:22):
It really starts with the history. You know, what's the diet,
what's the home care situation? Compliance?
Speaker 1 (01:27):
And pain? Cats hide pain so well exactly.
Speaker 2 (01:30):
That's where the Feeline Groom scale comes in. It's validated.
You look at ear position, whisker tension, head position, subtle
signs in the conscious cat.
Speaker 1 (01:39):
To quantify that discomfort before you even.
Speaker 2 (01:42):
Induce now national data absolutely okay, So.
Speaker 1 (01:44):
That's the awake assessment. But then under anesthesia the picture changes. Right,
This gets us into treatment t What dictates the approach.
Speaker 2 (01:52):
It's all based on what you find once they're under
visual exam, probing and crucially full mouth radiographs non negotiable and.
Speaker 1 (01:59):
The period donald Z stage, the PD stage that drives
the decision completely.
Speaker 2 (02:03):
So PD two, maybe early PD three, that's less than
say fifty percent support loss, you're thinking root planning, trying
to save the tooth.
Speaker 1 (02:11):
But when you hit PD four more than fifty percent
loss or maybe an F three furcation probe goes right through.
Speaker 2 (02:19):
Then extraction is the standard of care. The tooth isn't
salvagable at that point.
Speaker 1 (02:24):
Makes sense, and all this work, the assessment, the treatment,
it hinges on the last pillar, prevention P which puts
the owner front and center.
Speaker 2 (02:32):
Oh, absolutely, the owner is critical. Gold standard for prevention.
Daily plack removal.
Speaker 1 (02:38):
Brushing daily, that's the key.
Speaker 2 (02:39):
It dramatically slows down disease progression. The source is really
clear on that. Now, if brushing isn't feasible.
Speaker 1 (02:45):
Which let's be honest, can be tough with some.
Speaker 2 (02:47):
Cats, right, then you look at VOAPC accepted products, things
like orevit sealent, specific diets, certain treats. They help control
plaque and tartar.
Speaker 1 (02:56):
But the reality is without that owner commitment to prevention,
even good treatment for PD two or PD three might
just fail long term.
Speaker 2 (03:03):
It can yeah, yeah, which might make extraction a better
option from the start in some cases. It's a tough
conversation sometimes.
Speaker 1 (03:10):
Okay, good foundation. Now to treat effectively, we need the anatomy.
Let's touch on Denton. We know it's hard, but what's
the clinical worry?
Speaker 2 (03:19):
The tubules thousands and thousands of them per square millimeter,
like over forty thousand, and they communicate directly with the pulp.
So any breach, even a minor fracture without obvious.
Speaker 1 (03:31):
Pulp exposure, it's an open door for bacteria for pain stimulus.
Speaker 2 (03:35):
It's instantly exactly, super sensitive, high contamination risk.
Speaker 1 (03:39):
And the support system the periodontium. That's dementum PDL, alveolar bone.
Speaker 2 (03:44):
Right cementum is interesting produced continuously. The periodontal ligament or
PDL has the blood supply, the nerves carrying pain and
pressure signals.
Speaker 1 (03:53):
And the alveolar bone. On the X ray, that's the
laminadura right, That white line.
Speaker 2 (03:56):
A thin white line around the root. Yes, that's the
cribberform plate the bone. Proper and quickly on naming, use
the modified triad.
Speaker 1 (04:03):
End system important for charting. And remember the missing teeth
and cats.
Speaker 2 (04:07):
Yeah, so that first premolar you see in the upper
left jaw, that's two of six. There's no two of five.
Just got to remember those gaps, all.
Speaker 1 (04:14):
Right, Philosophy and framework down copat. Now let's get practical.
The actual setup the operatory. It's not just any room.
Speaker 2 (04:21):
Is it. Absolutely not. It has to be a dedicated space,
ideally multiple tables if you can manage it and critically
separate from general surgery.
Speaker 1 (04:29):
Why that's separation aerosols.
Speaker 2 (04:31):
When you use an ultrasonic scaler, it aerosolizes, saliva, bacteria, everything,
massive contamination risk for a sterile surgical field.
Speaker 1 (04:39):
Makes total sense. And what about the practitioner? This work
can be tough physically, ergonomics are key.
Speaker 2 (04:45):
Hugely important. The source details avoiding those bad repetitive motions
Class four, Class five, lots of twisting or reaching that
leads to muscular skeletal damage over time.
Speaker 1 (04:55):
So things like the right stool.
Speaker 2 (04:57):
Yeah, one designed to keep your hips open wider than
one hundred degrees, protects the lower back, and keeping your
head tilt minimal less than twenty degrees, which is where
magnification comes in handy too. Right loops essential usually two
point five x of maybe four point zero x. Helps
you see and helps your posture. Plus good lighting obviously
about twenty five thirty inches from the mouth.
Speaker 1 (05:15):
Okay, power systems air delivery runs at pretty high pressure yeah.
Speaker 2 (05:18):
Eighty to one hundred and twenty psi. Typically the tank
cycle on and off, and noise and heat are issues,
so ideally put the compressors and suction units somewhere remote.
Speaker 1 (05:28):
Good tip. Now, scaling powered scalers are efficient, but there's
a big warning in.
Speaker 2 (05:33):
The text a huge one. Rotary scaling is not recommended.
Don't do it.
Speaker 1 (05:38):
Okay, So we're talking sonic or ultrasonic. What's the difference.
Speaker 2 (05:41):
Sonic scalers are lower frequency, wider movement, better for like
fresh soft calculus. Not great on the really hard chronic stuff.
Speaker 1 (05:52):
So for that tougher calculus. Ultrasonic is the way to go.
Magnet restrictive or.
Speaker 2 (05:56):
Piazo exactly, higher frequency, very effective. You have to be careful,
how so, use only the sight of the tip, never
the point directly on the tooth that causes thermal damage, cancussive.
Speaker 1 (06:06):
Damage, and especially when you go subgingible below the gum line.
Speaker 2 (06:09):
Right, Decrease the power setting, increase the water flow, keep
it cool, keep it safe.
Speaker 1 (06:13):
Got it now? For extractions. Luxitters versus elevators, big difference,
critical difference.
Speaker 2 (06:19):
Luxitters are thin, sharp, They're designed to incise the PDL
expand the socket slightly. They are not for prying or leverage.
Speaker 1 (06:26):
So if you need leverage, especially if you're less experienced, then.
Speaker 2 (06:29):
You reach for a wing tipped elevator. They're designed for
that elevation force. But whichever you use sharpening, got to
keep them sharp constantly. The source says a one hundred
and ten degree angle between the instrument face and the
stone maintains that cutting edge geometry dull instruments cause more trauma.
Speaker 1 (06:45):
Makes sense. Okay, last piece of equipment, but maybe the
most important.
Speaker 2 (06:50):
Radiography, Absolutely mandatory FMX full mouth radiographs. You can't see
what's happening below the gum line without them.
Speaker 1 (06:58):
Period technology choices DR sensors versus CR plates.
Speaker 2 (07:03):
DR gives you instant images, which is great, but they're
expensive and usually only come in the smaller sized two
sensor CR phosphor plates need processing, but they're often more
durable and you can get larger sizes.
Speaker 1 (07:13):
And for tricky interpretations like overlapping roots on that upper
fourth pre.
Speaker 2 (07:18):
Moler, remember the slob rule, same lingual opposite bickle. It's
a tube shift technique helps you figure out which root
is which when they're superimposed.
Speaker 1 (07:27):
Okay, let's talk anesthesia.
Speaker 2 (07:28):
This is critical, it really is, and we have to
start with a strong statement from the AVDC, the American
Veterinary Dental College, which is anesthesia free dentistry AfD, sometimes
called non professional dental scaling or NPDS is inappropriate. It's
below the standard of care and risks serious injury.
Speaker 1 (07:47):
So proper general and athesia is the only way to
do copat safely and effectively, absolutely.
Speaker 2 (07:52):
And that starts with airway protection. A properly fitted cuffed
endotracheal tube is mandatory protects against all that water.
Speaker 1 (07:59):
And we also need to flag high risk patients. The
source mentions small cats.
Speaker 2 (08:04):
Yeah, cats under two kilograms, they have something like a
fifteen times higher mortality risk under anesthesia. Hypothermia, drug metabolism
big concerns.
Speaker 1 (08:13):
Okay, induction drugs. Let's compare propofol needs a.
Speaker 2 (08:16):
Bit higher dose in cats than dogs. Main issue is hypotension.
It depresses the myocardium and watch out for Heinz's body
anemia risk with repeated use.
Speaker 1 (08:26):
So if hypotension is a big worry, maybe a heart patient.
Speaker 2 (08:29):
Atominate is often the choice. Then it maintains cardiac output better,
but there's a potential downside reports of hemolysis red cell
breakdown in cats.
Speaker 1 (08:39):
Any other alternatives.
Speaker 2 (08:40):
Elfacts alone is a good one. Maintains laryngeal function well,
which is nice. Recovery can sometimes involve a bit of
paddling or trembling, though.
Speaker 1 (08:47):
Right now during the procedure monitoring, what's the absolute must have.
Speaker 2 (08:53):
Beyond just watching the patient, you need the electronic monitors
and the author calls one the anesthesia disaster early warning system.
Speaker 1 (09:00):
That would be etc. Two cabnography.
Speaker 2 (09:03):
Yes, it's the only thing that truly tells you about
their ventilation. Normal is thirty five to forty five millimealis g.
What if it goes up sharply could be hypoventilation. Maybe
the CO two absorbent is exhausted, faulty valves, something's wrong
with gas exchange.
Speaker 1 (09:17):
And if it suddenly drops, say way down to fifteen mili.
Speaker 2 (09:21):
Miliu stree, that's an emergency. Investigate immediately. It could be
the circuit is disconnected or worst case, cardiopulmonary rest. You
have to react fast.
Speaker 1 (09:28):
And pulse oxymmetries PO two. Keep it above ninety five percent.
Speaker 2 (09:31):
Ninety five to one hundred percent is the goal. Blow
ninety percent you need to intervene find out why.
Speaker 1 (09:35):
Anesthesia also means analggia. Pain control is key. Regional blocks crucial.
Speaker 2 (09:41):
Using local anesthetics like light a cane for fast onset
boopyvicane for longer duration, makes a huge difference in recovery.
Speaker 1 (09:49):
Okay, where are the main block locations for the upper.
Speaker 2 (09:52):
Jaw, the maxillary nerve block you target, the terygopalatine fossa
roshprevenral to the orbit, and the lower jaw. The mandibular
nerve block gets all the lower teeth, the jawbone, even
the front part of the tongue.
Speaker 1 (10:03):
What about the middle mental block.
Speaker 2 (10:05):
It's tricky In cats the foramen is tiny, angled, weirdly,
often difficult to hit, reliably good.
Speaker 1 (10:11):
To know and postop pain relief.
Speaker 2 (10:13):
The AUSO prefers bupernorphine good duration eight to ten hours.
Also be aware of feline or of facial pain syndrome FOPS.
It's a neuropathic pain thing often doesn't respond well to
standard painkillers. All right, Let's say some key pathologies periodonal
disease staging again PD one, just gingivitis up to.
Speaker 1 (10:30):
PT four and PD four especially with that F three
through and through furcation.
Speaker 2 (10:34):
That means extraction, no question, Okay.
Speaker 1 (10:36):
A uniquely feline issue tooth resorption. Tr How common.
Speaker 2 (10:40):
Is this extremely? The source says maybe fifty percent of
caps over three years old habit it's staged TR one
to TR five and.
Speaker 1 (10:48):
The tricky part is diagnosis right. They often don't show
obvious signs exactly.
Speaker 2 (10:51):
Hypersalivation, dropping, food, headshaking often absent, especially if the lesion
is purely subgingible, you won't see it without X rays
FMX again essential.
Speaker 1 (11:01):
What about trauma fractured teeth.
Speaker 2 (11:04):
Two main types. Uncomplicated just enamel or dentin loss and
complicated where the pulp is exposed.
Speaker 1 (11:11):
If it's complicated, pulp exposed, but it's recent, like less
than forty eight hours old and the cats young under
nine months, maybe with open root tips.
Speaker 2 (11:20):
Then you might attempt vital pulp therapy VPT that involves
placing an MTA plug mineral trioxide aggregate. Success means a pexogenesis,
the root keeps developing and the apex closes.
Speaker 1 (11:30):
And if VPT isn't an option older cat older.
Speaker 2 (11:33):
Fracture, then it's standard Root canal therapy RCT clean out
the puls shape the canal fill it opteruration, usually with
good of PERCHA, but RCT doesn't work well if there's
already advanced ped adonyal disease GOTCHA.
Speaker 1 (11:44):
Another big one feline chronic gingeovitis comatitis FCGS. That really painful,
widespread inflammation.
Speaker 2 (11:52):
Yeah, the exact cause is still a bit murky. Seems
like an over the top immune response to something antigens plaque,
maybe viruses type two FCGS involves inflammation way in the back,
the caudal mucositis, and.
Speaker 1 (12:07):
There's a link to multicat household.
Speaker 2 (12:09):
Seems to be Yeah, shared environment factor treatment standard.
Speaker 1 (12:12):
Now extractions full mouth or at least the caudal teeth first.
Speaker 2 (12:16):
Right, That helps or resolves it in maybe seventy eighty
percent of cases. For the ones that don't respond, the
refractory cases.
Speaker 1 (12:23):
Adjunctive therapies like cyclass.
Speaker 2 (12:25):
Brain, yes, but you need to monitor for toxicplasma with that.
CO two laser ablation is another option, or low level
laser therapy LLT Okay.
Speaker 1 (12:34):
Nearly there. Oral masses how common?
Speaker 2 (12:36):
About ten percent of feline tumors are oral. The big
bad one is squamous cell carcinoma.
Speaker 1 (12:41):
SEC malignant, poor prognosis, very poor.
Speaker 2 (12:43):
Medium survival is often just a couple of months. There
are links to environmental stuff, secondhand smoke, maybe canned tune
of fish consumption. Treatment is aggressive surgery if possible, Yes,
partial man to be electimir max eelectomy offers the best
though still guarded outcome.
Speaker 1 (12:56):
Also need to mention alveolar bone expansion that idiopath swelling
often around the canines.
Speaker 2 (13:01):
Yep, looks like bone swelling. Treatment is extraction and smoothing
the bone, alveoloplasty.
Speaker 1 (13:07):
And finally occlusal issues. What if a cat presents with
its jaw locked.
Speaker 2 (13:12):
Open that's open mouthed jaw locking usually due to TMG dysplasia.
The coronoid process gets stuck on the zygomatic arch. Treatment
often involves removing the coronoid process or part of the
arch and.
Speaker 1 (13:24):
Mal oclusion mal bad bites.
Speaker 2 (13:27):
Yeah, depends on the breed standard. Sometimes brackisphalics often have
a normal underbite mL three, but severe malclusion like lower
canines hitting.
Speaker 1 (13:35):
The palette that needs fixing. Extraction, maybe crown reduction with
VPT if appropriate, or even orthodonics with buttons and elastics.
Speaker 2 (13:43):
Phew.
Speaker 1 (13:43):
Okay.
Speaker 2 (13:44):
That covers a lot of ground from basic anatomy to advanced.
Speaker 1 (13:46):
Surgery, and the unifying theme really comes back to copat doesn't.
Speaker 2 (13:50):
It It does? It's complex knees anesthesia needs a deep
understanding of anatomy pathology. It's way beyond just scraping teeth.
Speaker 1 (13:57):
Absolutely, it's true medical and surgical management.
Speaker 2 (14:00):
So to kind of cement some of that critical safety
information we covered, let's.
Speaker 1 (14:04):
Give you the listener a quick exercise based directly on
the source material.
Speaker 2 (14:07):
Okay, imagine this. You're monitoring a cat under anesthesia for
a copad visit. Suddenly the kapnograph reading plummets. It goes
from a steady forty millimli at hg right down to
fifteen milli MILIHG.
Speaker 1 (14:22):
What do you check? Immediately, think fast, list two possible
causes that are not related to the patient, dying thing, equipment,
or circuit issues, and.
Speaker 2 (14:30):
Then list two potential patient related causes that would trigger
such a drastic drop and require urgent life saving intervention.
Speaker 1 (14:37):
All that over, think about airway circuit patient status. It
really brings home the importance of that EtCO two monitor.
Speaker 2 (14:43):
Definitely, keep diving into those resources until next time.
Popular Podcasts
CrimeLess: Hillbilly Heist
It’s 1996 in rural North Carolina, and an oddball crew makes history when they pull off America’s third largest cash heist. But it’s all downhill from there. Join host Johnny Knoxville as he unspools a wild and woolly tale about a group of regular ‘ol folks who risked it all for a chance at a better life. CrimeLess: Hillbilly Heist answers the question: what would you do with 17.3 million dollars? The answer includes diamond rings, mansions, velvet Elvis paintings, plus a run for the border, murder-for-hire-plots, and FBI busts.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.